Let's have a chat about knee pain.

[Bearbonesnorm]

A couple of years ago while attempting the HT, I was unlucky enough to damage my left knee. GP put it down to overuse and advised to ride less . Anyway, the pain eventually eased but I was left with a continual 'dull ache' that was worse if I bent my knee beyond 30 degrees, even something as simple as drawing your legs up while lay in bed hurt. Riding was generally okay although sometimes a 'twinge' would remind you to back off a little. I figured that my knees had taken a lot of abuse over the years, so the aching was a reasonable and expected side effect.

Fast forward to last week. All was well until 30 miles, when the ache in my right knee (yes, they both ache) started to develop into something a little more painful. I was riding a bike I don't use that often but it's certainly not a bike I'm unfamiliar with. I made a couple of adjustments to the saddle position and carried on. The knee received an hours rest and vitamin i at 40 miles but the pain worsened. By the time we'd finished at 48 miles, I was really struggling to put any pressure through my right leg both pedalling or walking. I thought it might be tight quads so did plenty of stretching and even a little self massage before retiring to my pit.

Next morning, the pain had lessened but was still there and my knee was very stiff. We set off on a rather hilly 40 miles in a painkiller / vitamin i daze. Pedalling really hurt (think hot knitting needle down the side of your kneecap) but walking was near impossible and any I did, could only be described as a limping hobble. That night, saw more stretching, rubbing and drugs.

The morning of day 3 dawned with much pain and limping. Within under a mile I was seriously starting to suffer .... long story, short. We did make it home without calling Thunderbird 5.

Two days later the knitting needle pain is still there, walking on the flat isn't too bad and is eased if I walk with my foot turned slightly outward. Climbing stairs is a pathetic struggle and walking uphill not much better. I'm bypassing the GP this time and going straight to the physio but to me everything seems to point towards IT band? Anyone have any thoughts?

Well done for reaching the end and thank you.

[summittoppler]

I had something similar about 10 years back. After a couple of tough days on the C2C my right knee swelled up and was very painful.

I ended up taking it very easy, but I think what did work for me was taking them glucosamine sulphate tablets. Maybe worth giving it a go......

[whitestone]

I've had ITBS and it's really painful. It's a classic overuse injury, in my case I developed it by increasing my running mileage too quickly. You don't say where the pain is but I assume that if you are considering ITB then it's on the outside of the knee just up from the knee.

Enough internet diagnosis, see what the physio says - hope they are a sports physio.

[Bearbonesnorm]

You don't say where the pain is but I assume that if you are considering ITB then it's on the outside of the knee just up from the knee.

Yes, outside of knee but lower rather than higher.

Enough internet diagnosis, see what the physio says - hope they are a sports physio.

It's rural Wales, I'm expecting ....

I ended up taking it very easy, but I think what did work for me was taking them glucosamine sulphate tablets. Maybe worth giving it a go......

I'll give 'em a go Jeff.

[Trail-rat]

just after i came back from a very long winter tour and was planning on taking the Expert catagory at SXC by storm I suffered from achillies and knee pain such as you describe knitting needles being stabbed in repeatedly

i visited several experts and spent many hundreds of pounds on treatment

They all alleviated the immediate pain by focusing on the areas that were sore but it would always return. Even following the leg stretching scheme i would inevitably get.

i had a chance conversation with a friends wife whos a physio in another area while waiting on him getting ready for a ride. And was given a set of exercises that stretch out my lower back which was as tight as hell.... spent 2 weeks doing my stretches 3 times a day and my knee and achillies pain dissipated gradually - still do them every other day or after any long ride i do not want that coming back.

how it was explained to me was that my back was super tight and was pulling on everything it was connected too , my knees and Achilles were much weaker than my shoulders hence they gave me the pain symptoms as everything was pulled taught.

Never did make that storm i was hoping to.... stopped racing xc in the end as it took me near 2 years to sort out .....but i have since done the puffer solo with zero pain - not even a hint.

