patellofemoral syndrome pain [Archive] - Women's Cycling Discussion Forums

Onix

09-18-2009, 02:19 PM

Hello all,

So, I have been battling feet/knee problems for the past several years. I just went to an ortho and was given the "patellofemoral syndrome" diagnosis. (Commonly called runner's knee). Basically, my knee tracks incorrectly (tendency to roll out), causing irritation, pain upon bending, straightening, stairs, etc. Popping, hyperextension, cracking etc. (Lucky me!)

I have been in physical therapy for 1.5 months. Am will continue with it. I was told I can still ride my bike (hallelujia!), but not as long, and not when it is painful.

In the past, I only had walking pain, not biking pain. But, now I am having some biking pain/swelling/irritation.

I ice, heat, take ibuprofen, take it easy, wear a brace etc.

But, anyone have this experience with patellofemoral pain/cycling? Any cycling specific things you found to be helpful? Any additional cycling stretches I can do to help with cycling pain? Any thoughts at all?

Thanks as always to each of yoU!

Pedal Wench

09-18-2009, 02:34 PM

Same thing here. I'm an ultra-cyclist -- my pain starts after about 150-200 miles... :) It got really bad towards the end of a 400K and I had to quit, but I'm back to back-to-back centuries and I just did a 216-mile ride, with minimal pain - I iced like crazy the day after.

What is your PT doing?

I'm doing IT band stuff with the foam roller, but I think the most important thing was an analysis of my pedal stroke. He discovered that I tended to swing out my knee slightly at the top of my stroke, and probably was really bad as I got further into the long-distance rides. So, I'm working on keeping my knees close to the top tube.

Any tips and exercises that you're doing that seem to help?

OakLeaf

09-18-2009, 03:08 PM

Make sure your crankarms aren't too long for you and that your cleats are perfectly aligned (even if they have tons of float). Has your PT analyzed your pedal stroke, and/or has your fitter measured your knees' flexion at the top of your stroke? What about your walking/running gait?

Years and years ago when I still had 170 mm cranks, stretching before a ride would normally keep my PFD from flaring up. I'd just kneel barefoot, *ss on my heels, for 2-3 minutes.

If your PT isn't working with your feet, if I were you I'd at least raise the subject - foot strengthening exercises, orthotics, something as simple as a pad under the first metatarsals if you have Morton's foot (which depending on whom you ask might be pretty common)?

Cataboo

09-18-2009, 05:40 PM

I have patellofemoral pain in my right knee... I did physical therapy for it for a couple months in 2001? I haven't kept up my exercises like I should, so certain things do flare my knee up.... skiing, going down hill hiking, etc.

For the most part cycling doesn't flare up my patellofemoral knee, provided that I have my seat at the right height, I use 165mm cranks, and I use speedplay frog cleats.

Has your physical therapist taught you how to tape your knee cap in place and counterbalance your improper tracking? That worked really well for me when I was having constant patellofemoral pain.

Becky

09-18-2009, 06:10 PM

I have it in my left knee. It originally started as an overuse injury from cycling. It seems like a tight IT Band goes hand in hand with my PFS. Stretching makes a big difference. The Stretch Book by Jim and Phil Wharton has some great ideas about active isolated stretching and targeted stretches for different conditions and sports. I've recently started using one of those foam rollers and attribute my recent knee pain-free century to regular massage with the roller. Previously, a ride half that length would have had my knee flaring.

I've also had good results with varus wedges in my shoes. They seemed to prevent my knees from rolling inwards towards the top tube when I pedal and, as an added bonus, I clench my toes less.

Of course, ice and Vitamin I help too! ;)

Good luck figuring this out. The scientist in me would try one thing at a time, and see what makes the difference for you.

KnottedYet

09-18-2009, 06:57 PM

I have been battling feet/knee problems for the past several years. I just went to an ortho and was given the "patellofemoral syndrome" diagnosis. (Commonly called runner's knee). Basically, my knee tracks incorrectly (tendency to roll out), causing irritation, pain upon bending, straightening, stairs, etc. Popping, hyperextension, cracking etc. (Lucky me!)

