Knee pain, repetitive stress injury?

[Melalvai]

I wondered if anyone had experience with this. In the past my knee pain has been fixed by adjusting saddle height: lower if the pain is in the back of my knee, higher if the pain is in the front of my knee. This sort of pain generally shows up the night or morning after a long ride, and goes away as I work it out during the day.

On this 720 mile ride, the first couple days I made slight adjustments to my saddle and then it was PERFECT. No arm pain, no knee pain.

Until the last two days. But this knee pain was different. It showed up on my bike as I was pedaling. It went away when I stopped. It comes back after a couple miles. (If I'd had more than two days to go, this might have ended it...)

I'm thinking repetitive stress injury, and that's what my bike shop mechanic thinks. I'm going to stay off the bike completely for the next week. (Funny, last week was Bike/Walk/Wheel Week the whole time I was gone, so now it must be Car Week...)

Any suggestions on how to treat? Should I wrap it? Take ibuprofen before it hurts? Ice? It did hurt today when I was walking around.

[reddDesign]

does it look inflamed? I know if I ride too much, or even just stand and mash the pedals too much, my knee will start to hurt on a ride...ice, compression and elevation are always the key...I always feel better the day after.

[Cataboo]

Both knees or one knee?

Is it painful to walk down stairs? More painful going down then up?

I'd take ibuprofen just to get the swelling down - keep taking it, even if it doesn't hurt. At least 2 pills every 4-6 hours. Ice or heat it depending on what's your thing (everyone has a different opinion on ice or heat), but soaking in a tub would definitely help. Elevating it when you sleep.

Hopefully if you get all the swelling away and let it calm down, it'll just go back to normal.

No additional 720 mile rides for a while.

[Biciclista]

keep walking! in the long run, unless you actually tore something, walking is a very good therapy.

[indysteel]

Sounds familar to the pain I have in my right knee. It could be IT band irritation. Look here for some info on it and some suggested stretched.

http://orthopedics.about.com/cs/sportsmedicine/a/itbs.htm

[Melalvai]

Thanks, this helped a lot. It sounds exactly like the description of IT band in the link you posted, indysteel. Sudden increase in training...yeah.

I'll keep off the bike, walk a bit, take some ibuprofen and generally take it easy. I'd do that last anyway! I can't believe how hungry & tired I am today!

[Kathi]

Yes, and don't ignore it! Possible cause could be coming from the foot or hip.

Mine started in the fall of 07, knee pain only on the bike. Also some pain in my foot. Thinking it was too much cycling I didn't worry about it. I had no problems with skiing (71 days) that season and thought the issue went away. As soon as I started biking the pain in my knee came back. I thought it was something wrong with my bike fit. The guy at the bike shop noticed that my femur angled toward the tt of my bike and my foot rotated out. We tried shims in my shoe which helped but didn't cure the pain.

The problem eventually graduated into lower back, hip and glute pain. I saw an ortho, had an MRI and spent 4 months in PT, got a brace for my knee but didn't get better and didn't understand what was happening.

I came across this book at Borders, "Athletic body in Balance" by Gray Cook. It's written for the general public to help one understand how to exercise efficiently and effectively and hopefully prevent injuries.
http://www.performbetter.com/detail.aspx_Q_ID_E_4667_A_rnd_E_13
I kept thinking that all my issues were connected and his book proved it. Last week I got this video "Secrets of the Hip and Knee" http://www.performbetter.com/detail.aspx_Q_ID_E_5196_A_rnd_E_23
Even though the video is directed toward trainers and PT's it is simple enough that I could understand it and it definitely shows the connections between the foot, knee and hip. Exercises are simple and progressive.

In retrospect I'm glad I got an evaluation from the Dr., had the MRI to rule out anything serious and got the brace. PT wasn't useful, except to help understand my body better, I could have skipped most of the sessions I had.

I'm riding my bike without pain, low miles at this point and bracing the knee. However, my position on the bike is so much better, my injured hip feels strong and functioning and have little lower back or hip pain.

Good luck!

[indysteel]

My IT band issues were caused by my triple crank. The q factor is too wide for me and I was really "toed in" while riding. The sad irony is that while many women prefer triples, most of the triples currently on the market have a wide q factor that's especially problematic for women. I went with a compact crank when I built my new bike. My IT ban issues are almost gone. :)

[Tuckervill]

Don't forget to roll it with a rolling pin or a foam roller when it's hurting. It does a world of good in making the pain go away.

