Popliteus Pain

[bluebug32]

I hurt my left calf muscle early in the season, but after that healed, I was riding fast on a group ride and felt a sharp pain in the back of my left knee. I've had recurring pain on and off in the back of my knee since and I can feel the popliteus is sore and swollen (a PT friend confirmed this). I rode a century last weekend and it started to hurt after the first hour. I've been icing it and wearing my calf compression sleeves ever since. It hurts less than it did, but it still aches even to walk for more than 10 minutes. Any idea what's causing the pain or tips for recovery?

[bellissima]

If is in fact the Popliteus the issue, it will take sometime to heal. In this case resting is essential and most likely you'll have to stop ridding for awhile. Using a foam roll on your legs and stretching calf and hamstring muscles is very important.

[Abarnes]

Did you injure this while running? this is usually found in runners but not unheard of in cyclists/triathletes.

if you've not had a bike fit, check seat height - posterior knee pain is a result of saddle too high. If your seat height is not out of range, for recovery and rehab you can drop the saddle height 2-3mm. Be sure to adjust saddle fore/aft to accomodate (as you lower, you bring saddle nose to bar; when you raise the saddle, it moves away from the bar on the seattube angle plane)

also, excessive float in the cleat can exacerbate injury. have a fitter check your cleat alignment, and try moving the cleats further back.

check with your PT about rehab, but here is a video link of popliteus muscle rehab exercise: http://www.youtube.com/watch?v=ViFXQra8GZw

[Abarnes]

Are you also a runner? This is more common in runners but not unheard of in cyclists/triathletes. The popliteus is part of the knee flexion muscle group and in my experience the 'last' muscle to be injured due to over extension of the joint. However, some of its function is to stabilise the knee in lateral movement. In this case for a cyclist some of the therapy starts in the shoe and pedal interface. Moving the cleats back can be a first step, but having a fitter check varus/valgus and cleat 'toe in/out' is important too.

For now, try lowering your saddle 2-3mm (and adjust saddle back 2mm to compensate). Try a short ride in small chainring first.

Curious to know how you injured your calf and which muscle of the calf it was?
Also is the popliteus pain is higher up towards the center of the knee joint or further down towards the side of the tibia? Does it hurt more when pulling up on the cycling stroke?

Your PT can suggest some strengthening exercises with leg bands too.
Anne

[bluebug32]

Thanks, Anne. No, I'm not a runner, just a cyclist and I do yoga too. I injured my calf (same leg) back in May. That injury was caused by doing calf raises, which made the muscle pretty sore. Then, instead of taking an additional rest day, I did a ride that ended up being hard and fast. My calf ached. It was basically in the middle of the big calf muscle and then extended up the outer leg to just below the knee (sorry, that's the best way I know to describe it).

I eased off riding and was feeling better. Then I ended up on another fast group ride and came home with the calf and the popliteus pain. The calf now feels much better and just kind of tight during long rides.

The popliteus hurts the most from the 5-7'o clock postion on the pedal stroke. It hurts less with a high cadence and when I climb (as I tend to shift back in the saddle). The pain is more toward the outside of my leg, just offcenter of the back of the knee.

Hope this helps and thank you for your input! I'll start with the saddle and also take a look at my cleats.

[Abarnes]

I thought I'd posted but when it didn't show up I re-wrote it, apologies for that.

Can't quit see that the calf strain is directly related to the popliteal issue, but the area behind the knee is a complex area. Not only do the soleus, plantaris and popliteus cross there, but its the end point for biceps femoris. Keep working with your PT and/or massage person.

When you say "pain at 5 and 7c'clock" are you speaking as if I am standing on your driveside? That would mean pain most intense on the downstroke. just making sure I understand.

not having seen your fit it's hard to say, but in conjunction with the seat height check, ask your fitter about reducing the amount of flexion or "ankling" during your pedal stroke. This will keep the gastroc/soleus from activating as much.

just to make sure that the swelling you describe is moderate, and not possibly a Bakers' cyst?

[bluebug32]

I thought I'd posted but when it didn't show up I re-wrote it, apologies for that.