Girl hips. Medial wedging, massive core strengthening, pelvic posture correction, and teaching yourself NOT to lock your knees are big juicy goodies for dealing with this particular problem.

Iliotibial bands get tight for a reason. Often in women they are trying to control rotation of the femur. Eliminate the reason, and you'll help eliminate the imbalance that caused the problem.

I worked with an ATC who called it "Dumb-Butt Syndrome." The external rotators of the hip (under the butt cheeks) go on vacation in a lot of women, allowing all kinds of trouble to occur. Since the knee is just a hinge, it often squeals when forced to deal with the rotation force sent down the femur by a woman's "dumb butt".

Stand in front of a mirror, in your normal posture. Next unlock your knees and squeeze your butt cheeks HARD. If you see your kneecaps roll away from each other and you suddenly look/feel a little bowlegged in comparison, then there is a good chance you need to do some core and hip work. Ask your PT for some guidance on this.

(BTW, knee caps will look like they have a tendency to roll out when actually the tibia and femur are rolling IN underneath them)

Onix

09-18-2009, 08:35 PM

Thank you all for your feedback!

OKay...lets see if I can answer all of the comments questions...

1. Feet: I have seen a podiatrist. They diagnosed me with nerve neuromas in the ball of my feet. And, gave me shots in my feet to try to calm them. This has worked about 80%. (thank goodness!) Feet are largely addressed. Occasionally though, I get numbness/pain in the ball of my feet (like I used to when I was walking) when I am peddling. Despite the fact that I really try to focus on not only the pedal push down, but the stroke up/having heel down---this continues to be a problem sometimes

2. As for perfectly aligned pedals/cleats...do you have any advice on this? I use light action speed plays. (My first, and only cleats/clip pedals). They are free floating. However, sometimes I wish the position could move further back on my foot (they're as far back as they go)...but...I'm not really sure where they are supposed to be. It seems to all be guess work? Any positions you have found particularly helpful for knee pain?

3. Cranks: How do you know what the right length is for you??

4. My PT has never seen me on a bike. How did you guys find PTs that know a lot about cycling? I have been fit on my bike. So, presumably, the seat height is good. The fitter also noticed that I rolled my knee out a bit with my stroke, which I have been trying to correct. He also noticed that I rock my hips a lot when I ride, despite having the right saddle height. Go figure.

5. I do need to learn taping. The J brace I have is good, but it is cumbersome, and makes it difficult to keep my knee bent for any length of time (thus making wearing it anywhere when I won't be constantly walking pretty much impossible).

6. As far as running gait---I don't even have a running gait at this point. I can't run. I can't even walk right. I'm trying to re-learn how to do that. I have done so many adjustments subtly to try to ease pain, that I have majorly screwed myself up.

7. I need to learn to not lock my knees. I am trying. It is hard.

8. Things I'm doing with my PT: muscle strengthening exercises for the muscles above the knee/inside the knee. Apparently, these are not muscles you develop with cycling. (And, since I haven't been able to walk more than about 15 minutes without intense pain, and I definitely can't run anymore---I was way lopsided. So, lots of half-leg lifts, balance exercises, stability exercises, etc. I can be more detailed about these muscle exercises if desired.

Thank you all again, as always for your feedback! (and taking time to read my lengthy, rambly posts!

lo123

09-19-2009, 03:41 PM

2. As for perfectly aligned pedals/cleats...do you have any advice on this? I use light action speed plays. (My first, and only cleats/clip pedals). They are free floating. However, sometimes I wish the position could move further back on my foot (they're as far back as they go)...but...I'm not really sure where they are supposed to be. It seems to all be guess work? Any positions you have found particularly helpful for knee pain?

My LBS does a separate cleat fitting session for $50. It made a HUGE difference in my hip/knee/ITB issues.

He also noticed that I rock my hips a lot when I ride, despite having the right saddle height. Go figure.

Same here--though it's only my bad hip. My fitter suggested getting on the trainer and focusing on a smooth full stroke to counteract my natural tendency to mash. I've tried to think about this on some road rides, but I can't concentrate on smooth strokes and the road at the same time without being a road hazard :p.