Karen

[lattae]

Do you feel that the video was worth it? I too suffer with ITB issues,, and am interested in Gray Cook's book. I've been doing stretches, and working with therabands to strengthen the hip muscles. I've had improvement but not 100% yet. I do ride a triple so that was an interesting comment with regards to the bike. I've had professional bike fit so there was no mention of the Q factor. It seems like its been a slow process of healing but I'm always looking for more info to help understand and learn more about this.

[indysteel]

Lattae, I tend to think that a lot of fitters don't take q factor into consideration. You might ask one of your riding partners if you look toed/kneed in while riding. In my experience, if the crank is the issue and you don't change it, no amount of stretching will really take care of the problem.

[lattae]

Thanks Indysteel.. do you mean that while riding your toes and knees have a tendency to be turned in greatly towards the TT with regards to the Q factor?

I do have the triple crank and eventually would like to purchase a new bike (maybe in a year) I'm going to keep the Q factor in mind. Maybe I should go back to my fitter and have him look this over now. I do still have some pain in the knee but has been reduced since stretching, but not totally gone. I also use the foam roller.

[indysteel]

Thanks Indysteel.. do you mean that while riding your toes and knees have a tendency to be turned in greatly towards the TT with regards to the Q factor?

You got it. Mine was really exaggerated, even with my cleats moved as far in as possible.

My fitter did a lot of research for me when I began the custom bike process. SRAM, Shimano and Campy's current triples essentially all have the same q factor. If I recall correctly, the only good choice I had was a TA Carmina crank, which was out of my price range. So, I went with the Campy 50-34 compact (13-26 in the rear). With that combo, I lost my smallest gear and my two biggest gears. So far, I haven't missed them too much. Every once in a while, I'll spin out, but that's okay. My knee is much improved. It hurt after my last ride, but I think that's because I went for a long ride with a fair amount of climbing after two weeks off of the bike.

[Kathi]

Do you feel that the video was worth it? I too suffer with ITB issues,, and am interested in Gray Cook's book. I've been doing stretches, and working with therabands to strengthen the hip muscles. I've had improvement but not 100% yet. I do ride a triple so that was an interesting comment with regards to the bike. I've had professional bike fit so there was no mention of the Q factor. It seems like its been a slow process of healing but I'm always looking for more info to help understand and learn more about this.

Yes, it gave me a good understanding of how the lower body works. But start with the book first, both to understand Gray's philosophy and to work out any general issues you have then if you haven't seen an improvement spend the money on the video. There is a companion video of the book that Borders didn't have but I was able to download it online for $9.99. You can get the set from PerformBetter. I wouldn't spend a lot on that video unless you have questions about the movement screen or exercises.

One thing I missed from the book that I got from the knee and hip video is how important the toe touch is. Since I have been doing the "Toe Touch Progression" (book and video) it is working wonders for me that none of the regular stretching has done. Because I'm closer to touching my toes I definitely seen a difference in how I'm sitting on my saddle.

My bike is a custom build and I use a compact crankset with Speedplay pedals but my toe out was much more extreme on my right side than the left. I also toe out when I walk and stand so to me that is an indication that my problems went far beyond the bike.

Perform Better has podcasts that include thoughts by Gray at the end of each segment. Lots of good information there.
http://www.performbetter.com/catalog/matriarch/OnePiecePage.asp_Q_PageID_E_262_A_PageName_E_StrengthCoachPodcast

I could go on and on about the changes I've seen in my movement patterns and issues that I've been struggling with that Gray's techniques have cleared up rather quickly.

[Kathi]

You got it. Mine was really exaggerated, even with my cleats moved as far in as possible.

My fitter did a lot of research for me when I began the custom bike process. SRAM, Shimano and Campy's current triples essentially all have the same q factor. If I recall correctly, the only good choice I had was a TA Carmina crank, which was out of my price range. So, I went with the Campy 50-34 compact (13-26 in the rear). With that combo, I lost my smallest gear and my two biggest gears. So far, I haven't missed them too much. Every once in a while, I'll spin out, but that's okay. My knee is much improved. It hurt after my last ride, but I think that's because I went for a long ride with a fair amount of climbing after two weeks off of the bike.

I have the TA Carmina crankset on my bike. I love it but didn't improve my toe out issues.

[Kathi]

Gray also recommends "The Stick" for getting in areas you can't get with the foam roll. I got the "Tiger Tail" Perform Better.Com and the "Fitball Therapy Ball" http://www.performbetter.com/SearchResult.aspx?rnd=30
The ball works better than a tennis ball for spots that need lots of work, especially the glutes and back.

Both are small enough to pack for travel, including bike tours.

[Melalvai]

I stayed completely off the bike for a full week. I've been walking a lot, just about long enough to make it hurt and then I stop. Today I biked 3 miles to work and home. Each ride it did ok until the 3rd mile and then it started to hurt, not excruciating just uncomfortable.

