Cellar

Hey everybody,

I wanted to ask a question regarding mileage, and how much is too much. I've been off the bike (but still fairly active) for about a year and a half. I have tried to start up a few times since I stopped but noticed some knee pain, which kept me off. I'd like to do things a little better this time and try to avoid 'too much too soon', and wanted to ask the question:

If my legs feel good and I just go out to spin, is that a problem? My knees may be a little angry if I mash, but will spinning and getting time in the saddle exacerbate the problem?

I was feeling good yesterday on my ride, so I took a little detour. The ride became quite a bit longer than planned, but everything felt pretty good. I noticed that one of my knees hurt a little bit if I really pushed that leg (at the beginning of the ride, it is at the front of the knee cap.), but felt fine if I focused on my pedal stroke and cadence...more the cadence really.

Any thoughts? (I do a lot of kneeling/bending/lifting/up and down stairs at my current job and have had some knee issues from that.) I'm looking at exercises and stretches to help with this. I'm trying to listen to my body, but don't want to wake up the day after a ride and think "Oh sh*t....over did it." I'd just like to be out on the bike.

Cheers,


P

Also, I have used the search function...I know knees are a big topic.

CliffordK

I strongly believe in "use it or loose it", so keep riding.

But, "knee pain" is a very broad catch-all.

People suffer from tendon issues, patella (knee cap) problems, as well as joint and cartilage issues. Oh, and OBESITY.

It may help to know what your pain is like, whether you have associated swelling, and whether you've had any surgeries to fix it.

Personally, I view mashing as strengthening the knees, especially the tendons around the knees. I've looked for good scientific studies with respect to mashing and knees, and haven't found any.

Another thing to keep in mind is your shoes, cleats, clips, or flats, and the adjustment of them.

Some of the questions might be best answered by a sports doctor. I wonder if there is anything like geriatric sports medicine? If not, there probably should be (depending, of course, on the individual needs).

Cellar

I think the best way to describe the pain as: sort of sharp, beginning at the base of my kneecap (or slightly below it). Definitely not the inside or backside of the knee. The same type of pain happened when I hopped down the last few stairs in a stairwell. Most of the time I don't notice anything really; a sure way to make it come back is to do a squat where I go past horizontal with my legs. (Butt near the floor, with good form.)

No swelling, no surguries. I had my bike fit when I bought it but did talk with my LBS about pedals/shimming cleats. I currently use speedplays.

Thanks,

P - Sadly, angry knees at age 30.

Machka 

Read this article about knee pain ...

CYCLING PERFORMANCE TIPS - Leg, Knee, and Hip Pain

nightvision

You can read up on this chondromalacia patella. I was suffering from that when I started to ride a lot, about 5-6 times a week. I had a sharp burning sensation outer to the lower part of my knees. It cracked a lot when I did squats (without any weight). The cause was that I typically did 3 exercises for my legs (leg extension, leg curls, leg presses). Due to limiting myself to these 3 exercises, my quads, hamstrings, hip-flexors were all at different strengths so my knee cap was off-center because my outer quads were stronger than my inner quads. To get better I basically had to ride less (1-2 times a week) and I incorporated other different exercises in the gym and eventually all my weaker leg muscles got stronger and my knee cap is back in the center. I have no issues with that and have been back to riding multiple times a week.

79pmooney

What you describe sounds like chrondomalacia patella (CP). I was diagnosed with it in 1978. I still live with it. The doctor who diagnosed me told me nore than I have heard in any one place since. I wrote a post for the forum I was on 14 years ago that I will repeat here. Maybe it will help you, (I don't width it on you because that would mean you do have CP. The doctor who diagnosed me told me I had to follow his advice or the surgery wold be done with a saw. Ever ortho I have spoken to since has said he was right. So:

Chrondomalacia patella. 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

Cellar

Thanks for the responses everyone, and Ben for the comprehensive post. I read through the link that Machka posted, good stuff in there too.

So what I am getting from all this is:

-Stretch/work everything. (Hitting the foam roller shortly here. Also that back problems can manifest themselves in the legs, per the linked site.)
-Keep the knees warm
-Exercise the quads
-Keep a high cadence
-Look at cleat/shoes...possible issues there.

Some more info about my situation:
-I think my seat height is OK, still the same from when I had it fit at the store.
-I sit fairly far back relative to other people I see; I have long legs.
-I feel comfortable on my bike.
-***I notice a little wobble from side to side, sometimes, of my knee as it goes through the pedal stroke. ***
-My leg muscles/tendons are all pretty tight right now.