Onix

09-19-2009, 03:45 PM

Good to know. I will check into the cleat fitting.

And, I think it is a good idea for me to get on the trainer more at home to monitor my stroke.

Thank you all for the good advice.

Lacy

OakLeaf

09-19-2009, 03:52 PM

Crankarm length for me was just, 22 years ago I read somewhere that I should have 165s, so when I built up my race bike, that's what I put on. The difference from the 170s on my touring bike was obvious right away, and I never had another cycling-related knee flareup.

It has as much to do with your tibia/femur ratio (which can't be measured very accurately without an X-ray) as it does with the length of your whole leg, but a good fitter should check the angle of your knee at the top and the bottom of your pedal stroke. Set the seat height based on the angle at the bottom, then choose cranks short enough that your knees aren't excessively flexed at the top.

An added bonus is that it's much easier to spin smoothly with shorter cranks.

My knees feel it right away when my cleats are off by even a little bit, so that's one thing I don't need a fitter for. I wonder, if you feel your cleats are too far forward though, if the problem isn't actually that your seat is too far forward? Unless you have VERY long toes (and mine are pretty darn long), there should be enough adjustment to let you get the cleat under the ball of your foot. But maybe your knee is actually forward of the pedal spindle (which would also cause excessive flexion), and that's what you're feeling?

Onix

09-19-2009, 04:54 PM

An added bonus is that it's much easier to spin smoothly with shorter cranks.

My knees feel it right away when my cleats are off by even a little bit, so that's one thing I don't need a fitter for. I wonder, if you feel your cleats are too far forward though, if the problem isn't actually that your seat is too far forward? Unless you have VERY long toes (and mine are pretty darn long), there should be enough adjustment to let you get the cleat under the ball of your foot. But maybe your knee is actually forward of the pedal spindle (which would also cause excessive flexion), and that's what you're feeling?

Interesting about the crank length. I am going to have to look into all of this further.
I think that my urge to move my cleats back is that the balls of my feet are very sensitive. I doubt my seat is too far forward. I actually think that I may need it to be more far forward. My seat post is laid back, and I feel like I need a straight one for better fitting (and was told that by fitter). Something isn't quite right though. I think I need to get a new seat post and then get re-fitted!

Thank you for writing back again!

Cataboo

09-19-2009, 06:30 PM

If you have knees issues... shorter cranks will help.

If you want to work on smoothing out your pedal stroke... rollers will also help.

NadiaMac

09-20-2009, 01:07 PM

which brace are you using (brand, model). I'm looking for a brace to help with similar issues. thx for input

Onix

09-21-2009, 01:13 PM

which brace are you using (brand, model). I'm looking for a brace to help with similar issues. thx for input

Good question! I will have to look when I get home! I think it is so work/sweated in that the tag inside has worn off! I will let you know!

It is a "J Brace" patella stabilizer in genre.

Jolt

09-21-2009, 03:14 PM

As far as working on your posture, you might want to check out the book 8 Steps to a Pain-Free Back by Esther Gokhale--it's all about good posture (the author did research in a bunch of different countries where people don't have the back problems etc. that we have here) and can help with more than just back pain. It doesn't address cycling but does address everyday posture when sitting, standing, walking and even sleeping.

OakLeaf

09-21-2009, 04:05 PM

That sounds so similar to Jolie Bookspan (http://www.healthline.com/blogs/exercise_fitness/)!

I haven't read her book, but I really enjoy her blog.

Onix

09-22-2009, 07:02 AM

Good question! I will have to look when I get home! I think it is so work/sweated in that the tag inside has worn off! I will let you know!

It is a "J Brace" patella stabilizer in genre.

Yep. I have sweat off the label. No idea on brand....sorry!

Interesting about the posture book... thanks for the reference.

NadiaMac

09-22-2009, 07:32 AM

no worries!

can you wear this brace while exercising (eg, riding)? Or is it for walking/activities of daily living? Have you tried anything that helps when you are riding? Thx for info

Wahine

09-22-2009, 11:23 AM

There are a ton of issues here. First I have to say +1 to everything in Knottedyet's post.

