Anterior knee pain - starting to get serious

by sergius   June 30, 2014  

Hi Folks,

Looking for some advice here (preferably not of the "don't ride a bike for a few months and see if it gets better" sort which my Doctor wife recommended).

A little bit of background:

I got my first road bike about 8 months ago, loved it, and have been doing a fair amount of cycling (30-80 miles once a week) over the last few months. I've been riding for years but had been of the bike for a little while and I never used to go out four 4+ hours on the MTB.

For the first seven months, the only pains I had were in my back and shoulders. I followed some advice from here and started doing some targeted core training which helped a lot. Things were getting better on that front.

I got myself a new saddle bag for my birthday (end of May) which didn't fit on the bike as-is. I had to move my saddle backwards around 1cm in order to fit the thing. I went out for my "normal" 65 mile loop around Surrey and after a couple of hours started getting pain in my right knee (specifically on the front and inside of the knee - it's especially pronounced when I push hard. If i'm just spinning out it's fine, climbing and getting out of the saddle make it much worse).

The next week, with the saddle remaining unchanged I went out for a quick loop of Box Hill (35 miles) - knee pain again returned after an hour. At this point I put the saddle back how it was and took the new saddle bag off the bike.

I took this as a sign that I really should get a bike fit done. So I popped off to my LBS and ended up spending £450 on a bike fitting + new shoes/bars/stem, ouch. I guess that's what you get if you buy everything of the internet and haven't had your feet measured in 20 years. The chap didn't have to change much, my saddle was already in the "ideal" position, the reach was too long and my shoes way too big. I went out for another quick loop of Box Hill and the pain was still very present, but I figured I'd tweaked something at this point and needed a rest.

I knew I had a Sportive coming up on the weekend just gone, so I took two weeks off riding. I still went to the gym a bit, but stuck to core and upper-body - I left my legs alone for two weeks.

I did the Wiggle Chiltern Classic (75 miles) on Saturday and my knee is worse if anything. My left leg/quads are now really sore as well - I suspect from over-compensating for my weak right knee. On the plus side, shortening the reach and narrowing the bars with the new stem/bars has eliminated the back and shoulder problems entirely.

My wife is of the opinion that I should stop riding for a while (funny that) and see what happens. I'm not particularly enamored with that idea, it's not like I ride a huge amount anyway - once a week maximum.

Has anyone had any similar issues? Assuming the bike fit was good, could this just be my body trying to adapt to an "ideal" cycling position?

Right now I see my options as:

- Stop riding and hope it fixes itself, then build up the miles again slowly.
- Do a bunch of strength training, squats etc, focusing on the problem muscles. Try riding local 4-5 mile loops and build up the distance until the knee pain starts again. Essentially train through it.
- See a doctor and be told, "if it hurts, don't do it". I'm not a big fan of this as you may have guessed, every other muscle injury I've had (and there's been a few, I did a lot of gym work when I was younger) I've worked through with targeted training and they've fixed themselves.
- Try playing with my bike adjustments to see if I can sort something myself, this strikes me as massively iterative and hard to judge as to whether or not it's the current injury getting inflamed further or actually making things worse.

Any other suggestions?

14 user comments

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Go and see a sports physio - cost me £40, they will be able to point you in the right direction.

If its not the bike it could be a myriad of things.

Best £40 I ever spent.....

posted by andycoventry [111 posts]
30th June 2014 - 10:52

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Dos'nt sound like you got a very good bike fit done there. Should never of gotten worse.
Sounds like you need to not ride for a couple of weeks and go see a physio as suggested or a bike fitter that knows what they're doing..

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posted by DanTe [51 posts]
30th June 2014 - 10:58

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+1 it shouldn't get worse post fitting !!

sounds like petallar compression syndrome ... bikeradar have a couple of knee
articles which are quite good ...

http://www.bikeradar.com/gear/article/take-care-of-your-knees-17010/

http://www.bikeradar.com/gear/article/take-care-of-your-knees-part-2-17445/

Have you checked cleat position and alignment ?? My right foot is VERY
susceptable to cleat fore/aft, but not so the left.

still on the 3rd switch-back of Bwlch !

posted by therevokid [679 posts]
30th June 2014 - 11:23

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Thanks folks,

I'd seen those Bike Radar articles before, some useful reading.

