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Knee pain...help diagnose(8 posts)

Knee pain...help diagnoseSpecialTater
Oct 3, 2003 8:56 AM
I've searched the boards on this but haven't found enough information.

My left knee just inside of my patella began hurting after the 70 or so miles last day of the local MS weekend before last. I've ridden 3 20 milers since and it hurts afterward each time. No change in set up before the 70. It feels like a bruise to that portion of the knee, tender to touch and a pain when I walk. It goes away 2 days after each ride. I thought 4 days off would help.

I'm riding SPD pedals. I've done 1850 miles without this pain.

What causes it and what can I do to prevent? Lower or raise seat? change pedals? Thanks in advance...
do we define 'inside' the same way?JS Haiku Shop
Oct 3, 2003 9:08 AM
by "inside", do you mean toward the other leg inside, or behind the kneecap inside?

if you mean the rightmost part of your left knee horizontally parallel to the patella, i've had the same issues. i'm guessing i pulled something on a mountainous century in may, pushing gears that were too large at the time. it hurt for about 2 weeks, then went away, but came back when i was really working hard on the bike. this was a *constant* pain on my 600k effort (just weeks after the mountain ride).

reduced my mileage substantially after 2 more weeks, iced it lots, stretched gently and frequently, kept riding but more easily, and it eventually went away completely.

often i have phantom pains like this that will go away with a little easing off the effort. many can be attributed to a quick (over)mileage ramp-up, over-the-top effort, or a biomechanical issue caused by a sudden change in bike setup or rider position.

if it is more than that, you definitely need to get to a sports specific doc before continuing on the bike. i know they are hard to find where we live, but it's important. first thing my doc did was take xrays to check patellar alignment and cartilage "spacing".

hope you get some other (more) helpful responses. knee pain sucks.
We do and I knew that would confuseSpecialTater
Oct 3, 2003 10:08 AM
when I re-read it. Both you and TN make a lot of sense. You describe it and that's likely what I will do.

I am planning on finding a sports-specific doc if I die trying. ha.

Thanks to you and TN
Tater.....TNSquared
Oct 3, 2003 9:18 AM
Hard to say if this an overuse injury or not, but my guess is that it is a combination of a sudden increase in effort (i.e. you overall mileage may not have changed much, but are you accustomed to two consecutive days of 70+ miles and strong effort?) and possibly an equipment issue that was exposed by the aforementioned extraordinary effort. Weaknesses in biomechanics, equipement, conditioning, etc. can really lie unnoticed until you ratchet your effort up beyond a certain thresh hold. I learned this once while training for a marathon. Even thought my base was solid, I went for a really long run the day after a 10 mile race and woke up the next morning with a very tender right heel. After a few weeks of taking it easy and changing running shoes, I was able to resume training and slowly build even beyond the level I was at when the injury surface.

I'd say your options are:

1) rest for several days to two weeks and see how it feels
2) try different pedals if you're not better after the lay-off (after ditching my spd's and then recently going back to them, I can't believe how rigid and vice-like they feel
3) if rest and/or equipement change don't work, see an orthopeadist

Of course, you could cut to the chase and go the ortho first, but I'm a big fan of "start with the cheapest solution and work your way up" approach.
re: Knee pain..Chen2
Oct 3, 2003 11:04 AM
I've lived with a lot of knee problems and everyone's knees are different. What works for me is a relatively high saddle and pedals with lots of float. I ride Speedplay X-1's.
~Al
The guessDrPete
Oct 3, 2003 2:38 PM
What I think you're describing is something called patellofemoral syndrome (PFS). Now, not knowing anything else about you and not having examined you, I can't say for sure so I recommend you see a doctor to confirm the diagnosis.

What PFS is, basically, is a repetetive motion/wear and tear type injury where the patella tracks over the femur during repeated flexion and extension of the knee, usually due to weakness and subsequent instability of the quads. As a result, the cartilage wears down and pain is the result.

So the big keys are 1. get back into riding slowly, increasing your mileage by about 20% each time.

2. Ice your knee for 10-20 minutes after activity

3. Unless you have a specific reason not to take them, NSAIDs (esp. motrin and aleve) are good for the pain

4. Strengthen your quads, but this doesn't mean using a nautilus machine. The easiest exercises are both done lying back resting on your elbows with one knee bent. First, take the straight leg and try to hyperextend it (forcibly hold it straight) for 10-20 seconds and relax, then repeat 5-10 times with each leg. Second, with the opposite leg bent again, keep your leg straight and raise it a few inches off the ground, and hold for 5-10 seconds. repeat 5-10 times.

What the orthopod would probably tell you is the above, and he wouldn't do it for free :) That being said, if those tricks don't make it go away in a few weeks (4-6) or if anything gets worse, see a doctor.

DrPete
Making housecalls on his CAAD3 Saeco
re: Knee pain...help diagnosebc165
Oct 3, 2003 3:54 PM
This site has some pretty good information on cycling injuries, plus a whole lot more. I think the guy who writes it is a Doc...

http://www.cptips.com/index.htm
re: Knee pain...help diagnosebburgbiker
Oct 3, 2003 5:56 PM
When I first started riding on the road I went through a bout with knee pain after riding mtn. for years with no pain whatsoever. I was using an SPD and then Crank Bros. with road cleats for the first 6 months of riding the road bike. After switching to the Look PP396 the knee pain began to go away. It also helped to ice down the knee after a ride to let swelling inside the knee go down. Also, I have learned the hard way that one of the most important adjustments you can make is with your cleats. I also tried many different seat heights and fore/aft positioning until I got it just right. There are many different ways that you can overcome your knee pain without haveing to stop riding for a significant amount of time but a week or so off probably wouldn't hurt. A good first step would be a new pair of pedals, the SPD-SL Ultegra model is reasonable priced. I went from the pp 396 to the SPD-SL DA and have been very happy with them. Hope this helps and good luck with the pain.