Knee Pain

[Noah Swartz]

I'm sure this has been discussed before, but since I couldn't find anything in the last 5 years in the list archives and I want to get this dealt with asap I figured I'd ask.

I'm having some knee pain on the bike - after a tough old caz where my inner thighs cramped for a large part of the ride.

I don't think it's currently being caused by improper bike fit or seat height or 'cleat position' - as it is recurring on a bike that I got a professional fit on.

I've done some general strength exercises for hips and legs, and plan to stretch my inner thigh - but I would love to hear if other people have dealt with recurring knee pain from overuse, and what they've done to deal with it.

Also if people have recommendations for PTs I would love to hear them.

I'm currently planning to ride EP1K this weekend with the hope that the pain won't recur and because I've heard that I won't do permanent damage by riding through it - but I'm happy to be dissuaded of this notion.

Looking forward to all of your 2¢

Noah

[Eric Walstad]

Hey Noah,

I've found that over time our bodies change, especially when riding
more and greater distances. The professional fit you had before might
not be right for the current you. What worked for me, after recovering
from a torn meniscus on the Hopland 400k, was to switch to flat pedals
(which I don't recommend before your upcoming long rides but
definitely worth a try afterwards) and trust my own ability to make
small adjustments mid-ride to alleviate pain. Small saddle and
handlebar adjustments of a centimeter or less at a time, riding for a
while and reevaluating/readjusting as needed, has worked well for me.
Mark your current positions if you are concerned about losing the
settings from your professional fit. Eventually you will arrive at a
fit that works for the current you. Also, you probably have enough
time in the bank to slow down and or get off the bike and walk a bit,
which helps ease the pain, too.

Good luck,

Eric

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[JinUk Shin]

Few questions I'd have:

1. When's the last time you took some extended rest (at least a week?) iirc you actually did take some time off but I was curious whether that was before or after the knee pain started.

2. Have you had a follow up session for your bike fit?  May be an avenue worth exploring.

Just for personal story time - when I last had knee pain, the thing that solved it for me was getting more stable on the saddle - the fitter and I made adjustments that ensured I would remain stable on the bike and reduced the overall excessive movement for my right knee, which was the problem.  He also recommended I foam roll to ensure I was continuing to heal and stretching it out.

On Wed, Jul 19, 2023 at 1:35 PM Noah Swartz <swar...@gmail.com> wrote:

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[Noah Swartz]

Thanks for the advice so far!
Some additional info:
I believe I hurt my knee on a bike that was not fit for me - due to a broken crank I wasn't riding the bike that was fit for me. Riding it feels a lot better! I think the fit is good, and mostly feel like it's not exacerbating the  knee pain, unfortunately the pain hasn't totally dissipated.

I took 2 weeks off between Marin Mountains and Old Caz, and have taken the time since Old Caz off - going from 200+ miles a week to about 20 miles a week - so I my hope is that this has been a nice break.

[JinUk Shin]

Yeah - what type of stretching/strengthening are you doing?  Do you have access to a foam roller?

JinUk

[Sourav Das]

Do the symptoms resemble IT Band Syndrome? It is quite common among runners but cyclists are also prone. I am not sure if this will help, but won't hurt -- try icing the knee and surrounding areas a few times a day.

My IT band got inflamed on a big trail run in Dec and then I messed it up with climbs on the bike the day after, ignoring what was then a mild pain. I would warn you to be extra careful, even while walking. A day or two after that while walking back home, I felt a sudden sharp, piercing pain in the knee, debilitating to the point where I couldn't stand. I believe the inflammation causes the tissue to contact a nerve and certain movements can trigger that. Icing helps to reduce the inflammation. I took a tablet or two of Ibuprofen (NSAIDs like Advil, not Tylenol) for the next couple of days to reduce the inflammation and used a hiking pole as support while walking.

Goes without saying -- I am not a doctor, but I would advise against foam rollers. Don't do anything to cause further inflammation. This is generic advice that may help and shouldn't do any harm. Runners may offer more useful advice.

