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Knee "clickling"

Old 08-14-21, 03:05 AM
  #1  
cyclopath256
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Knee "clickling"

Hi!

I've just returned from my first multi-day bike trip, camping on the way. To my great disappointment, I had to return much earlier than expected.

I was planning to ride some 600km (372mi), estimating 80-100km (50-62mi) a day. The first day I managed 85km (52mi) and the second day 105km (65mi). On the second day and after some 150km (93mi) I noticed strange pressure in both of my knees and every about 5-10km (3-6mi) they would "click" which made me quite concerned. This had never happened to me before. Do you know the feeling when you just need to crack your fingers? My knees felt exactly that way – pressure and a little discomfort inside them until they suddenly (and without pain) "clicked" on their own every few km.

I am in my late 20s and I've never had any problems with my knees. I guess they are not used to the recently purchased clipless shoes and the constant strain of pulling/pushing. However, I can't say that I set off for the ride completely unprepared. I don't own a car, so I cycle to work with normal shoes every day and even the clipless shoes had been used for some 300km (186mi) on various day trips before the camping tour. Sure, that was without 12kg of camping and other equipment. But I assumed this practice had been enough.

I still had lots of energy to complete the trip and I was extremely disappointed to have to return early. But better safe than sorry I thought. After taking the train home and a bit of rest the problems went away.

Do you have any experience with the knee problems I described? What do you do to eliminate them?

Thanks!
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Old 08-14-21, 03:27 AM
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A clear case of Knee Cancer. The highly trained medics here at Bike Forums can perform the requisite knee-ectomy. Your knees will be replaced with 50-year-old Campagnolo equipment and they will work pretty ok!

Just kidding. Look up knee bursitis.
Personally, I've gone in for physical therapy, and they assigned me an exercise to do before each ride. Seems to help. Your issue is likely different though, and so you should seek more appropriate treatment. For me, I put on an elastic strap that pulls on my tibia while I do a dozen lunges. Don't automatically do that of course - find a proper diagnosis and treatment.
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Old 08-14-21, 05:23 AM
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Did you raise the saddle after installing the new pedals? It sounds almost like your seat is a little too low putting excess torque on your knees....but that's just a guess. Never hurts to check your bike fit though.
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Old 08-14-21, 05:58 AM
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Another possibility: research Patella Tracking Error and weak VMO. Not uncommon for cyclists. This was my problem and PT and some minor movement changes have helped a lot.
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Old 08-14-21, 06:35 AM
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Other than getting a specific medical diagnosis and treatment, I have found that yoga or stretching after a workout is crucial.
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Old 08-14-21, 06:53 AM
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You are asking a Medical Question. See Your Primary Care Doctor for a Referral.
Please get it takin care of Before you get OLD.
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Old 08-14-21, 07:00 AM
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Originally Posted by cyclopath256
Hi!

I've just returned from my first multi-day bike trip, camping on the way. To my great disappointment, I had to return much earlier than expected.

I was planning to ride some 600km (372mi), estimating 80-100km (50-62mi) a day. The first day I managed 85km (52mi) and the second day 105km (65mi). On the second day and after some 150km (93mi) I noticed strange pressure in both of my knees and every about 5-10km (3-6mi) they would "click" which made me quite concerned. This had never happened to me before. Do you know the feeling when you just need to crack your fingers? My knees felt exactly that way – pressure and a little discomfort inside them until they suddenly (and without pain) "clicked" on their own every few km.

I am in my late 20s and I've never had any problems with my knees. I guess they are not used to the recently purchased clipless shoes and the constant strain of pulling/pushing. However, I can't say that I set off for the ride completely unprepared. I don't own a car, so I cycle to work with normal shoes every day and even the clipless shoes had been used for some 300km (186mi) on various day trips before the camping tour. Sure, that was without 12kg of camping and other equipment. But I assumed this practice had been enough.

I still had lots of energy to complete the trip and I was extremely disappointed to have to return early. But better safe than sorry I thought. After taking the train home and a bit of rest the problems went away.

Do you have any experience with the knee problems I described? What do you do to eliminate them?

Thanks!
r.e. bold -- Are your clipped in shoes positioned like when you ride in normal shoes? If not there could be a different pressure application to the knee joints resulting in clicking due to friction.

p.s. -- no medical background butt I did sleep in a Holiday Inn Express a number of years ago.
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Old 08-14-21, 07:17 AM
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Originally Posted by BHG6
Did you raise the saddle after installing the new pedals? It sounds almost like your seat is a little too low putting excess torque on your knees....but that's just a guess. Never hurts to check your bike fit though.
Good idea, I'll check that!

