knee pain-tried bike fit, physio, x ray, mri-next ?

[Strange Rover]

I get slight knee pain in my right knee just below the knee cap. Mostly notice it walking up and down stairs. For the most part Im basically aware that I have a dodgy right knee and I try not to load it too much in my day to day life (like on the stars or squatting down and standing up etc...im always careful not to stress it)

When riding my bike easy or hard it doesnt hurt. Can sit or stand out of the saddle and it doesnt hurt. Probably the only time I can get the pain on the bike is when I first go from sitting to standing...sometimes on that first pedal stroke it will tweak a bit. Once Im up and rocking the bike side to side and pushing down squarely its perfect. I think on that first pedal stroke the bike isnt lent over and I must be side loading it or something.

So been riding since January this year..and this fairly well started to this issue since I started riding. Didn't have it before - didn't do any sort of exercise before either.

Stopped riding for 6 weeks (holidays and then sick and other commitments etc) and still had the same issues. Back riding now and still the same.

Doesn't seem to be getting any worse nor any better??

In March (6 months ago) did the whole bike fit (guy in Brisbane at the sports clinic at the Gabba) Sports Doctor, x ray, MRI, physio. None of them could really definitively explain the pain nor provide me with a satisfactory solution. I think the doc diagnosed it as a possible inflammation of the fat pad under the knee cap or something like that...he wrote in in a letter for me to give to the physio and I think the physio kept the letter. The doc could also see some slight damage to the cartlage under the cap but the impression I got was that this wasnt current causing the pain. Both the doc and physio had trouble recreating the pain by manipulating my knee joint...they basically couldn't make it hurt.

The bike fit guy didn't do any shims or spacers on the pedals (he doesn't play with that sort of stuff). He just moved the position of the seat and cleats.

But anyway I had sort of given up on the problem and am just living with it. Im 39yo and 87kg and put it down to Im not as young as I once was and this is what happens? I ride about 100km - 150km per week most of it as hard as I can.

My current plan is to just put up with it.

Should I try to play around with shims and spacers and stuff? Can I do this myself?

Should I try to get a bike fit with Steve Hogg? (I live near Brisbane)

Other ideas?

Sam

[elantra]

Hi Rover, sounds like it could be patellar tendonitis, look it up on wikipedia.
Usually just a bit of a pain at the start of a run or cycle or such like.
Worse if weather is cold.
Try adjusting cleats on shoes but not much to do with bike fit.
I have had this problem, eventually settled down.
Hope that helps, steve.

[scotto]

pain on prolonged sitting or bending. pain squatting or up/ down stairs sounds like patellofemoral pain, or patella tendonitis, though the latter is way less common. either way:

was your physio able to drastically reduce the pain on squat / stairs by taping your knee cap medially or bu tightly applying tape across the bottom of the knee, just under the knee cap?
did they assess your quads muscle for deficiencies or shortening ?

at leat at home, some painfree quads stretching should be commenced. on your stomach, how close to your bum can you get your good heal? how close for the affected side ? different ? then stretch, but gently so as not to aggrivate the tendon

[Strange Rover]

I think both the physio and the sports doctor didnt believe it is patellofemoral pain or patella tendonitis..the pain on the stairs sort of pointed to this condition (from my internet research). I think I asked teh physio specifically about these conditions and I think I was led to believe that is it was somehting like this then we should be able to create the pain by manipulation of the knee cap...which we couldnt do. We ended up doing full exrays and MRI with the sports doc and didnt really come up with anyhting.

No pain on prolonged sitting or bending...alot of the time I sit in a chair with my right leg totally bent with the foot against the inner thigh of my left leg...it doesent lock or cause pain. (actually thought this habbit was a cause and gave it up for a while but didnt change anything)

The physio did test the firing order of the quad muscles and the inner one tensioned first on extension and so he thought that that wasnt an issue for me. Didnt do any taping though.

In the end the sports doc sent me back to the physio to get some excercises that strengthened/correct quad muscle firing...the physio looked at it again and believed there was nothing wrong witht he strength/firing...gave me some excercises anyway and that was that.

I guess I never really committed to the excercises...maybe I should give them another go??

Sam