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How to fix my knackered knee

Hi, avid reader, but first post! I wondered if others would be able to share experiences regarding the ever popular subject of knee pain and injury recovery.
I've been road riding for a couple of years (mountain biking for much longer) managing a few century sportives without ill effects. In May this year, I was training for such a ride, and had started using a single speed track bike for a 12 mile each-way daily commute, aiming to increase the workload. After a couple of weeks I noted slight discomfort in my left knee. Stupidly ignoring this, I went on my regular Sunday morning jaunt (40 miles) but 30 miles in I felt sharp pain in my left knee (pain on inner kneecap). I limped home and rested it up for a few days but missed the Sportive altogether.
Since then It just won't heal. I started by trying to self-diagnose and treat. Foam roller, stability cushion, icepacks, Ibuprofen etc. No joy, so visits to 2 separate physios (one through work, the other as part of a Retul assessment/fit) who have both said there's nothing majorly wrong with my knee other than overuse. They both gave me stretching (hamstrings, quads) and strengthening exercises (glutes, hips). One diagnosed a fallen arch on my left foot, the other (more specialised in cycling physio) said I have limited mobility in my left ankle which causes my knee to turn in. Both noted that my right leg is much stronger than the left. I have since purchased custom orthotics and had a professional bike fit, which mainly led to the saddle being brought forward and raised by a not insignificant 30mm..... It no longer conforms to the height setting using the heel method (its much higher).
I've religiously done my exercises twice daily, cut back on rides (5 mile commute once/twice weekly, occasional 20 mile ride at high cadence and no hills). However over 4 months it hasn't improved at all. My knee continually clicks, my shin makes cracking noises. If I sit for any length of time (my job requires it) it aches. If I do a lot of walking it seems to improve, but returning to work/sitting and the ache returns.
I suppose I'm trying to understand whether I have to accept that this might be permanent (neither physio thought so), or I am being impatient, or even whether someone can share tips on how they recovered from a similar problem? Should I abstain from all cycling for a prolonged period? I'm 44, btw, and otherwise quite fit.
Anyone care to share their own experiences? Thanks all!

If you're new please join in and if you have questions pop them below and the forum regulars will answer as best we can.

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33 comments

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CXR94Di2 | 8 years ago
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Good news, hope the recovery continues

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Blazingpedals | 8 years ago
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Brief update.... as per advice from most recent physio visit, I added calf stretches to my twice-daily routines, as tight ankles seems to be the main issue. Might just be coincidence but pain while sitting has eased, I also managed a 5 mile each-way commute, every day last week, only managing 1-2 days before. Only other change I made is icing after each ride for 20 mins.
It still feels like I need to treat my knee very carefully (no hills or mashing) but I'm definitely noticing improvement at last!

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The goat | 8 years ago
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As many have said get it checked but also look at your bike set up and the most obvious is the position of the foot on the pedal. From personal experience (in the days of clips and straps) fractions of an inch can make a massive difference. I've found the further back the ball of the foot there is less likely to be problems. After changing the position, light riding and avoiding heavy pedal pressure until things settled down worked for me.

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iggy | 8 years ago
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similar issues when upping the mileage this year using SPD's... speedplay zeros, not suffered since.

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Bobskie | 8 years ago
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I had a similar problem with my left knee. Sharp pain on the inner kneecap. During a cycling holiday in Italy, my knee was killing me. During my months of training I had 2 accidents, so I thought the source of the problem might be a damaged patella. Back home I visited a specialist and had my knee x-rayed. Nothing was found. More specialist followed... to make a long story short. In the end I found my saddle was positioned too high and I was overstretching my left leg  40
I had bought a new saddle a few months earlier and forgot all about it. I lowered my saddle about 1,5 cm and I'm riding without pain for a year now. Bike fitting is everything.
Good luck!