I think I'll try and sort out a physio, as well as doing some VMO strengthening and having a play with my cleat position.

The cleats already have wedges underneath - that's the piece the bike fitter spent most of the time on.

posted by sergius [28 posts]
30th June 2014 - 11:51

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I have a touch of what you described, especially bad during the jan feb march when its colder. The physio idea is a wise one one. I basically used kenesisology tape combined with massage and icing (bag of peas after a ride) and a bit of well timed rest to help it clear up. It may also be from muscle imbalance. The massage was the thing that really helped though to release the tension in my ATB, quads and calves. The tape helped to accelerate healing and reduce swelling and provided a bit of pain relief.

I never really tackled the imbalance properly though there are exercises out there on the web. Although people swear by an exact bit fit i believe the body can tolerate slight differences. I found that moving my saddle back helped but I then changed saddles to a Fizik aroine which i find a get into a TT position often on which bring my KOP forward. So basically i end up having various KOP positions during any one ride.

posted by Nzlucas [88 posts]
30th June 2014 - 11:58

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Your experience sounds similar to mine, as far as area of pain is concerned.

I found physic to be a good start, but to be honest it only really treated the issue rather than sorting the cause of it.

Have a look around and speak with a bio-mechanics coach in your area, similar cost to a physic, and whilst not necessarily able to fix the problem after its aggravated, they might be able to stop it from occurring again.

Best of luck!

Racer 074 for the 2014 Transcontinental Race; 2,000 miles from London to Istanbul.

http://themartincox.co.uk/2014/03/racer-074-transcontinental-race-2014/

posted by themartincox [319 posts]
30th June 2014 - 12:09

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1. Take a break sooner rather than later. Or at least, do more gentle cycling.

Learned this the hard way myself. Knees take ages to heal. The further you let it go, the longer you'll be off. Better a shorter break now, than a longer one later.

2. Google for "knee stability exercises".

Basically, standing on one leg on a pedestal/low-stool of some kind and doing slow movements (raising, lowering) to help build the muscles that stabilise the knee. I found this helped me.

3. Maybe take glutamate and cod liver oil supplements.

The scientific evidence for efficacy is mixed/sketchy at best, but there is at least a plausible mechanism for how these might help your body maintain tissues around joints. Can't harm at least.

4. Don't be afraid to get second opinions on your bike fit. Even just get a riding buddy to ride behind and see if there's any signs of possible problems (knees rocking horizontally across the pedal stroke, excessive hip rocking, etc).

5. Take a break... seriously.

posted by Paul J [558 posts]
30th June 2014 - 15:35

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First up, bear in mind that all medical opinion delivered via the medium of the internet is worth exactly what you've paid for it. Seek proper medical advice - as others have suggested, £40 (or thereabouts) for a physiotherapist will be money well spent - you wouldn't bat an eyelid at spending £40 to replace, say, a rear derailleur that was broken, would you? Is your future walking ability really worth less than that to you?

Generally, pain is your body giving you a message. Again, as others have suggested, listen to it. You maybe don't need to stop riding, but a short while easing up while you check it is worthwhile.

I've been advised by my physio to do a whole load of strengthening exercises for my glute med/min - being the geek that I am (and with an academic background that included quite a bit of biomechanics), that's prompted a whole load of personal research. If you have a mostly seated job, these will be weak in you too, and they play a huge role in stabilising the upper leg (and lower back) and, therefore, the knee. So, my other bit of worthless advice would be: do some work on strengthening your glutes, but especially med and min. Get yourself onto a good Pilates course. The long term gains in all sorts of areas will be worth it.

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posted by adamthekiwi [38 posts]
30th June 2014 - 16:49

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What did the fitter say your pain was caused by?

Knee pain is generally caused by overuse, that overuse either caused by simply riding more than your fitness currently allows, or because your set up is pushing your joints too close to their limit with regards to range of movement.

