Advice for new knee pain?
 

Hey! Been reading these forums for a while but I just joined as a user. I'd love your advice.

I've been commuting to work by bike for a while but I recently started riding more to prepare for a double century in July. It's been awesome! I now plan to continue biking long distances after

My problem: A month or so into training, I decided to buy a new bike designed for light touring. I love how it rides but I think my initial fit (just the shop eyeballing my size, nothing scientific) started causing discomfort in the front and around my knee.

I've now done about 400 miles on the bike and the knee discomfort is still there. I've probably fiddled with the fit too much now. But I've never felt knee pain before and it's really surprised me. I was riding 120 miles a week on an old, too big for me bike and didn't feel anything.

I just tried taking a couple days off to stretch and ice the area but it doesn't feel like rest is resetting the issue. I'm willing to get a professional bike fit if that will help but now I'm wondering if I need a physical therapist too?

Has anyone without prior knee issues worked through this and could offer guidance?

P.S. In between the new bikes, I also got food poisoning and was prescribed cipro, which I stupidly took without checking the side affects. They include the possibility of tendon rupture for months, so now that's on my mind too.

I'd start with the simple stuff. One standard seat height starting point is .883 x cycling inseam from center of bottom bracket to top of seat/saddle. Another is 1.09 x cycling inseam from pedal at 6 or 7 o'clock to top of seat/saddle. (It is said that the 2 measurements are usually close.) If your seat height isn't pretty close to those measurements, I recommend changing it to comply with the standard recommendation to see if it fixes the problem.

IIRC, the standard advice is that pain in front of the knee is likely to be due to a seat that's too low, but 'front and around the knee' sounds different.

Where you putting too much muscle into pedaling? My first suspicion in all knee pain is not shifting to a lower gear or not having a low enough gear for the terrain you ride.

As far as your fit from the bike shop, I'm sure they did a better job than we can with the info you gave us..... inseam, height, make and model bike, bike size, etc. <grin>

Another thing that might cause sudden knee pain.... IMO.... going to a longer crank if you had been riding a short crank for a while.

And as for the medication from the doctor, you really have to stay on the ball with that stuff. Doctors don't get much pharmaceutical training. Make sure they understand what's important to you. You can insist on something else.

Thank you both. Yeah, I learned my lesson with the antibiotics.


I think I have a tendency to stay in too high of a gear because I'm still learning. But I was doing that with my old bike too?


What's concerning me now is the knee pain is persisting even as I've taken a three day break from my bike now. Once you get the bike fit right, does the issue disappear or do you have to rest until you recover?


The discomfort is at the front of the knee cap and around it but not in the back.

The pain often indicates inflammation. You may need to rest longer to let it subside. Ice and ibuprofen are the standard for inflammation. I'd rather let it rest a bit more myself before popping pills.

Measure and compare the distance from the bottom of the pedal stroke to the top of the seat on both bikes. See if the new one is lower. Use a level (or eyeball) to check and compare the slope of the seats, should be fairly close to parallel to ground.

Get a bike computer with a cadence sensor. If your cadence drops below 80, shift to a lower gear.

There are some PT exercises to help build up and support the knee joint. I went to PT for a couple months for knee pain that started about 3 months after I resumed riding after many years and was ramping up.

Since you don't know what the fit issue is, but there obviously is one, go to a real bike fitter. Ask for recommendations.

Since the knee is inflamed now, and simply fitting the bike correctly isn't going to cure that immediately, stop riding until you get the fit. Don't make it worse. Act now. Also buy some sort of bike computer which will show you cadence. After the bike fit, every day if possible go for a 30' easy bike ride, pedaling ~90 cadence. You should not be breathing hard, just rather deeply. Do that until the knee stops hurting. It's odd, but it is usually just one knee that starts acting up after a bad bike fit.

In the future, try to ride 80-90 cadence until you run out of gears climbing.

Thank you all. This is very helpful.

When I was a teen and young adult, I could accelerate pretty quick from a dead stop with a fairly high gear ratio with no knee pain. But as a much older adult, I can't. If you feel yourself using a lot of muscle to pedal, then shift to a lower gear.

You do need to let your knee recover before you do any significant cycling. And if you do ride before it's recovered, then keep the load on your knees very light by using lower gear ratios than you have been.

OP, I wrote the following 15 years ago based on my experience with chrondomalacia patella which I was diagnosed with in 1978. This may not be what you are seeing. I am not a doctor. But your issues sound like mine. I triggered mine with a bike and crank length swap. Following the advice I've got, I am still riding my original equipment knees.




