So, I bought a bike this summer and really love it, except for one nagging detail - my left knee is in pain everytime after I bike.

So to backtrack a bit, I had biked earlier but it was on cruiser bikes, and now finally I upgraded to a road bike. Earlier this summer I had the fortune of falling and landing hard on my left knee and hitting it against rock steps while walking (yep, just walking).
Scroll down to 2 months later....When I first bought the bike I biked so much that I ended up with swollen and painful left knee. My dr said I was just getting overly enthusiastic, biking just aggravated the earlier injury, dx with patellofemoral inflammation and a little RICE will fix. So I did. Pain got better but not gone.

Then I fell off bike, not biked, knee pain disappeared completely during then (or I was hurting so much from bike injury that I did not notice left knee pain). This week I got back on my bike, and left knee pain started again. Now the swelling is entirely gone, but it's still a nagging persistent pain that feels a bit sore, coming from within the knee.

Question now is:
What's the next step? Should I:
1) Go back to bike shop and get fitted, seeing if bike fit is the problem (I've raised the bike seat since I bought it for better biking but alas that did not take care of pain. Also my right knee is perfectly happy)
2) Go back to dr, see what else is up his sleeve
3) Find a specialist who deals with this
4) ????

I am sure this must happen to lots of other folks. Please let me know if you have any suggestions or stories.
Much appreciated!

Thanks.

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get a good bike fitting. if the shop that sold you the bike didn't do one as standard practice, i would recommend going to another shop. several shops in town have really good fitters who have training cert's. a really good fitting will take about an hour, cost you a little, and may mean you need a new stem.

i had knee pain from riding a few years ago when i upped my mileage. a few little adjustments by a fitter made me more comfortable, faster, and happier.
also, if it's only ONE knee, your legs may be slightly different lengths. sometimes a shim under one cleat will do wonders
Go back to the doctor, there might be something wrong. Also, warming up, then stretching before and after might help. When I use to kickbox and practice jui-jitsu my knee always bothered me, It still does once in a while, stretching helps. Try balancing yourself on one leg(or hold on to something), raising one knee and rotate the lower portion of your leg clockwise, then counter clockwise ten seconds each way, switch legs, then repeat until you've done it three times each leg. Next you can jog a bit, or do some jumping jacks, or both to get your heart rate up and warm up a little. If you have a yoga mat sit on it and extend your legs. Start with the right, bend your knee and bring your foot to meet the outside of your glut/butt hold for ten seconds then begin to recline your back, hold that position for at least 20seconds. Repeat until you have done this on both sides three times.

You can just google more stretches, this usually gets my knees to pop and feel loose and relieves any pain in my knees.
It might also be your riding style. In general when riding at a high exertion level, such as accelerating from a stop, climbing a hill, riding at high speed or into a strong wind it is easier on your knees to use a lower gear and a faster pedaling cadence.

It's slightly counter intuitive in that pedaling faster often feels like more effort, but with a little practice/training a faster cadence comes fairly naturally.

Another issue is crank length. Crank length should be proportional to leg length but manufacturers often use the same length cranks on different sized frames. Thus shorter people are often riding around on bikes with cranks appropriate for someone much taller. Longer cranks encourage a slower cadence higher torque riding style. Long cranks combined with a low seat height can also cause trouble as you bend your knees more acutely.
Joe Stein knows his stuff.

Especially the slightly different length bit. I gather that is more of a common problem than one might initially expect. You seem to correlate the knee issue as only happening when you ride---as opposed to noticing pain from multiple, differing activities.

If you are overstraining your injured knee, you might reduce your gear ratio. High ratio's (read: big, hard gears) are great at building strength but not especially efficient. They can also really strain your knees. Crank length is another area on a bike that can not only affect your riding style (comfortable cadence), but also cause knee pain. A good bike fit could address these issues as well as more personal riding traits which might contribute.
Also, given your history on the left knee... Moving joints are basically like a headset on a bike. If the grease is compromised, or reduced below an optimum level, you will have bearing wear. Same with synovial fluid, bursae, and cartilage with your bones. Trust me, I am NO doctor. But I would guess that your previously injured knee COULD be more susceptible to repetitive-type injuries.

One such place on a bike where this has been argued to exist is cleats. Cleats fix your foot to a specific position, which it repeats every revolution. Flat pedals allow you to move your footing many times throughout a ride and in relation to your effort. It has been suggested that for this reason, flat pedals are healthier for your joints. I have never seen a scientific study in this regard. It does, though, sound like valid reasoning to me. At best, you can try it and see.
A professional fit session and modifying your riding style to a higher cadence would definitely help. If you have around $100 to spare, it is worth a shot.

Given the fact that your knee has been injured in the past, however, I would definitely recommend going to a sports practice doctor that specializes (or at least understands) cycling-related knee issues to get checked out if the fit session doesn't help. Some knee problems will not go away without medical help no matter how much you tinker with the fit of your bike or your riding style.

