Frustrating Knee Niggle
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- mogwaiboi
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Frustrating Knee Niggle
Postby mogwaiboi » Thu Apr 13, 2017 5:37 pm
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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Re: Frustrating Knee Niggle
Postby jpgibson » Thu Apr 20, 2017 3:29 pm
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Re: Frustrating Knee Niggle
Postby NhiTrac » Fri Apr 21, 2017 1:59 pm
I was going to suggest this but you're doing it all alreadymogwaiboi 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..
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
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
Maybe it's just geometry/position is different and causing issues?
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Re: Frustrating Knee Niggle
Postby mogwaiboi » Sun Apr 23, 2017 9:33 pm
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Re: Frustrating Knee Niggle
Postby User Name » Sun Apr 23, 2017 9:51 pm
Same length cranks? The extra knee flexion with longer cranks could aggravate itmogwaiboi 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...
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Re: Frustrating Knee Niggle
Postby NhiTrac » Wed Apr 26, 2017 11:41 am
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- mogwaiboi
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Re: Frustrating Knee Niggle
Postby mogwaiboi » Wed Apr 26, 2017 2:36 pm
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/
- Slow Motion
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Re: Frustrating Knee Niggle
Postby Slow Motion » Wed Apr 26, 2017 4:44 pm
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Re: Frustrating Knee Niggle
Postby Calvin27 » Wed Apr 26, 2017 7:09 pm
Cushy dirt bike
Very cushy dirt bike
Bike crushed by car (RIP)
No brakes bike
Ebike
- mogwaiboi
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Re: Frustrating Knee Niggle
Postby mogwaiboi » Wed Apr 26, 2017 7:15 pm
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Re: Frustrating Knee Niggle
Postby User Name » Wed Apr 26, 2017 7:39 pm
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.
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Re: Frustrating Knee Niggle
Postby Calvin27 » Wed Apr 26, 2017 8:09 pm
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.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 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.'
Cushy dirt bike
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Bike crushed by car (RIP)
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Re: Frustrating Knee Niggle
Postby Baalzamon » Wed Apr 26, 2017 9:32 pm
Only ones I've had are done by a more specialised person than a GP. And it's ultrasound guided to the inflammation point.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?
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Re: Frustrating Knee Niggle
Postby mogwaiboi » Thu Apr 27, 2017 11:29 am
Yes, so have I but I thought I'd really concentrate on it for a few weeks at least and see what happens.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
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Re: Frustrating Knee Niggle
Postby RhapsodyX » Thu Apr 27, 2017 11:45 am
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Re: Frustrating Knee Niggle
Postby mogwaiboi » Thu Apr 27, 2017 9:26 pm
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Re: Frustrating Knee Niggle
Postby RhapsodyX » Fri Apr 28, 2017 6:50 pm
You mentioned four bikes previously, commuter + 3 road.mogwaiboi wrote:Q-factor is the same between the 3 road bikes unfortunately.
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
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
- mogwaiboi
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Re: Frustrating Knee Niggle
Postby mogwaiboi » Wed May 31, 2017 12:44 pm
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
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.
Dan
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Re: Frustrating Knee Niggle
Postby NhiTrac » Tue Jul 04, 2017 12:23 pm
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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- mogwaiboi
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Re: Frustrating Knee Niggle
Postby mogwaiboi » Sun Aug 27, 2017 11:05 am
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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