1. Feet: I have seen a podiatrist. They diagnosed me with nerve neuromas in the ball of my feet. And, gave me shots in my feet to try to calm them. This has worked about 80%. (thank goodness!) Feet are largely addressed. Occasionally though, I get numbness/pain in the ball of my feet (like I used to when I was walking) when I am peddling. Despite the fact that I really try to focus on not only the pedal push down, but the stroke up/having heel down---this continues to be a problem sometimes

Are you using orthotics when you ride? Chances are you need them if you have these types of foot issues. You may not need a custom orthotic but Specialized makes and orthotic with a forefoot wedge and a metatarsal button that might work.

2. As for perfectly aligned pedals/cleats...do you have any advice on this? I use light action speed plays. (My first, and only cleats/clip pedals). They are free floating. However, sometimes I wish the position could move further back on my foot (they're as far back as they go)...but...I'm not really sure where they are supposed to be. It seems to all be guess work? Any positions you have found particularly helpful for knee pain?

I know that a lot of people out there swear by speedplays but I have to say that in your case they are probably contributing to your problem. If not your knee pain then they can make your foot pain worse. I often recommend a Look or Time style pedal to people with forefoot neuroma/pain and yes, you want the cleats positioned farther back on the shoe. Ideally the knuckle that joins your baby toe to your foot should be in line with your pedal axle when you are clipped in.

4. My PT has never seen me on a bike. How did you guys find PTs that know a lot about cycling? I have been fit on my bike. So, presumably, the seat height is good. The fitter also noticed that I rolled my knee out a bit with my stroke, which I have been trying to correct. He also noticed that I rock my hips a lot when I ride, despite having the right saddle height. Go figure.

You may be able to find a PT that does bike fitting. I do and so does Knott. But we're in the PNW... I have no idea where you are. I would ask around at PT clinics for a PT that does fitting, ask at the bike shops and any local teams you might know of.

8. Things I'm doing with my PT: muscle strengthening exercises for the muscles above the knee/inside the knee. Apparently, these are not muscles you develop with cycling. (And, since I haven't been able to walk more than about 15 minutes without intense pain, and I definitely can't run anymore---I was way lopsided. So, lots of half-leg lifts, balance exercises, stability exercises, etc. I can be more detailed about these muscle exercises if desired.

This all sounds pretty good except the bit about not working your muscle on the inside of the knee while riding. If you are riding well (good pedal stroke and painfree) it's actually a very good exercise to develop this muscle. If your pedaling is compromised by form issues, muscle imbalances or pain then it's not so good, but it's not bad either.

I always recommend a lot of hip stretches, foam roller work and stability exercises for the core and hips with these problems. You might want to ask your PT about these things if they are not already being addressed.

Hope that helps.

Onix

09-22-2009, 06:28 PM

no worries!

can you wear this brace while exercising (eg, riding)? Or is it for walking/activities of daily living? Have you tried anything that helps when you are riding? Thx for info

So...I have trouble wearing the particular brace that I have for riding. It is tight fitting, so, whenever I have my knees bent up (like in a peddle stroke, or sitting with them bent in a chair), I start feeling like my blood circulation is being a bit cut off. However, I imagine that there are braces that are designed more for more bending movement while still stabilizing.

I have no problem wearing the brace for walking (or, I'm sure running, if I could do that still), stairs, hiking etc.

Hope that helps!

I am interested in learning how to tape my knee to provide more support to the knee cap. It seems this might make it easier to get support while still giving a bit more knee bending freedom??

Onix

09-22-2009, 07:03 PM

Wahine,
Thank you for all of that feedback!

I didn't even think about asking my LBS for a PT fitter reference. What a dork I am!

Thank you!

Trek420

09-22-2009, 08:01 PM

So...I have trouble wearing the particular brace that I have for riding. It is tight fitting, so, whenever I have my knees bent up (like in a peddle stroke, or sitting with them bent in a chair), I start feeling like my blood circulation is being a bit cut off. However, I imagine that there are braces that are designed more for more bending movement while still stabilizing.

I have no problem wearing the brace for walking (or, I'm sure running, if I could do that still), stairs, hiking etc.

