work4bike

I've noticed that when people say they have knee pain they almost always equate it to poor joint health, however, if they have a pain in their shoulder or elbow, they are not so quick to equate it to anything related to joint health. A good example is Tennis Elbow. If someone suffers from Tennis Elbow, they usually look for remedies to address the sore connective tissue.

However, when someone suffers from knee pain, such as when running, they usually say something like: "I can't run, my joints are too messed up..."

I personally believe there is a definite difference between Joint pain and pain from stressed out connective tissue; however, it seems to me that when it comes to the knees, most people equate any pain in the knee as joint related, where in most cases it's probably just an issue with connective tissue.

Disclaimer: I'm not even sure I know what joint pain feels like, but from what I've heard I don't think I've ever had a problem with my joints. When people talk about the feeling of bone on bone, that kind of pain I typically believe is what Joint pain feels like -- I don't ever want to feel pain like that.

However, I definitely know the feeling of sore tendons/ligaments around the knees (and other places) and have definitely felt that pain after some exercise, whether it be running, cycling, lifting weights....

I also know from experience that if you injure connective tissue too much it can take a very, very long time to recover, nothing like a strained muscle. But I also know if you do the right things, you can recover and start to build up your body for anything, including running, hammering big gears and lifting heavy weights, but it takes patience.

This is where I can get in trouble... I believe many people use the pain in the knees as a crutch, calling it "bad joints", so they don't have to feel compelled to do certain things, such as running or riding with big gears...

Curious of others thoughts....

canklecat

It's difficult to feel the difference between inflammation of connective tissue and actual joint problems. And chronic inflammation can lead to joint disease. So it's understandable why some folks hesitate to strain their joints. Especially if they've been around family or friends who had joint replacements.

For years joint surgery was iffy, not necessarily an improvement. My granddad's knee replacement surgery in the early 1990s didn't go well and he didn't cooperate with physical therapy, so it's hard to tell whether the surgery itself was successful.

My mom's first knee surgery in the 1960s was a botched mess -- her knee was always swollen twice normal and never regained anything close to normal mobility. Her other joint replacement surgeries went more smoothly and did restore mobility and extended her relative independence for about 10 years. In her case there were definite joint deterioration issues. Now she's in a nursing home because of severe osteoporosis and joint disease. Home care just wasn't feasible anymore.

Considering joint problems, arthritis and knee problems run on both sides of my family, I'm pretty careful about my own body. I don't avoid exercise but I do minimize impact exercises such as running. I bicycle and walk a lot. I do range of motion exercises daily and basic strength stuff at home without weights or apparatus -- pushups, squats and lunges, abdomen and back exercises, etc.

I have some occasional bouts with mild psoriatic arthritis but nowhere near what my mom's osteoarthritis, and the rheumatoid arthritis some of my neighbors have.

When you see people experiencing that much chronic pain for years, it's understandable why they don't get much exercise. There are limits to what can be done. If they take strong enough pain relievers to cope with the pain so they can move, there's a risk of addiction and they tend to be groggy and lethargic. Anti-inflammatories can help to some degree but also carry risks. Nerve blocks can mask pain but increases the risk that a patient with damaged joints and bones may overdo it and cause serious injury.

I take a lot of ibuprofen to cope. My usual breakfast is three ibuprofen with coffee, then second breakfast of oatmeal, yogurt and banana. After about an hour I can lift my head (permanent C2 damage from a 2001 car wreck when my car was t-boned by a driver who ran a light). Then I can think about a bike ride, walk or some exercises.

The downside is ibuprofen may aggravate psoriasis and psoriatic arthritis, so it's a trade off. Not to mention the GI irritation and other stuff. But what are the options? Not much, really.

Supplements like chondroitin, glucosamine, etc., seem like woo to me. I just finished a month with Osteo Bi-Flex. Can't tell any difference. I've tried many of 'em before, never noticed any difference. NIH studies indicate there's no evidence of any benefits. If it makes folks feel better, that's fine. I can't afford to spend money on stuff that doesn't help.

I feel more relief from a good bike ride. So I'll keep doing that as long as possible.

Regarding effort, I don't mash much while sitting. But I do stand to climb and ride out of the saddle for 10-30 seconds several times each ride. Just to work different muscles, relieve the saddle pressure, etc. Seems to help. Mostly I sit and spin.