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Batchy | 8 years ago
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Thanks for considering my comments. I can assure you that I have gone through all the various stages of knee problems since injuring my left knee way back in 1967. Cycling has prolonged my sporting and fitness regime until ultimately a complete knee replacement was the only way out of pain misery in 2010. I now ride on average 8000 miles per year without pain or problems. Though cleat position has to be set up properly not just for me but everyone who rides a bike on a regular basis as no two knees are the same. If you live in the north west Wrightington Hospital IMO is THE place to go !

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Blazingpedals | 8 years ago
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Wow, great response, thanks everyone for taking time to read/comment! There's a lot of info to take in/consider. Batchy had a fair point, that medical professionals are best placed to help sort out injuries..... The aim of my post was simply to share experiences and to help set my own expectations, having never been laid off the bike for any length of time before.
So what I have taken so far from this....
- I am probably being impatient, an overuse injury can take a considerable time to heal
- An x-ray/MRI might reveal something (but 2 physios suggest otherwise)... Even if it did, would it be sufficient to warrant intrusive surgery? surgery is perhaps considered a last resort especially if I have full movement and function, albeit with some discomfort at times
- Even if I end up with surgery the future isn't bleak.... Some of you guys have had some quite major knee ops yet continued to clock up the mileage. Impressive!

@crikey, yes sounds like we have a matching pair! My left knee has a tendency to turn in (I had never noticed before), this is apparently due to a lack of mobility in my ankle that causes my left foot to pronate. The orthotics are intended to compensate for this.

@colinP The single speed and my regular road bike are now set up with identical geometry.... Admittedly as per the bike fit so different to the original pre-injury position.... The change of position will undoubtedly take some getting used to but my hope is that it improves my overall position and helps to prevent future injuries... (Although not posted originally, I did suffer a slight knee problem a year ago, this took 3 weeks rest to fix... Possibly due to the same underlying issues).Time will tell!

@kadinkski I think you are right.... Both physios say I have tight muscles, I have been working hard to address this, noting some improvement in hamstring, hip flexors etc. I have never done any strecthing before and this was obvious due to my restricted range of movements.

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Colin Peyresourde replied to Blazingpedals | 8 years ago
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Stretching and program of core exercises is what I think would work best for you and it is a matter of you keeping at it. Treat your body like your bike (or car - depending on what you treat better) and do regular servicing and tune ups.

Getting rid of stiffness and muscular imbalances doesn't happen overnight. Stick with a routine and over time you will heal yourself. Ultimately this is what you do anyway....surgery is just a kick start for the process in a way.

It is likely that you fixed your body into a position and then you get into a process of compensation (tight ankle requires flexible knee etc) which you would be well to try to unwind. It's the same with leg imbalances. You may find that this is because you tend to have a dominant standing leg (typically you'll hitch you hip and stand with one leg straight and one leg bent). Try to ensure you stand with both legs straight. It's little things but over time it can make a big difference. A lot of people just accept these things as being 'their body', but usually it is the way our environment and experiences shape us that cause these things and because we don't notice it happening and don't try to do anything about it we slowly get molded. But you can change these things if you work at it.

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jamtartman | 8 years ago
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Most likely, there is nothing wrong with your knee. The problem could be elsewhere and you are compensating for it in a way that is putting strain on your knee.

I have the same symptoms as you, but the opposite leg. Perhaps we should get together and make one good cyclist between us.

My problem is with my lower right leg. All else being equal, it does not 'ankle' as much as the other, and the calf muscle is not as well developed - not that you would immediately notice.

I have found I require a very different cleat setup on the right foot than the left, and also need saddle higher than the heel method (795 vs 780mm). Saddle setback is quite big too at ~100mm (I am just over 6ft) Any less, and the knee pain returns quite quickly.

The knee is less troublesome with this position, but I have lost speed. Maybe it will improve over time as I adapt to this position.

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crikey | 8 years ago
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Given that we all have access to the internet, it would be a good idea for folk to use it to look for the evidence regarding knee arthroscopy before getting all in a tizzy...

