new season - new pain: knees

[s_curran]

Hi all, so I have been researching this for a while and thought it couldn't hurt to ask here. This season I had some new pain show up in my first couple of rides. I have never really spent too much time on road bikes, but this year I decided I wanted to really give it a go. I started the season with an 100 mile weekend, which seemed excessive, but I felt great, I commute by bike all through the winter (only 5 miles or so), so it kept me in slightly in shape, and I had recently been climbing stairs and lost about 25 lbs doing so. After the second ride of the weekend I noticed a very sharp pain on the tops of my knees, just under the knee cap, especially after sitting for a few minutes. Since then, I have not been able to kick it, I started with one week off, and rode another 70 or so the next weekend and really regretted it for the entire week, that was the worst it had been. I then took 2 weeks off and eased in with some 20 mile rides and well as doing some Lower Iliotibial band stretch's and recently using a roller, which seems to help. I have got it to the point were it is manageable, and I can ride every other day or so, but it is really the only thing holding me back when I ride, I dont feel like I can push my strength and endurance as I would like too.

My question is whether anyone here has experienced this, and what there solution was. Will building up the surrounding muscles help (meaning, keep riding)? Should I be doing more streches? I am pretty sure it is not the bike fit. I have always pushed too big of gears, and Ive tried to pick up my cadence, which could be helping, but I dont really feel as good on the bike doing it.

Like I said, Ive been riding bikes my entire life, while mostly shorter, "explosive" MTB rides I have always thrown in long endurance type rides without proper training without issues before.

[dhoff]

My knee pain has completely gone away as a result of two things, first build up slowly doing no long rides until a few shorter ones have been completed and second and infinitely more important, FIT. I find that a difference of 1mm can be enough to bring pain into my knees that was not there, or make it go away forever. Tom Kellogg and Signature have each in their way made a huge contribution to my knees.

[s_curran]

My knee pain has completely gone away as a result of two things, first build up slowly doing no long rides until a few shorter ones have been completed and second and infinitely more important, FIT. I find that a difference of 1mm can be enough to bring pain into my knees that was not there, or make it go away forever. Tom Kellogg and Signature have each in their way made a huge contribution to my knees.

thanks, maybe I'll go to the fitter before the docs. Do you find it has most to do with height? or seat forward and back? I have messed with my cleats a bit to try and get my as much side to side motion out of my knees as possible, but its kinda scary stuff for me, trying to do small increments.

[dhoff]

it is such small increments that make a huge difference for me. TK had me move my saddle on an already great fitting bike, down one mm and back one and all pain went away.

see someone great and I hope it settles this for you once and for all.

[ned]

You have a biomechanical fault somewhere between your head and your big toe. Don't mean to be flippant but the orgin of your Patellofemoral pain is not necessarily a straight forward answer. A good PT should be able to pick up on the problem area(s). Bike fit is also a huge pice of the puzzle. Gotta make the bike fit the rider and the rider fit the bike.

My Internet diagnosis: your quads are too tight (places increased pressure on the patella), your knee is too far forward (not enough set back), and your pedal stroke is not smooth (think EKG reading vs straight line). The first two are pretty easy fixes. The last is where the skilled intervention is a must.

Whatever is going on, get it taken care of. The pain is not going to go away on its own--it's likely to only get worse.

[s_curran]

You have a biomechanical fault somewhere between your head and your big toe. Don't mean to be flippant but the orgin of your Patellofemoral pain is not necessarily a straight forward answer. A good PT should be able to pick up on the problem area(s). Bike fit is also a huge pice of the puzzle. Gotta make the bike fit the rider and the rider fit the bike.

My Internet diagnosis: your quads are too tight (places increased pressure on the patella), your knee is too far forward (not enough set back), and your pedal stroke is not smooth (think EKG reading vs straight line). The first two are pretty easy fixes. The last is where the skilled intervention is a must.

Whatever is going on, get it taken care of. The pain is not going to go away on its own--it's likely to only get worse.

Thanks, could you recommend some good reading on improving pedal stroke? I'm sure it isnt smooth (Its straight, but not smooth transitions from muscles). I have always rode flat pedal mountain bikes, coming from the downhill/jumping side of things, and am sure I dont have a great pull side of the stroke.

I think you are right about my quads, since stretching them things have started working better, I use the roller on them every morning. I'll push the seat back a bit, maybe go with a shorter stem because I like the reach, I had pushed it a bit forward from what I normally would because the bike seemed long at first and the post I have doesnt seem to want to hold my weight without slipping (I'm 6'4" 225lbs), I dont think it is though.

Thanks again, I will try a PT soon, but it will be good to try this out at the same time.

[kurto]

I'll echo what ned said as well as copy over what I wrote in the knee stability thread, since I think my pain is similar to what you're experiencing.
I have been able fix some knee pain (due to patalla tendon inflammation) by using compression bands above and below the knee for a couple minutes at a time and doing air squats. I use the Rogue Fitness MobilityWod voodoo floss bands (roguefitness.com), but many people use split open tubes for this. Google diy voodoo floss for instructions and whatnot.

[pdxharth]

I've been experiencing a similar, severe pain that has cut my my riding tremendously. My buddy described a very similar thing - a pain like a small stone underneath the kneecap - and advised a visit to a physical therapist. She diagnosed patellofemoral pain syndrome: Patellofemoral pain syndrome - Wikipedia, the free encyclopedia

It has to do with repetitive motion and alignment issues (as was mentioned). I'm back to stronger efforts but keeping the rides short. I miss long rides!

I have not kept up with my exercises and stretching so I cannot report a positive outcome yet, but I am hopeful this will go away over time and proper PT work.

Good luck,
Harth

[s_curran]

Thanks for the help kurto and harth. I really wanted to be through my first century by now, but it looks like I'll have to wait a bit longer to give it a go. I really wish I didnt need a referral for the PT, this will probably be a three step process to go through my doctor.

Kurto, what does the compression bad do to help? is it stretching the tight muscles?

[kurto]

The compression bands are said to tack down the tissue while you move it through a range of motion (kind of like ART), so they help get out the really tight spots that hold back normal range of motion; also, compressing for a few minutes leads to a big rush of fresh blood after removing the bands that is said to help healing. I can't really say how they work, but they totally do for me, and anecdotal evidence is very supportive of this technique.
Check this out - it explains a little bit: