Weird knee problem, advice for a broke college student?

A light bike doesn't replace good fitness.

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petereps
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Joined: Mon Sep 28, 2015 3:50 pm

by petereps

Gonna start off by saying that seeing a sports doctor would be very hard financially, which is why I am asking here first. If there is no other option than I could make it work.

I had a good season last year, training 20 hours a week consistently, and upgrading from cat 5 to cat 2. During this time I had no medical issues (knees or otherwise). After a hard month of racing in August, I took 2 weeks completely off the bike. I ran one 5k and was sore for a few days, but felt fine (probably unrelated, just giving details). After the break, I went for a 4hr zone 2 ride in the hills (low cadence at times). I felt sore, but completely fine. The next day and did another 3hr zone2 ride which left me very sore but still no knee pain at all on or after the ride. The next day, my left knee was really bothering me. Even on a recovery ride there was a nagging feeling. It doesn't HURT per se, but more feels week/tender. Specifically, it feels week/painful at the patella, from what I researched. The next day I did 2 or 3 hours zone2, and could barely hold that 200W by the end of the ride. took a day off, and back on the bike for 2 hours today and it still feels a bit painful, although raising the seat seems to have helped a bit. Another weird thing is that it doesn't hurt at all when out of the saddle, and seems to hurt less when doing hard efforts (vo2 max). This makes me think that when spinning zone2, some muscle or tendon is being strained. I have received many professional bike fits from very respected people, so that shouldn't be a problem. I have a leg length descrepency that is accounted for with shims. What does this sound like it could be? Too much too soon and a few days off should clear it up? Or does it sound more like patellar tendonities or runners knee? Hoping to start back on my training schedule, but will see if a few more days of rest help. Any advice is appreciated. Let me know if I can provide more context.

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grover
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by grover

Same bike, same position? (Up until you raised the seat recently) No other parts changes? (pedals, seat, crank length, stem length, handlebars, shifters, seatpost setback, seat angle)
Same shoes/insoles/shims/cleats? Cleats haven't had position changes? You didn't replace cleats?

Is the weakness/tenderness in the middle of the patella, along one side, top/bottom, does it feel deep or in front of the patella? Can you isolate it to a single point with one finger or is it a general feeling all over the patella?

petereps
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by petereps

grover wrote:Same bike, same position? (Up until you raised the seat recently) No other parts changes? (pedals, seat, crank length, stem length, handlebars, shifters, seatpost setback, seat angle)
Same shoes/insoles/shims/cleats? Cleats haven't had position changes? You didn't replace cleats?

Is the weakness/tenderness in the middle of the patella, along one side, top/bottom, does it feel deep or in front of the patella? Can you isolate it to a single point with one finger or is it a general feeling all over the patella?

No changes to the bike or shoes, cleats, etc. The tenderness seems to be slightly to the left (outside) of my left leg patella when I focus on it. Can't isolate to a single point, just generally in that area. Not tender to the touch at all. When cycling it seems a bit more general, like a weak tendon. No sharp pains or anything. Just naggin dull ache that makes my pedaling weak. Hope that was specific enough. Really apprectiate the help

petereps
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Joined: Mon Sep 28, 2015 3:50 pm

by petereps

accidentally double posted

petereps
Posts: 36
Joined: Mon Sep 28, 2015 3:50 pm

by petereps

Update: Went to my fitter and he seems to think its a knee tracking issue because apparently I have narrow hips. He put me on the shorter speedplay Ti spindles and slammed my cleats so my stance is as narrow as possible. Seems to have helped, no more pain, but still some soreness. Not to mention the constant slamming of my ankles to the crank arms. Not totally convinced thats it, seems weird that I never had knee pain last season, even with a comparatively much wider stance. But maybe since I took some weeks off, fit issues are rearing their head :noidea: . Fit issues are always a headache!

