Knee Pain

I mentioned in my last post that I’ve come down with knee pain. It seemed to start on my last training ride in January, when I noticed an ache/burning under my right kneecap.  I specifically recall feeling it while climbing on my first ride with significant hills this season.  For the past month I have only been noticing the pain while riding, and usually towards the end of a ride or when my training volume was highest.  I’ve tentatively diagnosed myself with .

Last week I had to stop a workout because of the pain.  It still wasn’t excruciating, but I could feel it on every pedal stroke and it was obvious something was wrong.  Since I also came down with a mild case of the flu, I took the week completely off.  On Sunday I was feeling better and going stir crazy from not riding.  I foolishly decided to join a local group and ‘ride how I felt’.  My legs felt great and I was raring to go, but my knee slowly made itself known.  I finished the ride without thinking I had done anything too extreme, but Monday was the first day I had pain while not riding so I ‘officially’ announced my trouble on the blog.

History:

I haven’t had any major knee problems, injuries, or surgeries.  However, I have had various aches and pain in the past.  During my first winter after getting a road bike (Age 18) I had on-and-off pain from my right knee, which in hindsight seems similar to my current issue.  I kept paper training logs, and I’m sure I would find them useful (and probably hilarious) if I had kept them around, but I threw them away years ago.  I remember spending about a month repeatedly taking a few days off and finding myself with pain until it finally went away.  I also recall having “movie goer’s sign” (a burning ache that gradually builds while sitting) in my knee during college, and specifically on the flight to Collegiate Nationals in 2001.

More recently, after a big gear hill workout in 2010, I had pain and tenderness just above my right kneecap.  This was likely a brush with , although it healed after a few weeks of relative rest.  In spring 2011 I had pain in my right hip, a burning sensation just behind the greater trochanter.  I had increased my mileage and lowered my stem, and a tight IT band was causing me enough hip pain that I had to stop a workout.  I went to the and got a card, but never made an appointment.  The pain was bad enough I was concerned it would impact my performance at the Tour of the Gila, but after some rest following the race, it went away.

Imbalance?

The first thing that I noticed is that I seem to have recurrent problems in my right leg.  It is said that many people have muscular or structural imbalance that can cause an effective difference in leg length.  One bit of history I left out earlier is a femur fracture from when I was very young, on my right side.  I took a look at my equipment and found some additional evidence of imbalance:

Uneven wear

First, my shorts.  Sorry for the oversharing, but I noticed a while back that my shorts wear unevenly.  The fabric on the right, inner side of my leg wears and pills up over time.  In fact, I’ll take the TMI to the next level and mention that the only (minor) saddle sore problems I’ve encountered are in this area.  I took a look at my saddle and didn’t notice anything obvious there.

Next, I’ll mention that I’m naturally duck-footed.  I stand with my toes pointed outward enough that my wife often trips over them.  When I ride, I tend to scuff chainstays with my .  On the road I use Time pedals that have what I would consider ‘soft float’, meaning they have float, but the tension slowly increases as your foot deviates from the center until it releases.  So yes, there is 5 degrees of float, but also a centerpoint you can feel.  I took a look at my cleats and noticed additional uneven wear.

Cleat Wear (Right image reversed for symmetry)

You can see the groove worn by the retention spring is much deeper on the outside of my right cleat.  This is likely from ‘pulling’ my heel more inward than the cleat alignment would allow.  The wear is unlikely to be from clipping out at intersections, since I usually will only clip out with my left foot.  My cleats were very close to identical alignment, but I did notice my right cleat was not quite as ‘duck footed’ as the left.

Conclusions:

As you can plainly see from my history, I’m generally not interested in seeing a doctor about my problems.  I believe many problems are solved by simply giving the body time and ideal conditions required for it to heal itself.

Although my symptom from a tight IT Band was hip pain last season, I think I may have a new symptom from the same problem.  Tight IT Bands can pull the kneecap out of position as the knee bends, causing pain and inflammation.  This week I am going to focus on flexibility in my legs, especially on the right side.  I will be stretching three times a day, and a solid foam roll session once per day.  I will commute short distances by bike only if pain free.  Otherwise, I won’t be riding until Saturday.

I already took the initiative to rotate my right cleat so it is equally duck-footed as the left.  This is the area where I could possibly use the help of an advanced professional bike fitting.  I haven’t made an appointment yet, but I do have the card of a good place if I need it.

About Russell

I have been racing bicycles for a decade. This blog will chronicle my efforts as a Category 1 road racer lining up with the pros.
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8 Responses to Knee Pain

  1. says:

    I feel the same way about going to a doctor with a few minor exceptions. I pulled my Plantaris on my left calf a couple of weeks ago and took a few days off before going in because I didn’t want to miss any more training than necessary for an IM 70.3 that I scheduled for the end of summer – my doctor put me back on the bike immediately but had me change my pedal stroke a bit by dropping my heel at the bottom to stretch the offending muscle and tendon and he had me drop the resistance to more of a recovery ride – it worked like a charm and I was happily surprised. I never would have guessed he’d put me back so fast, it seemed counterintuitive, but it worked. I was back to running in 3 days.

