Dreaded Knee Pain

[Dr_Mutley]

If u need some eSoles and are a 44-46 let me know, I have an unused pair that weren't needed for a bike fit... U will need to support your arch if its collapsing under load, prior to cleat wedging or u will end up torquing up your mid foot...

[philip]

If u need some eSoles and are a 44-46 let me know

Thanks for the offer, my shoes actually came with eSoles in them (I assume they are all the same?) so I think I'm ok there.

[Dr_Mutley]

That's a score Phillip if they did... What shoes did u get that came with eSoles? Did u get all the different arch height modules so u can customise them to your needs? If so trial the different arches til u get a sensation of pressure in your arch under load. U may need different heights in either shoe.

Here's what the aftermarket eSoles look and come with...

http://www.stevehoggbikefitting.com/sto ... h-support/" onclick="window.open(this.href);return false;

[philip]

They are bontrager shoes. I never realised what the soles were until I went and checked them after your previous post. Also I never knew they had a velcro part where the arch bit could come off! They only came with one "module" though. I remember when I first put them on I could feel a lot of pressure, I don't really notice it now though.

These are my shoes/soles:

[Dr_Mutley]

Look good! [THUMBS UP SIGN]

[philip]

I went and got some wedges from Steve Hogg today. Also borrowed a trainer from a mate and took a video, not very successfully, here it is:



First 30 seconds is without the wedges (I put 2 in), next 20 is with. Bit hard to see anything here, also I think the bike isn't even straight on the trainer so that's not helping. The view from the back is probably the one where you can see the right knee a bit closer to the bike. For me looking downwards the right knee is definitely tracking straighter with the wedges. I'll do a few short rides with them and see how I go.

[winstonw]

On my last couple of rides I've been paying a bit more attention to what my right leg/foot is doing and have a couple of ideas. Also my knee pain doesn't seem to be there now, definitely not the pain I was feeling previously anyway - but something in my knee still doesn't feel quite right. Hard to pinpoint what it is, it's just a sort of uncomfortable feeling (like what it feels like when you feel a joint needs to "crack").

You might also confirm your physio has cleared the following:

- for a fullness or feeling like a need to crack the knee jt, compare both ACLs (and may as well do PCLs). when one is looser due to previous insults, internal knee structures in the looser one tend to suffer cumulative insults more so, and can get inflamed, contused, or torn.

- get all horns and bodies of all menisci tested...requires very precise and repetitive orthopedic clinical tests and careful palpation right around the knee jt margins

- in relation to where the original arrow pointed, the lateral PFJ could be palpated and stress tested again very carefully.... in addition to looking for significant plicae, pain from the lateral quads tendon, and painful spots in the superior knee joint capsule when knee extended.

- if your knee has been medially deviating for some time, that can irritate the lateral margin of the 'knee cap' jt (PFJ), though this usually doesn't feel like something needs to be cracked to relieve pressure or discomfort.

in relation to your video, I have your minimum knee angle at 33 degrees. Rule of thumb for road cyclists is 30-35 degrees, and TT's and tri-athletes 25-30.
the larger angles
- put more pressure on the PFJ
- tension through the quads and patella tendons.
- and can be associated with more mid foot pronation and tibial internal rotation.

it's a bit difficult to judge what's going on in your video. it's better to get the camera oriented a lot squarer to the bike.
It seems movement of your right knee in the lateral plane may be compensating for your right shoulder deviating to the right. Your shoulder and trunk shifting to the right may indicate you are unloading the left lumbar facet jts or discs. Therefore, get your lumbar spine thoroughly checked.

[foo on patrol]

Looking at that from a ignorant persons perspective, it would seem your hips are twisted because your RHS is out of wack!

Foo

[winstonw]

Looking at that from a ignorant persons perspective, it would seem your hips are twisted because your RHS is out of wack!

Foo

yeah maybe Foo. but twisted which way....presume your thinking maybe the right hip sits further forward, and the right shoulder sticks further out to the right side to compensate??? or vv? that's why getting the video cam mounting squared up is important.

My way of dealing with these things is to think about common sites of pain, and compensatory movements/positioning....and also to consider centre of gravity. This is something I respect Steve Hogg for. Some of his articles have given excellent COG analysis. I am also into the neck and vision thing....magnets I don't know about.

[foo on patrol]

Yeah twisted with the RHS hips and shoulder coming forward and dropping.

Foo

[philip]

I had my wife (as of yesterday! feels strange to say "my wife") check my hips while on the trainer yesterday, she says they look straight. I think I'm a bit wonky in that video because the whole bike isn't quite vertical and I was compensating for that, bit of a dodgy trainer.

Anyway, I went out for a relatively easy 20km this morning and my knee felt great. No pain or discomfort, pretty much 98% of normal. Whether it's because of the wedges or the stretching/strength stuff I've been doing (or maybe just less time on the bike) or a combination or all but I'm pretty happy right now.

Thanks heaps to everyone who has replied in this thread so far, I know I haven't replied directly to everyone but I have certainly taken all comments on board. I know I'm not nearly out of the woods yet but at least I can see a light now.

[foo on patrol]

That's what we are here for Philip.

Foo

[philip]

Well it's been pretty good so far. I have been riding all this week with bigger rides yesterday and today with no pain. The more I think about it the more I think the stack that I had a couple of months ago has caused this, too much of a coincidence otherwise since I hadn't changed anything else. I did notice a bit of pain still in the right side of my back (lats area) a week or two ago when I stretched that way (e.g. reaching down/out to get something out of the back of the fridge) so I stretched that a lot as well, now that's all good too. That was definitely left over pain from the stack, so I suspect that may have been tight and pulling my hip up or something like that. Hard to say though since I've thrown a few things at it so can't be sure what has actually helped. Will slowly bring the kms up and hope it stays good.