When I feel knee twinges I shift my feet around or adjust the saddle. I just switched the road bike to clipless and the floating cleats leave plenty of room to find a comfortable position when I feel a bit of a knee twinge. Other than reminding myself to unclip for stops the transition from platform pedals hasn't been too difficult. I'm probably more likely to damage my knees falling from forgetting to unclip than from mashing.

FBOATSB

I've heard from many young people, seemingly fit, that their (X) joints are "bone on bone", almost seems like a popular phrase nowadays.

If you actually go to an Ortho and get an x-ray, "bone on bone" can be demonstrated and diagnosed, in my case as osteo arthritis. This is my right knee which will be getting replaced just as soon as I get down to an acceptable BMI to satisfy the Doc's guidelines:

Funny thing is, the pain level is quite manageable with some standard arthritis drugs, as long as I don't fall wrong and break the thing altogether I've had many ligament, muscle, "soft tissue" injuries and inflammations, both chronic and acute that hurt much more. The quite audible popping and cracking coming from that joint was enough to freak out a young physical therapist a few years ago. In hindsight, I probably should have warned her
As far as running is concerned, I have plenty of other maladies which will mean never running again, that's what the bike is for eh?

Carbonfiberboy 

I think the OP is correct. Too few people believe in the corrective ability of focused exercise. Osteoarthritis is a different animal. I have friends with that, too. What they do is take ibuprofen when they ride and climb at 100 cadence, faster on the flat.

My approach is always to figure out what's actually wrong, find the corrective action, and take it. That's always worked for me. For whatever reason, I've never had any arthritis, just "joint pain" including lower back pain. So far, I've always found a fix, including for my shoulder impingement. I have one cyclist PT I trust enough to follow their advice, all others have been failures both at diagnosis and corrective action.

My bicycle has been the best and cheapest doctor I've ever had.

Edit: I also should say that there's no such thing as overstressing your joints. There's only incorrectly stressing your joints. You can and should squat as much as you possibly can, working up to it and using correct form. Same with all other exercises, which always involve joints. Work it until it hurts, let it rest until it doesn't, repeat. If it doesn't hurt, you're not even close to fixing the problem. That's only true of course if you're doing the right thing in the right manner!!!

wolfchild

Is this just your opinion or is it an actual scientific fact ??...Not sure I can agree with you on that one. I think there is a limit how much stress our joints can take before something breaks down and requires a surgical fix to correct.
I am pretty sure that majority of these powerlifters who continually squat 900 pounds and deadlift 1000 pounds over and over again will eventually have to stop doing it or they will end up with some serious pain and damage when they get older.

Cuyuna

No, in most cases, knee pain is joint-related. The distribution, arthritis vs strained collateral or cruciate ligaments, will vary by age, but the root cause of "strained connective tissue" is self limited and will go away, whereas arthritis isn't going to go away...it will get worse.

Carbonfiberboy 

Here ya go:
https://www.muscleforlife.com/weight...oint-problems/

Years ago I tore a meniscus doing something stupid in the gym. The surgeon said my meniscii were perfect - no evidence of any deterioration. I was in my early 60s. I think they're still perfect.

An interesting but little known fact about meniscii: The problem with repair and maintenance is that there's no blood circulation in them. Thus how can oxygen and nutrients get in there? Through repeated heavy pressure. You squeeze those things into your meniscii when you jump or lift heavy weights or maybe even run. It's disuse that's most harmful.

CliffordK

I strongly believe in "if you don't use it, you'll lose it". And some stress is good as long as one doesn't overdo it.

I've had sore knees for eons. I do struggle with my weight some (170 to 200 or so), although lately it has plateaued at about 180.

Anyway, I'm a "Masher". Perhaps that is naturally evolving some. I just wish I had discovered 11T (and 9T) cassettes earlier, but I was stuck in a world with the occasional 12T freewheel, but mostly 13T freewheels. But, now, much to some member's horror, I have the good ones

Anyway, I've jumped from maybe 1000 or so miles a year, perhaps even less up to greater than 6000 miles a year. And, my knees have never been better, mashing, pulling up, and all. Although, get off the bike for a week, and the knees get sore again

Like you, I've tried to evaluate where the pain is, and came to the conclusion that a fair portion of it was in the tendons. Thus, I'm also not afraid of mashing or standing climbs, as I believe they strengthen the tendons, and thus make stronger, and more pain-free knees.