Hope that helps!

I am interested in learning how to tape my knee to provide more support to the knee cap. It seems this might make it easier to get support while still giving a bit more knee bending freedom??

Disclosure: no medical training, don't play a PT on TV but I do have totally non functional joints. I'm a wreck.

Please ask your own Dr & PT but according to mine the brace is a preventative measure. I wear a brace that makes me look like a Borg when training martial arts or anything else that has a lot of lateral movement (and with me that's only MA).

If I rip, tear, shred or otherwise damage anything else ever again it's over.

My understanding is a knee is a hinge. Knees generally do the hinge thing pretty well, they looooooove to do circles. :) And cycling, well cycling's great for knees.

For my knees I've been continually told that ultimately wearing a brace would be worse for me. Muscles supported by a brace can become complacent and even weaker. Since there's nothing that can be done surgically to my legs my option is just sit in front of the computer and sadly read about cycling and miss it and my glory days of being outdoors or on the mat :( or build up allllll the muscles that support my joints from the inside.

I've been ordered in no uncertain terms: stand up straight, line things up, get stronger, get flexible, fix your core or go sit down and go sedentary.

Your mileage may be different. :o

I had a prescription brace that I did not like, when I needed to replace it I got another one 'cause that's what my Dr. prescribed ..... it's worn out, I'll be getting this till I can get a referral for a carbon one http://www.rei.com/product/745518 but I've likely got different boo boo's than you.

Onix

09-23-2009, 06:57 AM

For my knees I've been continually told that ultimately wearing a brace would be worse for me. Muscles supported by a brace can become complacent and even weaker. Since there's nothing that can be done surgically to my legs my option is just sit in front of the computer and sadly read about cycling and miss it and my glory days of being outdoors or on the mat :( or build up allllll the muscles that support my joints from the inside.

I've been ordered in no uncertain terms: stand up straight, line things up, get stronger, get flexible, fix your core or go sit down and go sedentary.

Yhttp://www.rei.com/product/745518 but I've likely got different boo boo's than you.
Interesting. The ortho and PT both told me that I can wear the brace if I find it helpful, because it can't cause harm. Neither of them demanded I wear it. I usually only wear it when I know a considerable amount of walking is going to take place (i.e. not just between classes in the same building), or when my knee is really swollen/full of fluid. Then, it just feels good to have the pressure on my knee. I am in the process of trying to strengthen my muscles to help my joins as well! Good luck to you!! I hope your join problems improve!!

Onix

09-23-2009, 09:27 AM

I know that a lot of people out there swear by speedplays but I have to say that in your case they are probably contributing to your problem. If not your knee pain then they can make your foot pain worse. I often recommend a Look or Time style pedal to people with forefoot neuroma/pain and yes, you want the cleats positioned farther back on the shoe. Ideally the knuckle that joins your baby toe to your foot should be in line with your pedal axle when you are clipped in.

Wahine,
Why do you say that speedplays might be contributing to the foot/knee pain? Because they float??

Wahine

09-23-2009, 09:33 AM

Not because they float but because they might be irritating your metatarsal area. If your foot isn't happy you will change your pedal stroke to compensate and that might put more pressure on your knee. Speedplays seem to irritate the metatarsal area more than other pedals with a larger base to push off of, like Time and Look pedals. Having said that, more float is not always better. Some people actually do better with less float as long as the cleat position is properly aligned.

NadiaMac

09-23-2009, 09:57 AM

My ortho also says to wear a brace as much as I want if it is helping. Bearing in mind that I have hypothesized patellar tracking issue (further to an impact injury) and my current brace is very low profile -- just a little collar/horseshoe thing that rests against the patella and keeps it on track-- so my muscles continue to work even with the brace.

Braces vary a lot depending on your condition and I can totally see that support braces or stability braces would have different roles in the rehab process per the remarks above.

Yes, cycling is a very knee friendly activity, generally, but unfortunately, I can't tolerate more than 20-25 minutes at the moment due to my extreme sensitivity to load. My bad luck to have a knee injury that precludes even knee friendly cycling. Hopefully this is temporary...

