Knee pain - Kill blow!?

[wheelsONfire]

I have some knee pain which have accelerated to a point, i just don't know what to do.
It only get irratated when i cycle, but not really if i stand up and cycle.
It also seem less irratated if i sit up straight (on a trainer) and pedal.

I went to a training physiologist and was told to do one single exercise and one single strech.
(I am weaker in my left leg/ knee than the right.)
Quite much actually! This was obvious when i went to the training physiologist.

There are mainly two points which is irratated, which i can apply pressure to and that makes it feel better.
First it's the two points at the outside to the left of the left knee.
Second and less pronounced are one or two points at the left knee, but inwards - facing the right leg.

Any tips would be extremely appreciated!

[Stueys]

See a good bike fitter, ask around for local recommendations.

[mattr]

See a good bike fitter, ask around for local recommendations.

Been suggested, many times. To no effect.

[Djakninn]

Until you get to a bike fitter, to at least get things feeling a bit better, i'd say going from that top pic that the TFL and hip flexors are tight, pulling on the IT Band and causing the pain there, as i've had similar in the past (Long commutes to work sitting in car and sitting at a desk) Start giving your quads and hamstring a good stretch. Stretch the TFL and hip flexors last and spend a bit longer on them - this may in turn release the tightness on your VMO. Note : Don't foam roll your IT band!
This at the very least should make the affected areas feel better

[r33prman]

I have spent so much money on my bike and gear etc. to date the best money I’ve ever spent on my bike was a bike fit from a guy local to me in Melbourne AUS. Ken Ballhaus at adaptive human performance. 4 hours of fitting and I now ride 100-200km rides pain free. No point having all the nice gear if it hurts to ride it.

DT

[dricked]

I had knee pain when I first started cycling after having a basic fit from the LBS where I purchased my bike so I then had another fit from a second LBS. It took months for the pain to go away and it basically ruined my first summer of riding. After I purchased a new saddle and started trying to get it where I wanted it the pain didn’t come back. I built a second bike and no knee pain. I bought my current bike from the second LBS that did a fit and within 30km I had the knee pain again. I moved my saddle forward around 10mm and it was gone instantly. It seems that they have their numbers they try and fit everyone to at both shops (both were slightly different fits btw) but neither worked for me.

[KCookie]

I feel for you OP. I've been suffering from knee pain for years, only my right knee. Had multiple scans, x-rays etc and all the doc keeps telling me it's a tight IT Band. Doesn't matter what stretches I do I just can't shift the pain. Makes me wonder if a bike fit will eliminate this.

[RyanH]

Can you describe the pain? IT band pain is very distinct as it feels like someone is jabbing an ice pick into your knee (pretty much exactly where you drew the lines). This is due to the fluid sack having been worn down and the IT band is snapping across the bone every stroke. The first step is to take a month off the bike unfortunately. After that, what worked for me was lowering my saddle and moving it a little forward. You want to avoid your leg extension getting beyond a certain point (30* or something).

But as I mentioned, the only way to deal with an IT band problem is to take a long time off the bike. I tried to ride once a week the first month while doing the recommended stretching, foam rolling and whatever. That only delayed my healing. The fluid sack needs to heal. That injury ultimately sidelined me for 3 months.

[mattr]

Depends how badly it's gone. If you ignore the niggles for months, or have an insanely bad fit, then it takes ages to get better.
If you catch it early, foam roller, stretches, weight work, deep tissue massage will "fix" the IT band issue within days. And stop any knock on effects.

(Done the latter two or three times, recognised the symptoms, got it fixed. Carried on racing.)

[wheelsONfire]

Reading this isn't exactly making things happier...
https://transformativerunning.com/2015/ ... -syndrome/

[Mr.Gib]

The two most common problems that may include the symptoms you describe are Patello Femoral Syndrome (PFS) and Illeotibial Band Syndrome (ITBS)

Ryan gives an appropriate description of the latter, but I will add that it is not wearing of the underlying tissue, but rather irritation. There is a tiny area of highly innervated tissue that sits behind the femoral epicondyle that can get irritated and send pain messages to the brain. Usually the pain appears at the side of the knee but it can also extend down the lower leg into the tibialis anterior. Sometimes conservative therapy (physio, stretching etc.) can work but if it does not, surgery is the way to go. The surgery is very simple and has a success rate as close to 100% as is possible for any surgery. It involves cutting a small triangle out or the posterior of the IT band and simply removing the irritated tissue. I have had both knees done - riding in 3 weeks, back to 100% in 7 weeks. Many world class runners have the surgery profilactically so they don't run into problems in an olympic year. Common in runners, less so in cyclists. Make sure your saddle is not to high or too far back.

PFS, now this problem can be a bitch. The symptoms can be almost anything and appear almost anywhere on the knee. Most common is aching of the knee cap area (like it's bruised) and sharper pain in the upper lateral quandrant of the patella. But also the medial side and back of the knee can be painful. The cause is typically dominance and tightness of the lateral quadraceps muscles group and lateral patella connective tissue, and weakness of the medial quad muscles (vastus medialis). The solution is lengthen and soften everything lateral, and strengthen everything medial. The knee cap must float naturally in the groove in which it resides during quad contraction and not be pulled to the lateral side by tight muscles (the cause of the pain). The only solution is physio - surgery is never be an option for PFS (despite what some surgeons may suggest). The problem is you need a really good sports med clinic that really knows their PFS treatment - not enough do. Some of the exercises are not so obvious and yet they are critical. For example here is a link to a medical paper on the impact of the mobility of the patella: https://www.jospt.org/doi/pdf/10.2519/j ... 3.17.3.144. Ironically, people with PFS are more comfortable with a higher saddle.