From the fitting, your fitter should be able to see anything obvious.

Moving forward, I second getting professional help in diagnosing what has gone wrong, and why. Then you can make the right choices with regards to getting things fixed.

I have been struggling with knee pain on and of for the past two years. The cause is tracking challenges from my hip and pelvis. The situation is managed through stretching, foam rolling, Chiropractic treatment, and consistent training... I mention this, as in my personal situation, resting the joint may relieve acute symptoms, however it also contributes to the bigger picture problem.

Get professional help basically.

posted by Jimmy Ray Will [211 posts]
30th June 2014 - 17:00

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The fitter didn't comment to much on the pain (though admittedly I did the normal bloke thing and probably downplayed it a bit, especially as it was very recent and likely caused by my playing with my saddle positioning). He was mainly concerned with getting my ankles/knees straight - hence the shoes that fit and a slight wedge under the cleats.

I'll take the advice on seeing a physio, it can't hurt to get a professional opinion.

posted by sergius [28 posts]
30th June 2014 - 17:16

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Get to the physio. I've had two bouts of knee pain, had the bike fit first time around (which seemed to fix the issue the first time in conjunction with physiotherapy) and when I increased the distances this year it returned and this time I upgraded my shoes and pedals (my shoes were twisting under load). Both times I used the physio and they gave me exercises, ultra sound, infrared and laser treatment to improve blood flow and aid the healing.

I don't see the bike fit as a one off activity - as you adjust to the new position, new factors and new shoes etc bed in, so you may need to return a second time. Your ligaments stretch, you gain and loose flexibility and so its a constant process.

Do try and find one with either sports, or cycling experience. Just because they 'cycle' doesn't seem to mean they are expert about cycling related injuries.

Beekie

posted by beekie1 [6 posts]
30th June 2014 - 22:31

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I found this site really interesting for all types of knee pain:

http://www.knee-pain-explained.com

Visiting a physio though is the way to go.

posted by iso2000 [2 posts]
4th July 2014 - 16:52

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Had to join road.cc as this was interesting.
It would be interesting to know what fit system the bike shop used. Precision, Guru, Bio Bike, Retul etc. They should have given you a flexibility assessment and set your leg extension as appropriate. Do you know the angle they set you at? It should be written down somewhere. (45-30deg) The Knee over pedal (KOP) can be a little fore & aft to suit body mass, so a little adjustment like you suggest should not have caused the dramatic effect you suggest. Reason I am interested is because fit systems above differ on how they asses the riders ability. Eg, Fitness, flexibility, Core stability. They should have fit to your week leg, and posture. Without seeing you it is hard to guess, but my first thoughts are that the shortening of your reach has closed your hip angle forcing an irregular leg movement beyond the reach of your flexibility. Maybe you can check by observing the tracking of your knee in relation to your Iliac spine and ankle in front of a mirror. If your hip is closed you will see you compensate by rotating your femur out. Your fitter should be more than happy to review your fitting either way. Good luck.

posted by lifefan [1 posts]
4th July 2014 - 18:46

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Thanks for the additional replies, my LBS use Cyclefit Precision. They have a couple of options, the "full" fit and an "on the bike" fit - I went for the latter.

This is focused on adjusting your existing bike properly, while the chap wrote down some details - there's not a huge amount other than my physical measurements and some of the key measurements of the bike after his changes.

he certainly observed and measured my leg extension angle, likewise I got a 9/10 in the various flexibility measurements he took. Core stability measurement was "how long can you hold a plank"? My reply of "well I've never bothered doing more than 5 minutes" seemed to be enough for him.

There's a record of what he changed if that's of interest:

- Saddle height dropped 0.4 cms to compensate for thinner shoes than the previous ones.
- New shoes, slight wedges on both feet to compensate for the Varus, obviously new cleats + positioning
- Saddle wasn't entirely horizontal, adjusted it slightly.
- Saddle moved forward 1.5 cms
- New bars/stem (narrower/shorter) reducing measurement from tip saddle to hoods by 6 cms. This change is great btw, lots more comfortable.

posted by sergius [28 posts]
4th July 2014 - 20:06

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