Frustrating Knee Niggle

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mogwaiboi
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Frustrating Knee Niggle

Postby mogwaiboi » Thu Apr 13, 2017 5:37 pm

Hi All

I'm hoping you guys can throw some ideas at me as I'm getting quite frustrated with trying to solve this ongoing niggle. I've had an issue with my left knee on and off over the last 3 years or so, but it has been persistent over the last 12 months. It's a dull ache between the knee cap and shin, and occasional popping. I've tried a lot of different daily stretches such as hip flexor, quads (the quad stretch seems to irritate my knee), calves, hips. Foam rolling of my quads and ITB. Spiky ball on the hips, hip flexors, glutes and quads. Strengthening exercises such as wall sits, one / two leg squats, various VMO exercises, standing leg raises.
I've had my position checked by a physio who has worked with various cycling teams in the past, and he couldn't identify any fit issues that could be causing it. I had 3 physio sessions with him as well but didn't make any progress. He seemed to think it may be caused by a tight left hip, so I really concentrated on using the spiky ball to loosen it up as much as possible but it hasn't helped the knee ache (it did seem to eradicate the mild outwards flick of my knee on the upstroke).
I'm currently getting treatment from an Osteo (I've only had 2 sessions so far). He has been massaging my adductor, quad, lower back, hip flexor and behind my knee. No real progress so far, but he did comment that there was less irritation of my knee area when he was wiggling the knee cap in the second session, so I'll persist.
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jpgibson
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Re: Frustrating Knee Niggle

Postby jpgibson » Thu Apr 20, 2017 3:29 pm

Probs chondromalacia patellae. rest is the mainstay. only way to really find out is an MRI

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Re: Frustrating Knee Niggle

Postby NhiTrac » Fri Apr 21, 2017 1:59 pm

mogwaiboi wrote: I've tried a lot of different daily stretches such as hip flexor, quads (the quad stretch seems to irritate my knee), calves, hips. Foam rolling of my quads and ITB. Spiky ball on the hips, hip flexors, glutes and quads. Strengthening exercises such as wall sits, one / two leg squats, various VMO exercises, standing leg raises..


I was going to suggest this but you're doing it all already :shock:

My left knee gives me problems too but physio puts it down to a tight ITB so have been hitting the foam roller and the stretches you've mentioned. Just a month or two ago I had the same numbing pain in the same knee.

Started hitting a daily does of glucosamine which seems to have helped.
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mogwaiboi
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Re: Frustrating Knee Niggle

Postby mogwaiboi » Fri Apr 21, 2017 2:39 pm

Thanks guys. Yes I used to take glucosamine...I think I'll get a fresh batch and see if it helps. Osteo recommended doing wall sits daily. I've started consistently foam rolling my calf as well to see if that helps (that hurts!). Spiky ball all around my knee for a bit more torture.

I have a few bikes that I use and I've tried to set them up as identically as possible, but for some reason my commuter bike results in more knee aggravation than the other 3 bikes. Saddle height is definitely the same across all of them.
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Re: Frustrating Knee Niggle

Postby Zippy7 » Fri Apr 21, 2017 5:17 pm

Are you using different pedals and cleats/float/angle on the commuter?
Maybe it's just geometry/position is different and causing issues?
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mogwaiboi
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Re: Frustrating Knee Niggle

Postby mogwaiboi » Sun Apr 23, 2017 9:33 pm

I use the same pedals on the commuter, but different shoes (both Shimano R321 though). The cleats are set up as close as possible between the 2 pairs. I've done a reach / stack comparison between all bikes and have made a few adjustments on the commuter to try to get it as close to the others as possible. Time will tell...
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Re: Frustrating Knee Niggle

Postby User Name » Sun Apr 23, 2017 9:51 pm

mogwaiboi wrote:I use the same pedals on the commuter, but different shoes (both Shimano R321 though). The cleats are set up as close as possible between the 2 pairs...

Same length cranks? The extra knee flexion with longer cranks could aggravate it

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Re: Frustrating Knee Niggle

Postby NhiTrac » Wed Apr 26, 2017 11:41 am

Have you found the source of the problem? My left knee started hurting again a few days ago :(
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mogwaiboi
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Re: Frustrating Knee Niggle

Postby mogwaiboi » Wed Apr 26, 2017 2:36 pm

Yes my cranks are all 170mm
No I haven't unfortunately NhiTrac. A lot of information around knee pain seems to focus on developing the VMO muscle, so I'm going to give it a try:

https://www.physioadvisor.com.au/injuri ... -syndrome/
https://www.physioadvisor.com.au/injuri ... endonitis/
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Slow Motion
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Re: Frustrating Knee Niggle

Postby Slow Motion » Wed Apr 26, 2017 4:44 pm

My left knee used to give me a lot of trouble after a motorcycle accident when I was young and stupid... (now I'm just stupid :)) had it sorted a couple of years ago with a full replacement (probably a bit extreme for a niggle) but now its the best part of me :)