On the bracing/taping while cycling topic: I asked my PT about this today and he said that there is nothing that works due to the range of motion in a cycling pedal stroke. none of the braces or taping schemes tolerate that much motion, basically. rats...

NadiaMac

09-23-2009, 10:44 AM

Onix: on your taping question. I've been getting taped at the PT-- the taping is similar to McConnel taping, to keep my patella tracking. It is super tight, and my range of motion is much more restricted than when I wear my tracking brace. So I am not sure that taping will give you more flexibility as compared to your brace (but I suppose this depends on your brace and how it fits). Taping is wayyy more comfortable than the brace from the hot and itchy perspective, and also no-profile so getting your pants over the brace is not an issue. The taping works super well for me, from a pain-relief perspective but your mileage may vary...

Cataboo

09-23-2009, 10:48 AM

ny biker

09-23-2009, 10:53 AM

I don't know - My PT used to tape my knee & then I'd get on the bike at the therapist office without any problem.

The tape they used was really really strong - I had to put down a layer of white tape, and then this strong brown tape over it - and it just went from my knee cap to the inside of my knee. I was told never to put the brown tape on my skin because it would rip it off.

I didn't bike back then, but I never really had problems with doing anything that taping didn't support my knee.

When I was going to an orthopedic surgeon and PT several years ago for a patella tracking issue, the doctor said I could try the taping, and the PT taped my knee several times so I could try it out. I decided I didn't need it, but the plan was that if I wanted to do it regularly the PT would sell me a kit and show me how to do it myself. And the clear purpose of the taping was to support my knee during long bike rides.

Trek420

09-23-2009, 11:15 AM

I usually only wear it when I know a considerable amount of walking is going to take place (i.e. not just between classes in the same building), or when my knee is really swollen/full of fluid. Then, it just feels good to have the pressure on my knee.

Just speaking for my knee ;) since I have arth as well as structural issues warmth feels good. :rolleyes: I've learned to tell what it is by the kind of pain I have; is it the arth, the structural issues or both. :cool: if it's the arth the knee aches, the sharp stabbing "I should not have done that move" is the ACL, tendons etc.

If it's the arth keeping the joint warm feels good however I do that; tights, leg warmers and even the brace. I imagine if I was only structural that would feel good too.

But that's my knee :rolleyes:

Wahine

09-23-2009, 12:42 PM

Patellar taping is very effective for pain relief. It does not retrain the muscles around the knee or hip to support proper patellar tracking BUT it does help in that when there is less pain, muscle action/recruitment patterns can be improved. So, it's good to use the taping before exercises that are meant to strengthen these muscles. Eventually the goal is that the muscles take over and the tape is no longer needed.

Here (http://www.youtube.com/watch?v=sMJBHBiZjCs) is a link that shows how to do a patellar taping and this second link (http://www.youtube.com/watch?v=IBTNCDZaqm8&feature=related) can show you how to do it to yourself. I don't like either video as a stand alone, but they do work well together.

Do get your PT to show you how to do it. These videos should only act as a reminder on how to do it. They do not replace one on one instruction.

Cataboo

09-23-2009, 12:43 PM

Thanks Wahine.

I caused myself pain last time I tried doing it - it's been a while since I was taught.

Most of the time I have no pain, but for skiing, it'd be nice to tape it again.

Onix

09-24-2009, 09:36 AM

So, forgive me---I don't know how to include text from previous posts in replies when I am replying to more than one person....

Wahine: About the speed play having less of a connected base to push off compared to other pedals.... I was under the impression that the bases of cycling shoes were made of hard plastic/carbon to counteract that sort of effect. I was thinking that once shoes were connected to the pedal, they almost became one piece together. If the base of the shoe collapsed around the pedal, then yes, extra pressure would come onto wherever the shoe was connected to the pedal. But, with hard based shoes, shouldn't there not be extra pressure where the speed play pedal connects with the shoe? Since the shoe base is hard? Shouldn't pressure be distributed all the way around??? Does that make sense? Or, are you saying that speedplays create a propensity to distribute your pressure in your foot in strange ways---not that the connection itself is not the best? Sorry if that is confusing!