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Calnago
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by Calnago

Ok... here's some real "generalness" because it's next to impossible to give anything but general fit advice without actual seeing the person on the bike etc.
Cleat alignment is crucial in order for your legs/feet to "track" properly. Yet, you say you were fine for a long time with your current setup. Still, if you think it may be a tracking problem, have someone who you think knows what to look for ride behind you and see how your feet alignment looks, and any other stuff they may be able to see that's obvious. You can't see that without looking from behind. A stationary trainer is better than nothing, but I find it's often better to look at that on the road. Take a wrench so you can microadjust the cleat if necessary. This can be a rather lengthy trial and error process till you get it just right and you won't know it's right till you can do some trouble free lengthy rides back to back for multiple days, etc. But I've found that if it's right, you just don't even notice the cleat or your knees when everything is tracking correctly, so important. I use the red cleats (Shimano) which are fixed, which makes cleat alignment even more critical, but now that I've got it dialed, they just feel so natural, and I don't feel "trapped" in them in the slightest.
I'm guessing that your fitter is now just guessing as well as to what the problem is... but if your ankles are hitting the crank arms, then that is unacceptable. That much I know for sure.
You mention that one leg is shorter than the other. Just how much shorter is it? No one's body is perfectly symmetrical, and the body is remarkably adept at accommodating minor differences. That's not to say shims etc. might not help in certain extreme situations, but I think their importance and usefulness is grossly overstated in general. And once used, you can become dependent on them, either for real, or psychologically. Some might say there are a lot of "gimmicks" being marketed when it comes to fit. I tend to agree.
Perhaps just some easy stuff to get back slowly, or laying off it completely for a while, might help if there's an actual injury somewhere going on inside. If you're sure there's no injury you're dealing with, then I'd say just let time do it's think and, barring any glaring fit issues, hopefully it will subside. Otherwise... go see a doctor.
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petereps
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by petereps

Calnago wrote:Ok... here's some real "generalness" because it's next to impossible to give anything but general fit advice without actual seeing the person on the bike etc.
Cleat alignment is crucial in order for your legs/feet to "track" properly. Yet, you say you were fine for a long time with your current setup. Still, if you think it may be a tracking problem, have someone who you think knows what to look for ride behind you and see how your feet alignment looks, and any other stuff they may be able to see that's obvious. You can't see that without looking from behind. A stationary trainer is better than nothing, but I find it's often better to look at that on the road. Take a wrench so you can microadjust the cleat if necessary. This can be a rather lengthy trial and error process till you get it just right and you won't know it's right till you can do some trouble free lengthy rides back to back for multiple days, etc. But I've found that if it's right, you just don't even notice the cleat or your knees when everything is tracking correctly, so important. I use the red cleats (Shimano) which are fixed, which makes cleat alignment even more critical, but now that I've got it dialed, they just feel so natural, and I don't feel "trapped" in them in the slightest.
I'm guessing that your fitter is now just guessing as well as to what the problem is... but if your ankles are hitting the crank arms, then that is unacceptable. That much I know for sure.
You mention that one leg is shorter than the other. Just how much shorter is it? No one's body is perfectly symmetrical, and the body is remarkably adept at accommodating minor differences. That's not to say shims etc. might not help in certain extreme situations, but I think their importance and usefulness is grossly overstated in general. And once used, you can become dependent on them, either for real, or psychologically. Some might say there are a lot of "gimmicks" being marketed when it comes to fit. I tend to agree.
Perhaps just some easy stuff to get back slowly, or laying off it completely for a while, might help if there's an actual injury somewhere going on inside. If you're sure there's no injury you're dealing with, then I'd say just let time do it's think and, barring any glaring fit issues, hopefully it will subside. Otherwise... go see a doctor.

Really appreciate the response. I probably should have clarified: He had me switch to speedplay pedals with huuggeee float in order to rule out cleat placement. I'm not used to the free movement, which is why I occasionally hit my ankles on the crank arm. Only happened 5 times or so in 3 hours accidentally. The free float didn't immediately help the pain. But moving the cleat as far outward (to put my foot as close to the crank as possible) did yield a lot of improvement.
As far as leg length discrepency, two expert bike fitters have told me my left femur is ~2cm shorter. I have known this my whole life, as I stand crooked and have a tilted pelvis. Before getting shims I sat very tilted to compensate, which the shims largely helped. I've had them awhile and had no problems. I'm thinking that maybe I injured something, and for some reason a narrow stance doesn't hurt the injury. So whatever lets me train faster I'm cool with. Maybe after it fully heals I'll go back to shimano pedals with regular spindle length and see how I feel. Thanks again.