[whitestone]

Does this sound about right? http://breakingmuscle.com/running/how-t ... b-syndrome It's from a runner's perspective but last time I checked they weren't a different species

[Taylor]

I had similar problems when Jase and I did the Cairngorms loop.
By day 2, I was quite uncomfortable and by day three I could barely walk a flight of stairs.
A few days later I rode Glenlivet trail centre which strava reckons I did pretty well despite a stop for a wee and I had only minor knee pain until I climbed a flight of stairs again.
Back in Brizzle I booked into the physio and she jabbed me with needles, dug her thumb into my knee and a bit of ultrasound. She gave me some IT band stretching to do on rollers at home and whilst it's been better, it's certainly not fixed.
Long steady bike packing where I'm sat down peddaling for longer periods seem to be worse than short trail centre type rides where I'm in and out the saddle more.
I quite often take a dose of Vitamin I before bed if I'm out bike packing to reduce any inflammation overnight.

[MM-on-POINT]

Here you go, all they have left out is the knee love to be kept very warm and forget Ibuprofen get some narpoxen for gp.
Bottom part of articles is mainly for you


http://www.knee-pain-explained.com/knee-stretches.html

[gypsumfantastic]

I'd second the opinion that the pain in your knee probably doesn't originate there, there'll be something that's fastened to it somewhere along the line causing the issue.

I'd recommend Core Advantage byTom Danielson and Allison Westfahl linky

Danielson is a guffhead and should be flatly ignored (ImHO) but Westfahl is a genuis, she'll take you through common cycling specific ailments, trace them back to the origin, fix them and rebuild you stronger.

There's also a youtube playlist of exercises and stretches to try, if you tyre of looking at pictures of Tom and his stupid hat! clicky here

Pilates is worth a punt too, the hardest part after walking through the door is not farting mid 'manouvre' or laughing when someone else does

[ianfitz]

I'd second the opinion that the pain in your knee probably doesn't originate there, there'll be something that's fastened to it somewhere along the line causing the issue.

absolutely this...

A decent sports physio will be looking for this. Probably by asking your to push against resistance with limbs in different directions. this allows them to see where you are weakest which will usually lead to the cause.

Most of my knee pain when I did a lot of fell running was due to two tight vertebrae (L2+3) which interputed the nerves that control muscles around the hip. this meant that one leg lacked stability and the soft tissues in the knee where always the weak link...

So if they are just looking to treat the pain then walk away, or hobble or what ever

[Mariner]

I developed a dodgy knee couple of months ago.
By the end of a gym session had an egg on the side of my knee so of to Sports Physio after lots of sitting time with an ice pack.
Physio checked me over and pointed out my hips were not inline with my shoulders.
You can check this yourself next time you are passing a mirror in your shreddies. Its the arms that give it away.
Stand straight with arms hanging loosely and check the gap round about forearm position.
Same each side is good if its narrower one side then you need some straightening exercises.

On a slightly different tack I notice that some people at the gym pedal asymmetrically ie one pedal stroke is quicker than the other.
I have also found that the new bike appears to have slightly wider pedal line than before and unless I consciously move my knees wider to over my feet I start to get the beginnings of a grumble in the knees. Have you changed bikes or are riding one more than others?

[DoctorRad]

See what the physio says and talk to them about whether a foam massage roller might be useful.

I had a Transverse Myelitis[1] just over seven years ago, and was left with about 90% mobility in my legs overall, along with some balance and proprioception issues[2]. In my legs, it seems to have affected my left side more than my right, and I had a significant quad weakness which was causing me knee pain on that side.

I got some exercises from a tame physio, and a massage therapist friend suggested I tried a foam roller. The roller was excruciating the first time I used it on my quads, but that largely goes to show how bad a state they were in. I now use it regularly after both riding and dry-slope skiing on my buttocks, quads, IT bands and calves, and it makes a huge difference in recovery / ability to walk properly the next day.

Cheers,

Dr. Matt...

[1] http://healthinsurancefact.org/things-y ... -myelitis/
[2] Foot not hitting the ground when my brain thought it should have done, leading to comedy dismounts and two sprained ankles.

