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How to fix my knackered knee

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  • August 25, 2015 at 7:30 pm #24697
    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!

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  • August 29, 2015 at 6:50 am #858185
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    racingcondor

    Raising the saddle a lot
    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.

    August 29, 2015 at 6:39 am #858183
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    Stumps

    Gavlee wrote:Hi stumps, what

    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.

    August 28, 2015 at 9:17 pm #858181
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    Boltsy

    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.

    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.

    August 28, 2015 at 7:47 pm #858179
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    antonio

    Consultant, x ray, scan have
    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.

    August 28, 2015 at 11:10 am #858177
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    CXR94Di2

    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.

    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.

    August 28, 2015 at 10:57 am #858175
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    Kadinkski

    Keyhole knee surgery is a
    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.

    August 28, 2015 at 9:51 am #858173
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    Gavlee

    Hi stumps, what procedure did
    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.

    August 28, 2015 at 9:26 am #858171
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    Stumps

    Totally agree with the
    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.

    August 28, 2015 at 8:38 am #858169
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    Gavlee

    Freebsd is realistic in their
    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.

    August 27, 2015 at 8:51 pm #858167
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    NigelSign

    Problem is everyone’s pain or
    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

    August 27, 2015 at 10:25 am #858165
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    drwinston001

    Got a very similar problem
    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.

    August 27, 2015 at 6:39 am #858163
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    Groggy PM

    My knees are shot – running
    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.

    August 26, 2015 at 11:01 pm #858161
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    Blazingpedals

    Thanks to all for the
    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 😕
    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

    August 26, 2015 at 8:54 pm #858159
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    CXR94Di2

    @fr3esbsb
    He has already been
    @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.

    August 26, 2015 at 6:59 pm #858157
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    freebsd_frank

    My experience: About 20 yrs
    My experience: About 20 yrs ago I bought my first set of clipless pedals. On
    the recommendation of my LBS I bought some Shimano SPDs. I started getting
    knee pain after I upped my miles. I saw a thread on usenet where some guy was
    also complaining of knee pain and the overwhelming recommendation was to
    switch to Speedplay pedals. I did and the result is I’ve never had any
    problems since.

    My recommendation is that rather than waste money on physios and expensive
    scans, get yourself some Speedplays. Until you use them, you don’t realise how
    constraining other pedal systems are and the stress they put your knees under.

    You’ve seen a couple of physios and if they thought there was anything
    seriously wrong they would have sent you for scans and then to a consultant
    with possible regards to surgery. They haven’t, which almost certainly means
    that they think the injury will heal. What they haven’t told you is that these
    types of injuries take a long time to heal.

    I injured my shoulder lifting my mother a few years ago. It didn’t hurt most
    of the time but things like mowing the lawn were out of the question (what a
    shame!). I went to my GP and told her that I thought I’d damaged a ligament or
    muscle in my shoulder and explained how I did it and the symptoms. I suggested
    she might send me to a physio. Her advice: it will take months to see a physio
    by which time it will probably have cleared up so don’t bother. She was right
    though, although it took over 6 months before the shoulder was right.

    My understanding is that injuries involving ligaments and such like in the
    knee can take many months to heal. For example, young fit premier league
    footballers can be off for many months even though they’ve got the best physio
    etc. money can buy.

    My advice: keep cycling and up your miles; if your knee starts hurting, then
    you’ve done enough miles. Steer clear of your fixed speed
    bike and carry on spinning and avoid steep hills. Gentle exercise will
    strengthen the knee and stop the very real possibility of getting depressed.

    If your knee starts hurting when you’re sitting at work, try going for a 5 min
    walk and see if that relieves it. Also, see your GP for anti-inflammatories
    (I’ve found diclofenac effective in the past) and painkillers for when your
    knee plays up.

    If your knee hasn’t got any better by Xmas, then go and see your GP, tell
    him/her that you injured it in May and it’s no better and affecting your
    hobby/work and demand to see a specialist.

    Hope it gets better sooner rather than later but I’m sure it will get better.

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