Knee pain

[cycling@42]

I have been cycling now for about a year. I cycle frequently (5-6 times per week) but can't seem to get out for long rides as much as I would like to. I am a stay at home mom...dear son is 5 and will be starting kindergarten in about 3 weeks. I had been riding a Specialized (cheap) mountain bike for the first 9 months. My husband bought me a Trek 7700FX on 6/1/02. I have logged 250 miles per month in June and July. Recently, I have noticed right knee pain, below the patella. I know by bike is fitted to me correctly as I had it done at the bike shop where purchased. I do use clipless pedals and am wondering if the pain could be caused by the cleat being mis-positioned. Any thoughts on this? It is only my right knee. I am hoping to ride in a 60 mile ride in September but am concerned about the knee pain. I welcome any comments. Thanks! I just love the feeling of being on my bike, even if it is only for a short period of time.

[han-grrl]

Hi Cycling

i can relate to your knee pain. I have right knee problems and here are some suggestions:

1) make sure your seat height and fore/aft position has been done correctly
2) it IS possible the cleat isn't set up properly on your shoe. Your clip in position should follow your leg "bends". that is, if your knees point in then the clips should be pointed in a bit.
3) another possibility is trying another type of pedals, i have heard that Speedplay pedals are a lot nicer for sore knees.
4) you may have a weak right knee. have someone watch your pedalling, does your right knee "fall in" on your down stroke? this will probably also happen if you try doing squats. what it means is that your muscles around the knee are weak, and you need to do some exercises to strengthen them (this is what my boyfriend had to do).

hope some of these ideas help.

happy riding
Han

[ayermail2]

Some notes from a clinic that our local University held recently on "Bike Fit & Its Relationship to Injury". The speakers were physical therapists. (I am not, not even close, but I did try to take good notes!)

The pain just below the knee is known as "patello femoral pain syndrome" and could be a symptom of any of several things:
*seat too low
*seat too fore
*being a "masher"
*going too hard too soon
*too many miles too soon
*low cadences
*hamstring too short/weak
(80 miles a week = 200,000 knee extensions!)

Some tips they gave:
1) use cycling shoes instead of sneakers
2) make only small adjustments, and take measurements before changing anything so you can put it back the way it was, also change only one thing at a time
3) consider a RAD fit on cleats changes
4) begin a stretching program, and after 4 to 6 weeks of stretching, reassess bike fit
5) "mashers" - do "single leg cycling" to get out of the habit - "usually knee pain on the front is a sign of mashers" [ take one foot out of the cleats, pedal with the other foot in complete circles - push down, then "scrape mud off your shoe" at the bottom, then pick up and "jam" your knee toward the handlebar to make a rounder pedal stroke ]
6) work on increasing cadence - elite riders who pedal at 90 to 110 are more efficient than casual cyclists who pedal at 70 to 80
7) do strengthening exercises that are "closed kinetic" (i.e. one foot is planted on the ground) and forward/back in motion, such as lunges, squats (not kicks)

They also suggested that it takes 10 years or 10,000 hours of extensive practice to excel in anything...

Sorry to be so long, but I tried not to leave anything out...

[liner]

When I first went clipless, I had knee pain in my left knee. I consulted my LBS, and we did a slight adjustment to the cleat. It worked, no more pain. It's worth a try.

Liner

[missliz]