Thank you all for your replies! I'll try to play with the saddle height and if that doesn't help, I'll go to see a doctor. :-)

Last edited by cyclopath256; 08-14-21 at 07:25 AM.
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Old 08-14-21, 07:54 AM
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I have the same issue
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Old 08-14-21, 07:55 AM
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Originally Posted by cyclopath256
Good idea, I'll check that!

Thank you all for your replies! I'll try to play with the saddle height and if that doesn't help, I'll go to see a doctor. :-)
Step 1 - See a doctor, preferably an orthopedic sports specialist. He/she will be able to diagnose your issue - possibly using only a medical degree, and no random forum advice. Hopefully, it's a temporary thing, and can be corrected with rest and/or therapy. Mention that you are a cyclist, and just switched to clipless pedals. Don't try to correct a possible medical issue by making bike adjustments on your own, which may make your condition worse.
Step 2- Get a bike fit. A good one. One that checks all your measurements, including cleat positioning (fore/aft, in/out, angle)
Step 3 - See Step 1

DISCLAIMER: My medical training ended with a Boy Scout First Aid Merit Badge in the 60s. If you ever need a broken forearm splinted with a tree branch and a couple of neckerchiefs, I'm your guy. However, after some rather extensive knee surgery, I learned how important bike fit can be. It can make the difference between riding in pain for a day, and walking on crutches for the next few weeks, and being able to enjoy your ride.
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Old 08-14-21, 08:07 AM
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Pete at 80 years Old (Center Guy in Pic) had both knees replaced. Now He Leads 100 mile bike rides.
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Old 08-14-21, 08:32 AM
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Switch back to platform pedals and see if the problem clears up. Lachlan Morton did that in July during his solo alternate-Tour de France, riding more distance than the official race and finishing sooner. Morton is an experience pro cyclist, part of the EF team, but is better known for ultra-distance cycling. He developed some ergonomic problems during the first week with clipless and switched to platform pedals for most of the rest of the tour, including some distance wearing flip-flops or sandals. Morton said there was no significant difference in his power and speed between clipless and free-footing it with platform pedals.

Meanwhile, sure, muscle strain can cause some minor problems with patella tracking, which can cause some annoying clicking. There are simple support braces that can help with patella tracking. Meanwhile, try some home physical therapy (there are zillions of tutorials on YouTube, but only a few good ones), and switch to platform pedals while giving the knees a chance to recover.

With no foot retention it's easier to move the feet around on the pedals to suit yourself. With foot retention - clipless or toe clips -- you're locked into a narrower range. If the setup isn't right for you the only way to fix it is to move the cleats -- but most cleats offer a very limited range of motion, even with plenty of float.

If you do switch back to clipless, go easy for the first couple of weeks and pay careful attention to getting an ergonomically friendly bike setup.
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Old 08-14-21, 09:32 AM
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I have a patella tracking issue on my right leg. Sometimes I tape it with kinesiology tape. The thing that really helps it is swimming. I went to an orthopedic surgeon and a PT for quite a while and all they ever did was hurt it.
But it's a real problem if my saddle is too low.
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Old 08-14-21, 10:44 AM
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Once again, someone asking a medical question in a bike forum. We're not medical professionals, go see a doctor.
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Old 08-14-21, 10:51 AM
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+1 go find a good knee and hip ortho doctor. I ride with SPD mountain bike pedals because they provide more float. My knees like them.
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Old 08-14-21, 10:53 AM
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Originally Posted by Milton Keynes
Once again, someone asking a medical question in a bike forum. We're not medical professionals, go see a doctor.
There are a couple of MDs who are Addiction regulars. We also had a regular DVM, but she doesn’t contribute much anymore.
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Old 08-14-21, 11:12 AM
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Originally Posted by indyfabz
There are a couple of MDs who are Addiction regulars. We also had a regular DVM, but she doesn’t contribute much anymore.
Even so, they can't diagnose over the internet.
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Old 08-14-21, 12:20 PM
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Originally Posted by Milton Keynes
Once again, someone asking a medical question in a bike forum. We're not medical professionals, go see a doctor.
Originally Posted by Milton Keynes
Even so, they can't diagnose over the internet.
Surely I DON"T resemble those remarks!!!