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Calnago
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by Calnago

Yes, good luck. I'm curious if because of the leg discrepancy other problems don't crop up, particularly possible saddle sores on one side that has to compensate. I would think it would. I've spoken to a doctor that was saying that the body can compensate for up to 2" of leg length discrepancy. That seems like a lot to me. I tell him that symmetry on the bike is very important, and that I suspect a 2" leg length discrepancy unadjusted for would lead to issues at the saddle area. Would you agree with that, given that you actually have a leg length discrepency?
Thanks, and good luck in getting it all sorted out.
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Unlinked Builds (searchable): Colnago C59 - 5 Years Later; Trek Emonda SL Campagnolo SR; Special Colnago EPQ

chipomarc
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Joined: Mon Sep 19, 2011 4:56 pm

by chipomarc

Just replace the knee. Lots of do it yourself info online

http://www.webmd.com/pain-management/vi ... eplacement

11.4
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by 11.4

A few thoughts here, sharing Calnago's precaution that it's hard to diagnose without seeing you in person.

First, changing to different pedal axle lengths does very little to change the geometry of your legs. They are really more to address the rotation of your feet (longer axles if you have to rotate your heels inward and you are trying to avoid clipping the cranks).

Second, throwing you on massive float is no way to determine if cleat position is an issue. Not knowing your fitter, I'd have to say that's really inept. Different people need different float, but usually as you dial your cleat position in you are able to exert more power and have fewer problems with lesser float. But simply throwing in a bunch of float can cause hyper mobility in your knee joint which can really mess you up quickly. I would absolutely go back to what you were riding before.

Third, two centimeters is a huge discrepancy. However, people ride with bigger discrepancies all the time, without any compensatory adjustments, and never have a problem or even notice it. I wouldn't ascribe your pain to the leg length issue per se.

Fourth, you did do that run. Here's where I'm focusing more. You appear to have had a cycling position that worked for you and you were doing quite well with it. But the health and comfort of your lower extremity joints is very dependent on the balance of tension you've created with lots of training and racing. If you do something that changes the relative tension of supporting musculature, you can throw that out of whack. I'm guessing you tightened up something (nowhere near enough info to identify what, but quite likely one of the smaller supporting muscles such as the peroneus or possibly the sartorius) in that run. Now triathletes can switch from cycling to swimming to running, but they train for that. You didn't. And they adjust their positions to allow for the switch. So my first guess, and where I'd look before you make any changes deviating from a formula that worked for you before, is that you need a little rest and some regular massage and some very very low-power spinning. You've probably irritated part of the knee joint itself, and that can take 2-4 weeks to recover. Take naproxen for the pain, spin around in a very low gear just to keep the legs moving, and keep the distance super-short (like 5 miles the first day, or less if that much hurts). Do this with the original fit that worked for you, with the original pedals. Get a few Groupon massages (typically $39 less 20-40% with ubiquitous coupons) because they will help with recovery and also work out any tension in your legs -- basically spend the time on the massage table doing legs and up to your glutes. Check back in about 2-3 weeks to see how you're doing. Don't race for 4 weeks at least and don't get into big gears until then.

This will serve the double purpose of fixing a tension problem you created with the running and that is hurting you when cycling and also give your knee a chance to recover. Working a knee that's already hurting rarely improves matters. And don't change anything else unless this doesn't fix it. Your running itself didn't appear to cause the pain, but it probably changed how your legs track (and that could be anything from how your feet rotate to how your hips were compensating in the running). Just aim first of all to get back to where you were. If you want to run and ride after you're back healthy again, start with very short runs and work with a good fitter (honestly, probably not the one you worked with here) to adjust your cycling position for the inevitable slight changes the running will induce. (My most common experience with road cyclists starting to ride triathlons is that they have to change hip rotation and saddle height slightly.)