Well first- hurray for me! I had my last knee surgury in a series tuesday, and will be back on the bike in October after three years! Life has meaning again.
More importantly though, it sounds like you're describing patella tendonitis. That's an inflammation of the tendon that attaches at the bottom edge of the kneecap and the front of the shin bone. Muscles strengthen faster than tendons sometimes, and if the quad muscle is overpowering the tendon it will get overstrained and inflamed. You did say below the knee cap not underneath, right? This could be a cleat thing, but I'm thinking that a fabulous new better bike has you working harder for the fun of it, and this is a training thing. If the bike is lighter and more responsive the first thing we all do is push a bigger gear and be a bird, right? ;)
By all means get the cleat looked at, but I think you need to back off a cog or two, and do some boring conditioning work. Spin in a middle gear and the 36 to 40 tooth chainwheel, try to think serene thoughts when people pass you, use your ankles. Pushing too big a gear too early is the big culprit in most knee troubles. A mispositioned cleat is usually pain behind the kneecap from the joint being pushed out of alighnment. Strengthening the hamstrings won't hurt either, get some leg weights and spend five minutes doing slow curls when you come in and you're still warm. Tendonitis can be a real pain in the neck to get rid off; If you can use Ibuprofen, try 400 mg 3x day for maybe two weeks. You need to have a blood level going on for it to work. Ice that puppy after you ride for a good fifteen minutes. You'll heal up, and the slower work (practice your spin!) will pay off in better total strength. Oh and taper off the dose of ibuprofen; if you quit it abrubtly it can backlash and the problem will return.
Another cool trick- and these cool tricks all come from either my orthopod or Physical Therapist- is a patella tendonitis strap, also called a jumpers strap. It's a band that goes around the leg just below the kneecap. they're made of neoprene and velcro on. There will be a rubber lump in the part that goes over the patellar tendon; this supports the tendon and helps with any overload the quad may be putting on it. These work great. I've been in rehab hell for knees lately and swear by these gizmoes. You can get one at Super Evil Wal Mart or almost any sporting goods store at the mall, $6 to $12. A little yummy smelling Ben Gay will help too. :p
Miss Liz

[missliz]

That Ibuprofen dose I gave above is the max daily recommended; If you want to use less it will still help so long as it's spread through the day.
It occured to me that not every one shares my beleif in NSAIDS. If you don't use them at all the less intense training with ice will still help. And don't underestimate ole stinky Ben Gay et al. Applied before exercise they help get the blood flowing through the parts. My PT recommended it to me, apparently people still love it. I find it really helps. The scent will clear your sinuses too.
Miss Liz

[cycling@42]

Thank you all for your thoughts and considerations. I've been backing off a bit to see how my knee does. Started to walk/ride on alternate days. Seems to be helping. First time I walked (it had been months) my glutes were so sore! Just goes to show, different activity, different muscles used. I just posted a new problem...numb feet!

[missliz]

Numb parts suck! Cycling shoes are so weird- they tend to be awfully narrow and give a lot of folks problems. This may not be your problem specificly, but it's common. I have some shiny (yes they're silver) new Lakes for the great day I get cleared to ride again. They tend to be wider in the forefoot than most shoes, and on the trainer they are significantly better than the ole Diadoras. Too pointy a toe will be hell after those first ten miles; Your feet expand and move up in the shoe and the fit can be very different than in the store. You gotta wonder what shoe designers think woth those pointy toes. They don't fit most people, especially men.
So how did the cleat/ knee issue work out? Is it resolved? Something that can help enormously is an orthotic, and you can get some surprisingly good ones for cycling and skating called Peterson Powerbeds. Performance Bike used to have them or your shop can get them from Gita USA (the distributor for Giordana and Diadora). Cost about 30 bucks. Orthotics will improve the way your foot sits in the shoe and stabilize your heel if it tends to swing around. Knee trouble from an unstable calcaneus is an involved explanation, but it happens and a lot of cyclists use these guys and love them. Even my orthotocist, who makes my expensive custom screwed up legs orthotics was impressed. There fantastic for skates, too.
Just a thought. Sorry to overwhelm you with information. After all I've been through with knee trouble and the trouble it caused in my feet and hips I wouldn't wish a sore knee on my worst enemy. Best to correct it early.

Miss Liz

[pennys]

a caution on patella femoral syndrome.

I was (Mis) diagnosed with this for 6 years. Treid all sorts of stuff.
Finally went to go see a sports specific podiatrist/gait specialist who rediagnosed me correctly with overtight ilio-tibial bands. These are the muscles that insert at the hip and run down the outside of your leg, and connect to the lower leg just below the knee. I was put on a prescription stretching regime. I know for a fact the regime I was given was posted on the web I'll see if I can find a link.

