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About knee pain. Kerry, Wayne...Bueller?(24 posts)

About knee pain. Kerry, Wayne...Bueller?Kristin
Apr 24, 2003 6:09 AM
If I asked this before, I apologize. My knee pain is starting again--though mildly--and I'm nursing a suspicion that what I have is not ITBS. Why? Where the pain is located. Everything I've read about indicates that my pain on the ouside of the knee, parrell to the kneecap. But I feel a sharp, stabbing pain below my kneecap about halfway between the center of my kneecap and the outside of my knee. If I look on muscle charts, this would be near where the IT Band attaches to the bone. I've never had on-bike pain anywhere else but in that location. Do some ITBS sufferer's have pain in this area, or could I have a different injury?

I know, age old advice...find a doctor. I'm trying to get a referal for someone right now, but I haven't had any luck. I won't just pick a doc out of a phone book--not after my last debauchle. In the meantime, I'm curious. Somehow, my gut is telling me this might not be ITBS. At the very least, even with stretching the band, it seems to return very easily.

Here is a picture of where ITBS normally hurts (in blue) and I marked in red where my pain is. Thanks for the input.
patellar tendonitis?JS Haiku Shop
Apr 24, 2003 6:17 AM
it's actually a ligament, but i think they call it patellar tendonitis. unsure if that's what you're suffering, but it sounds familiar.

last year during itbs troubles and PT, i switched briefly from black look cleats to red arc look cleats. not only did the added float make my itbs worse, the extended unclip motion gave me an irritated knee where the patellar ligament meets the bone (i'm not an anatomist, forgive me).

aside from RICE and stretching, this helped:



the downside was that i had a funny tanline over the winter.

go see a sports doctor.

-J
Question for you JFTMD
Apr 24, 2003 6:55 AM
I have a bad left knee, with chrondomalicia and/or maltracking. I've considered that strap you pictured before. It is my understanding that it places a bit of pressure on the lower side of the patella and causes it to raise or lift up a bit. If so, that could help me considerably. My questions are: is my understanding correct on what the strap does? And did you find that the skin on the back of your knee got irritated? I'm worried that the fabric would irritate the skin back there, as it would be in the way at the top of the pedal stroke.

Any insight appreciated.
answersJS Haiku Shop
Apr 24, 2003 7:20 AM
your assumptions on the cho-pat strap's purpose(s) are correct.

at first they had me on a full knee brace, with stiff wire supports on both sides, and a gel donut for the knee cap. they were hoping to isolate the ITB above and patellar ligament below, and keep the kneecap tracking correctly (which was the third problem). wearing this full brace tore up the skin on the crux of my leg opposite the knee ("back" of my knee) on extended rides, plus it was hot and uncomfortable.

printed and took to the doc the info on the cho-pat strap *and* their ITB strap. the ortho was not familiar with the second product, but indicated that both would be ideal for my situation. i wore both on all rides (including two extended rides) last year, from May until November. once i wore the cho-pat strap on a few rides, adjustments were made, and no adverse problems with rubbing or marking 'cept for the funny tan line. throw in the ITB strap and it looks fairly odd, but worked and didn't rub. the material of the cho-pat strap is close to (but not) women's hose, only thicker and softer/less abrasive.

they only cost a few bucks and can be had either online or at your local druggist. the PT showed me *exactly* where to place the cho-pat strap, which seemed to be a fairly important step.

knee problems--though i still get a little tweak every now and again--went away in November of last year (10 months). i've ridden long and/or very strenuous extended rides since, with no major issues. the PT/ortho attributed my initial problems to a biomechanical problem with bike setup (pedals etc.). i'm convinced overdoing the training and pushing too hard over the winter was a major factor. building-up the miles gradually and training/riding consistently seems to be the ticket.

good luck.

-J
ps: a year-long prescription of Vioxx helped, too. nmJS Haiku Shop
Apr 24, 2003 7:22 AM
answersFTMD
Apr 24, 2003 7:42 AM
Thanks. I'll check out the strap then. Good to hear that you had no chaffing issues. Tan lines be damned.

Vioxx -- got a friend in the biz and she gave me about 500 of those suckers, so I'm set up. I try not to take them and only do if I know I'm going to be riding consecutively for 3 days or more. Otherwise, I want to feel any twinges or pain to let me know if my weight lifting and stretching is working. This time last year I was lucky if I could ride five miles and now I'm riding pretty much when and how far I want, so it is improving.