[Physiobikefit]

Hi Folks,
Some interesting conversations here on knee pain. Something I see a lot as a cycling physio and bike fitter (and long distance rider myself). The knee isn't always the cause of the issue (underlying knee pathology does happen such as tendonopathy due to overuse, buy since cycling is given as a rehab exercise for knee injury, it is common to find other areas 'at fault'). The back tightness problem was spot on, and the glute maximus' can also be a cause, as can ITB 'issues', a contentious area as the ITB itself is usually not the actual culprit, but the the muscular system which exerts a pull on the ITB. This can be a weakness or imbalance issue.
It is normal to have an imbalance, left or right dominance, but be unaware of it until many miles have been ridden, usually when embarking on an ultra.
Stretching is a really useful tool to help alleviate pain, but a good approach for the long term are specific off the bike exercises to strengthen what may be weak. What happens at the hip and lower back area has a huge influence on the lower limb, such as knees moving inwards on pedalling, knee pain, lower back pain and it isn't always down to the bike set up! Bike set up is just one component. Strong glute maximus and a strong lower back (and I don't mean deadlifts!!!) are key to help reducing knee/achilles pain on the bike when riding for the long haul. The body is being demanded to sustain a strong cycling posture for many hours, strength and conditioning exercises off the bike are essential to help it do this and avoid pain.

[Zippy]

I think a few people here have hit the nail on the head (IMHO). I had some knee problems a while back - long story short I am now very careful and stretch after every ride.

But the problem with the knee pain, is that it's just the outcome and not necessarily the cause - all our muscles are inter-connected, so could be any of them . Back is pretty common, but have heard stories of jaw muscles causing pain in other weird areas including knees...

You're the best person to work out what Stu, physio and others to be fair just help point things out and try things.

Good Luck.

[LSJ]

Hi Folks,
Some interesting conversations here on knee pain. Something I see a lot as a cycling physio and bike fitter (and long distance rider myself). The knee isn't always the cause of the issue (underlying knee pathology does happen such as tendonopathy due to overuse, buy since cycling is given as a rehab exercise for knee injury, it is common to find other areas 'at fault'). The back tightness problem was spot on, and the glute maximus' can also be a cause, as can ITB 'issues', a contentious area as the ITB itself is usually not the actual culprit, but the the muscular system which exerts a pull on the ITB. This can be a weakness or imbalance issue.
It is normal to have an imbalance, left or right dominance, but be unaware of it until many miles have been ridden, usually when embarking on an ultra.
Stretching is a really useful tool to help alleviate pain, but a good approach for the long term are specific off the bike exercises to strengthen what may be weak. What happens at the hip and lower back area has a huge influence on the lower limb, such as knees moving inwards on pedalling, knee pain, lower back pain and it isn't always down to the bike set up! Bike set up is just one component. Strong glute maximus and a strong lower back (and I don't mean deadlifts!!!) are key to help reducing knee/achilles pain on the bike when riding for the long haul. The body is being demanded to sustain a strong cycling posture for many hours, strength and conditioning exercises off the bike are essential to help it do this and avoid pain.

I agree, had knee problems also at one point, a bike fit where almost was correct. What really helped me was a wedge under my right cleat.

Stu, was it only the bike that differed, no new shoes, (or fresh cleats) or other things changed below the knee.
I know with the level of experience you seem to have (I only know of you in here, but you don't seem to have started yesterday ), that you might have considered the above. But hopefully others can benefit from having a wedge under their feet. or at least the knowledge that they are availible, they actually take away a lot of knee pain for a lot of people.

Lars

[Bearbonesnorm]

was it only the bike that differed, no new shoes, (or fresh cleats) or other things changed below the knee.

Actually, I was wearing new shoes but I ride flats, so I'm not sure that would have too much bearing? The bike was also one that I don't ride that often, however when I had the same problem previously the bike was my usual one.

[Taylor]

Ah, Scott, I was just about to come and see you at Penny Porter's when Ian told me you'd moved to Brecon.
Are you still doing bike fits in Brizzle?

