Knee Pain – Diagnosis

My knee pain had improved significantly with taping and stretching, and I was tempted to race Sunday and cancel my appointment.  However, I decided to keep my ‘eye on the prize’ of my later season goals and picked up an overtime shift Sunday to make sure I couldn’t race.  I also kept my appointment with , and I’m glad I did.

The skill of medical diagnosis is one of pattern recognition.   A symptom like knee pain has a very large number of causes.  Anyone who has tried to research something with as many causes as knee pain online quickly encounters the massive amount of information, advice, causes, and recommendations.  An experienced practitioner can use their extensive real world experience to quickly determine a accurate diagnosis.

This certainly was true in my case.  I arrived a the and filled out some paperwork.  Health insurance will often cover these visits, but with my new job I have a complicated insurance situation, so I waived my insurance benefits and opted to use the ‘pay cash today’ discount.  My visit would cost less than $50!  I saw a fellow Cat 1 in the waiting room and we chatted about our knees until our names were called.

The Spot

I met with Andy and started telling him the ‘long version’ of the events surrounding my knee pain.  I was only about half done when he started “uh huh”-ing me rapidly and nodding a lot, like he already had some good ideas so I wrapped it up and he went to work manipulating my leg.  After prodding around my kneecap for a while, he pushed on a particular spot and I said “Ouch.  Right there.”  He was pressing deep into the knee right next to the patella, on the lower inside where there is a distinct ‘notch’ in the kneecap.

He then described my problem, which I’ll do my best to paraphrase.  The major support system for the kneecap when viewed from the front is in the shape of a cross.  The top and bottom are the patellar and quadriceps tendons, and the sides of the cross are the medial and lateral retinacular ligaments.  Generally, there is no movement in the plane of the cross, but if there is, it will cause inflammation, and in my case it is the weak point between the medial retinaculum and the patellar tendon.

Knee Q-Angle

He said the injury is very specific to cyclists, skate skiers, and breast-strokers where the knee is stressed by ‘falling to the inside’.  The excessive q-angle puts stress on the medial retinaculum and causes the pain I’m experiencing.  He said in my case it is likely caused by my foot position.  A lack of arch support combined with my pedal system (worn springs and cleats).

My Time pedals are a few seasons old and as I mentioned in an earlier post, the springs can be ‘pushed’ against.  He said that when I put more pressure on the pedals, my heels collapse to the inside and push against the worn springs.  When my foot comes back up the foot springs back into position.  He said the worn equipment is part of the problem but that I would be better served by a more stable pedal system.  He said “It is easy for me to spend your money”, but recommended a Shimano pedal and (blue).

Luckily I already use Specialized shoes, which he said offer top-notch stiffness and stability.  In fact, he was the one who worked with specialized to design the Body Geometry S-Works shoes and footbeds!

Along with the equipment changes, he suggested a routine of ice and deep friction massage.  The area doesn’t have a lot of blood supply and deep friction massage will increase blood flow and promote healing.  It is a relatively slow healing injury, but he said if I still have problems it also responds very well to cortisone injections.

Clearly, visiting a professional was the right thing to do.  I now have a plan and expect to see continued improvement.  I chose the Boulder Center for Sports Medicine not only because Andy on cycling, but because they also had all the other services I may have needed (PT, X-ray, 3D bike fitting, physio testing) available in house.

At the end of our meeting we talked a bit about the State Time Trial and I when my new frame comes in I will definitely be back for a fitting.

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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4 Responses to Knee Pain – Diagnosis

  1. says:

    Bravo! A lot of people forget that if you cash pay, you don’t pay a whole lot for services in lieu of insurance. Glad that you got a dx and are able to move forward. Just from the mental aspect you must feel a whole lot better than trying to do the dreaded “online self diagnosis”.

    • says:

      Yes, it is a much better feeling to know what is going on, and be aware of it while riding.

      I already took the new pedals and insoles out for a ride and along with tape was pain free for the two and a half hour ride.

  2. Cat4Fodder says:

    Interesting…not going to disagree with Dr. Pruitt, but my understanding of one of the benefits of the Time system was the float, which, with the springs, kind of allows for float without feeling like you are pedaling on ice cubes (Speedplays…yes – I know, you can set those for zero float, but the screws used habitually come lose while riding).

    I switched to Time just this season for precisely the secure pedal system…interesting.

    • says:

      I’ll add that I had a 3-4 season old pair of RXS pedals paired with a 6,000 mile season in my cleats. The new iClic2 pedals are better, but the DuraAce 7900 pedals I’ve been using this week are rock solid. 3 degrees of float in either direction, no lateral float. Basically it feels like you’re feet aren’t going anywhere except for the float which just feels like a little play in the system. In my case I needed more stability, not more float.

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