When you are back on the bike and racing successfully, if the pain recurs, you may simply have developed a problem from your imbalance or whatever that simply won't go away. At that point, there's a lot of information needed and a lot of potential options to pursue. But you won't be able to assess them until you've gone through what I've suggested above. This is also a very non-traumatic approach which doesn't make you work through any pain -- a good approach since you're at the end of the road season anyway.

grover
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by grover

My response will be brief as 11.4 has nailed it.

If nothing about your bike or shoes/cleats has changed then that's unlikely to be the answer. What your fitter has done has accommodated your bio-mechanical problem somewhat, hence you feel better. It sounds like the problem is with your body though. That needs fixing.

You take some time off the bike. Things get tight and stiff. You start running, things get tighter. Your bio-mechanics changes.

The discomfort you describe makes me think of problems that take a long time to settle down. If you keep pushing that discomfort will be pain and you will be off for even longer.

A note on non-steroidal anti-inflammatory medications. They are not nice to your liver. It's annoying to be off the bike. Personally as it's a hobby, I'm happy to go the extra few days to let it settle down without anti-inflammatory drugs so as to protect my vital organs. They have their use if you absolutely must have the quickest recovery possible.

Rest. While resting put your bike fit/pedals/cleats back to how it was.
Massage - lower back, glutes (more glutes), quads, hamstrings, calf.
Ride - low load/torque, short. If you start getting sore, stop. If you have rollers they'd be a good idea as it means you don't have to make it home once you get sore. It also makes you build core and hip stability and concentrate on a smooth pedal stroke.

My best guess without seeing you would be tight glutes causing increased tension through ITB effecting your knee tracking. You need to rectify the glute issue and perhaps look at better control of hip abduction/glute med etc.

But really you need to see someone that can look at you in person. In Australia I wouldn't go to a doctor. I'd go to a Physiotherapist. I'm not sure how it works where you live.

petereps
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by petereps

11.4 wrote: **11.4's response**


Thanks for the thorough response. The fitter is well regarded in SoCal and has decades of experience working with pros and amateurs. Although I understand that doesn't mean much and he could be mistaken. Also, I think my post was more negative than the situation is. The pain is ONLY on the bike. I can run, jump, do squats with almost no abnormal feeling in my knee. Pedaling causes a tiny nagging pain that goes away when out of the saddle, making me think it is a fit issue. I'll try to comment on all your points.

-Would smaller pedal axles not make my knee track better with my foot if my knee bends inwards? This was what the fitter was trying to address. I immediately felt relief when I adjusted the cleat as far out as possible. I started the ride with pain, and an hour later when I pulled to the side of the road and did this, I was able to do 2+ more hours with little to no pain.

-I've never heard of excess float causing an issue. Seems like most fitters agree that if everything else is correct, more float can't hurt. Some people just dont like the "skating" feeling of speedplays. Do you have any info on the harms of excess float?

-I thought this could be a possibility, but the run was literally 15 minutes followed by a week of rest. Could that really cause issues? I did two 4 hour days without knee pain when I returned from my time off.

Overall I think i should stress that the narrower axle width with cleat all the way out helped immensely, and allows me to ride without the pain. There is still residule soreness, but I can ride without much or any pain.

Lastly, with that info, I would assume it is safe to train if riding doesn't cause it to hurt or get worse? I will be careful to stop if it comes back, but it seems to be fixed, and I need to start training ASAP as I have big races in Feb. Sorry if my info is scattered, hard to tell the whole story without writing a novel.


Calnago wrote: **Calnago's Respons**

Before shimming, I did favor one sit bone, which caused pain. I assume this would lead to saddle sores, but I never experienced them. Once I got shims I put pressure on my sitbones more symmetrically, and don't suffer from saddle pain anymore.
Last edited by petereps on Tue Oct 11, 2016 1:36 am, edited 1 time in total.

petereps
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Joined: Mon Sep 28, 2015 3:50 pm

by petereps

grover wrote:My response will be brief as 11.4 has nailed it.