[Kumquat]

Hi Stu
Could be that one aspect of your discomfort might be caused by a need for better arch support in your shoes.
There may well be more to it than that but it could be a contributing factor.
Hope it improves soon.
Tk

[Richard G]

When this happened to me I had two a week physio visits until it was better... but in reality, I know it's going to be a lifelong struggle to stop it coming back.

It's no co-incidence that this tends to come on in the winter. I've noticed that I can significantly slow down the onset of my IT band problems if I wear roadie knee warmers. Sure, they're not exactly fashionable, but they do help to keep the ligaments and tendons warm... and keeping them warm keeps them happy.

As mentioned by other posters, arch support can make a big difference too, as changing the angle of your foot essentially alters the kinetic chain right the way up your leg.

However, what's really kept it away for me is regular foam rolling... and not of the IT band, because it's basically impossible to roll that with any meaningful effect. You need to work on everything around it. Three times a week I spend about thirty minutes on leg / hip mobility which involves (amongst other things) foam rolling all over my legs and using a lacrosse ball for my ass / hips.

Give what's in this vid a go: https://www.youtube.com/watch?v=5YYb9vyj6zQ (it's not exactly what I do, but the principals are the same)

[Moder-dye]

Another one with a knee history and arthroscopy on my cartiledge. Mine is mostly down to tension in my hamstring, even though I'm pretty flexible (hands flat on the floor forwards bend), there's an imbalance with my quads. Sports physio exercises to engage my hams and glutes more along with deep tissue massage and massage ball to release TLF and hip flexors has made a massive difference, but if I slack on the exercises it gets bad again.

Hope you get sorted, didn't sound like fun.

[darbeze]

I experienced very unpleasant knee pain on the BB200 2014, which really slowed me down and the only way to make progress was to get off and walk on any incline and walk like a penguin with my right foot sticking out sideways.

When I rode the BB200 2015 route a couple of weeks ago, I had no knee pain to speak of. Only a slight twinge in the left knee, which I am prepared to accept given the circumstances.

I have to say Pilates has done wonders for me since I trapped the L5 nerve in my back September. Physio gave me some lower back stretches to do every two hours (at first) which I do every morning along with other exercises.

I really think that having a stronger core has made a real difference to my riding. As said above, once you get past the fart in mid stretch syndrome, Pilates is great!

Si

[Trigs]

I have something similar which i thought was ITB syndrome at first, but ive also suffered back pain for 2 years now, and it took a while before i realized the pains were connected. Not had a diagnosis, but i think its sciatica.

Best bet to see a Physio like the others have said, and hope they cure it or at least locate the problem. Got an appointment on Wednesday myself. Dont hold your breath waiting on a NHS physio unless your areas better. 17 weeks wait here.

[journeyman]

In the past I had similar problems but caused by running - resulting in knee and really bad lower back pain. I had some good private osteopath treatment which relieved any spasm or sciatica and worked on breaking down the tightness in my thighs; but the big difference came from using superfeet insoles (green ones with max arch support) - I do not have any problems now. I use them in trail running shoes with v12 flats. Superfeet do a carbon fibre (!) insole especially for low volume low drop fell shoes which I might try but they have less arch support. I also try and include some (a lot actually) of p90x style core work in the weekly routine to keep the mono-pack in good working order.

[Ian]

Stretching is a really useful tool to help alleviate pain, but a good approach for the long term are specific off the bike exercises to strengthen what may be weak. What happens at the hip and lower back area has a huge influence on the lower limb, such as knees moving inwards on pedalling, knee pain, lower back pain and it isn't always down to the bike set up! Bike set up is just one component. Strong glute maximus and a strong lower back (and I don't mean deadlifts!!!) are key to help reducing knee/achilles pain on the bike when riding for the long haul.

Compared to only a few years ago, the older I get the more I find myself needing to do this sort of stuff. It does help and I certainly notice the difference on the long rides

[Mike]

I do believe we are all getting older