"Chrondomalacia patella. CP. Yes, I can tell you a little about it. I was diagnosed in ’78 and given very good advice by the doctor (an orthopedic in sports medicine. He was also a novice bike racer, so he had more understanding of the cycling aspects of CP than most). I will do my best to pass on what he told me.

In CP, the kneecap is not aligned with the knee under it, hence there is chafing as the knee is moved. This causes wear, first to the cartilage, then to the bone under it. The wear accumulates with number of repetitions and pressure. At some point, the wear can cause permanent damage.

Some people are more prone to CP than others. It can be triggered by exercising in cold weather, exercising without adequate stretching of the hamstrings, i.e. touching your toes or less extreme stretches of the same tendons. It can be brought on by exercising without adequately strengthening the small quadriceps muscles just above the kneecap.

I brought on my CP by training to return my body to racing form after a very serious accident. (I was weak enough after my hospital stay that I was no match at 24 years old for any 7 yo.) The accident was in November, and I returned to riding miles in March. I did nothing to keep my knees especially warm and did no stretching exercises (rationalizing that since my leg never extended to anywhere near straight, there was no chance of injury, hence no need to stretch). I was wearing just full tights and thermal underwear under them in Boston. The temperature was probably not much above 30. The ride that started it was 100+ miles on my racing bike, my first outdoor ride on that bike. It had 175 cranks. My trainer, with fixed gear and very low BB, had 168’s. After the ride I had a dull pain in my mid to upper knee in front. That Saturday was the first race of the season. I was forced to drop out, my knees hurt so much.

After that race, the race promoter introduced me to an orthopedic surgeon who diagnosed me in the back of a cold van. He laid out for me then and in later phone calls a plan that I will pass on here.

He first stressed that I had to stretch my hamstrings, touch toes or lean forward against a wall or post with one leg back and straight and stretch that hamstring or sit and touch toes. I now prefer the lean forward method. Very specific and hard to hurt yourself. (I am now a 48 yo, I damage if I am not careful.)

Second, he had me sit on the floor and do leg raises. He had me raise one leg at a time and hold it several inches off the floor for a while (I don’t remember the time, but 15 secs should work. Important – while the leg is raised, tense up your quads big time and tense up those little quads just above and beside the kneecap. Feel for them and get to know them. It is those little guys that keep you kneecap aligned. If you are in riding shape, you can do this with say 5 pounds on your ankles, but the tensing up is much more important than the resistance.

Third, KEEP YOUR KNEES WARM WHEN YOU RIDE!! For me, this is critical. I wear these dumb looking “knee warmers” for most of my rides, always below 70 degrees, often under tights. Since keeping the hamstrings loose is important, I had to stretch the elastic. To keep them from falling down, I sewed on garters that I clip onto my shorts.

Fourth, back off riding until you have been doing these two things long enough to make a difference. Keep up the exercises and especially the stretches after you resume riding. Build up your riding slowly. The doctor stressed this to me and it has been very true. My ability to come into real form and resilience on the bike is limited more by my knees than by my lungs/muscles.

After rides, take aspirin or Ibuprofen to speed recovery. I personally think aspirin is better, that my knees recover more with it. I disagree with the ice. I have always felt that moving my knees when they are cold is causing the damage I am trying to avoid. Perhaps ice speeds recovery, but I feel it also continues the damage (at least in my knees).

Big gears are the enemy of CP knees. I love to climb hills standing. I love to ride hilly country on fix-gears. It is a fact of my life that I can only ride certain not-so-steep hills on my commuter and that I have to have and use a granny ring on my custom. It is a fact that there are days, weeks and months when I have to let whippersnappers blow by me on hills where I know I can humble them.

Lastly, what you did not want to hear, but again what the doctor told me. Get used to the idea of CP. If you are at all like me, it will be a fact of your cycling life for a long time. 23 years later for me and I am feeling my knees now because of a very easy ride I did in street clothes without knee warmers at noon today.

Sorry to be the bearer of bad news, but you can still do a lot of riding. I raced that season (I already knew it was my last) and have done 60,000 (?) miles since. I still commute, but only on alternate days. (But for the first 7 years with CP, I did not own a car and rode everywhere.)

I took the time to spell all this out because in the 23 years I have had CP, I have never seen all of this in one place. In fact, I have only heard about the importance of keeping the knees warm from that one doctor. That is the single most important aspect of the program for me. Thank you Dr. Kish, wherever you are. I will probably ultimately need those carbon fiber knees, but by following the regime, I figure I can wait until a) the product improves, b) the price comes down and c) I’m old enough that my cycling level will be within the abilities of those knees. I hope to delay another 10 years.