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Re: Frustrating Knee Niggle

Postby Calvin27 » Wed Apr 26, 2017 7:09 pm

I got a cortisone booster and rested it for a month after about 9 months of 'managing the problem'. Knee specialist said sometimes you just have to break the cycle somehow and stabbed the injection into my knee (it goes straight in where you think the knee cap is). Told me to promise not to use it no matter how good it felt for a month and after that all good. It's still not 100% but much better.
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mogwaiboi
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Re: Frustrating Knee Niggle

Postby mogwaiboi » Wed Apr 26, 2017 7:15 pm

Yes I've thought about trying to get a cortisone injection to see if it helps. Is it something that a normal GP can administer?
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Re: Frustrating Knee Niggle

Postby User Name » Wed Apr 26, 2017 7:39 pm

I've read conflicting stuff about the medialis. Some say it's impossible to isolate or even focus on the muscle unless you use a tens machine, and it may not have anything to do with patella tracking at all

https://www.painscience.com/articles/pa ... dialis.php
http://www.strengthpowerspeed.com/vmo-isolation/
http://www.thestudentphysicaltherapist. ... te-the-vmo
http://dougkelsey.com/muscle-myth/

That said, I recently bought a "civilian-level" tens machine from a chemist.
Last edited by User Name on Wed Apr 26, 2017 8:28 pm, edited 1 time in total.

Calvin27
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Re: Frustrating Knee Niggle

Postby Calvin27 » Wed Apr 26, 2017 8:09 pm

mogwaiboi wrote:Yes I've thought about trying to get a cortisone injection to see if it helps. Is it something that a normal GP can administer?


Not sure. I went the whole hog physio, oesteo, then ultrasound and mri. decided to stop wasting money and see a knee specialist and they did it. The confidence levels between the professionals is astounding. The knee guy who only did knees basically sounded like he had seen it all.

Not sure if a GP acn do it but I'm not sure a GP would want to. I expected him to jab throug hte side ot top or behind the knee or something. Nope straight front on. I have never been so uncomfortable but it was pretty painless. I asked him how he knew where to jab and he was like, 'lrelax' I've done tonnes of these.'
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Re: Frustrating Knee Niggle

Postby Baalzamon » Wed Apr 26, 2017 9:32 pm

mogwaiboi wrote:Yes I've thought about trying to get a cortisone injection to see if it helps. Is it something that a normal GP can administer?


Only ones I've had are done by a more specialised person than a GP. And it's ultrasound guided to the inflammation point.
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mogwaiboi
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Re: Frustrating Knee Niggle

Postby mogwaiboi » Thu Apr 27, 2017 11:29 am

User Name wrote:I've read conflicting stuff about the medialis. Some say it's impossible to isolate or even focus on the muscle unless you use a tens machine, and it may not have anything to do with patella tracking at all


Yes, so have I but I thought I'd really concentrate on it for a few weeks at least and see what happens.
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Re: Frustrating Knee Niggle

Postby RhapsodyX » Thu Apr 27, 2017 11:45 am

Re. it being one bike which aggravates the knee more, what's the Q-factor between the bikes? I get the same knee issue if I ride too narrow. MTB width is fine, Road can be horrible.

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Re: Frustrating Knee Niggle

Postby mogwaiboi » Thu Apr 27, 2017 9:26 pm

Q-factor is the same between the 3 road bikes unfortunately.
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Re: Frustrating Knee Niggle

Postby RhapsodyX » Fri Apr 28, 2017 6:50 pm

mogwaiboi wrote:Q-factor is the same between the 3 road bikes unfortunately.


You mentioned four bikes previously, commuter + 3 road.

Are you tall with wide hips? If so, I'd try "knee savers" or longer axles as an experiment. Cheaper than new knees.
OR - do you have enough float in the pedals? My speedplay's binding up with dirt or insufficient float (limit screws) often presents as knee pain on my fragile side.

Bike fit can be a bit more than the basics - I run 6mm spacers under my left shoe for the short leg, 1/2" longer axles and angled cleat wedges between the shoes and clears. But last year, after injuring the right knee after straining the VMO, I had to revert (for about a month) to standard axles with 20mm spacers to stop the pain.

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Re: Frustrating Knee Niggle

Postby mogwaiboi » Sun Apr 30, 2017 2:36 pm

Yes sorry, 3 road bikes and 1 CX. Commuter is one of the road bikes. I'm actually fairly small at 172cm, and could be classed as having wide hips. I have thought about trying longer axles so no harm in trying knee savers as an experiment. I tried reducing the Q-factor with the side-to-side adjustment of the Speedplay cleat but it feels very wrong if I have it anywhere but as close to the inside of the shoe as possible (wide stance). I've experimented with float and I've come to the conclusion that my knees seem to prefer less float if anything.