Certainly weight is also associated, so the closer I approach 200 lbs, the worse off the knees.

I haven't done much jogging for quite some time, but also believe that mild jogging would also benefit the knees, as long as it is kept mild with rest-days.

Of course, one has to realize that each person is different, and some may have actual cartilage damage or bone spurs.

Actually, I had a knee that would "lock?" I'm not sure how you describe it, but if I bent it wrong, then stood up wrong, it would cause enough pain to drop me on the ground. I never had it treated, and just learned not to move it wrong, and how to recover. Over many years, that disappeared, so now it has been at least several years since it happened, not a weekly occurrence as before. Anyway, I'd much prefer natural healing to having doctors open up the knees and repeatedly shave out cartilage until there is nothing left.

wolfchild

Agree about the disuse. If you don't use it you loose it....but at the same time overuse injuries is a reality, there is such a thing as too much of a good thing.

Carbonfiberboy 

Overuse injuries are, I believe, most commonly known as RSIs or Repetitive Strain Injury. But . . . every RSI has a cause and it's always bad form, and for every RSI, there's a fix through exercise. AFAIK. Been there, done that. Our bodies are amazing self-repairing machines, and with the correct stimuli they'll keep doing it until our telomeres get too short. But . . . there's a but:
https://www.apa.org/monitor/2014/10/chronic-stress.aspx

Hence the need to meter out the training stress carefully and to keep one's life stresses at a minimum. Too many athletes find that their sport stresses their personal life. It's a big problem for the above reasons, a bigger problem than most want to acknowledge. I'm a lucky SOB: my wife rides tandem with me.

An interesting discussion occurs to me. Engineering is nothing more than stress and strain. Stress refers to the load. Strain refers to the deformation which results from that load. So it's interesting that RSI refers to strain, not stress. IOW this injury is not the result of loading, bur rather the result of repeated slight damage to what's being loaded, however lightly. For instance the commonest RSI in the West is from keyboarding. The fix for that RSI is heavily stressing the strained tendons or ligaments, thus making them stronger. It's not rest. It's forcing them to repair themselves.

knitguy

Meanwhile I'm 30 and have damaged cartilage and mild arthritis in both patellas. It can be seen in MRIs, I have a hard copy of arthroscopy pictures from one doctor of cartilage damage in at least one knee, and said damage and arthritis has been confirmed by two doctors at two seperate practices/hospitals (over the span of four MRIs, two per knee probably four years apart). That doesn't mean that I'm going to stop being active, but it does mean that I am acutely aware of the difference between soreness and pain. I will work through soreness, I will not work through pain (I will, however, see a medical professional for pain).

Good for you for getting to your 60s without any miserable joint deterioration. That said I can assure you that not everyone is or will be in that position.

Carbonfiberboy 

Several friends have kids who destroyed their knees in their teens with ball or contact sports. I stayed away from all that and did endurance sports, recreational Alpine skiing, and Nordic racing. Never hurt my knees until I tore that meniscus. That's my rec to parents: try to keep your kids away from that crap. It's really bad in our culture. Adulation of that crap is on big screens everywhere you look. People know the names of sports figures back to 1931 but don't know the periodic table. Bread and circuses.

I was at a gym where a serious bodybuilder worked out. One day he looked out the window and saw a drug buy going on. He ran out the door and started shouting "Don't do that! Your body is a temple!" I was a little taken aback, but also sympathize with that feeling. The older I get, the more I see that life is all about choices where you won't know the result for 20-30 years and tradition is not particularly helpful.

I've been a hiker for over 50 years. I've always noticed how few gray haired hikers there were. I always thought that was just that they got weak or lost interest or whatever. About 10 years ago I realized that I've only been seeing the uninjured out there. As people age, their injuries take a toll.

For cyclists, it's usually blowing out your heart. I'm now the oldest cyclist in our ~130 member group, mostly because I still have a fully functioning heart. Why? It seems that's partly because I came to road cycling late. I rode in my teens but quit and didn't pick it back up until 50. The other thing is that I try to never get overcooked and always recover thoroughly from hard efforts. I've seldom done formal intervals. Yeah, so I've never been really fast, but then I've never cared enough about that to damage myself for it.

Rode a century on Saturday, averaged 17 in the saddle but only 3400' climbing, temps 32° - 43°, a little rain, snow, sleet, graupel, but mostly just wet roads. Completely recovered on Monday, going snowshoeing with my wife. Good times.