NadiaMac: Bummer you can only ride 20-25 mins at a time :(

NadiaMac, Catriana, Ny Biker: Thank you for your personal stories/experiences with taping. That is helpful.

Wahine: Thank you for the taping links. That is helpful. I haven't been taught by my PT yet, but I imagine I will need a refresher once I am.

Trek 420: I agree. Warmth does feel good on my knee too. I hope it isn't arthritis for me, but the warmth feels good nonetheless!

Wahine

09-24-2009, 09:53 AM

Wahine: About the speed play having less of a connected base to push off compared to other pedals.... I was under the impression that the bases of cycling shoes were made of hard plastic/carbon to counteract that sort of effect. I was thinking that once shoes were connected to the pedal, they almost became one piece together. If the base of the shoe collapsed around the pedal, then yes, extra pressure would come onto wherever the shoe was connected to the pedal. But, with hard based shoes, shouldn't there not be extra pressure where the speed play pedal connects with the shoe? Since the shoe base is hard? Shouldn't pressure be distributed all the way around???

That's what the manufacturers would say and in theory I wouldn't disagree with that if the interface (transition points between parts of the shoe and pedal) was perfect. But it's not. At every interface you introduce a certain amount of play. It might be very small but it's there. The more play, the more the forces at the interface can affect contact surface etc. So speedplays have a double whammy here. The have more play at the cleat/pedal interface and they have more interfaces between the pedal and the shoe - pedal to cleat, engaging part of cleat to stabilizing part of cleat, stabilized part of cleat to triangular cleat base, triangular cleat base to shoe. My Looks go pedal to cleat (which is all one piece and has less play) cleat to cleat base in shoe. I'm sure that this is a great explanation but it is the best theory I have.

So really, I'm not positive what's going on here, I've noted the difference clinically and through my coaching experience and that's the best explanation I can come up with. All I can say for sure is that my clients with forefoot issues almost always do better with a larger cleat base/pedal, especially the ultra riders I work with.

Hope that helps.

Onix

09-26-2009, 05:30 PM

That's what the manufacturers would say and in theory I wouldn't disagree with that if the interface (transition points between parts of the shoe and pedal) was perfect. But it's not. At every interface you introduce a certain amount of play. It might be very small but it's there. The more play, the more the forces at the interface can affect contact surface etc. So speedplays have a double whammy here. The have more play at the cleat/pedal interface and they have more interfaces between the pedal and the shoe - pedal to cleat, engaging part of cleat to stabilizing part of cleat, stabilized part of cleat to triangular cleat base, triangular cleat base to shoe. My Looks go pedal to cleat (which is all one piece and has less play) cleat to cleat base in shoe. I'm sure that this is a great explanation but it is the best theory I have.

So really, I'm not positive what's going on here, I've noted the difference clinically and through my coaching experience and that's the best explanation I can come up with. All I can say for sure is that my clients with forefoot issues almost always do better with a larger cleat base/pedal, especially the ultra riders I work with.

Hope that helps.

Gotcha. That does help. I can definitely feel more pressure in the ball of my foot...but couldn't make sense of it all :) Thank you for all of your help with this issue.

Kathi

09-26-2009, 07:18 PM

I was diagnosed with patellofemoral pain many years ago. Cycling really helped and for many years I had no pain even though I used Speedplay pedals. I even used them on my trainer when I tore my ACL. Then I started having foot pain and progressed to knee pain which progressed to hip and back pain. My old knee exercises, leg lifts, etc did nothing to alleviate the pain. Because of the negative things I had been reading about Speedplays I really started to believe the they were causing the problem. After 4 months of PT I changed therapists and he looked beyond the site of pain and found my left SI joint was locked, whereas the 1st PT had been treating the site of the pain, my right side.

2,000 miles of riding this summer with Speedplays, X1's and Frogs and no pain with knee or foot.

BTW, the podiatrist said I had 2 neuromas in my foot. I now can walk barefoot with no issues, no burning in the morning, no pain while riding. I'm using my orthotics less and less.

