Grumbly knee

[Beakyboy]

After a recent event, my right knee has started to sound like an ungreased bearing, it has always clicked a lot but now it is noisy too. I haven't any pain just the usual ache after doing a long ride (150k or so).

I went to the quack and she referred me to a sports injury physio in cork as apparently cyclists only use one side of the leg muscles a lot more than the other and suggested that he would give me exercises to build up the muscles on the other side.

I have googled this and it seems to be a common problem and not one that should warrant too much worrying. I have now joined the massive ranks of the unemployed and cannot afford the costs to see this guy, so has anyone experienced this sort of problem and can anyone offer any kind of advice?

[531colin]

All this has been posted before, but I'm too stupid to find it....hey ho!
In the Quadriceps group of muscles, only 1 springs into action when the knee is almost straight, this is the Vastus Medialis (VM).
Cyclists and others who basically exercise with bent knees dont develop this muscle.
This would not be a problem except that the VM is the only one that pulls the knee cap (Patella) medially, ie towards the midline.
All the others (Vastus Lateralis, Rectus Femoris, Vastus Intermedia, in no particular order) pull the knee cap laterally, ie to the side.
So in all us bent-leg exercisers, the patella can be pulled against the lateral edge of the groove that it runs in in the end of the femur. This usually results in pain behind the patella, and if you sit on the floor with your legs flat out in front of you and the muscles relaxed, and you poke your fingers behind the patella, it can be sore to the touch.
I think this is what your doctor is talking about. I am less sure that it matches your symptoms.
However, the excercises you need to do to develop the VM are isometric straight leg Quadriceps exercises.
I would also recommend stretching; however somebody will be along in a minute to tell you its a waste of time.
Have a good Google at some of this stuff.
Get back on if you want to know anything, I will do my best.
If you PM me your address, I will lend you a book on ""Knee Health" by a physio. called Vivian Grisogono. The book is bursting with knowledge and practical advice.

[snibgo]

All this has been posted before, but I'm too stupid to find it....hey ho!

The post might be: viewtopic.php?f=1&t=36998&p=296150&hilit=quadriceps#p296150

[Beakyboy]

Thanks for that guys and a very good explanation Colin. I have reserched it further on t'interweb and found some stretches to try out, I have also doubled my Glucosamine intake.

Thanks again, I'm glad its not serious, I was waking up in cold sweats thinking that my cycling days were over!

[Colin63]

After a recent event, my right knee has started to sound like an ungreased bearing, it has always clicked a lot but now it is noisy too. I haven't any pain just the usual ache after doing a long ride

that sounds familiar. My right knee sounds like it's made of bubble wrap when I crouch down. It's done it for a few years and like you I suffer no pain, although it is obviously much weaker than my left knee. I was told that I have crystals behind the knee cap and that it's nothing to be concerned about.

I'm still not convinced and I'm going to take a look at this physio's book too.

Having gone straight to Amazon and searched for the author I found quite a few people flogging the book for a penny plus p+p. So I ordered one

[Beakyboy]

Having gone straight to Amazon and searched for the author I found quite a few people flogging the book for a penny plus p+p. So I ordered one

Me too!

[saudidave]

I had this problem about 15 yrs ago, but it went a stage further and my patella was so far over and tight that I developed chronic pain and ulceration at the rear of the patella.The specialist reccommended a procedure called a "lateral release", where they go in to your knee keyhole and then rip a load of tissue to free up the patella. You immediately commence physio designed to pull the patella straight and keep it loose.

I was diligent with the physio and it worked well - I've had no problems with the patella since - but trust me, you don't want to let it get to that stage, I was in a lot of pain after the op and for a long, long time!

[531colin]

Stretching and straight- leg isometric Quads exercises, chaps.....all in the book.....I'll get that woman a knighthood....

[rualexander]

Yep, 531colin has it right, if patella/femoral pain is indeed your problem, there are of course other knee injuries that might need to be ruled out.
I've had bouts of the patella/femoral pain 'syndrome' over the years and my main piece of advice is not to listen to your doctor, but do listen to a physio! (especially one who has an interest in sports injuries).
I've always recovered from it eventually without resorting to surgical methods thankfully, so hopefully you should be good for a few more years on the bike yet. Take it easy, do the exercises and stretches, and maybe think about trying shorter cranks.

[dkmwt]

I've just googled Vastus Medialis images to see where it lies in the leg.

Going by what Colin says about it I've just seen the difference between DF cycling and recumbent cycling, for me anyway. If I'm right the VM in my legs (just above the knee on the inside) are quite well developed so hopefully I shouldn't develop any lateral patella problems.

[531colin]

VM is the one that hangs over the medial side of the patella when the knee is straight.
Why would 'bent riding be different, you dont lock your knees out, do you?

Remember, as rulealexander says, there are other knee problems.
I am not certain the OPs symptoms are a good fit to patella tracking problems, but I think thats what the GP was talking about.

[Gearoidmuar]

Beaky, this is Garry from Cork.

I know what to do.
Stand up when you're climbing, as much as possible. This strengthens vastus medialis.
If necessary for a while, ride BMX pedals with no cleats.
Do static quad contractions. That means tense the muscle above the kneecaps as much as possible for 15 secs, relax 30. Six times, six times a day.

It should get better.

[dkmwt]

VM is the one that hangs over the medial side of the patella when the knee is straight.
Why would 'bent riding be different, you dont lock your knees out, do you?

Remember, as rulealexander says, there are other knee problems.
I am not certain the OPs symptoms are a good fit to patella tracking problems, but I think thats what the GP was talking about.

It is said that when anybody first starts riding a recumbent they find it hard work because they haven't developed "bent legs", using different muscles in different ways. So I figured this could be one of the differences. I don't lock my knees but I do get very close to it when pushing against the back of the seat for short bursts of acceleration. Most of the time I just ride. Also don't forget that I haven't got a saddle between my thighs so the slightly different angle might make a difference.

[Beakyboy]

Thanks for the advice guys.

Garry: will do, in fact I'm doing it now!

[bigjim]

True about the muscles on the side of the knee pulling the patella. I had this to some degree as I had a lot of bad knee pain and considered giving up cycling. However after breaking my arm whilst clipped in and losing some confidence in cleats I resorted to using platform pedals with trainers. Well I now have no knee pain at all. I am amazed. I can now do up to 80 miles in a day without any knee pain. I do not find my pedalling any slower or less efficient so evidently this works for me.
Jim