I have tried Steve Hogg heel wedges on and off as my left knee has a slight tendency to move towards the top tube on the downstroke, but they didn't make any difference to my knee issue. Also tried Specialized wedges, but no luck either.

Knee feels a bit better at the moment - I'm hoping it's due to exercising the VMO 3 times a day, but time will tell.
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Re: Frustrating Knee Niggle

Postby andycross » Sun Apr 30, 2017 6:51 pm

I have knee pain too, I found the reason in the end via MRI. Cartilage worn out so the pain was from bone on bone on the spots without cartilage.

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Re: Frustrating Knee Niggle

Postby mogwaiboi » Wed May 31, 2017 12:44 pm

A follow up on the knee issue if anyone is curious. I've been doing 1 minute wall-sits at least twice a day for the last few weeks and it seems to have helped my knee more than anything else.
I had a partial bike fit with Ken at Adaptive Human Performance, and he advised I was certainly on the right track as that specific exercise loads up the knee tendons and promotes healing. He also advised that for my saddle height (692mm BB to saddle) I should be using cranks no longer than 165mm to minimise peak knee flexion. 3 of my bikes have 170mm and the other 172.5mm, so that could potentially explain why the bike with the longest cranks seemed to aggravate my knee the most. He set up my cleats in the most natural position after observing my stance off the bike. He also mentioned it would be beneficial for me to look at longer Speedplay spindles next time I need new pedals, and also consider orthotics to reduce any twisting between the knee and bottom of leg.
I've ordered a 165mm chaninset for one of the bikes to begin with, so it'll be interesting to see how that works out.
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Re: Frustrating Knee Niggle

Postby vander » Fri Jun 30, 2017 3:27 pm

How is the knee going now?

With knee pain rarely do you need anything more serious done like a cortisone injection or surgery etc. A lot of the info on here is a bit misleading.

There is no reason that a wider Q angle will help knees in a lot of cases, it may shift load from one tissue to another (although sometimes it wont) it may deload the tissue that helps you it may have some effect.

Different crank lengths. Yes it might change peak knee flexion however a shorter crank decreases the moment arm so may increase torque required to push it.

Orthotics are similar to the longer pedal spindles it may change somethings it may not. Standard orthotics often don't help much because the pressure is more through the ball of the foot than the whole foot.

However taking a more globalised approach to it, getting you generally strong (which is what the wall sits have likely helped with) will help to improve tissue tolerance and decrease your risk of pain. Decreasing your fear about damaging your knee may have a big impact on your pain (pain is more multifactorial than just the tissue). Getting enough sleep greatly decreases your risk of pain (your body needs rest to recover). The last quick point and probably the most important is looking at your loads and taking a gradual loading approach to gently load up the body and allow it to adapt to the load periods of higher than lower loads of often not great for the body. Long periods of rest only work if you are happy for a long period of a rebuild afterwards. Often you don't actually need the rest and could have went straight into the rebuild.

Hope your knee is feeling better.

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Re: Frustrating Knee Niggle

Postby NhiTrac » Tue Jul 04, 2017 12:23 pm

So a few days ago I raised my seat by about 5mm (per the heel to pedal measurement) and moved my cleats back by about 5mm (spindle wasnt 100% under the ball of my feet) and knee pain is completely gone :o

Hope I'm not jinxing myself but did a moderately hard ride this morning and I'm perfectly fine. Hope it keeps that way!
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Re: Frustrating Knee Niggle

Postby mogwaiboi » Sun Aug 27, 2017 11:05 am

Thanks for the latest replies guys, sorry for my late reply.
Thanks for the detailed reply Dan, some good info in there.
Yes NhiTrac, seat height and cleat position definitely plays a part, I have my saddle as high as possible as per the last bike fit I had. So you've essentially raised your saddle 10mm with that combination.
Knee is definitely better at the moment, it hasn't made any popping noises for a while and even after a hard 100km / 1700m yesterday there is only the slightest hint of soreness in the tendon. I did put 165mm cranks on 2 of my bikes so that could have played a part, although the ride I did yesterday was on 170mm cranks.
I don't do the wall sits daily anymore as I haven't felt the need due to it feeling better. I still don't stretch my quads as it seems to aggrevate my knee issue. I foam roll my ITB and qauds at least twice a week for 3-4 mins each side. Spikey ball / foam roller on the glutes. Stretch hamstrings, glutes, calves and hips daily. I've been doing a boxing conditioning class once a week for the last 3 months so that could have helped it (skipping, core work, bag work). First class I nearly spewed as it's very intense! I'm definitely not short on sleep quantity, but my quality of sleep is not the greatest due to a number of problems with my nose and snoring...save that issue for another thread. I take Glucosamine most days.
I'm still keen to try out wider pedal spindles and either custom carbon insoles or Solestar insoles.
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