I had pretty severe knee pain last year whenever I went over 50 miles. A professional fitting session and cleat adjustment (for clipless shoes and pedals) definitely helped a bit, but the pain still didn't go away. I eventually went to a sports doc, had the real problem diagnosed, and went on a rehab program. My problem was weak hip flexors and core strength that caused my right knee to track incorrectly--an issue that would not have been resolved without learning specific stretches and exercises to fix the problem. Simply put, I had somehting very similar to runners' knee based on an imbalance between my leg strength and my hip flexor strength.

Athletico, which is one of the bigger physical therapy parctice groups in Chicago, does free sports injury screening at many of its locations. If Athletico finds a problem, they are pretty good about hooking you up with a sports doc that specializes in the type of injury you have.
Check seat for front to back. Joe Stein probaly said it best. Never know you may have the wrong size bike. After I was measured and got the right size frame the end result was no pain in the knees. Took a few adjustments on the seat location. Then it was joy to ride..curt
Honestly, this might sound weird, but go off dairy for a few weeks and see if the pain decreases or disappears. I sometimes get stiff and sore knees and going off the dairy for a bit usually does the trick. I too have had knee injuries, nothing too serious, but I don't suffer from inflammation when I get the pain. It is just a perpetual soreness and is of course aggravated by climbing stairs and biking. Good luck!
Like Adrian, I used to get knee pain in my left knee past the 60 mile mark (approximately) before I started wearing cleated cycling specific shoes. Our knee pains were probably similar conditions to yours.

In my case, as soon as I switched from clipless pedals to cleats I never felt that knee pain again. Therefore, in my case the pain came from only pushing down on the pedal and never really pulling up very much. Without your foot actually affixed to your pedal you can only really be moving it for about 180 degrees, my knee(s) would hurt because they were doing all the work.

I'm going to guess that your knee pain caused by weak gluteus maximus muscles, or, like me, your current pedal set up only allows for your quadriceps (and knees) to push down, and your glutes can't pull up enough. Cycling is all about balance, and your knees seem to be suffering from am imbalance in muscle output. If you do already have a clipless set up I suggest doing some exercises to strengthen your glutes if you don't want to pay for a sports trainer, which I probably wouldn't.

Adrian Rohrer said:
A professional fit session and modifying your riding style to a higher cadence would definitely help. If you have around $100 to spare, it is worth a shot.

Given the fact that your knee has been injured in the past, however, I would definitely recommend going to a sports practice doctor that specializes (or at least understands) cycling-related knee issues to get checked out if the fit session doesn't help. Some knee problems will not go away without medical help no matter how much you tinker with the fit of your bike or your riding style.

I had pretty severe knee pain last year whenever I went over 50 miles. A professional fitting session and cleat adjustment (for clipless shoes and pedals) definitely helped a bit, but the pain still didn't go away. I eventually went to a sports doc, had the real problem diagnosed, and went on a rehab program. My problem was weak hip flexors and core strength that caused my right knee to track incorrectly--an issue that would not have been resolved without learning specific stretches and exercises to fix the problem. Simply put, I had somehting very similar to runners' knee based on an imbalance between my leg strength and my hip flexor strength.

Athletico, which is one of the bigger physical therapy parctice groups in Chicago, does free sports injury screening at many of its locations. If Athletico finds a problem, they are pretty good about hooking you up with a sports doc that specializes in the type of injury you have.
thx arrak!

Arrak Thumrs said:
Joe Stein knows his stuff.

Especially the slightly different length bit. I gather that is more of a common problem than one might initially expect. You seem to correlate the knee issue as only happening when you ride---as opposed to noticing pain from multiple, differing activities.

If you are overstraining your injured knee, you might reduce your gear ratio. High ratio's (read: big, hard gears) are great at building strength but not especially efficient. They can also really strain your knees. Crank length is another area on a bike that can not only affect your riding style (comfortable cadence), but also cause knee pain. A good bike fit could address these issues as well as more personal riding traits which might contribute.
i was actually going to start a thread about something similar to this...and maybe still should...in relativity to comfort and proper fitting...but most specifically, how gear ratio and geometry affect the rider.

my regular ride is a 58 pista, 170mm cranks, 50t front, 15t rear fixed, 700c wheels. all is good. its basically the perfect fit for me, even with the high gear ratio, its great.

im now on my winter commuter...which last year felt fine. but its killing my entire leg this year. 'large' frame KHS solo one, 175mm cranks, upgraded from 44t to 48t front, 16t rear freewheel. after a few days of commuting, my leg will start to hurt. i stay off it, it starts up again.

i have noticed i have been sliding forward on the seat a bit this year. not sure why.

Thoughts? Suggestions? Should this be its own thread?

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