Knee pain

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Knee pain

Postby cf73 » Mon Aug 22, 2011 2:05 pm

Hi all,
I am in the middle of training for a 1000km ride and on the weekend have hit a problem - pain/stiffness in my right knee.

We are riding 150km - 180kms a week at this stage with a mix of riding - hills, flat, 30km rides, 120km rides. Last Tuesday I put my bike in for a service and saturdays ride was the first biggish ride after that. It was a 60km solo ride with a lot of climbing but no climbs that I havent done before. In fact I do these climbs every week just maybe not all of them in the one ride.

I had a backup ride on the Sunday but had to pull short due to a really sore right knee. The pain is on the outside of the knee (right side). I ended up riding to the LBS where my bike was serviced to see if they had maybe adjusted the seat height but the guy who worked on the bike wasnt there. They had a quick look and we raised the seat about 1cm.

I havent had to adjust anything on the bike in the 3,800kms since I have had it as I got a set up done when I bought it (not a proper measured bike fit) and have had zero problems.

I have now booked the bike in for a proper bike fit this Thursday but my main concern is the knee.

Does anyone have any thoughts?

Cheers

Cheers
Carl
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by BNA » Mon Aug 22, 2011 2:53 pm

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Re: Knee pain

Postby simonn » Mon Aug 22, 2011 2:53 pm

What sort of cleats?

I had a knee problems which would start after ~100km into a ride when I got a new bike and decided to swap to SPD-SLs from having used SPD (i.e. MTB) cleats exclusively before this.

It only became apparent after ~100km so it was hard to figure out. After three rides where I had knee pain, someone mentioned that they had duck feet (i.e. toes pointing out) and they had had similar knee pain until they positioned their cleats to take account of their feet.

I sat at my chair normally. Duck feet, check. Positioned my cleats so that my feet would be in their normal position when riding. I have done five rides > 100km since with no problem.
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Re: Knee pain

Postby dancar » Mon Aug 22, 2011 5:10 pm

HI Carl,

If you are looking at any long rides and training 120kms rides with climbs counts alone (not to mention your 1000kms), get a bike fitting done. There's a lot of things that can contribute to knee pain (and different types of knee pain), such as seat height, position front and backward, your ankle lock, the consistent roll of the legs (not just pushing down stroke), any twist you may have in your back, different length legs, etc... These issues really present with the longer rides and more load such as climbing. So if there is a problem it really wouldn't present so much on a 30km ride, but a 120km it'll start to show up.

Without any further info, the knee pain sounds like the usual ITB. This can be managed through physio, stretches, core strength work or position changes.

No offense intended Simon, but cleats are not a "huge" factor. Yes they can be a part of the picture. If you are using the Shimano Yellow cleats, there's 6 degrees float there so the angle adjusts as you ride. The important factor is the forward position of the cleat, aim to have the ball of your foot on the pedal. Simon's angle technique will be a good start if you think your angles are way out, just note that such things change when on a bike, loading, seat positions, etc... compared to sitting in a chair.

In short, go to someone who can look at you and do some measurements. Well worth the money.
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Re: Knee pain

Postby jacks1071 » Mon Aug 22, 2011 11:24 pm

cf73 wrote:Hi all,
I am in the middle of training for a 1000km ride and on the weekend have hit a problem - pain/stiffness in my right knee.

We are riding 150km - 180kms a week at this stage with a mix of riding - hills, flat, 30km rides, 120km rides. Last Tuesday I put my bike in for a service and saturdays ride was the first biggish ride after that. It was a 60km solo ride with a lot of climbing but no climbs that I havent done before. In fact I do these climbs every week just maybe not all of them in the one ride.

I had a backup ride on the Sunday but had to pull short due to a really sore right knee. The pain is on the outside of the knee (right side). I ended up riding to the LBS where my bike was serviced to see if they had maybe adjusted the seat height but the guy who worked on the bike wasnt there. They had a quick look and we raised the seat about 1cm.

I havent had to adjust anything on the bike in the 3,800kms since I have had it as I got a set up done when I bought it (not a proper measured bike fit) and have had zero problems.

I have now booked the bike in for a proper bike fit this Thursday but my main concern is the knee.

Does anyone have any thoughts?

Cheers

Cheers
Carl


Your pain spot definitely sounds like an ITB issue - go to Physio and they'll teach you some stuff you can do yourself, if you really hammer the physio and stretching you can possibly be 100% within about 3 weeks. If you can find a physio who is a cyclist they are the BEST. You'll need to back the KMS right off until you are sorted.

I had a ITB problem about 3 years ago - I went from being able to ride 200km to not being able to stand 10km in a very short period of time, the pain was chronic. It was caused by a big increase in training over a short period of time. Basically I had a big race comming up and I had doubled my training load instead of working it up steady.

Your issue might not be caused by bike fit at all, it could just be a rapid increase in KMS.

Could be a bike fit issue.

If you put the cleats all the way to the rear of your shoes it'll be easier on your knees until you have time to get fitted up professionally.