Observations/questions:
-So for riding, it may not even be an issue of too much work on the knee/problem areas (mashing/etc), but repetitive motion? Alternatively, does this mean spinning is also bad for the knee in question?
-What impact would this have on ultra events? (Would like to get past my old mark of 200k.)

Thanks again everyone, looking forward to getting this all squared away.

P

79pmooney

One exercise I did a lot in the year after my diagnosis was to ride "brushing the top tube". Attempting to wear out the paint on the sides of my top tube by brushing it with my knees as I rode. I didn't actually hit it, but attempting to ride that knock kneed was a real benefit for my knees in both the short and long run. That may just be a quirk of my particular situation, but it might also be worth trying. Using all the tools I learned, I was able to resume racing that season, building to a 100+ mile race with Cats 1 and 2. And I did that without long term further damage. I've ridden 150,000 miles since. (No competition.)

Ben

Carbonfiberboy 

If position is correct and the pedal stroke is even, I don't think repetition, i.e. cadence, will bother one's knees. Mashing can hurt if your knees aren't ready for it.

I'm a fan of building up strength of muscles and tendons in the gym. Barbell squats, leg presses, single leg presses, step ups, Romanian deadlifts, leg extensions only from 120°-180°, all that stuff helps. I started by doing sets of 30, which act to improve endurance and motion without overly stressing anything. It's important that the weight should be such that the last couple of reps are very hard to get.

On the bike, work at having the pedaling seem effortless. That sounds stupid, but try it.

Cellar

I have noticed that my knees angle inwards towards my top tube, feet 'slightly' pointed in. I'm still wondering about that knee wobble. Any thoughts? Rolled and stretched my legs. Exercises in the A.M.

Would it be worth getting a more thorough fit? The fit I got when I bought the bike seemed like it would cover most of the bases, but there may be more to be done?

Carbonfiberboy: It doesn't sound stupid at all. I was trying that with the spinning; kind of hard to do though as it's tempting to push and go faster.

Thanks,

P

Carbonfiberboy 

While we do see pros pedaling "knees in," and it is more aero to do so, the "authorities" say that the best thing for the knees is to keep them centered over the pedals. Which makes sense. When I pedal knees in, I also pedal pigeon toed. The knee wobble might be a case of some muscle firing at the wrong moment. You might try gearing way down and pedaling very fast, as fast as you can without bouncing on the saddle, thinking about having a cushion of air between your foot and shoe insole. Doing that once or twice a week for a while might just fix it. Or maybe not, but worth a try.

Cellar

Going to use some of my roommate's resistance bands for the exercises mentioned in a separate post for working on the VMO. Thanks everyone for the replies.

I'll update in a few weeks to let you know how I'm doing.

Thanks,

P

Cellar

Update:

I noticed on my ride tonight that I find more pressure being placed on my left sit bone than my right. It also feels like my left leg is more powerful than my right. I also noticed (I think, else I might just be convincing myself that I am) that I dip my body slightly to the right when my right foot goes down.

Thoughts? I am reading some stuff on Steve Hogg's website right now. Was thinking of going for a fit in Reno, 3 hours away...

berner

I have a cranky knee that I believe began when I spent about 8 days on hands and knees lofting a 65 foot sailboat on a plywood floor. I would recommend that if you must work on your knees, wear knee pads.

For my cranky knee, what helps the most is exercises to strengthen all the muscles and ligaments surrounding the joint. Since cycling strengthens the muscles that articulate the legs front to back, I focus on lateral exercises to strengthen muscles that move the legs to the sides and inward, such as those used in riding a horse. If I do these exercises on a daily basis, my cranky knee keeps quiet. Otherwise it begins to complain and I begin thinking I need a nee brace. Then I step up the exercises and forget about the knee brace.

Carbonfiberboy 

Did you build the boat? I always used knee pads for that, but now it's all electronic, yay! Similar with the knees. The gym is wonderful. Hiking's good too. I also have to stretch now; never used to.

berner

I worked for several boatyards. Early on, during the 80s, we built custom aluminum sail race boats up to 65' including the one that lost the America's Cup to Oz. I moved away for a while and when I returned to Rhode Island the boats were still mostly race sail with a few motah yachts in there but now they were carbon fiber and more extreme in design. To my eye, the new designs are sort of industrial looking and I learned the ropes when there was a strong element of romance in sailing which I believe is now gone.