Originally Posted by OldTryGuy
..................p.s. -- no medical background butt I did sleep in a Holiday Inn Express a number of years ago.
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Old 08-14-21, 02:42 PM
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Originally Posted by Milton Keynes
Even so, they can't diagnose over the internet.
One correctly diagnosed the cause of my bottom bracket clicking.
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Old 08-14-21, 02:54 PM
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Originally Posted by Milton Keynes
Even so, they can't diagnose over the internet.
The last ortho I used wasn't any better in person. I would have had artificial knees years ago if I had kept being "treated". In that light, I think I would look for a sports specialist or someone familiar with cycling issues. Steroid shots and pain pills until knee replacement was my selected treatment.
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Old 08-14-21, 03:25 PM
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Like I said upthread, my experience with the medical profession on this subject was less than satisfactory. Around here, they know how to treat football players and maybe runners. OTOH, all the videos I use to learn to tape my knee came from PT's, so they are out there. But I'm pretty sure the number of orthos or PTs that know how seat height affects your knees is vanishingly small, and most wouldn't think of that at all.
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Old 08-14-21, 03:34 PM
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Originally Posted by RH Clark
The last ortho I used wasn't any better in person. I would have had artificial knees years ago if I had kept being "treated". In that light, I think I would look for a sports specialist or someone familiar with cycling issues. Steroid shots and pain pills until knee replacement was my selected treatment.
That's pretty much been my experience as well. The last Ortho I found was honestly the first Dr. I've found who actually sat down and listened to my questions and concerns - he even brought up my bike fit when told him I ride 100 + miles/week.
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Old 08-15-21, 08:28 AM
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As a few other folks noted, seeing a doctor in person doesn't guarantee a constructive outcome. Sometimes feedback from other folks who've had similar experiences can at least offer a starting point toward effective treatment.

The first time I seriously injured 20 years ago (my compact car was demolished upon being t-boned by a full size SUV that ran a light at highway speed), six vertebrae were cracked in my neck and back. I walked around for weeks with a cracked C1 and C2 before an X-ray tech notified me of the injury. If you know how medical protocol works, X-ray techs are NEVER supposed to discuss observations with patients. But this tech couldn't believe that I'd been walking around with an undiagnosed broken neck because the clinic docs neglected their duties.

I was hit a second time three years ago, this time while riding my bike. Broken and dislocated shoulder, grade 4 separation. I saw three or four ortho docs at one hospital and got a different opinion and suggestions for treatment from each. The pain hadn't improved in the slightest after six weeks so I asked for an injection of anti-inflammatories. They referred me to their pain mismanagement clinic, which told me the soonest appointment was months away, take it or leave it, and hung up on me. When I told my next ortho doc, he was surprised and did the anti-inflammatory injection on the spot.

After another even worse instance of misdiagnosis and mistreatment (unrelated issue, thyroid cancer), I ditched that health care system and switched to the VA, which was generally excellent until the pandemic. While the VA was immediately responsive to my thyroid condition, they pretty much shrugged off the persistent neck and shoulder pain, basically saying they'll re-evaluate it every year and eventually determine whether a shoulder replacement will be necessary. Meanwhile, no treatment plan. I'm on my own.

I shouldn't be too surprised. I worked in health care during the 1970s-'80s and saw a wide range of responses from doctors, ranging from very good to total indifference. I'm sorry to say that most doctors I worked with, and those I've seen as a patient, tend to treat patients like machines. They're competent parts replacers and repair techs. They aren't particularly good at dealing with the human element. And, like bicycle repair techs, gunsmiths, etc., there are many doctors who can competently follow the Chilton's Manual for Humanoid Meat Sacks, but who struggle to cope with any symptoms that aren't easily diagnosable and treatable with minimal effort. There are relatively few physicians who earned the equivalent status of master craftspersons who can not only replace parts, but can fabricate custom parts from scratch.

I've had a couple such master physicians and surgeons. Unfortunately they were at the ends of their careers and have since retired. Their replacements are just going through the motions, barely responding to my questions, usually weeks late (they're supposed to respond within 30 days, but it's usually months before I hear anything).

So, yeah, there's a valid reason why recreational and amateur athletes ask questions like this on forums.
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Old 08-15-21, 02:49 PM
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Originally Posted by cyclopath256
Good idea, I'll check that!

Thank you all for your replies! I'll try to play with the saddle height and if that doesn't help, I'll go to see a doctor. :-)
You have this backwards…. GO SEE a doctor, and then check FIT. I am in my mid 40’s with bad knees that could have been avoided in my early 20’s by visiting my doctor for wired pressure in the knees. Now PT for the rest of my walking (and riding) life. Had I just seen a doctor in my younger years I would have had 6 weeks of PT and no more issues.
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Old 08-15-21, 05:47 PM
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I second, or third, or nth, the advice to go see a doctor. Specifically, I would suggest an orthopedist who takes care of your nearest professional sports team, big time university athletic program, or ballet. This organizations will have the best and his (a knee specialist is most likely to be male) patients will not be happy with a suggestion to discontinue their activity. He will be of a mindset to help you continue your sport.
Good luck, and keep us posted.
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