Can't quit see that the calf strain is directly related to the popliteal issue, but the area behind the knee is a complex area. Not only do the soleus, plantaris and popliteus cross there, but its the end point for biceps femoris. Keep working with your PT and/or massage person.

When you say "pain at 5 and 7c'clock" are you speaking as if I am standing on your driveside? That would mean pain most intense on the downstroke. just making sure I understand.

not having seen your fit it's hard to say, but in conjunction with the seat height check, ask your fitter about reducing the amount of flexion or "ankling" during your pedal stroke. This will keep the gastroc/soleus from activating as much.

just to make sure that the swelling you describe is moderate, and not possibly a Bakers' cyst?

In terms of Bakers' cyst, it really just feels like a sore muscle. My husband is a chiro and my friend is a PT. Both have palpated it, and said the popliteus felt a little inflamed. Unfortunately my PT friend was just visiting, so I won't be able to work with her on this. Any recommended exercises/treatments?

Yes, the downstroke hurts the most, especially the brief pulling up motion at the end of the pedal stroke.

In terms of cleat position, I plan to move them back today before I try to ride, but I do have float in my Look cleats. Could this have something to do with possible ankling? I've had my bike fit checked several times and he set up my cleats then.

Thank you, Anne

[Abarnes]

I strained my gastroc awhile back and it took a really REALLY long time to heal, but it didn't affect my cycling. My thinking about the cleat is that the popliteus muscle is also related to lateral stability of the knee - too much float may be allowing for aggravation of the muscle/ligment.

My assertion is that 90% of riders need no float whatsoever, IF the feet and shoes have been properly assessed, on TOP of a regular fitting. Varus/valgus measurement, arch supports and a RAD adjustment or laser level assessment of the leg tracking are components of 'foot' fitting. I would not say that the foot/leg is ever totally "locked" into position with a no-float cleat (black color, in the case of Look) but it's in the correct position for your natural range of motion, per accurate measurement of the feet and observation of the leg movement. Toe 'in' and 'out' most directly relates to knee rotation in the pedal stroke and is addressed in the RAD. Fore and aft alignment is primarily for best support of the foot as a lever inside a rigid cycling shoe. Normally this alignment alleviates toe numbness etc but can also be use to alleviate knee issues.

When we speak of ankling, it's the amount of 'toe up' and 'toe down' in the pedal stroke - some of which is natural. Obviously your foot needs to rotate in the pedal stroke, but if we move the fulcrum point (pedal spindle) further back towards the heel, we lessen the plantar/dorsi flexion of the foot - which in turn lessens the activation of muscles of the lower leg that effect this flexion. Theses muscles are - you guessed it - gastroc, soleus, plantaris, etc. All of which cross in the area of the popliteus.
Hope this makes sense?

In terms of Bakers' cyst, it really just feels like a sore muscle. My husband is a chiro and my friend is a PT. Both have palpated it, and said the popliteus felt a little inflamed. Unfortunately my PT friend was just visiting, so I won't be able to work with her on this. Any recommended exercises/treatments?

Yes, the downstroke hurts the most, especially the brief pulling up motion at the end of the pedal stroke.

In terms of cleat position, I plan to move them back today before I try to ride, but I do have float in my Look cleats. Could this have something to do with possible ankling? I've had my bike fit checked several times and he set up my cleats then.

Thank you, Anne

[bellissima]

bluebug32, before you start moving things around on you bike, try to let the injury heal. That type of injury can happen when you do a hard upward pull with your leg and may have nothing to do with your position on the bike. I've had that issue before and it happened in a race while pulling upwards. I had to take sometime off the bike and do quite a bit of stretching as well as the foam roll, but never was my fit changed as I've being riding and racing with the same position for at least a year at the time with no issues. Cheers

[bluebug32]

Thank you, both. As of now, I'm resting it and was icing and just started heating it too. It's just frustrating because it's been a week and I still feel the pain even while just walking slowly. I feel like I have excess energy to burn and hate sitting around. But not sure what other exercise I can do in the meantime. Tomorrow I'm going to put my saddle down 2mm and check my cleat position (may move them back a touch) and do a very short, easy ride.