A15th

Hello all,

I'm new to cycling (rower from college who switched to cycling) I did this last year, but around March had to stop cycling because of knee pain. I have gone to 2 physical therapists and things don't seem to be improving much. The pain is on the top inside corner of my left knee and I also have a lot of medial tightness in my adductors and hamstrings.

I know these posts are probably annoying, so I apologize, but I am a little desperate for help. I can't seem to get back on the bike and I have now gone without working out for 4 months (so all fitness from rowing is pretty much gone).

My VMOs are very developed from rowing. I have been strethening my glutes to help with muscle imbalances but there are not really that weak. I got 2 separate bike fits. My leg feels better from the time off but it still doesn't feel 100% and anytime I try to get back on the bike it feels questionable.

I want to fix this issue so I can gain some fitness back and actually race for the first time. Any help is appreciated. Thanks!

Rajflyboy

E bike could be an option while you are healing (just don’t like it too much)

VegasTriker

You might no be able to continue regular cycling if your knee problems are permanent. If two different physical therapists have not been able to provide a solution, that may be the case. There is an alternative and it uses the muscles you already have developed. It is handcycling. I've come across a group of handcyclists twice in San Diego. They are fast and their upper body is far better developed than regular cyclists. I could never outpace that group. Unfortunately, handcycles are very expensive at least for the good ones. You might post in the Adaptive Cycling section https://www.bikeforums.net/adaptive-...t-other-needs/.

gregf83 

All physiotherapists are not equal. I certainly wouldn't give up on cycling based on the failure of two physios.

I don't know where you're located but ideally, you would find a sports doctor with some experience with cycling to examine your knee. Locally, there is a very good physiotherapist who is a former MTB national champion, an assistant professor and also performs bike fits. You may need to do some more research in your area to find the right doc/phsio.

FlatSix911

There are a lot of people who have been able to keep riding on eBikes due to injuries or disabilities.

https://peopleforbikes.org/story/how...anged-my-life/

Slightspeed

I've had a wonky knee since two falls on the same Eroica ride in 2016. They were slow speed tip overs with feet stuck in the evil required toe clips. I fell right on the pointy part of the same knee both times. Slow learner. 😡 I finished the ride, but later that night could barely walk across the motel room. I've had it looked at by orthopedic surgeon, and there is permanent damage that may need surgery down the line. Now, I can ride the bike all day without problem, but walking 50 yards kills my knee. Like stated above, fit is important. If cycling is important to you, get properly fitted. My wife has both a knee and hip replacement, opposite sides. Our orthopedic surgeon, (who is also a cyclist) recommends stationary bike workouts as a low impact therapy to build up leg muscles and strengthen the knee connecting tissue. A pedal/cleat system that allows some horizontal float is important to preserve knee health. I tried Shimano road SPD and Speedplay, but settled on SPD mountain bike pedals for my road bikes. Old school toe clips and cleats provide for zero horizontal float, and I only use for Eroica, where they are required. Good luck with your issues. Hope it resolves itself.

sumgy

Nor are all bike fits.
I agree that he needs to find someone who understands biomechanics, rather than simply relying on a computer program and being able to use a plumb bob and angle finder (both pointless IMO).
Problem is quite probably saddle position related (maybe too far forward, and/or too high).
Potentially there is also an actual or functional leg length discrepancy meaning the OP is pedaling more with one leg, or his knee is collapsing inward as he pedals. Shims and/or wedges may solve this issue.

Maybe see if Steve Hogg has any fitters nearby.

canklecat

Knees are easy for owners to reach. Try some self-massage, including careful use of vibrating or percussion massagers. Some include soft attachments to avoid bruising bony knee bits with tips that are too hard. You don't want hard plastic or metal tipped vibrators knocking and bruising the patella, bony medial condyle, etc. If the massager doesn't have replaceable softer tips, use some foam or an ice pack to pad the bony bits between the massager and knee.

Add a good topical analgesic. I highly recommend Ted's Pain Cream, which really does seem to "reset" nerves stuck in pain mode after an injury has technically healed but still hurts. Read the research papers on their website. Sounded like hocus pocus until I checked the publications and tried it myself. Now I buy it for friends who say it's working for their old injuries too. However it's not effective on recent injuries. That just takes time and other appropriate methods to heal.

That combination finally relieved chronic shoulder pain that had pestered me for more than a year after an injury. Even physical therapy and chiropractors didn't help. But massage, including a percussion massager used to apply the Ted's Pain Cream, finally did the trick after a couple of weeks of daily use.