    My doctor is a Kenisiologist, meaning he studies the science of human movement, so he understands how I work a whole lot better than I do. He’s been able to get me through some very rough patches. You may want to try that route. I wouldn’t trade my doc for anything – he’s excellent. For what it’s worth, It’s just my experience (as minimal as that may be compared to yours). From your description, your problems seem to be related to mechanics, but one more arrow in the quiver couldn’t hurt.

    Good luck with the fitting.

  2. Ryan says:

    I used to have IT Band knee pain. After riding with powercranks for a few weeks, the problem went away. Not sure exactly why they helped, but it worked for me. Thanks for writing this great blog!

  3. Hadley says:

    I’m paid for about 3 “professional” fits (I was retul or whomever. It was “only” $150 and in Denver), and my only complaint is that it’s not exactly science. Seat height 29.2 inches, plus or minus 0.25. I wanted an exact number, not a range. I could say things like “try orthotics, get stiffer shoes, move your seat up, use this kind of cleat, etc…”; however, there are simply too many variables. All I know is, “pain = make changes”.

  4. MCG says:

    So I’ve read this with some interest over the last couple of days Russell. First off, I enjoy reading your blog. You offer a lot of interesting information and seem to have a pretty good following. I offer some insights regarding this issue in hopes that your masses can gain some good information.

    First off, I’m a Registered Massage Therapist and have worked with cyclists since the late 80′s, so I do have some experience with this. And as always, none of this is to be taken as medical advice or diagnosis since that does not fall within my scope of practice. (that is legal disclaimer)

    I’d highly recommend getting an evaluation from a good PT or MT in the Boulder area; BCSM or the PT that an earlier poster mentioned a few days ago. I’m always amazed at how much money cyclists throw at equipment, coaching, etc but won’t spend $80 on their own body to consult with a good therapist.

    I know from personal experience that sudden, excessive climbing and these crazy winds that we have recently experienced can trigger this problem. Two years ago I suffered the same kind of injury after riding into a ferocious headwind going to the start of the Koppenberg in Superior.

    If you haven’t changed your position on the bike then it might not be a great idea to start now. True, there may be imbalances but in my opinion it is better to fit the body to the bike if there is some imbalance happening which could likely be at the pelvis. Typically with IT band involvement the pain will be in the lateral knee since the IT band’s purpose is to provide stability to the lateral knee. So, with your pain under the patella this may indicate a problem with one of the Quadriceps Femoris muscles. In my experience I’ve had a lot of success targeting trigger points in the Rectus Femoris. There is a lot of debate around tendinitis versus tendinosis which I wont go in to here. Here is a pretty good link on what tendinosus is.

    Also, I’d be cautious around agressive stretching, especially static stretching. There is a lot of research showing that this actually weakens the musculotendinous junction. I prefer Aaron Mattes method of Active Isolated Stretching which targets muscle weakness as well.

    And the hardest piece of information that I give my clients and that I have difficulty accepting is that quite often, rest is what is best. But I know that most of us always want to keep “testing” the injury. If you do have to ride, I’d recommend high pedal cadence and a light load on the pedals. At the very least you can maintain leg speed with this approach but won’t stress the tendon as much.

    Be smart and keep us posted. Especially as you discover what you find to help a) discover what the cause might be and b) what methods of treatment or self treatment bring relief.

  5. says:

    I’ve enjoyed reading your blog, thank you.
    I have had similar issues in the past and one thing to consider is the possibility of SI joint dysfunction. This is common in athletes and leads to a slight lengthening of the leg which may be enough to cause a strain on your knee cap since your right leg is little more forward then the other one. A physical therapist to address the SI joint and a bike fit to potentially adjust your fore aft position on the bike could lead to less strain on the knee cap. SI joint problems also lead to hip/buttock symptoms related to the pyriformis syndrome.

    I’m dealing with a posterior tibial nerve entrapment in my right leg at the moment but fortunately it’s not bothering me on the bike.

    Good luck…

  6. Brian P says:

    I’ve got the same leg length thing going on. Just checked my tires and the wear indicator on one side showed more wear than on the other. Guess I lean the bike over more on one side than the other.

    A fitter looked at me, though, and said it was a tight hip flexor on one side that was more of the issue than any leg length difference.

  7. Chris says:

    Great subject as always. Like reading others comments and advices too. What I’m really interested in is what kind of stretching your doing. I’ve been dealing with tight hamstrings for a few weeks now but haven’t done anything about it. Finished a more aggressive than usual 65 yesterday and walked the last two blocks to my house because my hammy’s locked up. You mentioned stretching 3 times a day with a Foam Roller session as well. This makes perfect sense for my issue since my flexibility sucks and I don’t believe it’s a nutritional/hydrational issue. So my question is, what do you recommend for a cyclist who just needs to stretch more? Id love to get my hands on a cycling specific yoga video or a stretching for strength program or something I can incorporate into my weekly training. I think this might also help me from needing to see my chiropractor as offen as I do for my hip alignment issues. Thanks Russell

  8. Mike says:

    Go. See. Charlie. Quit d*cking around man. Do you really want to see the hours in the freezing-balls cold wind go to waste?

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