If nothing about your bike or shoes/cleats has changed then that's unlikely to be the answer. What your fitter has done has accommodated your bio-mechanical problem somewhat, hence you feel better. It sounds like the problem is with your body though. That needs fixing.

You take some time off the bike. Things get tight and stiff. You start running, things get tighter. Your bio-mechanics changes.

The discomfort you describe makes me think of problems that take a long time to settle down. If you keep pushing that discomfort will be pain and you will be off for even longer.

A note on non-steroidal anti-inflammatory medications. They are not nice to your liver. It's annoying to be off the bike. Personally as it's a hobby, I'm happy to go the extra few days to let it settle down without anti-inflammatory drugs so as to protect my vital organs. They have their use if you absolutely must have the quickest recovery possible.

Rest. While resting put your bike fit/pedals/cleats back to how it was.
Massage - lower back, glutes (more glutes), quads, hamstrings, calf.
Ride - low load/torque, short. If you start getting sore, stop. If you have rollers they'd be a good idea as it means you don't have to make it home once you get sore. It also makes you build core and hip stability and concentrate on a smooth pedal stroke.

My best guess without seeing you would be tight glutes causing increased tension through ITB effecting your knee tracking. You need to rectify the glute issue and perhaps look at better control of hip abduction/glute med etc.

But really you need to see someone that can look at you in person. In Australia I wouldn't go to a doctor. I'd go to a Physiotherapist. I'm not sure how it works where you live.

In the US so can't really afford the Physio. My fitter has been kind enough to do these follow ups for free. Yea rest seems best, but I should really be already in the thick of base training, so I'm doing 3 hr zone 2 rides every other day, and it doesn't seem to be getting worse. If at all it starts to go downhill I'll shut it down until it's fully healed. But for the past few days with the new pedals it seems like it is getting much better. Being sure to not train when sore, and plenty of massage and foam rolling. Thanks for the help.

Nefarious86
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by Nefarious86

#obamacare would fix this..
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alcatraz
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by alcatraz

Being an amateur and not a doctor/therapist I should be quiet. Still I want to boldly diagnose this as a form of tendonitis. I might be completely wrong! Here is my story...

I used to have knee pain that my doctor couldnt diagnose (xray bla bla) which I managed to myself "cure" 100% with a few weeks of a specific knee stretching exercise. First it happened to one knee and then the next year the other. I found the solution on the internet. The pain only came when riding, otherwise fine.

My pain came from the outside (slightly forward) of the knee. At first I could feel it towards the end of my rides. Ignoring it just made it come earlier and earlier, until I got it after only 40min and to the point where the pain was so strong that I had to unclip and ride home with one leg. Thats when I made a doctors appointment with the local orthopedist. He didnt help me other than suggesting that I visit a physical therapist which to me sounded like giving up. It did give me the idea to check the internet and I found on youtube that the pain is common and that there is an exercise. A few days later I was riding again. At first I had to stretch patiently before every ride, sometimes even mid ride stop and do it looking like a weirdo by the side of the road, but now few years later I havent had to do it for years. I know what to do when the pain comes back, if it comes.

There is a tendon there sliding over a pointy bony surface every time you bend your knee. After months of frequent training the tendon tension becomes higher and higher increasing the friction sliding over the bony surface. It gets to a point where this bony surface friction irritates the tendon and the pain comes.

The exercise is quite painful and can bring a man to tears but the relief afterwards is way worth it. It stretches the tight tendon and thus reduces the friction. There are several youtube clips but I can't decide which one to send you. Here is a pic of that one exercise that solved my problem. For details just find the same one on youtube. Just search for "Patellar tendonitis exercise". After finding the sweet spot of hitting the sensitive area (adjusting the angle of the leg on the roller) I knew what to look for and could make without the roller. I didn't buy a roller, just used something equivalent for a few days until I could do it without. The roller is for people that are not that flexible.

I hope your problem is as easy to solve as it was for me.

/a

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by Weenie


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