General Discussion Triathlon Talk » Knee pain during bike - any help? Rss Feed  
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2009-07-26 3:47 PM

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Subject: Knee pain during bike - any help?

Hi everyone,

First season as a triathlete, and for that matter it's my first season as a biker, runner and swimmer.  I've had a few aches and pains along the way but it's been a great experience...however, in the past month I've run into some knee pain that can be absolutely debilitating at times and while I'm planning on visiting the ortho at some point in the next week I wanted to get some feedback from the community, anyone who's dealt with something similar.

It first begin a little more than a month ago, during the B2B ride from Boston, MA to Windsor, VT.  Because of a ton of early summer rain and a hectic schedule--both at work and out--I didn't quite get the training in that I probably needed to feel comfortable on the whole ride.  At about mile 95 I started to feel a dull pain in the middle/lower portion of my knee.  It slowly, slowly started to increase in intensity--not to the point where I couldn't continue but it certainly hurt.  When I got off the bike I noticed it hurt more walking, and stairs gave me problems.  I had it checked out by the medical staff at the end of the 150 mile ride and was told there was nothing structurally wrong, and to just pound down the Advil and ice it. 

I did that for the next few days, took a full week off the bike (didn't run, either).  It slowly dissipated and the past few weeks it didn't hurt at all.  I did a slow, slow 70 mile bike a week ago without any problems, but then on a rideof 120 miles to the Cape it started back up--dull pain on the bike, same spot on the right knee, followed by alot of pain once off the bike.  It did, however, disappear very quickly--within two days--so I went for a 50 miler today.  I was fine until the last half mile, when it literally just exploded into intense pain, I basically did a slow spin into the finish with my left leg, and immediately threw down a few Advil.  It actually isn't bad right now (4 hours later), going up and down stairs theres a slight pain and if I move it after it being immobile there's a slight pain but nothing bad at all. 

My question: has anyone dealt with this in the past?  I talked to the guys I rode with to the Cape and they mentioned keeping a higher cadence, but I really don't think that's it: I generally sit at 85-95, and watched people closely today and I was definitely at a cadence as high as anyone else out there.  I'm guessing it's tendonitis but am wondering if there's something else that it could be.  I'm still pretty young--29 years old--and haven't had any knee issues in the past so it's rather discouraging finishing up the Cape ride with guys almost double my age and being the only one needing ice at the end.  Could it be as simple as me not being prepared for the distance I rode to VT, and a similar unpreparedness on the Cape ride?  That'd be best case scenario, of course, as I would just have to know to fully work up miles, but I'm worried it might be a recurring thing that I'll just have to treat very carefully.

I'd love to hear if anyone has any suggestions or thoughts on it, I really can't be taking days off--let alone weeks--as I have an important sprint tri in 4 weeks followed a week later by my first OLY so I just have to get miles in.  Thanks!



Edited by Brownie28 2009-07-26 3:54 PM


2009-07-26 6:01 PM
in reply to: #2308699

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Subject: RE: Knee pain during bike - any help?

I just got a new bike yesterday and my LBS told me to come back in immediately if I had any knee pain while on the bike. It could be your cleat set up or something with the way you are pedaling (an assymmetry on either side)...My cleats are set up so it appears as if I am standing with my feet turned into one another. The bike shop said this is so when you are pedalling that there is good medial allignment from your hip-knee-ankle; but if you are doing something wonky with your legs while pedaling that you will feel it in your knees when riding. I'm not sure if this is what you are experiencing, but I guess it is something to think about. Good luck!

2009-07-26 8:01 PM
in reply to: #2308699

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Subject: RE: Knee pain during bike - any help?
It sounds like tendonitis or patellar femoral syndrome. The fact that you can ride fairly long distances before the pain kicks in leads me to believe that it's not bike fit related, but areas to check for are seat height (too low of a seat can cause pain in the lower front of the knee) and cleat alignment.

Definitely see a medical professional.

scott
2009-07-26 8:40 PM
in reply to: #2309068

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Subject: RE: Knee pain during bike - any help?

Thanks for the input.  As far as fit, I actually had some knee pain on the left side--similar pain that occured after much shorter distances, 5-10 miles or so.  After some unsuccessful tweaking of my own I took it to the LBS and the seat height, saddle position and cleats were adjusted. 