During the time while you are having this problem - stay out of the hills and spin EASY gears, don't try and push big gears until you are sorted or you will increase your recovery time. If you are in pain riding then that is BAD. When I had my issue I put an 11-27 cassette onto the bike so I always had a low enough gear to keep it spinning with no load on my knees. I went to physio 4 times a week for 20 mins (I was lazy for doing my own stretching and wanted it fixed quick). In between that - and the bit of stretching I did myself I was 100% in 3 weeks. I know a few people who've had the same issue and 3 weeks seems to be the magic recovery period if you do everything right.

Hope that helps!
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Re: Knee pain

Postby Cleasts » Tue Aug 23, 2011 10:36 pm

Hello there,

The best thing for knee pain is rest for a few days and after try to get a massage on your legs and lower back. The most important thing is if you start stretching after every ride, If its possible.
I know, sometimes stretching is very hard after a long ride, but maybe a few hours later when you are rested you can try stretching your muscles.
Start with easy stretch on your hamstring, one of the biggest muscle. Every stretch should last about 30 sec, but eventually you should go up to a minute.
Second important part is your hips and at least but not last your glutes, that's where your long hamstring start.
Good luck, and keep riding!


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Re: Knee pain

Postby cf73 » Mon Aug 29, 2011 11:36 am

Hi All,
Thanks for the help and advice.
I went and had a massage last Tuesday and the masseuse did mention that it could be the ITB band. I have been given a couple of exercises to massage that out myself.

I also had a bike fit done last Thursday, the seat had to be raised 3cms and I must say the riding position did feel a lot better. We went out for a 160km ride on Saturday which had been planned for weeks so the timing wasnt that great considering the injury and the new bike set up. But I felt great up to about 120kms and then the pain settled in again. The last 40kms into the wind was painful.

I got home did some stretches and applied deep heat to the knee. The next morning I did a couple more massages on the leg, put deep heat on and took a couple of nurofen before heading out on an easy 35km flat ride. Took it VERY easy and the knee seemed fine.

I will continue with the massage on the side of the leg and watch how it goes.

After ;ast week where we did 360kms this week will be a bit lighter.

Thanks again for your help.

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Re: Knee pain

Postby JamesA » Tue Aug 30, 2011 9:13 pm

jacks1071 wrote:Your issue might not be caused by bike fit at all, it could just be a rapid increase in KMS.


My money is on this. I developed a problem in my knee on the outside, and it got worse, being sore when I sat on the couch or any other time I bent it (eg in bed). Once the GP ruled out arthritis, I was sent to the physio.

The physio immediately determined that it was most likely to be patellofemoral pain syndrome. Basically, I had upped my distances too quickly, going from my longest ride ever having been 25km, to 35km one week, 45km the next and near 60km the week after. I'm overweight, so that didn't help either.

Basically, my quad muscles on the outside (vastus lateralis) are tight and pulling the kneecap over to that side, and my other quad muscle (the vastus medialis) is not functioning properly to keep the kneecap where it should be.

Result is that the back of the kneecap is rubbing on the femur bone and getting aggravated. Solution is to have it strapped/taped by the physio to keep things in place until my vastus medialis strengthens up and starts doing its job.

Basically I went too hard too soon.

Could be a bike fit issue.

This is what I thought, as did my GP (who rides).

The physio didn't even want to see my bike, reckons the body will adapt to your bike fit (except perhaps for elite level riders). And my physio is awesome, he's races vets track I believe. As soon as he strapped it the first time, the pain largely went away for day to day stuff, and then he strapped it differently for me to ride - and I was able to do a ~30km ride with a small hill (~150m) with only a few twinges. I would've gone further, for another 30km or so, but didn't want to push my luck.

So my recommendation is to see a physio, and see if you can find one who is a cyclist.
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Re: Knee pain

Postby Schmenz » Thu Sep 08, 2011 2:20 pm

just on the ITB problem. It is a really hard muscle to stretch properly. A great muscle release for it is to get a foam roller, and while lying on your side, slowly roll it up the ITB. When you get to a spot that hurts, hold there until the pain decrease, and then keep rolling.

The foam rollers often seen at the gym can be too firm for someone with tender ITBs. I get my patients to start off with a pool noodle that has been cut into manageable lengths. Cutting it also makes it a little softer. Then you can upgrade to a firmer roller from there once you build up to it.

:)
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Re: Knee pain

Postby dancar » Fri Sep 09, 2011 6:15 pm

Schmenz wrote:just on the ITB problem. It is a really hard muscle to stretch properly. A great muscle release for it is to get a foam roller, and while lying on your side, slowly roll it up the ITB. When you get to a spot that hurts, hold there until the pain decrease, and then keep rolling.

The foam rollers often seen at the gym can be too firm for someone with tender ITBs. I get my patients to start off with a pool noodle that has been cut into manageable lengths. Cutting it also makes it a little softer. Then you can upgrade to a firmer roller from there once you build up to it.

:)
happy pedalling


+1 for the foam roller.

Also good for quads and glutes.

YouTube has some great vids of different techniques for the ITB roll
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