But be open minded to other problems as well. See a good sports medicine specialist, preferably one that rides a bike and get a good diagnosis. Try to stay optimimistic. Amazing recoveries are possible. I have had both the afflictions to the point where I was literally unable to walk, and yet over the last three days I have ridden 730km. Everything is possible.

[Mr.Gib]

Reading this isn't exactly making things happier...
https://transformativerunning.com/2015/ ... -syndrome/

A few years ago, during research on a cadaver, a physician reported that the nature of the IT band is such that it cannot be stretched. That's where the sentiment in the article comes from. OK, so the IT band cannot be stretched, but what about all the muscles that are attached to it? Sometimes that's all it takes to get relief. But it does go back to the point that I made above which is when it comes to IT band syndrome, conservative therapy can be a waste of time. If IT band syndrome doesn't resolve quickly after therapy or returns after a previous recovery, start to think about surgery.

Don't get caught up in the gloom and doom of internet medicine. Stay positive, there is a solution

[wheelsONfire]

Can you describe the pain? IT band pain is very distinct as it feels like someone is jabbing an ice pick into your knee (pretty much exactly where you drew the lines). This is due to the fluid sack having been worn down and the IT band is snapping across the bone every stroke. The first step is to take a month off the bike unfortunately. After that, what worked for me was lowering my saddle and moving it a little forward. You want to avoid your leg extension getting beyond a certain point (30* or something).

But as I mentioned, the only way to deal with an IT band problem is to take a long time off the bike. I tried to ride once a week the first month while doing the recommended stretching, foam rolling and whatever. That only delayed my healing. The fluid sack needs to heal. That injury ultimately sidelined me for 3 months.

The TP i went to told me to stretch and do one legged muscle training.
Sitting at a chair, hold arms/ hands crossed leaning at shoulders and from sitting, raising myself and then down.
The stretching practice is bending knee so fot is pointing towards the ass, knee perpendicular down.
Pushing at the ass and holding upper body straight.
The the shinbone pushed towards a sofa or chair, other leg straigt onto the floor.

Went to a doctor today, she said, don't ride the bike, eat anti-inflammatory meds and use anti-inflammatory ointment.
Call a physiotherapist.

It happened like this. I went for a ride and it turned out badly. Next ride i went about 55km and it felt badly afterwards.
Waited 5 days, resting and using meds and ointment. Went for a 65km ride.. Uh, hurt afterwards.
Next ride it felt bad after quite fast, but i got about 30km. Next ride, severe pain after 7.5km, turned back home.
Now here i am. I have never had this experience before. It just happened BANG! Like that!

Perhaps it was raising saddle as i rode it pretty low on my trainer. Lower than i ever have before. It just felt like i wasn't taking stance when i was biking outside again, so i raised saddle a bit progressively. Perhaps this was the issue? But i never suffered from it that i noted.

Some years ago i even rode with saddle higher. Haven't changed clear position. I have never had issues with my feets and i don't feel like feets are force in awkward position either. I use Time/Mavics Xpresso 12 pedals with "float" cleats.

The thing is, my buddy quit cycling due to this very issue on both knees.
I haven't managed to locate a TP focused on mainly biking related issues.
It's probably a too narrow field were i live.

This is why i thought i check with you guys.....

The pain and how it feels, well, i don't know how to explain it!?
Perhaps the best way is like you just did. I can't come up with anything different.

[wheelsONfire]

Reading this isn't exactly making things happier...
https://transformativerunning.com/2015/ ... -syndrome/

A few years ago, during research on a cadaver, a physician reported that the nature of the IT band is such that it cannot be stretched. That's where the sentiment in the article comes from. OK, so the IT band cannot be stretched, but what about all the muscles that are attached to it? Sometimes that's all it takes to get relief. But it does go back to the point that I made above which is when it comes to IT band syndrome, conservative therapy can be a waste of time. If IT band syndrome doesn't resolve quickly after therapy or returns after a previous recovery, start to think about surgery.

Don't get caught up in the gloom and doom of internet medicine. Stay positive, there is a solution

This is very good graphics of the pain, the green "bursa".

I don't know if it is this, but for me, applying pressure on these (green) spots make it feel better.
This while pedaling in cycle pose.
Again, the weird is, standing cycling pain goes to low level. Sitting with straight back (trainer) pain goes a bit lower.

[RyanH]

The article was an interesting read as it seems I was misinformed about how the IT band moves. What you have been doing though is what I was doing in the beginning. I took 5 days off, then tried a 20 mile ride and then hobbled back home in serious pain and then repeated a week later. Fortunately, I know what caused my issue. I went to play with Q factor on my speedplays and set them up as narrow as possible. I did a 80 mile ride like that, which I was more or less fine. The next day I big ringed the Nichols climb and midway through the 30 minute ride I felt a searing pain.

I had a month of attempting to ride, like you, then a month of no riding. After a month, I tried lowering my saddle (I previously fixed the Q factor on my cleats) and started riding again. I set it too low for awhile and over time I brought it back up. I'm at 72.5cm now, I think I was down to 69cm when I first started recovering. I haven't had the issue since but it was extremely frustrating, I remember at one point trying to come to the realization I may never ride again.

The one takeaway from that article is to figure out what is wrong with your pedaling. In my case it was cleats setup wrong that caused it but to cope with the recovery I had to fix the cleats and ride at a lower position for awhile.