Thanks again.

Kristin, sorry to hijack your thread. :)
re: vioxxJS Haiku Shop
Apr 24, 2003 7:47 AM
since i was riding pretty much daily, i'd take one 25 mg vioxx per day and 2 on the day before and the day of a "big ride".

once the knee settled down, i would take 25 mg/vioxx daily only on the 2 days leading up to a "big ride", and 50 mg on ride day.

of course, this worked for me, and under doc's orders. YMMV--vioxx doesn't work for everybody.
My MD gave me somehting like that.soup
Apr 24, 2003 6:56 AM
I couldn't keep mine in place while riding, but I did wear it when not riding. It seemed to help.

soup
Also, I'd love our physiologists opinions on this article:Kristin
Apr 24, 2003 6:31 AM
http://www.syracusechargers.org/therapy/chapt11.htm

Eegads. If biomechanical imbalance causes it and they don't know what biomechanics are the problem!!!! I was born with a few biomechanical imperfections. This is disparaging.
Sounds like what my physiologist has said to me . . .ms
Apr 24, 2003 7:04 AM
I am not "balanced" and need to be "straightened out." (My wife and mother both got good laughs out of that!) I now have stretching and strengthening exercises from a PT that is supposed to correct the problem. I am six weeks into the process (I see the PT once every two weeks). I think that it is working (less knee pain), but I am not completely cured.

I would repeat the advice that I gave someone a few weeks ago: Find a sports medicine doctor that rides a bike and who will let you bring your bike with you when he/she examines you. Most of my initial "examination" with the doc consisted of his watching me ride my bike on the trainer. The PT puts me on an exercise bike for a minute or two every time I meet with her to see how my position is doing. If your doc and/or PT are not familiar with cycling and your bike position, I think that they will have a much harder time finding a solution to your problem. Now finding such a doc is easier said that done -- it took me six months of asking every cyclist I knew until I found a cycling doc who specialized in sports medicine.
Patellar Tendonitis?soup
Apr 24, 2003 6:53 AM
Can you locate a painful spot along the lower edge or side of your patellar? It might take firm pressure to find it. If so, it might be patellar tendonitis. That's what my doc says I've got.

Are you near a university? If so, call the athletic training department and ask to speak to someone who handles their refereals. Could be a clerk, could be a physical therapist. (If no university, call the largest high school in the area and speak with the trainer.) Find out which orthopod they refer their knee cases to. Call that doctor and get an appointment.

There are great anti-inflamatories out there-- Celebrex, Vioxx, Bextra, etc. My guess is that a good course of NSAIDs coupled with a therapy routine set up by a PT will have you feeling better soon. But don't take my word for it, go see a doctor.

In my case, I tried rest, ice, advil, stretching, etc. to no avail. (I actually took 30 days completely off, only to have the pain return after some climbing.) Once I got to the MD and started the meds and PT, things turned around. Its been kind of slow, especially since I have continued riding hard. My MD said riding was ok, as long as things were not getting worse-- a benefit of finding an orthopod who works with athletes, I think.

Finally, ice is your friend. I always have three of four "ice cups" in the freezer. Massage the area for 10 minutes after you ride and again before you go to bed. Stretch everyday, especially your hammies.

Good luck, and sorry for the scattered message.

soup
Don't think so.Kristin
Apr 24, 2003 7:24 AM
If you bend your knee 90 degrees, then feel for the bony part of your tibia that sticks out (below the kneecap). Then move your fingers about 1.5 inches to the outside of the knee. Is that where your pain is? (I tried your test and have no pain in my knee cap at all.)
what about...funknuggets
Apr 24, 2003 8:19 AM
Kristin,

Sorry to hear about your knee pain. And Im not real sure about your history. Why exactly did you take all that time off? As a former competitive long distance runner, I have had more than my share of these injuries and like the others on the board have a bevy of past diagnoses to pull from.

Can I ask a few more things? Do you get much popping and cracking of the knee? In addition, didn't you just get back on the bike? Im a bit curious whether this may be more starting training pain, but then again if you are experiencing the same exact pain as before, I, like you would expect something more mechanical.

With the time off, I would strongly doubt chondromalatia already, but would not rule out the patellar tendonitis or ITBS. With those, however, I would suspect more of a dull pain that is tender to the touch on the tendon. However, you are experiencing a sharp pain, that sounds like it only manifests itself in a specific range of motion... so Im thinking of either some cartiledge damage, or free floating debris that gets pinched in a specific position...

