Knee injury

[PotomacCyclist]

The IT band is on the side of the knee. It runs up the lateral (outer) side of the thigh to the hip.

I’m not a doctor and I won’t pretend to diagnose what’s going on with your knee. There are many possible causes, from doing too much too quickly, riding too many hills or adding too many hills too quickly, muscle imbalances, traumatic injury, etc.

I’ve had a couple experiences with knee problems, but from running. I’ve never had an injury from cycling (other than from tip-overs and the one potentially bad crash I had a few years ago). When I started out running as an adult in 2008, I quickly developed runner’s knee. I ramped up the mileage way too quickly, getting up to a 6-mile run by the 3rd week after starting from scratch. Really bad idea. I had good aerobic endurance from swimming but insufficient leg development for running.

All those miles spotlighted a muscle imbalance in my thigh, particularly a problem with the inner/medial part of the quad or the VMO. When that part of the quad is weak or imbalanced with the rest of the thigh, it doesn’t hold the kneecap in place properly during physical activity. My kneecap literally started clicking with every step, even while walking. The pain wasn’t bad at first. But within a month, it was so bad that I could no longer bend the knee at all. I had to stop running. For the next 8 weeks, I focused on swimming, elliptical machines, stationary bikes and strength training.

The strength training helped almost immediately. It resolved the VMO issue, which was the cause of my specific injury. However, it did not heal the existing cartilage irritation from the kneecap scraping against the bone in the knee (of the lower leg). Only time, good nutrition and low-impact cross-training helped with that.

In 2009, I had a temporary problem with lower back and hip tightness, partly in the ITB. I found that core weakness contributed to the problem. During my early long runs, I discovered that if I consciously tightened up my abs toward the end of those runs, the ITB irritation would go away immediately. That’s only a temporary solution. The permanent solution is a program of regular and balanced core training (obliques, lower back, spinal erectors, hips, glutes, gluteus medius, abs, thighs).

I’m only typing this to give you some ideas of what can happen to the knee, but I’m not pretending that I know whether this is the problem with your knee. If you’ve done too much too quickly, only rest will help, although you might be able to do some easy riding in the meantime. That would mean shorter rides, slower rides and no hills (if possible). Easy gears too.

As part of my general workout routine, I always do a warm-up, unless I’m just doing an easy ride that day. I like to ride easy to moderate for at least 15-20 minutes before doing more strenuous work. Once I’m done with the workout, I spin at a very easy gear with low effort for 10-15 minutes or longer, to shake out the legs. If it was a hard ride, a long ride or a run workout, I will go through a series of post-workout static stretches. Besides the usual quad/hamstring stretches, I make sure to hit both calf muscles, the bottom of the feet, the shin muscles, hip flexors, glutes, inner/outer thighs/ITB, obliques, abs and upper body/shoulders.

If I’m targeting harder workouts, I build up to that effort level gradually. If I haven’t done any hard workouts for a few months, or ridden any steep hills, then I will start easy. Maybe brief bursts at medium-hard effort to start off. Or with hills, I will just do a few weeks of moderate hilly routes, at a steady effort. No hill sprints at first. As the weeks go on, I step up the intensity level gradually.

Sharp pain and long-lasting pain is never a good sign. It’s probably best to be safe than sorry. In that case, rest would be a good idea. You won’t injure yourself by taking some time off, whereas too much riding with an injury might cause further damage. Until you know exactly what’s going on, caution is preferable to toughing it out. If you’ve torn a ligament or a meniscus, riding on it wouldn’t be a good idea, I think.

[Certifried]

@PotomacCyclist 28999 wrote:

I found that core weakness contributed to the problem. During my early long runs, I discovered that if I consciously tightened up my abs toward the end of those runs, the ITB irritation would go away immediately. That’s only a temporary solution. The permanent solution is a program of regular and balanced core training (obliques, lower back, spinal erectors, hips, glutes, gluteus medius, abs, thighs).
—
I’m only typing this to give you some ideas of what can happen to the knee, but I’m not pretending that I know whether this is the problem with your knee. If you’ve done too much too quickly, only rest will help, although you might be able to do some easy riding in the meantime. That would mean shorter rides, slower rides and no hills (if possible). Easy gears too.
—
Sharp pain and long-lasting pain is never a good sign. It’s probably best to be safe than sorry. In that case, rest would be a good idea. You won’t injure yourself by taking some time off, whereas too much riding with an injury might cause further damage. Until you know exactly what’s going on, caution is preferable to toughing it out. If you’ve torn a ligament or a meniscus, riding on it wouldn’t be a good idea, I think.