Maybe I'll mess around with the saddle a bit more, see if that does the trick.

2009-07-27 8:38 AM
in reply to: #2309148

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Subject: RE: Knee pain during bike - any help?
Brownie28 - 2009-07-26 7:40 PM

Thanks for the input.  As far as fit, I actually had some knee pain on the left side--similar pain that occured after much shorter distances, 5-10 miles or so.  After some unsuccessful tweaking of my own I took it to the LBS and the seat height, saddle position and cleats were adjusted. 

Maybe I'll mess around with the saddle a bit more, see if that does the trick.



You started getting pain on one side early in a ride, so you had the bike refit by a LBS, and now the pain doesn't occur until longer in the ride but is worse and now on the other knee? Sure sounds like a fit/cleat issue to me. I suggest you not ignore this as tendon issues can be difficult to resolve once they're inflamed.

First, there's no reason why someone with healthy knees should be forced to ride a high cadence to avoid pain. IMO, that's bad advice.

One thing, I'd do is switch to speedplay pedals. You can get a cheap pair off ebay to test or use. They have unlimited float and so most all pedal related knee problems should be resolved. If the pain doesn't resolve it's probably not due to pedals/cleats. They're funky at first. It feels like you're ice skating or something. But that goes away quickly.

Secondly, I'd take a bunch of photos of your position either on a trainer or on the road from the exact side view on the crankset side. Get a clear shot when your crank arm on the view side is in line with your seat post. Wear a tight shirt (or better, no shirt). Mark the place on your bike shorts where your hip bone protrudes so it's visible in the photo. Then post it here in a new thread and ask people to evaluate your position. If your position is grossly off, it will be very obvious to some of the people here.

Concerning the LBS fit, considering some of the people I've seen working in shops and some of the advice they've given some of my less experienced riding friends, there's no telling what they did to your bike. I walked in one local shop because I couldn't find my chain whip asking them to just loosen the cassette on my Zipp 1080 and they were making fun on my wheel as if they'd never seen one before, "That wheel sure looks light, ha ha ha", etc, etc. All the shops here are mountain bike related but still...

Edited by breckview 2009-07-27 8:42 AM
2009-07-27 9:29 AM
in reply to: #2308699

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Subject: RE: Knee pain during bike - any help?
It could be fit (seat too low, too far forward, etc.), or it could be a simple matter of riding more miles than you're ready for.  Looking at your logs, it looks like you've ramped up the mileage, but with fairly low mile weeks followed by some serious mile weeks.  Not a very smooth ramp up.  Even your 29 year young knees might not be quite ready for those long rides.

After resting a bit more, I'd consider building the miles more slowly and not worry about 100+ mile rides for a few months.

Brian


2009-07-27 12:44 PM
in reply to: #2308699

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Subject: RE: Knee pain during bike - any help?

Ditto 100% what Breckview said. I'm just now back to 100% from Patella-Femoral syndrome. My first inclination once the pain started is that there must be some sort of injury because of how intense the pain was. it would start mid-way to later in a ride and then would last pretty intensely for a couple of days. After carefully considering what changes had been made recently, I concluded there was likely some sort of "fit" issue going on. I had just recently began track racing and had replaced my Speedplay cleats with a fresh set when I bought a set of pedals for the new bike. I didn't pay close enough attention when doing that and ended up putting the cleats only about 1/4 inch too far forward. My fitter picked this up and also raised the saddle very slightly. It has taken about 6 weeks for this all to work itself out (continued to ice and ibuprofen over this time). Its really amazing how what appears to be very minor tweaks have such major impacts on the body. I'd recommend doing a careful self-assessment prior to and when the pain began. One other thing I personally have found is that when I get really tired on a long ride, I'll get sloppy and let my knees track a little to the outside. This too can lead to some real knee pains. I'm now conscious to periodiccally watch my pedal stroke during long rides and make sure I'm not doing this.



Edited by Hacksaw 2009-07-27 12:45 PM
2009-07-27 4:48 PM
in reply to: #2308699

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Subject: RE: Knee pain during bike - any help?
I had the same problem years ago. I would get off of the bike and feel that dull pain and as soon as I tried to run or do anything strenous I was in agony.

I switched my pedals to Speedplay with unlimited float. After doing that the pain was gone within a week and it has never been back.
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