...and more importantly, perhaps people should ask medical professionals about injuries rather than a load of random nodders on a bike website...

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harrybav | 8 years ago
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My dad had knee surgery, wisely sought out the guy that does all the top footballers, rather than letting local general surgeon bod have a bash. Cost £3k or something.

But all your woes are since May - that's no time at all in knee recovery. Best course would have been to remove the new factor - the single speed - not to introduce another (bike set up) - and give it 3-6 months (in my uninformed opinion). Would 3 bike set-ups give the same set-up recommendation? I think not, and would be wary of this "profession" and the 3cm seat height bump on that basis.

Wary of medics on same basis, to be fair!
Walking helps? That is good news. Do walking! Good for basic strength.

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Colin Peyresourde | 8 years ago
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Surgery is really a last resort. I think practitioners are increasingly dubious of what it can achieve. Scraping away tissue only creates scar tissue, so unless you are replacing a joint it tends not to make things better.

You are better off working with your physio. Quite often the main issues are related to range of motion. If you have been a regular exerciser and not maintained your body with stretching you will get joint stiffness and over time lead to limitations. You can recover ROM but it requires a dedicated regime. Often imbalances occur due tightness which also mean retraining muscles. But I'm sure you're physio will have that in hand.

The hip is actually one main area which you may need to look at. Your leg imbalance may actually be due to muscular impingement and tightness which should be readdressed. We're not really made lopsided and it's usually down to our activity that causes this.

Unfortunately this may mean that you have to go back to square one with things but it will be worth it in the long run. Don't be macho about what you can do.

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Kadinkski | 8 years ago
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I said keyhole surgery is a waste of time. Obviously general orthopaedic surgery such as open-knee is necessary and successful in many cases.

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exilegareth replied to Kadinkski | 8 years ago
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Repeating an unreferenced generalization doesn't make it a better point. In particular, the evidence appears to be pointing against the use of arthroscopy for degenerative meniscal tears associated with osteosarthritis, but that leaves the possibility that arthroscopy may be of use for those with non-degenerative tears and another indicator such as knee-locking.The article I consulted is here; http://blogs.bmj.com/bjsm/2014/06/15/time-to-stop-meniscectomies-for-deg...

If you're a doctor you should be more careful with evidence -if you're not, why are youoffering medical advice on't'internet?

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racingcondor | 8 years ago
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Raising the saddle a lot seems a risky move for someone with a leg length discrepancy. Raise it too high and you'll be tilting your hips which will throw your knee alignment off.

I had a good fit a couple of years ago where I had my short leg shimmed (between shoe and cleat), moved my cleats back quite a bit and dropped the saddle. Most of the focus of the fit was on knee angle and getting my pelvis stable. Worked for me though.

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antonio | 8 years ago
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Consultant, x ray, scan have to come first. Anecdotal is all very well but those giving the advice don't have your complaint. I suffered job related arthritis and knackered knees and at one point thought my cycling days were over, could not pedal over top dead centre due to loss of strength, could only push when pedals were at 'quarter past'. I overcame this problem by returning to fixed gear, worked for me but I would be outnumbered and scorned if I thought this would work for every one. My knee problems started in my forties, I have just completed a summer series of 'tens', in five weeks I will be seventy eight. I hope you recover well and don't give up hope, nothing worse than facing a life without the bike, if you love bike riding that is.

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Kadinkski | 8 years ago
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Keyhole knee surgery is a waste of time, it can make things worse and cause new issues altogether. A good physio and exercise program are more effective.

The NHS are considering halting keyhole knee surgery altogether.

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CXR94Di2 replied to Kadinkski | 8 years ago
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Kadinkski wrote:

Keyhole knee surgery is a waste of time, it can make things worse and cause new issues altogether. A good physio and exercise program are more effective.

The NHS are considering halting keyhole knee surgery altogether.

That statement is a bit sweeping. Some will need to have surgery whether keyhole or full open surgery and others will benefit from minor damage by rest and physio.