Thanks, this is what I’m asking for, these experiences. Core weakness – definitely a problem I have. I’ve been working more on my core lately because it really helps with the lumbar pain. I have a ton of physical therapy exercises and personal trainer taught exercises to work on that. I slacked for a while, but am getting back in to it.

I definitely am probably hyper-aware of the damage I can cause, which is why I posted this. I needed some common sense voices in my head. It’s sharp(ish) pain, though mild in the kneecap. The IT band pain is an old friend, so I was leaning towards working through it. The kneecap pain is new to me. I think you’re (obviously) 100% correct here, riding is probably not a good idea. Not commuting anyway. I think I’ll take some slow spin flat rides for a few days to see how the knee handles it. Beech Drive here in Bethesda (runs along 495) is amazing for that, it’s totally flat. I’ll use the new Jamis for them just so it’s seeing usage other than as a wine rack LOL.

Thanks. I wanted to push it, ride anyways. I still feel guilty about not riding (personal weakness lol), but I think avoiding the strenuous commute is wisest.

[KLizotte]

Take the pain as a warning sign. It could be something as simple as your cleat placement needing to be adjusted.

[KelOnWheels]

Seat high enough? That’s what had my knees going.

[PotomacCyclist]

+1 on bike fit. I hadn’t thought of that.

Another comment about strength training. Since I got more serious about strength training (for endurance athletes), all of the running injuries disappeared. I did have some shin tightness problems in early 2009, after I came back from the runner’s knee injury. But since summer 2009, I haven’t had a single injury. Of course, I’ve been sore after some tough bike and run workouts, and I could tell that I was starting to push close to my current limits, but an easy day or a rest day always helped me to step back from the brink. (I don’t train super-hard year-round either. Only in the lead-up to my key races, of which I only have a couple each year. Any other races are secondary and I train through those.)

For much of this summer, I’ve been doing 7-8 speed workouts a week (3 swim, 3 run, 2 bike, meaning that I do some two-a-days, while scheduling a very easy day each week too, and a cutback/easy week every 3rd or 4th week). I’m hammering my legs hard but I haven’t gotten injured. That’s because I did a lot of base training earlier in the year, because of the strength training that I did (mostly in the winter and spring) and because I have increased the training intensity gradually from year to year, not suddenly. (Except for that first year, when I made some big mistakes.)

As I said on the (now-closed) strength training thread, you don’t have to be super-strong to benefit from strength training as a cyclist. You just need a decent level of strength, good core strength, balanced core strength, and overall muscle balance (especially in the legs, hips and core). If I compared myself to a bodybuilder or a football player, I would be quite lacking in the strength department. That’s OK. I don’t plan on competing in those activities. But for what I do (cycling, running, triathlon), I now have decent enough strength to help with the training and to protect against injury.

[vvill]

Generally (very generally), knee pain on the bike for me is caused by
– seat too low
– riding with knees too far out
– mashing without warming up at all

I have actually realized I can stubbornly cycle through the pain when it’s low level – if I keep riding at a good cadence and smooth-as-possible pedal stroke the pain will actually go away! But I am most definitely not a doctor. This is just an anecdote, and I have only ever been diagnosed with patellar tendonitis – nothing too serious as far as I know.

If I have been riding a lot of climbing miles (or miles in general) or I am anticipating doing so I will sometimes wear one of my good ol’ knee braces. It has a band that I position under the patella — I find it helps to reinforce my knee a lot.

[rcannon100]

Yes to the above, and

> Check your cleat float – no float can bother knees – I switched to speedplay frogs and love them
> Move your cleat back. Another common problem is having the cleat too far forward.

I am not a “get a professional fit” person. Really think its over hyped. Get a bike that is the correct size for you – and then adjust, adjust, adjust until it feels right. Read up on bicycles and knees, and then fiddle with those variables until it feels right. For me it was ultimately
* Better Float
* Raise the Seat
* Move the cleat back
* Warm up well before pushing hard (no hills until warmed up – avoid hill work until knees are better)

[Certifried]

The bike fit should be close, Clovis set it up with all my injuries in mind. I mentioned the IT band history. The knees out thing just hit a major chord here, I do that. Other have caught me doing it. On the longer ride I did on Thursday I was definitely pushing it, and tired. I’d bet I had my knees out, bad. I’ll try some easy rides and see how the knees do, then go from there. I also have a free check up with Clovis coming, so I need to schedule that too.