I used to sail and race quite a bit when much younger but not having an independent income it became necessary to work regularly. I have friends in Newport who make a living delivering boats for the rich and I would occasionally hitch a ride one one of these deliveries. These days I ride the bike mostly.

Cellar

Short update, it's Sunday and snowing...

-I've been stretching regularly and hitting the foam roller. I do this almost daily.
-I've done the leg raise/quad flexing as described above.
-Knee pain is still persistent, but not bad if I take it really easy...One ride I went out a bit enthusiastically and was sore for 3 or so days after.
-I get a twinge if I push too hard as the pedal stroke falls forward (from 1 o'clock to 5 o'clock roughly). I find it does this if I'm using my knee, but not so much if I am "pushing" with my upper quads, leading with my heel into the bottom of the stroke. Does that make sense?
-The pain is manageable (I don't notice it unless I bike, or have biked the day prior. Day to day I am A-OK) and I don't ride if I have concerns about the knees from the start.

Still thinking about that comprehensive bike fit and dropping ride mileage/times down. Current rides are around 14mph for 70-80 minutes, generally 3 times a week. I might do 40-50 minutes 3-4 times a week. No sore muscles, just the d*mn knee!

Looking for some resistance bands...

P

edit: Also, I wear knee warmers under tights for every ride. I'm also taking Glucosamine & Chondriton tablets 2x a day. Going to run the bottle out on that one before I pick up something new.

Cellar

Hi everybody,

Thanks again for all the input. I'd like to give an update on my situation.

I've been keeping up on stretching and leg exercises, and they all seem to be helping. My legs feel pretty good, and I think I've found that about ~5hrs a week is where I should be right now. Pretty low, but I'm in it for the long haul. Regarding fit and things, I found where my knee pain was coming from. I'm ignorant of bicycle mechanics much beyond changing a flat, and to save myself some embarrassment I'll just say that I had been doing something that tilted the back of my bike maybe 4-5mm or more. I fixed that and the knee issue I had seems to have gone away.

Now I'm starting to get a little bit of knee ache on the insides of the knees. I may try adjusting my cleats out to move my feet in towards the BB. This seems to be the recommendation by a few sites. Still thinking about that fitting.

Anyways, the bike felt great after my adjustment, now I'll keep on with the exercises/stretches and keep working on fit.

All the best,

P

Carbonfiberboy 

Yes, that makes sense. It'll be easier on your knees if you use your legs to push on the pedals everywhere but the downstroke. The downstroke will take care of itself. Push forward at the top of the stroke ("kicking a dog off your front wheel"), pull back at the bottom with your heel cup with ankle relaxed ("scraping mud off your shoe") and hold that pulling action into the start of the backstroke.

The knee being a little sore on the inside might possibly be your VMO getting too strong? You might try pointing your feet straight ahead and see if that helps. Just try slightly different things.

You could try doing one-legged knee bends on a chair beside a wall, just touching the wall with your fingers. You could try doing one-legged pedaling on the bike while going up a long, very slight hill. That helps balance left/right strength and pedaling action. Jam the unused foot into the bottom of the frame triangle so it doesn't get hit by the other pedal. It's really, really hard to do but is completely possible with practice.

Cellar

I moved my cleats to the outside of their range and my right knee (the previous problem knee) feels great. I'm still feeling it a little bit on the inside of the left. So, having my feet pointed more forwards and less towards the bike seems to have helped. I'm not sure where to go from here as far as my left knee is concerned.

I keep trying to see where a wobble might be in the left leg's rotation. Sometimes it looks like the knee comes in towards the top tube, but when I am pushing on the pedals it can wobble (out?) a little at the bottom of the pedal stroke. The cleat is as far as it can go to the outside of the shoe, and it did help, but would in-shoe-shims be the next way to go? I'll look at it again on my next ride.

Thanks,

P

EDIT: Also, this thread seems to be drifting to something more fit oriented. I may post a thread in "Fitting your bike" part of BF. Thanks!

Carbonfiberboy 

My WAG is that more plain old ordinary leg strength would help most. Hence my talking about one-legged knee bends and that sort of thing. I've been a gym member since '79 and think squatting is a big help. When I do barbell squats or one-legged presses, I toe out slightly and concentrate on keeping my knee exactly aligned with my foot, never moving from side to side. Even the slightest side to side motion with a heavy weight risks injury. Hence it might be true that one can get RSI with high volume knee movement at light pressures, i.e. pedaling.