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Boltsy replied to Kadinkski | 8 years ago
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Kadinkski wrote:

Keyhole knee surgery is a waste of time, it can make things worse and cause new issues altogether. A good physio and exercise program are more effective.

The NHS are considering halting keyhole knee surgery altogether.

Yes! take note of this; my father (80) has arthritis in his shoulders. Leading specialist who he is now seeing says (this week) that keyhole is a waste of time -apparently a major and robust study in Canada showed that in a blind test keyhole surgery tested against people having the holes and nothing more showed no difference in outcome. My Dad's surgeon said that although he's done keyhole (arthroscopy) for years he could never really understand why people said there was an improvement after the op.

He has recommended full op to my Dad - in which he does a proper shoulder replacement - not likely that Dad is in enough discomfort to take that option given his age.

I have similar knee issue and will now seek out those who are going to assess properly and give option of proper, not palliative op.

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Batchy replied to Kadinkski | 8 years ago
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Kadinkski wrote:

Keyhole knee surgery is a waste of time, it can make things worse and cause new issues altogether. A good physio and exercise program are more effective.

The NHS are considering halting keyhole knee surgery altogether.

This is total bollocks. An arthtoscopy can prolong the need for future surgery and eleviate a great deal of pain. Usually performed to clean out bone particles in the knee joint that cause pain and locking up of joint .

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Gavlee | 8 years ago
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Hi stumps, what procedure did they do to your knee if you don't mind me asking. That is a long time to be inside someone's knee.
You mentioned injury at work was this traumatic or repetitive like in the post? Just curious.

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Stumps replied to Gavlee | 8 years ago
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Gavlee wrote:

Hi stumps, what procedure did they do to your knee if you don't mind me asking. That is a long time to be inside someone's knee.
You mentioned injury at work was this traumatic or repetitive like in the post? Just curious.

It was a traumatic injury at work, to complicated to explain here though. As for the op they opened up my knee, cut the tendons and ligaments around the knee and removed the "knee cap" which had shifted position. They then drilled the femur and the tibia in about 12 places, as I had ripped off the cartilage. This allowed the bone to "bleed" and subsequently scab over which hardened and became scar tissue which takes the place of the cartilage. They then realigned my knee cap and finally trimmed and stretched the tendons and ligaments which keeps the knee in place and allows you to walk properly.

Obviously I was unconscious for it all but the consultant surgeon said it took that long as each piece was like a complete surgery one after the other hence the time period. I was not allowed to put weight on it for 4 month then basically had to learn to walk again whilst on crutches. As for the comment by Kadinski about key hole surgery, if it had not been for key hole then the extent of my injury would not have been found and I would probably now be out of my job and unemployed.

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Stumps | 8 years ago
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Totally agree with the comments on MRI. I damaged my knee at work and like most people rested it, took pain killers etc etc. It didn't get better and i went to see my GP who advised physio, no good. Ultimately an MRI was scheduled and it showed the problem.

A subsequent key hole surgery found large scale damage inside the knee, round about where you are getting pain and that meant a massive 7 hour op and 6 month on the sick recovering.

Basically what i'm getting at is keep pushing your GP for the scan and then push some more to see if they will do key hole surgery as thats the only way to really see whats going on in there. My knee is now spot on with no pain.

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Gavlee | 8 years ago
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Freebsd is realistic in their views. In the absence of true locking or giving way in the knee MRI and xray are of limited value to managing this type of condition. Two physios specialists in musculoskeletal injuries are happy and confirm each others ideas of overuse injury. They are much better placed than any forum to judge this.

MRI and xray findings bear little correlation to clinical symptoms unless the above mechanical signs are reported, or clinical assessment shows dysfunction of a particular structure. They can act to create more anxiety rather than reassurance if you are found to have OA changes or meniscus tears, both can be found in non painful knees regularly over the age of 30.