And while some folks avoid stretching and massage before rides, runs or exercise, I find it essential to enjoying a ride and finishing with less pain -- or no pain on good days.

There are various theories about why massagers -- manual or vibrators -- work. Maybe it's increased blood flow. Chiropractors claim it unsticks bits that are stuck together. I dunno. I just know it feels good. But use vibrators carefully and for only a few minutes at a time. There's a risk of nerve damage with overuse.

Loose Chain

So what exactly is the problem? Can you run? Can you swim? I assume you can walk?

I am not going to tell you what everybody else will tell you. Sometimes things hurt and unless there is some damage being done, then let it hurt. In other words, ride it off. Everything on me hurts, my shoulders hurt every stroke I make swimming, my hip and left leg hurts every stride I take running, my knees hurt when I cycle and this has been going on for, oh, 40 years give or take. Pain is my friend, make it yours.

livedarklions

Have you seen an actual doctor about this? Physical therapists can't tell you if surgery might be in order. Some of the knee operations are really bandaid stuff.

A15th

I did actually yeah. I got an MRI too. They said the cartilage was inflamed, but nothing else looked bad and that I just had to wait until the cartilage decided to die down. That was in July I believe, time off helped a little, but basically anything demanding on the knee (very long walks, running, biking) make it bother me.

Targeting the glutes for excerise have made some improvements, but nothing signficant (I can pedal at low pressure on the bike now, but that doesn't do me any good since I can't get fit), and slowly adding distance doesn't seem to make my knee any more able to handle normal pressure/effort.

Nermal

Around here, no pt will deal with you without a doctor's referral.

Jicafold

There are no clinical trials performed on this product indicating that it has any proven efficacy. It is only allowed to be sold because it probably won't hurt you.

Doge

My kids went from cycling to rowing and back. I used to ride with Xeno Mueller. Cam Wurf is a semi local and acquaintance left rowing for cycling. I've spoken with both of them about making the change. Xeno was just rec cycling. Cam is world class.

As you likely discovered it is not a 100% cross. Your stroke rate is a ~ 1/3 of a cycling cadence and your knee bend is much deeper in rowing. While certain systems are used by both and some things are very developed, some aren't. My *guess* is you are cycling with too low of a cadence and pushing too hard. There is nothing wrong with a hard down pedal stroke, but for you spinning a circle might help.

Anyway, I have no sure cure, other than having seen some pretty good in one do the other, it can be somewhat more difficult.

bakerjw

A couple of weeks ago, my wife and I rode out mountain tandem in some remote areas with modest trails. i.e. no single track but lots of bumps and washboards.
On the first day, my right knee started giving me grief which has happened before if I'm on the bike for 8+ hours or so. With the additional force required for the tandem it came around much sooner in the day. On our mountain tandem, we run flat pedals so it is possible to move your feet forward and back as well as vary rotation. That's something that can only be changed with an allen wrench when using my typical Shimano SPD-SL road cleats. I could not find an angle or position that was comfortable for my knee. The pain went away after a bit but occasionally returned over the course of our 5 day ride.

I didn't see if you clip in to your pedals or not. Oftentimes the usual culprits are under or over extension of the knee. Foot angle if clipped in to the pedals. If you are not using flat pedals, you might put some on and see if you can get a foot position/angle that feels better.

Best wishes on finding a resolution.

JasonD67

I've suffered from knee pain while riding also. For me the answer was the pedals. I went from minimum float pedals (Looks) to high-float pedals (Speedplays). Immediate relief. Maybe checkout the amount of float in your pedals and increase it if you have minimum float pedals. Maybe just try regular flat pedals at first to see if that helps.

Rajflyboy

This is the main reason I love the E bikes so much.

canklecat

They go into all of that on the website. I won't rehash it here because they've already addressed every concern, including why their topical analgesic is marketed as it is. As of now the FDA doesn't recognize resveratrol as a pain reliever, but research indicates it seems to be effective applied topically for some pain, while it may be less effective ingested.

Resveratrol is popular with the woo/alt-med crowd, mostly to be ingested in some medium -- capsules, tea, etc. It's claimed to be an anti-oxidant. Mostly associated with grapes, but apparently much more available in Japanese Knotweed. If it turns out to be proven useful as a topical analgesic, that's good news for folks who are concerned about Japanese Knotweed being an invasive species. It may be morphed into a welcomed crop.

Short version:
Drs. Ted Price and Greg Dussor = neuroscientists, not voodoo purveyors.