People can injure their meniscus (especially older people) without any trauma as the cartilage weakens and wears thin over time, setting the stage for a degenerative tear, which you "may" have. Cartilage degeneration that starts at the inner edge causes a horizontal tear as it works its way back. If your meniscal tear does not heal on its own and your knee becomes painful, stiff or locked, you may need surgical repair. Depending upon the type of tear, your age and other factors, your doctor may use an arthroscope to trim off damaged pieces of cartilage.

Chris
Thanks for the post. Here's the historyKristin
Apr 24, 2003 8:53 AM
I left out the details because so many people have read them in the past. Here it is.

First, and I never tied this in before, I do have some skelatal abnormalities. I was born with congenital bowing of the legs and was placed in full leg casts at 2 months of age. I can't remember how long I was casted, but I do remember walking with orthopaedic shoes (bar running between) at the at of 2. The end result was pigeon toes, a slight knock-knee and a sway back. (Thanks to all the doctors who made my posture so grand!!!)

Okay, fast forward 28 years. I bought a road bike (ill fitting) in May 2001 and was riding crazy hard all summer. I got sick in the end of August and decided to attempt a metric despite the fact that I'd only ridden 4 hours in the 2 weeks prior to the event.

By mile 50 I was feeling a slight twinge just below my kneecap and sort of to the outside of my knee. I didn't find a sag wagon for another 7 miles. By then it was a stabbing, painful pain. However, I was only 3 miles from the finish and the sag was this stupid kiddy-trailer. So I finished out the ride at mile 64...since I got lost during the final 2 miles.

The pain went away after just 3 hours, and I tried to ride a few days later, but the pain would come back within 5 miles. This went on for 2 months.

I found a sports doc, who put me into endless PT and kept telling me I should keep riding. Finally I quit him and too 4 months off (winter 2001-2002). Last summer I barely rode 50 miles/week and the pain came and went.

I bought new pedals (Looks with red cleats). This has helped a little. I had SPD's before. The pain isn't as agressive now. In addition, I'm working on not charging out of the gate, so to speak.

Due to lack of motivation, I took this winter off too. I've had 6 rides this spring--crappy Chicago weather--and there is already the hint of things to come. It hasn't hurt on the bike yet, but its the same thing. I rode on Tuesday and yesterday, I felt it when I flexed my leg on a long drive. Today I can feel it climbing stairs. Not a sharp pain yet...but a hint of pain.

I rode a hybrid for 2 years before getting the road bike and had zero problems with my knee. Also, there is no popping or cracking, and I don't have any problems with my knee either giving out or locking.
Ok...funknuggets
Apr 24, 2003 10:57 AM
So, this sports doc, what did he see in your film? Plus, what did he say regarding your physical differences and your position on the bike and/or over the pedals. Which Look pedals do you have and have you had any luck adjusting the Q-factor?

Also, Im really interested in your seat height and fore/aft in relation to your pedal stroke. Your difference in normal leg position may change your stroke to where it does not match the 'typical' sizing/positioning rules. So, for example, if you go by the typical heel brush at the bottom of pedal stroke/kneecap plumb over the pedal axle... it may not be the proper set-up for you. I've seen some pretty dramatic cycling injuries be remedied by as little as a .5-1 cm change in saddle fore/aft or height. I think these guys are right, you really need someone that knows cycling and knows the physiological difference your leg and foot position will make on your mechanical stroke.... or at least on that one side. You may be compensating dramatically at the pedal by bowing your knee out which would put some insane stress on your knees.

Im sure you have done a lot regarding your seat and cleat positioning and I would be curious to see what your experience with a really "floaty" type pedal like a speedplay has been.

Chris
More answersKristin
Apr 24, 2003 11:23 AM
Films? No films ever taken of my knee. Not even ordered. Only PT perscribed...FOREVER!

Pedals: Look PP337 w/delta (red) cleats

There is plenty of float, as was there in my SPD's. I've never messed with my Q-Factor. We played around with the cleat alignment before, but it didn't help.

My seat height has been all over the place at the urging of various "experts" on the matter. Doctors had me lower, lower, lower it. The the PT's had me raise it. Over time I had gotten the saddle WAY too low. Now its back up and I can at least pedal more efficiently.