Sorry for the long, somewhat OT rant, but this stuff has been on my mind lately.

FBOATSB

What an excellent post. In high school, I succumbed to the contact sports kool aid. Plenty of opportunity for the big fat kids as linemen aka human battering rams. Two hyperextensions ended that while setting me up for arthritis. Later in my twenties I was riding centuries just for fun on my Schwinn Varsity but couldn't run around the block. Long time ago.....

noglider 

I've had mild knee pain since I was 24 years old. I'm 57 now. I manage. A bike shop mechanic said it's important for my cleats to be aligned, so I let him install my cleats last year. That probably helps. I take glucosamine+condroitin pills every day, which also help. I try not to push too high a gear, and I never measure my cadence, but I think I'm doing OK with that.

knitguy

Yeah see my mom didn't let me play contact or high impact sports (she was worried about injury) - my primary sports were swimming and rock climbing. That said I stopped participating in sports with any real frequency when i was around 15 in order to prioritize music (it was a time commitment thing - I couldn't compete in rock climbing and also be as serious as I was about flute due to scheduling conflicts during the competition season). All that is to say, I'm not part of the, people in their 30s with issues in weight bearing joints due to high impact sports, demographic. As an aside, alpine crashes can lead to some major knee issues no?

That said, I did have patella alta bilaterally which eventually lead to dislocating one knee when I was 20. While the dislocation happened when I was rock climbing, it was essentially waiting to happen anyways. That then lead to the other knee overcompensating, major patella instability in both (and that's where the arthritis and related cartilage damage comes in), and a series of surgeries, and massive amounts of physical therapy.

Thankfully all of the physical therapists I've had in relation to my knee issues have been surprisingly good. Two have been/are cyclists and all four work(ed) with both amature and professional athletes on a very regular basis. While I'm currently stuck inside due to a fractured humerus it is very clear that I'm coming out of my fourth (and hopefully final) knee surgery stronger than I've been since high school. It's a combination of being stronger going in, a pair of very good PTs, and working my ass off both in terms of doing my home exercises and on the bike inside.

canklecat

Yup, U.S. high schools put way too much emphasis on competitive sports for the elite few -- especially football in the south -- at the expense of overall fitness for everyone.

Besides ruining young bodies rather than emphasizing lifelong fitness habits, schools have participated in corrupting the health of young people by allowing junk chemical dispensaries -- sodas, candy and snack vending machines -- the proceeds from which are used to fund football and other programs for the few rather than benefiting the entire student body.

In effect the school system is punting the burden of health care onto taxpayers and the entire economic system later, by emphasizing contact sports too early that lead to lifelong injuries, and de-emphasizing overall fitness for most kids, and encouraging poor diet, aggravating the worsening problem with obesity, diabetes, etc.

I'm starting to sound like those curmudgeons I detested in my own youth, but the fact is when we were kids you rarely saw obese kids. Most kids were lean and reasonably fit from normal play activities. Nowadays it's rare to see any school age kid who doesn't have a layer of about 5-10 lbs of excess blubber, just from years of snacking and indolence. And that's being promoted as the new normal, so we don't risk harming the self esteem of the fattened cattle. It's not the kids' fault but they're being abused by an entire system that treats them like commodities and consumers for profit.

T1mWelch

Of course, people who don't understand medicine can misdiagnose. Nothing is surprising in this.

Gym123456

I had a problem during Freshman year of High School, called 'Osgood-Schlatter Disease', which is caused by the lower patellar tendon pulling on the connection point to the Tibia. Mine were fractured, but the bone hadn't released. Rest and time are the best remedies, but it was most evident when kneeling, squatting or leaning backward. I have also had tendon pain but the most recent was from my foot slipping in the bathtub and trying to make one knee bend sideways, so....

If activity causes the pain, I have been told and have found ice to be a great help, although heat can be good if the surrounding tissues are tight and need to be relaxed. I have only found Aspirin and some version of Naproxin Sodium to help, although Alleve and the generics have sodium, so many can't use it.

I had a bout with 'Runner's Knee' (Chondramalacia) and used Naproxin for it, but it's not good to take too much of that, so I would ice/elevate and rest it. This is particularly painful going up and down stairs, which I do very frequently, so I needed to find a solution. One night, I looked on YouTube, to see if anyone had videos to explain what I might be suffering from and had only typed 'Pat' in the search bar when it showed 'Patellar Pain Syndrome', with many videos from doctors & physical therapists explaining what it was and some solutions to try. I decided to try Kinesiology tape and after four applications, it was gone.