No more 70+ mile rides for me, but I don't really want to, so that's all good.

I can't believe how light my bike felt after lugging all that stuff all over the midwest!

[Melalvai]

I continued to walk (and drive) after the one trip to work last Wednesday. Yesterday (Friday) I noticed that even long walks didn't trigger any knee pain. So just now I tried out a short trip. 4 miles, a couple big hills, and NO knee pain. I'm cured!!!

I'm so excited that I can quit being a motorist.

However I will not head out on any 70+ mile trips quite yet.

[Melalvai]

I'm confused.

The 4 mile bike ride yesterday did NOT trigger any knee pain. Walking hasn't either, for the last 3 or 4 days.

Sitting in my daughter's recital, and sitting through Star Trek, DID.

What do you think? Does it still sound like IT band? I suppose I could see a doctor. Eh.

[Kathi]

Yes, if it continues much longer it's worth getting checked out. It's not worth sitting around worrying about. Seeing a Doc will give you reassurance and it may be ok.

That's exactly how my knee pain started years ago. I could ride my bike but couldn't sit or climb stairs. My diagnosis was Chondromalacia, was told the muscles needed to be stronger and was given exercises for the muscles around the kneecap. Note that newer theories are indicating problems in the hip, not knee cap tracking.

Last summer I ignored my knee pain because I didn't want to hear the same old story. I ended up with hip, foot and back pain as well as knee pain.

In late Feb. I finished 4 mos of PT and still had issues. Still thinking my bike fit was the cause of all my issues I went to a PT who also does bike fit hoping he could spot the problem. Instead, he rechecked ME! and found my left SI joint was locked up while the right SI joint was very loose. After a little manipulation all the pain went out of my right hip. That was on Friday, today I did a 22 mile bike ride with some really good hills and no pain anywhere. Just tiredness because I'm deconditioned at this point.

I'm still in awe that such a simple little thing could cause so much pain even though I experienced no pain in that joint.

Good luck, and congratulations on doing your tour.

[coyote]

Wow, this is exactly what I'm going thru right now. I can't go up stairs or sit for long periods. Biking doesn't really bother it. I'm in my 3rd month of PT and not seeing any real improvement. I go back to the Dr. in a couple of weeks.

I went on vacation a few weeks ago and really tore it up...the friends we stayed with lived up a flight of stairs. Biking is becoming diffucult. I'm getting frustrated, and depressed.

This thread gives me some hope.

Thanks,
Mary

[lattae]

I went out biking today and seems like the ITB inflammation and pain has subsided but now I noticed that I had pain under the knee cap and surrounding it a bit. I'm really getting tired of it. Been to PT, sports dr so don't know what to do next. I've taken my daughter to a chiropractor recently and he is using a light laser on her back so I may discuss my knee problem with him. Has anyone had any success with chiropractors with knee issues?

I've been doing stretches that I've learned from PT on a regular basis too and that seems to loosen up the hips which I know are tight. Don't know if this will be a chronic problem but was hoping that I'd be able to bike without pain. I'm thankful that the ITB pain is eliminated but would like things to get back to normal. I don't know whether to return to my sports MD and discuss it with him or maybe even visit my LBS to check out the fit again (I've had this bike for 5 years and had a pro fit at the time of purchase)

[Kathi]

My advice from my pt is to go back to my bike fitter for a refit. It's been 3 yrs for me, I was recovering from ACL surgery, things have obviously changed. His advice is to go back to the person who did the fit because different fitters will have different ideas. Also he does not believe in shims, etc.

If you can't see the original fitter then my pt's recommendation was to start fresh with a new fit, he suggested 3 dimensional such as a Retul fit.

I'm seeing my fitter on Monday, I hope he doesn't think an entire fit is necessary, I've spent a lot of money on this with little results (except for my new pt).

My ortho was more discouraging than helpful, told me to live with the osteroarthritis in my hip, although he said something was causing it but he didn't know what, wanted to do lateral release surgery and prescribed a brace for my knee. I'd read online that people with piriformis issues (I thought that's what mine was) tried chiropractors and acupuncture but didn't get much of a resolution.

My original Pt told me my right hip was weak and I was "overdoing it" but his exercises made me feel worse. I was to the point of just living with the pain and wasn't going to pursue any more medical attention.

Before you spend any more money buy or borrow Gray Cooks book and also check out Gary Gray (he has some articles online). My new pt follows Grays principles and I knew that before I went to him. You could have an inpingement that you're not feeling. Cook and Gray won't help you diagnose yourself but will help you understand asymmetries and movement patterns. They seem to be on the same page, the hips can be an obnoxious neighbor.