The stretching ( of the proper muscle group) really helped; I am cured.

penny s

[pennys]

http://www.physsportsmed.com/issues/2000/02_00/fredericson.htm

this is the link for my IT band prescription stretches

[missliz]

Very cool link, but what is patella femoral syndrome?

[missliz]

OK, I looked it up, and patella femoral syndrome is just patellar tendonitis is justy early chondromalacia patella- which I have. Tight iliobiotal bands are a whole 'nother deal, in fact the description at the above link has nothing that really even overlaps with major patella trouble. I mean grind your knee apart trouble, not just hurts like a bastard trouble. Unfortunately most orthopods are morons so I'm not surprised that you got the wrong diagnoses penny. (my knee surgeon is the president of the American Academy of Orthopedic Surgeons and HE thinks most orthopods are pretty dumb).
The moral here is that people don't stretch properly to start with, don't crosstrain in a balanced way, don't take care of themselves.Yoga and Pilates mat work are fabulous for not allowing a lot of weird injuries to ever happen in the first place but how many cyclists do this stuff? How many people period? It goes back to the crappy excuse for phys ed we get in school.

Miss Liz

[angriecow]

hey, simple simple question: what kind of pedals????
afterall, most pedals are lock-down cleats, like the spds, spdrs... unless you shucked out lots of $$$, you are not getting pedals with a good float, and that means locked knees for hours on end.
my patellas grew in incorrectly, i can't even jog for 5 min without falling down and crying, but i can bike, a lot. invest in speedplay pedals or look. as to numb feet, specialized wsd shoes are amazing :D slightly wider, slightly shorter than men's so there's no slipping when you get the right width, and no pinching for the right length

[goddess1222]

ok so i got shoes for spin class. they are SPD's. i have Look's on the road bike so i am not used to spd. my right cleat is lined up properly, and i took hangrrl's advice and checked my fore-aft position. i have no problems on the road bike at all, but on the spin bike, now my knees bother me. especially my left medial. they don't get sore, they just feel weird, and after class, they feel heavy.

i didn't have any problems with knees on the spin bike until i got the spd shoes. i was going with the foot cages before. since i have Look's on the road bike and foot cages for spin, these both have tons of float which i love. maybe i am too "locked in" for my knees to be comfortable on an spd pedal.

ok i know this is a somewhat disjointed post, but i am so frustrated i can't tell you. i am ready to chuck the shoes out the window and stay with foot cages forever. my local bike shop is not an option because i don't trust them to do a good job.

aaaaaaaaaaaaaah! could you all please send a request out to the universe that a little shoe fairy comes my way to take care of my problem?

i have read everyone's advice and am taking it all in. but i just wish i KNEW exactly what was causing it. i feel quite helpless right now. (no i am not a control freak, not me ) heee heee.

ok, i need a little encouragement here.

and yes i did start another thread about this very thing, but i am still having problems.

thanks gals

[Veronica]

Do you use the same spin bike in every class? Sometimes the bikes can be messed up. We even had a crank fall off one day. I use the same bike (some of the women think I'm obsessive) but at least this way I have some idea of what shape it's in and if something should start to feel weird I can report it.

Good luck!

Veronica

[goddess1222]

no, i don't use the same bike. that could be my problem. i go twice a week to two different gyms, and one gym has the Johnny G bikes and the other has the brand new V Bikes. and you are right, my set up is not the same on both bikes. i will check it out.

thank you veronica

[Kathi]

If your short and using a 165 crankarm on your bike the longer crankarms on the spinning bikes could be the problem. My knees would bother me unless I warmed up for a good 1/2 hr. I finally decided that the longer crankarms were the cause of the problems so I bought a trainer for my bike and do my indoor riding on my own bike which is a lot safer for me. I also have PFS so my knees are very sensitive to change.