LCL Pain

[Mr. Bloom]

OK, I rode tonight for the first time in three weeks since the temps were up to a hot 60 degrees!!

I did 20 miles. About 5 miles along, my LCL pain came back. The LCL is the ligament attaching to the top of the fibula (outside of legs at the top of the calf).

Prior research indicates that LCL injuries are rare, but will result from
- repetitive motion aggravation (too many miles too quick - like the 250 miles I did in five days on vacation), or
- pedal 'float' - which I understand to be shoes/clips being out of line


As I look down, my foot looks straight. Is pedal float a tilt in the foot where the ball of the foot is tilted, or is it a crooked foot on the pedal????

I've been criticized by this group for being a "masher". So, I'm being very conscious of it, but I now feel the pain is worse when I'm on a rapid cadence...so, it is possible that the repetitive motion at a high cadence is causing this???

I welcome thoughts on what I should do next (other than Rest, Ice, Compression, and Elevation that I'm already doing....

Thoughts?

[makbike]

Mr. Silver:

You might check out this website http://www.kybikerides.org/ It contains a lot of local information (for the Louisville area) but the "performance hints" section contains some useful health stuff. The webmaster is an avid cyclist as well as a well respected chiropractor in the Louisville area. I can't promise that he has a solution to your problem but it might be worth a look. Heck you can also check out a wide range of rides hosted by club members, some neat photos, etc.

Hope you get to feeling well soon.

[silver]

OK, I rode tonight for the first time in three weeks since the temps were up to a hot 60 degrees!!

I did 20 miles. About 5 miles along, my LCL pain came back. The LCL is the ligament attaching to the top of the fibula (outside of legs at the top of the calf).

Prior research indicates that LCL injuries are rare, but will result from
- repetitive motion aggravation (too many miles too quick - like the 250 miles I did in five days on vacation), or
- pedal 'float' - which I understand to be shoes/clips being out of line


As I look down, my foot looks straight. Is pedal float a tilt in the foot where the ball of the foot is tilted, or is it a crooked foot on the pedal????

I've been criticized by this group for being a "masher". So, I'm being very conscious of it, but I now feel the pain is worse when I'm on a rapid cadence...so, it is possible that the repetitive motion at a high cadence is causing this???

I welcome thoughts on what I should do next (other than Rest, Ice, Compression, and Elevation that I'm already doing....

Thoughts?

mr. :( sorry you are having this problem. i do want to point out however that we never "critisized" you for being a masher. we only pointed out the problems that might be associated with it, but recognized that some people are more comfortable with it than others. we don't critisize one another here ;) ;) *hugs*

[Triskeliongirl]

Sorry to hear you are still in pain. Probably your injury was caused by ramping up your miles too quickly. Indeed, now that you are injured, fast cadences may be painful, so you may need to back off unitl its healed and then start back gradually, with easy gears AND a slow cadence. The recommendation for faster cadences are to allow you to be in an easier gear, but if you were trying to spin faster without dropping your gearing, that may have also have caused the problem. Probably its best to consult a sports med type PT or orthopod.

[lovemybike]

This problem is such a aggrevation... I seem to have to same problem but it only appears 80-90 miles in to a century and last for the rest of the day and maybe the next. I did some research after it last happened, and found the same thing that you were talking about...it's basically from high milage on your knees. I did talk to an "older" more experienced rider in my group about it one day and he suggested that I allow my clips to float as much as I could stand. This allowed me to change the position of my knee throughout the ride. Seems to have helped. If the pain is still there, see a sports trainer PT or someone of the sort, just to be sure. Hopefully is nothing serious. Then you will know for sure nothing is injured and you can find a way around the pain.:(

[Mr. Bloom]

he suggested that I allow my clips to float as much as I could stand. (

So, what is "float"?
- a staight foot alignment with a tilt on the ball of the foot, or
- a twist of the ankle, placing the foot at an angle to the bike?

[makbike]

Mr. Silver, if I understand it correctly float is the amount of "wiggle room" your foot is allowed once it is positioned/secured on the pedal.

[Thorn]

float is the amount of "wiggle room" your foot is allowed once it is positioned/secured on the pedal

Yep, that's what I've heard. I've never heard, however, that too much float causes a problem, but I have heard that a fixed position that isn't right will cause problem.