Me: Skeptical guy who rides a bike and has chronic pain from various injuries. Tried every topical analgesic available since 2001, some costing ridiculous money. Only Ted's has worked well enough to provide lasting relief**.

Costs $20. Not a bad risk. Considering the quality packaging, understated graphics and overall product design and marketing, I doubt they're making much money on the product. Some competitors cost much more, up to $50, with less info backing up the claims.

Give it a try. It's the only stuff I'm impressed with enough to buy it for friends with similar chronic pain from injuries that technically healed long ago. And I don't have enough money to waste on stuff that doesn't work.

As an interesting side note, Ted originally planned to investigate CBD for pain relief but found the results didn't match the hype. I found that interesting because if his interest were purely mercenary he'd have jumped onto the hemp bandwagon and made a ton of money like everyone else. Instead he went with a fringe product that's less sexy based on some promising research.

However that decision to discontinue researching CBD as a topical analgesic pre-dated the recent relaxing of laws regarding hemp in Texas. For awhile, including very recently, merely researching or stocking CBD was risky because some local law enforcement in Texas were exploiting the gray zone in the law to shake down businesses for easy money in fines. The recent law change should open possibilities for a hemp market, although industry experts say Texas is so late to the game it may be difficult to compete with other states. I'm betting he'll resume studying CBD. The full spectrum CBD with 0.3% THC when ingested has been effective for me for moderate pain. The topical balms from various cannabis products didn't work particularly well for me, although none used any transdermal carrier such as MSM. And CBD is expensive for what you get -- I find it useful for pain up to level 6 out of 10, so it's roughly comparable to ibuprofen or diclofenac but far more expensive. However the mail order company I buy from offers generous discounts to veterans, something like 65% off their already industry-low price.

**(Other topical analgesics using MSM, a common transdermal carrier, provided some temporary relief for 20-60 minutes, tops, with no lasting relief. That includes Stopain, Osteo Bi-Flex and others. Many of those contained all of the same ingredients as Ted's, with one notable exception -- resveratrol.)

Jicafold

True. It's worth a try for $20. I'm puzzled why the OP still has knee pain at such a young age despite an relatively unremarkable MRI. However, what it does show is potential anterior knee pain which he has already addressed with extensive therapy.

Slightspeed

I forgot to mention above that I use Knee Saver pedal extenders on several of my bikes. When I had the knee injury in 2016, they seemed to help. As I acquired a few more bikes, a never got around to adding them to those, so maybe my problem got better. Here's some that Amazon sells.

https://www.amazon.com/KOBWA-Extende...08080455&psc=1

DIY physical therapy is not recommended, and you should get checked for fit, and actual diagnosis, but these seemed to work for me.

BlazingPedals

Bikes generally don't cause knee problems; so unless you're working with a known previous injury, it's most likely a use/over-use injury.

My recommendation is first to make sure you're spinning. Beginners often mash, thinking to go fast they must use the highest gear. Mashing puts too much strain on the support muscles around the knee, and isn't good for the cartilage either.

Second if spinning 80-100 rpm doesn't help is to check your feet on the pedals. Sit on a bed or table, so that your feet are hanging free with knees a foot or so apart, like they'd be on a bike. Relax and look at your feet. Are they both pointing straight ahead or are they toed in or out? Whatever they are, note the angle and duplicate that with your feet on the pedals. Failure to keep the right foot angle will cause your knee to track differently from its natural motion. If your feet are splayed out a lot, that's where pedal extenders come in to keep you from banging your heels against the crank arms.

If 1 and 2 don't help, try adding #3 , namely just going slower until your knee's support muscles are in better shape.

tomato coupe

There are a variety of drugs and treatments that can reduce the inflammation: cortisone, iontophoresis, Voltaren, PRP, acupuncture, dry needling, massage, and good old ibuprofen. Talk to your sports medicine doc and have at it.

Viich

Agree with a bunch of commenters, with one addition - try shorter cranks to go along with using lower gearing, spinning faster and going slower.

sumgy

Good advice.
My knees can't cope with Time road pedals (self-centreing), or Shimano MTB pedals.
Time MTB pedals and Speedplay road pedals are what work for me.

fishboat

Google "andy pruitt bike fit"..he has a good presence on youtube also. His book is packed with good info. Sounds like you have a fit problem that needs to be worked through..and out.

Some background:
https://cusportsmedcenter.com/about-us/

Andy's book:

https://www.amazon.com/gp/product/19...?ie=UTF8&psc=1