Knee pain

[creadinger]

On my recent long ride (150 miles), I was struck with some significant knee pain. I’m hoping people with more experience can help to diagnose the issue on which specific thing may be causing it.

The pain is on the outside of my left knee. And hurts most between about noon and 2-o-clock if the pedal is a clock spinning clockwise. It was a cold day of riding, and my feet/ankles were numb for the bulk of it and thus I didn’t use the full range of motion for my ankle/calves because I was afraid of muscle tears etc, trying to flex frozen muscles. I think I may have been able to work around it better on a warm weather ride by working in more muscles.

That’s about all the specifics I can come up with. It wasn’t debilitating, but was certainly irritating and made the last 50 miles much less enjoyable. Without the pain, I think I would have had more miles in me even – which is significant because I’m hoping to do more than 150 miles very soon.

I noticed that the hard plastic sole on my right shoe has a big crack in it, so it’s probably time for some new shoes. And I’m probably due for a new bike fitting as well so I may try to get all of that done.

Topic

[wheelswings]

Hi creadinger,
Sorry to hear of your knee pain.
It’s tricky to diagnose since there are several possibilities that affect the outer part of the knee….and I’m not sure if you mean all the way on the side – the ilio-tibial band – or more toward the front, like patellar tendinitis. The treatment is completely different… happy to chat at the HH if you’re there.
I’m no expert but I’m a bit of an injury geek and my heart goes out to anyone who gets hurt – been there.
My suggestions are:
1.One of my favorite reference books on sports injuries is called, Listen to your pain: The Active Person’s Guide to Understanding, Identifying, and Treating Pain and Injury, by Ben E. Benjamin. It’s got diagrams and diagnostic tests to help you figure out what’s wrong, plus recommended exercises and other fixes for each injury. It might be worth picking up a copy.
2.If you decide to elevate this beyond input from the Forum :+), you might consider an appointment with Dr. Ayne Furman in Old Town Alexandria.
http://www.archandsole.com
She’s top of the line for this sort of injury. And since she’s an avid runner and cyclist herself, she “gets it” and won’t simply tell you to stop riding. She diagnosed an ankle injury of mine years ago after I’d been in pain for 16 months under the ‘care’ of multiple other doctors. She fixed me in a week and had me racing again in a month.
Good wishes. w&w

[kwarkentien]

Ditto what w&w said. Lots of variables like type of pedal/shoe combo, whether you have need of varus/valgus shims to correct any foot/knee tracking issues, leg length discrepancies, and the like. I will recommend the use of a foam roller if you don’t already do that as bikers as a whole are prone to issues with IT bands and hip flexors since the pedaling action keeps us constantly in sagittal plane, which results in them becoming very tight and causing pain. Good luck!

[PotomacCyclist]

Yes, it could be one of several different things. Aside from the specifics, if the pain feels serious to you, then you may want to dial back the riding, until you figure it out. Continuing to ride through a significant injury can turn a short-term layoff into a long-term one.

As noted, bike fit is important. Since you ride a lot, you may need more frequent bike fits than a casual rider.

Did you ramp up to that distance suddenly, or did you bump up the long ride gradually? Sudden jumps in intensity/duration/weekly volume can often cause problems. Did you include many more hills than usual for you? Did you jump from 60-mile long rides to 150 miles in just one week?

Core stability and muscle imbalances (quad/hamstring/glutes, shins/calves, etc.) can also play a role in many overuse injuries. But strength training works better as injury prevention. Once you get injured, it doesn’t fix the injury.

Did you warm up properly before doing any high-intensity efforts/tough hills?

Most of my overuse injuries have resulted from running, but there are some similarities with cycling. It could be the IT band, or it could be a knee ligament. At least with running, hip weakness (esp. the gluteus medius) is often associated with IT band syndrome (ITBS). I don’t know if the same applies with cycling, since we don’t have to support our bodyweight or stand on one leg like someone does in running. But I think it could be a factor.

I don’t usually get overuse injuries from cycling (although I don’t ride as long as you do). When I’ve had issues come up, it happens after I’ve been on a consecutive days streak, for something like the National Bike Challenge. I know some people ride most days of the year, but I don’t find that to work for me. I just plain feel better and avoid issues when I don’t try to ride every single day. (I might swim on those non-bike days, or do an upper body strength workout. If I need a break from cycling, I probably won’t run on that off-day.)

[creadinger]

@wheels&wings 111965 wrote:

Hi creadinger,
Sorry to hear of your knee pain.
It’s tricky to diagnose since there are several possibilities that affect the outer part of the knee….and I’m not sure if you mean all the way on the side – the ilio-tibial band – or more toward the front, like patellar tendinitis. The treatment is completely different… happy to chat at the HH if you’re there.
I’m no expert but I’m a bit of an injury geek and my heart goes out to anyone who gets hurt – been there.
My suggestions are:
1.One of my favorite reference books on sports injuries is called, Listen to your pain: The Active Person’s Guide to Understanding, Identifying, and Treating Pain and Injury, by Ben E. Benjamin. It’s got diagrams and diagnostic tests to help you figure out what’s wrong, plus recommended exercises and other fixes for each injury. It might be worth picking up a copy.
2.If you decide to elevate this beyond input from the Forum :+), you might consider an appointment with Dr. Ayne Furman in Old Town Alexandria.
http://www.archandsole.com
She’s top of the line for this sort of injury. And since she’s an avid runner and cyclist herself, she “gets it” and won’t simply tell you to stop riding. She diagnosed an ankle injury of mine years ago after I’d been in pain for 16 months under the ‘care’ of multiple other doctors. She fixed me in a week and had me racing again in a month.
Good wishes. w&w

Thanks for the replies everyone!

Doing a little research on my own, it seems most likely to be an IT band issue. I’ve been dealing with low grade patellar tendonitis since high school (where it was a serious issue because of volleyball), so I know all about that, and it’s not that this time.

Interestingly, this issue seems to have cropped up as my participation in ashtanga yoga practice has stopped over the past 6 weeks, so maybe that was actually providing the stretching I needed to keep it in check. I need to get back to yoga anyway so I’ll try to do that sooner than later. One thing yoga has taught me is that my left hip joint is a mess (like deformed I think) causing all of the other joints to work around it, which may cause these issues.

I’m going to take a look at that book. A doctor seems premature at this stage, but thanks for the recommendation! I need to see if my uncle in law has heard of her. He’s quite old, but walks A LOT. Like he’s a weekday/weekend warrior walker, just like we’re cyclists. Over the past couple of years though, he’s been dealing with some debilitating plantar fascitis and has had to take time off, and he limps, and it’s all very depressing. He’s also very weird about treatment though, because I’ve had some minor plantar issues and more or less solved it with some Dr. prescribed sole inserts. I don’t know….

Anyway, it’s been 2.5 days since my ride and my knee feels fine right now. Last evening I did a little home workout that included some no-added weight squats and it felt good then too. So at least for now, it’s not a major issue. But now would be the perfect time to nip it in the bud! I’m trying to schedule a fitting at Freshbikes, because it’s been 6 years since my bike was first built up and fitted for me, and I have some new equipment. I’m guessing it’s primarily a shoe/cleat issue and I would love to hear what a pro thinks about my pedal stroke/alignment.

[Author]

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