I have a very unscientific method for adjusting my cleats. When you're clipped in, twist your foot in and out while pedalling. How does your knee feel? Does it think that if you could just twist a tad more to the right (or left, be more forward, be more back) that it would be happier? If so, get out the wrench and adjust the pedal so your knee's happy spot is in the neutral position of the pedal.

I find that my foot position is a bit splayed (?term--basically, not pigeon-toed). I start with the cleats looking neutral and then, invariably find I need to tweak them until my heel almost touches the crank. Obviously, you'll be different, but you need to play with the position until you find your happy spot.

[BleeckerSt_Girl]

Mr S., I suspect that you pushed your body too fast, riding so many miles so soon after starting to cycle. I don't think your muscles and joints and ligaments had a chance to strengthen and build up to what was being asked of them. Now something is slightly damaged, and you'll need to back down and work gently for a while and build up v-e-r-y slowly to where you were before. Just my own humble opinion as I am no expert.

[Mr. Bloom]

All good feedback. Went to LBS and will try getting refitted later in the week. Tonight I did 20 miles. Halfway in, I lowered my seat a bit and it may have helped.

Technical Question: Can we really strengthen a ligament?

[aicabsolut]

More float in your pedals can help you get around some error in your pedal alignment. It's alignment that can strain the ligaments. Note that what's the proper alignment for your biomechanics will likely not be "straight" relative to anything.

Check to see if you have any forefoot abnormalities that can affect your knee alignment--fixable with wedges.

Have you considered your ITB? It is a common lateral knee pain culprit.

[Wahine]

All good feedback. Went to LBS and will try getting refitted later in the week. Tonight I did 20 miles. Halfway in, I lowered my seat a bit and it may have helped.

Technical Question: Can we really strengthen a ligament?

Two things, you can strengthen a ligament. However in this case strength refers to tensile strength of the ligament structure, not contractile strength like muscles have. Proper recovery from injury strengthens weakened ligament tissue such that it returns to normal. Graduated increases in stress along the ligament's long axis will stimulate the ligament cells to lay down more collagen tissue, creating more strength such that the ligament can endure more tensile stress.

Think of a ligament as a rope with fibres. If I load the rope up with too much weight some of the fibers will break. The rope maker walks by and notices so he adds more fibres to increase the strength of the rope. But if you keep breaking fibres down with repeated or excessive stress at frequent intervals such that the rope maker can't keep up, eventually you've got a problem. If the rope maker has time to respond, he keeps making the rope stronger. That's what the cells do.

Now, the second thing. I agree with aicabsolut, I think it's more likely that you have an IT band problem leading to inflammation at the lateral aspect of the knee where it joins on to the tibia. In which case, you likely need to do some hip stretches to release pressure of the ITB. I've posted stretches several times on this forum. If you search IT band or ITB you should find them.

[Mr. Bloom]

Have you considered your ITB? It is a common lateral knee pain culprit.

Aica and Wahine, Thanks to both for the new idea

What does "ITB" stand for?

If the pain is right at the top of the Fibula, can it still be ITB?

[aicabsolut]

ITB = iliotibial band. http://www.kneepaininfo.com/kneeITBand.html

While it attaches to the tibia at the bottom end, it runs along the outside of the knee and next to the top of the fibula.

If by pain on the fibula you mean a little more lateral-posterior pain (while the LCL is just lateral), or attachment point pain, there are some other things to consider.

For example, the biceps femoris (hams) run just under/behind the ITB, and tightness or strain of the muscle can hurt on the lateral-posterior part of the knee. This kind of strain is often caused by too much reaching--cleat too far forward, knee tracking inward (toward top tube) too far, saddle too far back, and possibly saddle too high.

An example on the other side of the knee is a strain of one of the longer adductor muscles. These attach at the medial side of the tibia, and tightness can cause a deep pain below the medial knee at the attachment point. But it is unrelated to knee ligaments.

It is pretty uncommon to hurt the LCL, but ITB or ham strains are pretty common and can show up as knee pain. Ligament injuries are often accompanied by heat and swelling. If it's ITBS, there might be hot spots along the band 1/3 of the way up the thigh. You may not notice the hamstring problem until you do something like get a massage. You might be able to stretch the same as normal, but a massage could burn.