One thing I have noticed when I pedal. I tend to pronate my foot. I catch myself doing this all the time. I'll pull up with the inside of my foot, while forcing the outside ball of my foot down and use just the outside of my foot to drive the pedal down and through the bottom of the stroke. My upstroke is lazy at best. I'm making a conscious effort to keep my foot parrell to the ground and to place even pressure on the pedal. I don't know if this can cause knee problems, I just know that I do it.

Who knows. This is all very confusing and frustrating. It could potentially cost me $1000's of dollars and I might never get the problem resolved. I'd rather quit cycling all together than go through that. Not to mention...I don't HAVE thousands of $$$'s.
fantastic informationfunknuggets
Apr 24, 2003 1:41 PM
wow, no one has EVER x-rayed or MRI'ed your knee? Thats where I would start. Cant you just complain about knee pain, and hit your primary physician and have him give you the diagnosis or at least send you to the orthopod?

Im so baffled at the medical community these days. Im not a doctor, but I play one on RBR. Anyway, there is several interesting things you said here, most noticably the pronation. I dont think the pressure that you feel in the inner or outer part of your foot in the motion is all that uncommon, as the muscles utilized to perform that movement are different. However, I would have someone halfway experienced look at your pedal stroke from behind (no wisecracks please) and watch your foot and knee travel. Im also really interested in whether you have hip waggle.

Also, their are differing types of pronation. With the "right" therapist, they might even lean to the orthotics, which was a discussion we had just last week. It might enable you to distribute power to the pedal more efficiently. But again, that is going to run you a bit of cash.

Without even seeing you or having any firsthand knowledge of your physiology, Im going out on a limb to say that you may have one leg longer or angled a bit differently, effectively making one leg longer than the other. Now, Im guessing that you may have to compensate by dropping your hip either to the effected or opposing side. This would definitely place additional stressors to your knee. With cycling being so repetitive, it would exacerbate any imperfections, tears, or arthritic deterioration. However, the lack of swelling or popping is really confusing me, if this were the case.

There are tons of interesting stories. There was a pro rider, that is eluding me, in the late 90's that had a childhood accident which left one leg some 2-4 inches shorter than the other, and he had a surgery in 96 to help fix that and he came back to cycling and actually rode really well... who the heck was that. I think Sherwin and Liggett talked about it in either the 1997 L-B-L or the Fleche-Wallone... but it eludes me. Anyway, if he can deal with that, I have complete faith for you!!!

Chris
Well below/outsine the patella, no?soup
Apr 24, 2003 8:41 AM
If I were you I'd be beating down the door of the best sports medicine guy in town-- the weather is getting nice.

soup
You wanna give me his name and number?Kristin
Apr 24, 2003 8:59 AM
I can't find out who the best sports doc is. There is a sea of ortho's in Chicago and its hard to locate the cream of the crop. I avoid anyone trained overseas and shoot for Ivy Leaguers, but still its no garentee. I was lucky when I broke my wrist as I was referred to the Harvard trained son of one of the best hand surgeons in the nation. I haven't had any good sports doc referals.
Well below/outsine the patella, no?soup
Apr 24, 2003 10:11 AM
If I were you I'd be beating down the door of the best sports medicine guy in town-- the weather is getting nice.

soup
Who has had good results with short cranks?Eug
Apr 24, 2003 7:55 AM
There are lots of different injuries that can occur in the knee, and I guarantee you that most average family docs won't know how to properly diagnose them. A good family doc with a sports med fellowship, or a good physiotherapist or a good physiatrist and/or orthopedic surgeon would know though.

Anyways, I'm back to the clinic soon, and I'm also gonna give some new 165 mm cranks a whirl. I normally use 170 mm cranks but at this point I'll try anything.
Who has had good results with short cranks?FTMD
Apr 24, 2003 8:52 AM
I went with 170's on a new bike I just built, as opposed to my normal 172's, just to see if that makes a difference. I spin moreso than mash anyway and wanted to see if the 170's do anything for knee pain. Haven't got enough miles in on that ride yet to tell one way or another about the knee, although I can tell a difference in my spin.
I couldn't find 167.5 mm.Eug
Apr 24, 2003 9:54 AM
Yeah, I went looking for 167.5, but nobody seems to carry Ultegra in that size, and Shimano 105 isn't made in that size at all. Dura Ace is too $$$$ for me.

So I ordered 165 mm. Should prove interesting.

I'm a lousy biker anyway, so I can't get THAT much worse. ;)
Arnica arnica - if it doesn't help, it's not going to do any badPeterRider
Apr 24, 2003 11:09 PM