alvaroe16

Guys,
I am hoping to get your experience on some knee issues. I know we all go through these but I want to know how to best tackle it. The last 4 rides I have gotten pain in the Outside of mi right knee after about 20mi. The pain starts mild but gets worse if I keep going. The moment I get home, the pain starts going away. Ice will normally make it go away. I do not have pain while I walk or sit or anything. Only when cycling after a couple of miles.

A bit of Background:
1- I had a bike fit last year about this time
2 - I haven't change anything on the bike
3 - My right side leg is always the least flexible one. Tight hamstrings and tight quads.
4 - I have started stretching a lot to see if that helps... haven't been able to test results yet.
5 - I started training with power this season... so maybe I am going a bit too hard?
6 - I am prepping for a long 500mi multi day ride in Sept in Spain and would absolutely hate to miss it due to knee pain.
Could it be IT band related?

What would you do?
Thanks!

big chainring 

Check to see if your hips are level. Stand in frint of a mirror sans clothing. Hips level? If nilot there are tutorials online to even them out.

flip

+1 @big chainring

#3 might be the key. my tight hip and hamstring caused my effective leg length to be shorter on right side. I've added a shim under right cleat. knee pain from riding has disappeared.

Fiery

If you haven't changed anything since last year, and you didn't get any pain last year, it is quite possibly a case of too much too soon. Having some proper rest would be a good first step.

Aubergine 

BonkonFleet

I recently started getting a some IT band pain in my right knee as well. I lowered my seat about an inch if that and also adjusted my shoe cleat so that my tow was pointed out slightly. Remember to try to stretch everyday and use a foam roller or , what I do is use a rolling pin like you would use for baking. Works great. If its your IT band thats hurting rolling the side of thigh from your hip bone to your knee should help a lot.

alvaroe16

Thank you so much for the input!
I have started IT band stretches and working on muscle balance exercises. Tomorrow, I am going to my LBS to double check the fitting and see if bringing down the seat works out.
I will get back to you guys when I know more...

zaxmalloy

I had sudden knee pain on the outside of my left knee at the end of a rainy Tour de Cure 45-mile ride two weeks ago. Like you, I've never experienced pain on my road bike, and unfortunately I had the MS 150 coming up the next week so it was bad timing - so here's what I did and it worked.

A) I rested, riding only 2-3 ten mile rides between the events with at least one day's rest in between
B) I watched some You Tube videos on seat position (GCN) and adjusted mine slightly
C) For the MS 150, for the first time ever, I used KT Tape one band the first day and a second layer the next day.
D) Kept in a lighter gear than usual and increased my cadence - tough for me because I tend to want to push a big gear

So now that I had a pain free MS 150, I need to make sure the problem isn't repeating which I intend to address by evaluating and adjusting:

A) Bike frame size. I won my custom Felt/Shimano 105 carbon road bike in a charity auction for an impulse bid that I thought would never win. It's an awesome machine but it's a size 56 and I'm 6'1" and it's probably too small despite a Ritchey stem with a huge rise.
B) Shoes and cleats and do it in a LBS where someone can evaluate my position
C) Train better - not longer rides, but more frequent rides of 20+ miles on my road bike

I've got a metric century ride coming up July 4 and will hopefully have everything together and be KT free by then. YMMV.

berner

I'm also a fan of KT tape. I'm also a fan of of lateral exercises for the knees. The pedaling motion on a bike strengthens the leg muscles in front to back movements but I think the lateral movements provide a better balance of strength.

79pmooney

When you say "outer knee" do you mean the right side or the kneecap, ie front? If you mean right side, I cannot help you. But pain under the kneecap is something I know more than a little about, having lived with chrondomalcia patellae (CP) the past 40 years. The following is a piece I wrote 17 years ago for a long defunct forum that better sums up what I have learned than any one article I have ever seen. (It took my decades to see all the advice the doctor who diagnosed me in 1978 told me and still I have never it all in one place.)"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"

If this sounds like you and you want to make some super knee warmers that are far better than anything you can buy for CP knees, PM. Since i wrote the above, I designed and had made kneewarmers that are very specific to my kneecaps and that I can wear very comfortably up to the high '80s F. In cooler weather, I wear regular kneewarmers over them. They make a huge difference, both during the ride and how I feel after. Above all, what I am doing works. I get to ride and I haven't had to go to 3rd party knees yet. (And since i wrote the above, I have ridden Cycle Oregon 4 times on fix gears. Yes, stopping and changing cogs, but still, fixed. Every inch. (My avatar was taken going up a 14% grade I didn't stop and change cogs for. 42-17. I was 61 years old.) Even if you do have CP, all is not lost.

zaxmalloy

Fascinating Ben. Thanks.

So when I say outside the knee, to provide more clarity, I meant to the left and below the kneecap area - not under the kneecap itself. That said, based on what I've read about CP, it could be the same thing. Either way, a lot of what you've written here just makes good sense. I'll try the stretching exercises (which I never do) to strengthen hamstrings/quads, glucosamine. The knee warmers seem like a practical suggestion - I do a lot of cold weather biking here in Minnesota.) Ice makes sense as well in terms of repair and recovery. Not sure how Asprin or Ibuprofen would help recovery but I was advised that taking it during/before a ride could help which I did during the MS 150. Ice regimens have helped me in the past.

I returned from a broken ankle last year to doing endurance events and had no problems but perhaps that good fortune was a false flag,

McBTC

...saddle too high? Many use the method of putting the saddle height to where the leg is straight at six o'clock with your heel on the pedal. It's a good place to begin and doesn't matter which leg you use if your legs/hips are exact mirror images... otherwise, you'll probably have to make an adjustment. While there could be a problem of unequal leg length it apparently is not as common as some might think, however...

https://somaticmovementcenter.com/un...en-leg-length/

79pmooney

I stay away from ice because I can feel the damage I am doing to my knees just walking around the house when they are that cold. Runs counter to advice everywhere except the other piece of advice from that doc long ago. Listen to those knees. Heed what they have to say.

Nachoman

Check out Andy Pruitt's Medical Guide For Cyclists.
He's got a whole chapter on knee pain, including symptoms, causes and treatment, largely based on where exactly in the knee the pain is coming from.

cyclezen

4 yr old thread... let's hope he has it sorted...
i sometimes also make the mistake of trying to revive a long dead corpse... LOL!
... still, in the future, someone might do a 'search' and find this useful..

McBTC

Could be... Crondo.

Chondromalacia patellae is caused from overuse but in my experience, in the past, it's was due to pushing too hard, the fix for which is... more spinning instead of pushing higher gears.