Since I wrote this a year plus ago, my physician has recommended that I take glucosamine. He was very specific, that I should take 3000 mg/day in the form of glucosamine sulfate or glucosamine hydroxide, but to avoid chrondroitin. This I did faithfully for 9 months. Between riding steadily starting two years ago and the glucosamine, my knees never felt better than they did last summer. I was passing whippersnappers uphill. Then my riding tapered off, I tapered down on the glucosamine and got sick so my riding and conditioning dropped. Thanksgiving I rode 50 miles with 2500’ of climbing on a cool day. My knees hurt. How many of those rules outlined above did I break?

Ben"

Knees are tricky and they are all different. In fact, my right is different from the left. While the left one is trouble free, the right one complains from time to time. Some years ago I played tennis regularly; a one hour lesson weekly with the club pro, tournament play Saturday and Sundays one or twice a month and league play twice a week. Our club had clay courts but some clubs had hard courts. Eventually, hard courts brought on discomfort but clay courts did not.

These days I no longer play tennis and but occasionally experience discomfort in that cranky right knee. Not often but when I do, leg extensions with 10 pounds of ankle weights works to strengthen the muscles just above the knee. The quads are also strengthened but the ones that stabilize the knee are the ones I'm after. I also stretch a lot to maintain mobility.

My right knee also used to flop to the inside brushing the top tube ow and then. I added a one and one half degree shim under the cleat on that side and built up additional support under the arch of foot beds that already had good arch support. I spent some time early in my cycling getting used to a higher cadence pedal stroke by shifting to a lower gear and pedaling furiously while maintaining speed and then shifting down again. Do this often enough and when you shift back to a normal gear it is clear how slowly you have been pedaling. I still need to do this but not as often.

So over time I've learned to deal with my own issues and in time you will also, whatever your issues may be.

Saddle too low, cleats too far forward, inadequate float with your pedals, cranks too long. Your saddle should be high enough that it's impossible to reach the peddles with your heels at the six o'clock position without tipping your hips to the side.

Uh...no. That would most likely result in too high of a seat height. Had you not made the statement, "impossible to reach," I might have let it slip by.

knee pain
 

I would see a SPORTS doctor, soon. Someone who specializes in sports injuries is usually in a better position to keep you on your bike than a GP who may tell you to quit riding.
Proper positioning is very important; I did everything by the book and still ended up with arthritis in both knees. The doctor that replaced my right knee, about 2 years ago, did tell me that the fact that I'd been riding all these years, helped to delay the need for surgery.

Oh no, somehow I missed the more recent replies to this. Thank you!




Thought I'd share an update:




I've been seeing a physical the****** who told me it was overuse and that I should stay in the lowest gears. The PT also gave me some exercises. I followed the instructions and it didn't seem like my knees got better but they did stay about the same for a bit. I also got a bike fit. Then, suddenly, after a not very difficult ride, my legs got much worse. They felt like they were made of wood. Only riding my bike seemed too make them feel better. I guess that's because they were swollen and exercise would get the blood flowing.




Still, the PT examined my knees and didn't think I was doing permanent damage. So I did the 200 mile ride I mentioned above. It wasn't a problem. But my knees still feel swollen anytime I'm off the bike. So, after that ride, I decided I would take a couple weeks off to see if I could kick the problem. Unfortunately, after about a week and a half of doing nothing but elevating and icing, my knees feel the same.




I'll probably see a sports doctor now just to get another diagnosis/treatment ideas. The PT didn't think it was tendinitis because my tendons are not tender. He didn't think it was a torn meniscus either. He thought maybe it could be patellofemoral pain syndrome. In general, I feel pretty much no acute pain (although I might if I started running). It just seems to be swelling, pressure, stiffness and discomfort around the knee.




I'm pretty bummed because I've always been a big runner and hiker too. It's hard to stay still.




Anyway, I'll try to post another update. I've read a lot of knee pain threads now and always wished people would share how things turned out.


P.S. editing this to add that I'm 29 in case that's useful to know.

Well that's great that you aren't seeing as much issues while riding.. Especially that you made the double century. If you are happy with the physical therapy person, stay with them as long as you can. Hopefully the knees will fully recover and be trouble free. Just be aware how much muscle you shove into the pedals in high gears.



Interesting that therapy is okay but not if performed by a the******. At least according to the new forum censor bot. <grin>