[Blazingpedals]

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!

Topic

[CXR94Di2]

Good news, hope the recovery
Good news, hope the recovery continues

[Blazingpedals]

Brief update…. as per
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!

[The goat]

As many have said get it
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.

[iggy]

similar issues when upping
similar issues when upping the mileage this year using SPD’s… speedplay zeros, not suffered since.

[Bobskie]

I had a similar problem with
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 #o
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!

[Batchy]

Thanks for considering my
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 !

[Colin Peyresourde]

Stretching and program of
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.

[Blazingpedals]

Wow, great response, thanks
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.

[jamtartman]

Most likely, there is nothing
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.

[crikey]

Given that we all have access
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…

[Batchy]

Kadinkski wrote:Keyhole knee

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 .

[exilegareth]

Repeating an unreferenced
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-degenerative-tears-practice-must-catch-up-with-evidence/

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

[harrybav]

My dad had knee surgery,
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.

[Colin Peyresourde]

Surgery is really a last
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.

[Kadinkski]

I said keyhole surgery is a
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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