LCL Pain

[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.

[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%20...ETRY_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.

[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.