Sourav

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[Megan Arnold]

other food for thought - sometimes where we are feeling pain is not where the source of the problem is

more personal story time - at one point I had some nagging knee pain, it turned out it was from my hip being jammed up

PT recommendation: Dara Richman - she's also a cyclist, although not rando she knows what it is. She's super knowledgeable, and very keen on getting you dialed in so you can ride (or whatever your sport is) pain and injury free, and set up so you can help yourself - if you see her you'll get homework!!!

take care

- Megan

(and if you REALLY don't want to ride 1000k, don't do it. that's a big boulder to push uphill if you're not feeling it)

-  Team DNC

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From: sfra...@googlegroups.com <sfra...@googlegroups.com> on behalf of Noah Swartz <swar...@gmail.com>
Sent: Wednesday, July 19, 2023 2:03 PM
To: JinUk Shin <jinu...@gmail.com>
Cc: SF Randonneurs <sfra...@googlegroups.com>
Subject: Re: [SFRandon] Knee Pain

 

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[Shriram V]

Agree with Megan. I have been dealing with patellar bursitis in my left knee for the last 12 weeks or so. Turns out it’s due to weak hamstrings and glutes and being quad dominant. A fit change (I did have a professional fit done earlier too that worked for 3.5 years), PT, leg work at gym and naproxen are slowly helping to address the problem

-Shriram

On Jul 19, 2023, at 2:27 PM, Megan Arnold <em...@hotmail.com> wrote:



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[richar...@gmail.com]

There is another aspect of bike fit -  if pedaling cycle not even – when doing a 200km brevet in January 2022 lady behind me commented that my pedaling seemed uneven. I was getting pain in my right knee. I went to bike shop where I had previously had bike fitting. Owner installed a couple of Bikefit cleat wedges under my tight cleat. I had less knee pain after the cleat wedges were installed

 

Cleat Wedges – BikeFit

 

 

Richard McCaw

408-838-9863

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[Sourav Das]

It seems the injury was specifically caused by riding a different, ill-fitting bike over a long distance and substantial elevation gain, and did not occur over time. If you’ve been riding daily/consistently, as opposed to just isolated brevets, the fit on the existing bike is unlikely to be an issue. A bike fit or major cleat readjustment so close to PBP is not a good idea. 

Sourav

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[Vijayshree Sundaram]

Hi Noah,

Knee pain can be due to overuse, poor bike fit, tight muscles around knee, inflamed soft tissues etc.

I can share my story……during SCR 400k in March , I developed bad knee pain, was able to finish the ride but it worsened later.  Went to PT. was diagnosed with ITBS, she said she had never seen such badly inflammed IT band. I had started riding brevets and doing trainer rides after 3 months break and that lead to the injury for me.  After few PT sessions, I did couple trainer rides and pain moved to anterior knee, now the quads tendon was inflamed too.

What helped me was regular PT sessions, icing once every day for 15 mins, stretching and body weight strengthening exercises. The exercises PT recommended used to take an hour every day but had no choice.   During the sessions, PT used to use different tools to release the muscle tension.  

Within 8 weeks, I was able to ride 600k. 

Hope this helps, take care !!

Vijayshree 

Sent from my iPhone

On Jul 19, 2023, at 1:35 PM, Noah Swartz <swar...@gmail.com> wrote:



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[Todd Teachout]

I dealt with some overuse knee pain in the 2003/2004 time frame when I was 45yo.   Saw a Orthopedic Dr. who "prescribed" speedplay pedals.   The X/2 model was available at the time.   This pedal accommodates a lot of horizontal rotation of your foot and ankle while the foot rotates vertically around the crank circle. This system worked well for me.  I've happily enjoyed tens of thousands of knee, ankle, and hip injury free cycling miles as a result.    Alas Speedplay sold themselves to Wahoo.  Wahoo has discontinued the X/2 line.  The downsilde of the X/2 pedal was that it only releases one way, a slight rotation of the cleat, something that may or may not happen if you have lost control and crash (I had this happen once and tore a hip flexor trying to uncleat as I was going down).   The X/2 also offers little support for out of saddle efforts.  You must adapt by strengthening and using the core muscles more than many cyclists use when riding out of the saddle.   The Wahoo pedals made now, allow for multiple release geometries and provides more support for out of saddle efforts than the discontinue X/2 line.

Others have made the point that your body continues to change from year to year as we age.   I agree.  I did experience a small IT band tear about a year and a half ago, for no particular reason other than likely just getting old.   A lot of rest ( 3 weeks for me) and then using KT tape over the injury for about two months as I got back on the bike.

Doing complete rest for more than a week, for me, results in some de-conditioning.   So beyond a week I would suggest light duty rides.  Also, I found that walking on pavement in my cleated cycling shoes add stresses to the ankle, knee and hip that could lead to injury.  Especially on rides, like PBP where you may have to walk a long way between where you park your bike and where you sign in and where you get food, rest, or supplies.  So I suggest taking your cycling shoes off and walking around barefoot or maybe pack some sandals if you cleat extends below your shoe sole.

Nowadays I'm riding around 100-125 miles week.   

Todd Teachout

RUSA 227, 5 time PBP ancien