For some reason this time I rejected the ortho's suggestion of surgery and braces, the podiatrist injections and decided to let things run its course. And for me, I can confidently say the Speedplays were not the issue.

Onix

09-27-2009, 12:54 PM

Wahine

09-27-2009, 10:01 PM

The SI joint is the joint between your sacrum and your ilium, parts of your pelvis. It's there to allow a little motion, (only about 12 deg each way at each joint if they are healthy), so that torsional forces during leg movements can be dissipated, especially when walking or running. Without them in combination with the pubic symphasis, our pelvis would be one solid bone constantly under torsional stress and getting microfractures. Not to mention the important role of the SI joints in childbirth.

Sometimes this joint can become dysfunctional by moving too much or too little. This can lead to all kinds of compensation during movement and will result in pain locally and/or elsewhere... knee included. So yes, if your PT hasn't looked at your low back-pelvis-hip mechanics. It's worth having them check it out. A messed up SI often goes right along with the "dumb butt" syndrome Knott mentioned earlier.

Onix

09-28-2009, 11:24 AM

Kathi

09-28-2009, 12:29 PM

Onix, yes working on the joint definitely helped. The 1st time my PT worked on it I immediately felt the tension go out of my right hip. He told me to go ride my bike no limitations. I rode a 20 mile ride with a few good long hills and no pain.

In my case my lower back started locking up when I'd bend over. At first I thought this was unrelated to the knee/foot pain. By the time I sought medical care my entire right side hurt down into my right leg. And yes, walking seemed to make me more uncomfortable.

An MRI didn't show anything except for osteoarthritis in my right SI joint and right hip. Ortho said something was causing the arthritis but didn't know what.

1st PT focused on painful side and did some things to loosen the right SI but I ended up feeling worse. He also said my right glute was weaker than left but his prescribed exercises made me feel worse.

2nd Pt, with information in hand, examined my left SI. One thing to note is 1st PT did lower back exam but had me laying on my stomach. 2nd PT did it with me on my back. I could tell the difference between right and left SI when he moved them, left had no movement and was hard as a board, right had lots of movement.

Before discovering the SI issue I used to sit on my left glute no matter how hard I tried to sit balanced and when sitting for long periods, like traveling in car, I'd feel very stiff and have a hard time straightening up. After walking around for a few minutes I would loosen up. Often the left glute would be very sore from the pressure on the car seat.

Finally, I tore my ACL in 06 and had surgery. In spite of faithfully doing the exercises my right leg never regained the muscle that it had pre surgery. My ortho was concerned but didn't pursue this. This summer, in spite of doing no quad exercises my muscles have returned to pre surgery size and are pretty symmetrical with the left side.

Also, be sure your cleats are clean and lubed and placed properly on your shoe.

Hope this helps you find the solution to your problem.

Onix

09-28-2009, 06:24 PM

Kathi,
That is all great information!

Thank you so much for that!

OakLeaf

09-28-2009, 08:18 PM

Also, be sure your cleats are clean and lubed and placed properly on your shoe.

Did you mean lube the pedals... or are cleats supposed to be lubed? If so, with what... surfboard wax or something? :confused: I'd never heard that before.

Kathi

09-28-2009, 09:38 PM

Did you mean lube the pedals... or are cleats supposed to be lubed? If so, with what... surfboard wax or something? :confused: I'd never heard that before.

From the Speedplay website:

Where should the X cleats and pedal surface be lubricated?

"Apply a dry-type(PFTE) lubricant such as Super Lube Dry Film, RZ-50, DuPont Performance Dry, Liquid Wrench Dry-Lube, Pro Gold, or Blaster Dry Lube to the cleat springs and the center area of the cleat where the pedal nests. Be sure to keep the cleat cavity free from dirt and debris. Additionally, be careful not to apply lubricant to the outer plate of the cleats as it may cause the cleats to become slippery on some floor surfaces."

Occasionally I run a very thin screw driver between the springs and the metal bottom plate to clean debris or grit out of springs. If they get really dirty I take them apart and clean them. Also, I replace cleats when the springs start to look flat and the metal piece is wearing thin at toe.

I also lubricate my Frogs.