Most recently (June 1, 2021), I dislocated my left kneecap but I haven't needed much pain relief.

DaveLeeNC

I am also a graduate of the Osgood Schlatters disease school. Mine hit me in 5th grade and ended with a torn tendon. Many months of rest seemed to fix the problem. 60-some years later I struggle with osteo arthritis in my knees and spine (spinal stenosis). Few of us get out of here on an easy path.

dave

chaadster

I had O-S, too, in 7th, and got a full leg cast for each leg to the tune of 2 or 3 months apiece; I don’t recall exactly anymore how long it was, but it was many weeks. I’ve never linked my arthritis to the O-S, though; is there data to suggest that O-S sufferers are more likely to develop arthritis later in life than the general population?

Gym123456

No idea about the data- I have been going for PT because I dislocated my left kneecap (I tell people I was proving that I don't actually have Cat-like reflexes) and WRT OS, that was the worse of the two when I had it in high school. The recent X-Rays showed that the tibial tubercles had healed completely and the cartilage was intact. I have always been a bit knock-kneed, which brings its own issues, but I think I have been lucky since I haven't had a lot of knee problems. Didn't need casts and was cleared to be on the golf team while I was excused from PE class. I had a bout of Chondramalacia (Runner's Knee) a few years ago, brought on by knee extensions with too much weight and that really sucked. It was more painful than the dislocation.

If I have Arthritis in my knees, it would be from the decades of standing, walking and kneeling on hard floors in my work doing AV/home theater/networking jobs.

The frustrating thing I hear from Drs is "Everyone is different". No crap. The physical therapist says it, my friends' doctor says it when he asks about his herniated disc,...SOMEONE must have crunched the numbers.

Carbonfiberboy 

Apparently not. The little info available says that later knee pain in adolescent OSD sufferers is connected to the tibial tubercles not ossifying correctly. Osteo arthritis, is not mentioned. The later knee pain seems to be quite common though. And if the tibial tubercles aren't quite like they are supposed to be, seems like future kneecap positioning could become an issue. As you say, it is true that everyone is different.

I didn't realize that the knee pain I've been seeing in the children and grandchildren of friends was a result of them being in sports before their bones had finished growing. I had assumed that it was do to an injury. OSD apparently results simply from overuse by adolescents.

Gym123456

When I was diagnosed, the specialist said it was from bones and tendons growing at different rates. Makes sense, but I WAS involved in several sports and when we played basketball during PE class, it was on a concrete floor with some kind of tile on it. The older classes often played on the real court, which was wood and much more forgiving. Surprised that we didn't see more shin splints, which I had after playing on the same tiled floor during open basketball on weekends, years after I had graduated.

At 64, rehab for a kneecap dislocation sucks- I'm 6 months out from the injury and 4 months from starting rehab and I still can't do a full knee extension when sitting or laying down. My quads partially tore and in the first few days afterward, I was walking without my brace (stupid, really) and it buckled several times ,which I'm sure, caused further injury. It was definitely painful. Can't go up/down stairs normally, which sucks because I have a 2 story house and need to go up & down frequently. The weird thing is that during the first two months, I used almost no pain meds- Alleve and Aspirin a few times each and that was all. I did ice it fairly regularly, but that's the extent of the treatment.

Carbonfiberboy 

Well, I don't know. Seems like it's not a doctor thing. Best thing I can think of is go see the kneesovertoesguy and sign up. It'd be coaching by someone who seems to know how to coach knee pain. it's cheap compared to the alternative. I'd do it in a minute.
https://www.atgonlinecoaching.com/

I have no relationship with him, but I've tried some of his stuff and it works. He's all over YT, but you need coaching.

Gym123456

Do any of you use Kinesiology Tape? I had seen it on athletes for years, but didn't need to know what it did until my kneecap pain several years ago, which started while I was doing knee extensions on a machine. I tried it and the relief was almost immediate, it improved daily and after four applications over a few weeks, it was gone. This past weekend, my knee felt like crap and, while it felt strong in some ways, it seemed to want to hyperextend when I walked. I decided to tape it last night and again, the knee improved, due to some correction of the patella tracking better. I'll see how it does during therapy today, but I suspect it will be a big improvement.