Sent from my DROID RAZR using Tapatalk 2

[Dickie]

Some great advice above. I will add that I remember you showing up to happy hour and telling me you felt the knee “give” when you were riding, and you used the word “twinge” as well. I am certainly no expert and many of the suggestions above are probably more informed, however it appears to me that the injury occurred quickly, almost immediately based on a twist, or a strange movement on the bike. My cycling knee issues always build up slowly and are aggravated by repetition, tendinitis is certainly in that category. Fit issues are often the cause of this for me… cleats wearing creating weird float, small saddle adjustments, even clothing that changes/raises my cycling position can exaggerate my disproportionate leg length and thus aggravate an existing issue. I recently read an article about seat height and it was suggested that too high of a setting can cause your pelvis to shift while riding (as it tries to balance out the legs during each stroke due to differences in leg length), this can eventually lead to knee pain. However, I get the feeling based on your description that you simply moved or honked at the wrong time with your knee in a vulnerable position and strained it. I would stay off it for a while, use the RICE method and see if that helps any, and if not go see a specialist when your insurance kicks in. For what it is worth, I have to believe that if it was a serious knee injury you would probably not have any desire to ride, or walk, or even get a beer from the fridge. My worst knee injury occurred playing ice hockey, I twisted it and was certain I would require some sort of surgery…all I needed was some rest, ice, compression, elevation and it was better in no time.

[Tim Kelley]

Just to add a little more to the confusion, I tend to get ITB symptoms when I do to much running and biking in combination. For me, it was having tight glutes, hips and hip flexors from being hunched over on the bike and that could my ITB to be tight and pull on my knees. In addition to just foam rolling your ITB, thinking about trying to stretch the rest of your mid-section too. Worked for me!

[dasgeh]

Sounds like you’re still in pain – you might want to try alternating heat and cold on the knee tonight. Otherwise, you’ve gotten some great advice (and apologies if someone already said the hot-cold thing)

[Certifried]

Thanks everyone! Definitely some great advice, and really appreciated. I didn’t ride in today, partly because of a concert last night 😎 Also, partly because 1/2 the time it feels fine, the other 1/2 it feels like there’s definitely something wrong. To echo what Dickie said, there definitely was a defining moment when it happened. I felt it happen and knew I had hurt it. I was pushing my daily mileage farther than usual, and probably wasn’t keeping my knees in like I should. I have a bad habit of that. The knee probably was vulnerable at that time for all the reasons everyone has mentioned (weak core, didn’t stretch, etc). Fortunately, I don’t think it’s bad. The knee feels pretty good, I can walk up/down stairs without issue. No “locking” problems, and the sharp pain is more like a dull prick (no offense to any of you dull pricks).

I’ll try a nice slow flat ride (no offense to any of you slow flat rides) tonight and stop at the first sign of pain. I’ll do a good pre-ride stretch too :p

I have this really bad personality, it’s the “type A” personality, an “ENTJ” for you Myers-Briggs fans. That means I can’t stop myself from pushing myself too far. So I probably won’t do any stretches or slow rides, and will end up writing about how I can’t walk tomorrow. Argh, I hate me! LOL

[PotomacCyclist]

I never do pre-ride stretching. I just warm up with easy riding (or running) for 15-20 minutes. But I always stretch after runs and after many rides (usually long rides and hard rides, but not after most easy rides).

Stretching cold muscles and tendons can cause problems. There is also recent research to indicate that pre-workout stretching can have a temporary negative effect on muscle performance. A current trend is to do pre-workout dynamic stretching. I tried that a couple years ago but stopped because it didn’t feel good. Maybe I didn’t do them right. But I feel OK with just a long warm-up.

[KLizotte]

Certifried,

If it makes you feel any better, last year I threw out my back and was couch-ridden for three days because I got up from a chair incorrectly. I’d never done that before and finally understood why old people walk funny. I walked like a turtle for about 2+ weeks.

It sucks getting old.

[Dickie]

@Certifried 29086 wrote:

(no offense to any of you dull pricks).

No offense taken!

[Author]

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