If it's only on one side, check cleat placement, knee alignment, and pelvic symmetry. Is this by any chance on your left side? Many cyclists tend to drop their right hip, which creates a functional leg length discrepancy (I drop my left because of some biomechanical issues). This leads to all sorts of overreach problems with the other leg.

For some info on pelvic symmetry: http://www.cyclefitcentre.com/pdf%20final%20docs/THE%20PROBLEM%20OF%20PELVIC%20SYMMETRY_final.pdf

[Wahine]

+1 what aicabsolut said.

[Mr. Bloom]

Thanks. THis is very interesting. The pain is identical on both sides, so I'm leaning toward overuse, or seat height, but not pedal float (since I wouldn't expect this to be a problem on both sides...)

After reviewing the links, I'm inclined to think it's not ITB since the pain is right on top of the fibula "bump", specific to that area, and not following a band.

No pain when the leg is extended straight; pain peaks on stairs or when I'm reclined to sit.

I spoke to the owner of a local health club for a sports medicine specialist today and will pursue that if the pain extends into next week.

[aicabsolut]

Could still be the hams. Could also be the peroneals (lateral calf muscle). Any lateral foot pain (5th metatarsal area)?

Look at how much of a heel drop style you have, knee tracking, and fore/aft position as well as height. Too far back strains the backs of the legs, too far forward usually cases quads or medial/anterior knee pain.

You can strain the peroneals if you pronate (or supinate if there's too much stretching), and that can be a lateral cleat position thing (foot too close to cranks, for example). You can also strain them if your cleat is too far forward (pedal axle should be a few millimeters behind your first metatarsal joint). Look to see if you have any forefoot abnormalities or anything else that would affect your knee alignment. If that's ok, then look at your saddle adjustment.

I find it hard to believe that you've blown out both LCLs. Despite all my blabbing, I'm no expert (just frequently injured), but something muscular on both sides goes more with the odds.

[Wahine]

No pain when the leg is extended straight; pain peaks on stairs or when I'm reclined to sit.


This would strongly suggest that it is not your LCL. I'd epect a muscle balance issue. Do you get a sharp paon when you sit in your recliner, with the knees bent 30 to 60 degrees and push your heels into the foot support by trying to bend your knees? That would indicate tight hamstrings irritating the joint that I spoke of earlier.

Otherwise it may be the peroneii as aicabsolut suggested.

[Mr. Bloom]

Once again thanks.

The human body is amazingly complex! The pain comes while bending with a 'lateral twist'. Like climbing steps, or squatting to sit down (where my feet aren't necessary straight as I'm squatting).

I'm getting the refitting today to see if LBS can see anything obvious. I'll let you know what comes from this.

I'll also visit my chiropractor on Friday.

[aicabsolut]

ITBS also flares once knee bend is past 30 degrees in a squatting motion.

Having your feet pointed inward or outward doesn't just affect knee alignment but also which of the contracting and stabilizing muscles fire more.

I read something on lack of float (plus improper cleat angle position) where feeling the "need" to rotate your heel somewhere the cleat position won't allow can strain the biceps femoris tendons, which attach at the head of the fibula. So there, float may be the problem. But its' still not the LCL, though over time, you can strain the knee.

What kind of pedals do you have? Do you have any new calluses on your feet, such as under your 5th metatarsal? Do your knees track straight (with someone watching in front of you) or do they wobble?

Of course the greatest strains on the biceps femoris are caused by saddle too high and/or too far back. Have you evaluated whether your knee is over the pedal spindle (or how far off it is)? Do you tend to be a little short in the femurs?

[Mr. Bloom]

OK went to the chiropractor - he confirms ya'll are right. It's the ITB.

Had bike readjusted and we're going on a 36 mile ride tomorrow. Will let you know how it goes.

[aicabsolut]

Good luck! By the way, massage therapy and stretching can work wonders. Get your chiro or someone to show you how to stretch the ITB. It can be tricky. The stuff I thought stretched it were really abductor and glute stretches until my physical therapist set me straight.