Patellofemoral pain of which you give a good description of can take 6-9 months to settle once the cause has been corrected. It sounds like the physios are working to address these causes with you however they take time. No quick fixes.
As previously stated don't stop activity just modify to keep within pain limits.
I hope you start feeling the benefits soon.

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NigelSign | 8 years ago
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Problem is everyone's pain or symptoms could relate to a host of different problems.
Get it scanned to get a definitive diagnosis, that way you will then get a rehab programme that is appropriate.
A number of years ago I got a pain in my left knee after running on a treadmill, foolishly I pushed on in the following weeks.
I went from being diagnosed with ligament damage requiring physio, then a quartos one injection, neither worked. Eventually diagnosed as arthritis and given 2-5 years before a knee replacement. It lasted 2 years before I had to gave a half knee replacement in January this year.
If that is what gets diagnosed don't let them fob you off by trying to get you to wait for the op. Apart from the first couple of weeks post op which was quite painful it is now at least as good if not better than it ever was. Completed ride London 100 in 4:46 and 24:10 for a ten mile tt along with a couple of hundred miles riding every week.
Good luck with whatever the result

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drwinston001 | 8 years ago
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Got a very similar problem myself. I've been off the bike now for 3.5 weeks and it is getting better. Having rested it for a few days previously (or not at all) I decided it was time to try and let it heal properly. The urge to get on the bike is a nightmare to fight but I know it's probably the best thing for me in the long term. I will only get back on again once I no longer feel any pain and when I've had a proper bike fit which is the first thing I intend to do once it's better.

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Groggy PM | 8 years ago
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My knees are shot - running did for them a few years back. I do jujitsu which involves a lot of kneeling at the start of each session - I can't get the heels of my feet to touch my backside - it makes my knees feel as if they are about to explode.

One thing I've noticed is that, as you get older (I'm 41) injuries take much longer to heal. I pulled something in my right forearm bouldering and it took 6 months to get back to normal.

Be patient and don't try and come back too soon. You could investigate paying for knee surgery privately, but it's pretty pricey. Try swimming in the meantime to keep fit.

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Blazingpedals | 8 years ago
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Thanks to all for the replies, great feedback and support. I saw the physio again today, mentioning possibility of scanning. She gave my knee a lot of pulls, prods and pokes and is still confident that there is no significant damage. In her opinion a scan 'might' reveal some minor condition (as expected for someone my age) but nothing anywhere serious enough to contemplate operating on it.
She was happy with my stretching progress but now thinks that my calves are very tight (my left being significantly worse). More stretches, also to shorten my training rides which crept back to 25 miles (weekly). I should start icing after activities, which I haven't been doing recently. I might need to shop around for a leotard as she thinks that Pilates might be beneficial  39
I'm going back to the GP to see if I can get referred for a scan... For the very least, to put my mind at rest! I'm also interested in the Speedplay recommendation, I'll definitely look into that. Cheers everyone
Daz

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CXR94Di2 | 8 years ago
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@fr3esbsb

He has already been suffering months with pain and discomfort. There is no wastage in getting professional scans after this time.

He may recover on his own but maybe he won't and continuing activities that exacerbate the problem will be detrimental to his health. Whether he goes private or via nhs he needs to know if there is a problem. Waiting is just delaying.

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Tjuice | 8 years ago
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I've suffered with remarkably similar symptoms for the last 2 years in both my knees. It's a massive problem that I've not managed yet to overcome through exercises/physio/complete rest and abstinence from exercise. Regular gym sessions seemed to keep the pain somewhat in check, but never resolved it.

Very demanding job, added to recent strenuous demands of home life mean that I have had no opportunity in the past couple of years to prioritise myself or my health, so I have been struggling on, in pain and unable to train, but without finding the opportunity to see all the relevant health professionals to resolve the issue. It actually feels like it is getting worse.

Don't be like me - go and see all the specialists you need to get it sorted quickly. And let me know what the problem / treatment ends up being - might help me!!

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