Knee/Thigh Pain

[adamr100]

​
Good morning all,
I'm new here and I'm driven here by an agonisingly protected knee complaint. I'm a cyclist have have been for 10 years. I'm 25 and a teacher so advice I've had to stay seated constantly isn't particularly effective.

In March I was competing in an audax and 100 or so miles in I started to experience a dull ache in my right leg above my knee to the outside. I had no option but to cut short and cycle 70 miles home.

Over the next few weeks I abstained from cycling but the pain didn't subside. I went to see a Physio who diagnosed it as a pulled tensor fascae latae (excuse my spelling) so he manipulated it and prescribed a tens machine. After several weeks off and using the machine to no avail I visited another Physio who attributes it to weak glutes putting excess stress on other parts of my leg and prescribed a series of gluteus activation and strengthening exercises.

These seemed to work for a while and for a period I was able to get back cycling. I kept up my exercises but again the injury returned and now it's worse than ever. I'm currently into a stint of 12 weeks off, now with an NHS Physio who has given a similar diagnosis but the exercises don't seem to be doing anything. I wondered if anyone could offer any advice if they have had a similar injury. I'm still not wholly sure it is my itb and it could be my lat vat.

I have finally been given an MRI appointment (6 weeks time) because in my off time I was recommend to swim and now I have a suspected torn meniscus but I want to do all I can in the meanwhile because I'm getting incredibly fed up and down about not being able to do anything.
Any thoughts/opinions would be greatly received.

[Paulatic]

​
Good morning all,
I'm new here and I'm driven here by an agonisingly protected knee complaint. I'm a cyclist have have been for 10 years. I'm 25 and a teacher so advice I've had to stay seated constantly isn't particularly effective.

In March I was competing in an audax and 100 or so miles in I started to experience a dull ache in my right leg above my knee to the outside. I had no option but to cut short and cycle 70 miles home.

Over the next few weeks I abstained from cycling but the pain didn't subside. I went to see a Physio who diagnosed it as a pulled tensor fascae latae (excuse my spelling) so he manipulated it and prescribed a tens machine. After several weeks off and using the machine to no avail I visited another Physio who attributes it to weak glutes putting excess stress on other parts of my leg and prescribed a series of gluteus activation and strengthening exercises.


These seemed to work for a while and for a period I was able to get back cycling. I kept up my exercises but again the injury returned and now it's worse than ever. I'm currently into a stint of 12 weeks off, now with an NHS Physio who has given a similar diagnosis but the exercises don't seem to be doing anything. I wondered if anyone could offer any advice if they have had a similar injury. I'm still not wholly sure it is my itb and it could be my lat vat.

I have finally been given an MRI appointment (6 weeks time) because in my off time I was recommend to swim and now I have a suspected torn meniscus but I want to do all I can in the meanwhile because I'm getting incredibly fed up and down about not being able to do anything.
Any thoughts/opinions would be greatly received.

1 Double check saddle height/position
2 Don't have much faith in the medical profession
3 Swimming is good if you've a pool handy.
4 Try Pilates
I'm a recent convert to Pilates. I was loosing mobility especially bending joints.
After
Week 1 Came down stairs in the morning one tread to each step and without hanging onto handrail. Felt good
Week2 Bending has become easier
Week4 Sciatica has gone
Week6 A pain I've had whenever bending my right knee, for last 8+ yrs is a lot less than it was. Still there but I'm getting a lot more bend before initiating the pain.

[adamr100]

I forgot to say I have also had a bike fit with my cycling team.

[531colin]

I forgot to say I have also had a bike fit with my cycling team.

Riding position, and therefore "bike fitting" are governed by fashion.....this strikes me as odd, because the way your body works is not governed by fashion.
Current bike fitting seems to follow 2 major fashions.....
1) Aero is everything. This is unlikely to hurt your knees directly, except that it might force you into a lot of pelvic tilt, which can affect what part of the range of muscle contraction you use. If you sit very far forward over the pedals it can result in a "toe down" pedalling posture, which may cause your bike fitter to raise your saddle to try to get your knee straighter.....which brings me to fashion number 2.....
2) Get your saddle as high as possible. This starts from the (true) observation that you get maximum force for minimum muscle work when your knee is (almost) straight. However, it seems to ignore the fact that most of us, most of the time, are not looking for maximum force, we are "just tapping along" at a high cadence and low force. This suggests to me that saddle height should be set low enough so that you are smooth "through the bottom" on your worst day, when you are tired, stiff, injured, etc. ....because if you are not smooth through the bottom, you are over-reaching, and its just a small step from over-reaching to injury. For the 1% of the time you are looking for maximum power, you can slide back in the saddle, this increases the distance from hip to pedal just as surely as raising the saddle.

Right now, you should be thinking....."yeah, but this is just the internet......the internet gives everybody the opportunity to express their opinion to a wide audience, but gives no guarantee that they have anything worth saying".

So, heres some reading......note its all from the same bike fitter.....this is because he doesn't use any magic formulae like saddle height should be this body measurement times that magic number, or that angle should be between X and Y degrees.....he sits the man on the bike and watches the body.
https://www.stevehoggbikefitting.com/bikefit/2011/05/addendum-to-seat-height-how-hard-can-it-be-2/
https://www.stevehoggbikefitting.com/bikefit/2011/05/seat-set-back-for-road-bikes/
https://www.stevehoggbikefitting.com/bikefit/2011/08/ironman-triathlon-position-how-marketing-overcame-some-peoples-reality/
https://www.stevehoggbikefitting.com/articles/

If you want it simple, go here http://wheel-easy.org.uk/ride-calendar.html and download my basic guide from the yellow box...."bike set up" .
Change one thing at a time, but before you change anything, mark, measure, and photograph everything.

But first, ride your bike, and see if you feel like I feel riding my bike......
If you slide back in the saddle and you strain to reach the bottom pedal, then I think your saddle is too high.
If you are "off the back" of the saddle and still smooth through the bottom, you are too low (i think thats unlikely, with a modern bike fit)
If you can spin the pedals really fast without bouncing on the saddle, and if you can slide back in the saddle without stretching to reach the bottom pedal, then i think your saddle height is about right.
If you can't take your hands off without falling forwards, then your saddle is too far forward. Just tapping along, you should have enough weight on your hands to steer....and no more. As soon as you start working, you should be pulling UP on the hoods.......pull up on right hood as right pedal goes down, pull up on left hood as left pedal goes down.



Best of luck!!

[NATURAL ANKLING]

Hi,
I am just wondering whether its not a local injury but a problem with your back
Have you ever damaged you back? If not then forget I mentioned it.

[adamr100]

Thanks very much 531Colin for your very detailed post. I have read a lot of Steve Hogg information before and cross referenced my bike fit with it after I had it. I have thought for a while it could be fit but what made me think that was less likely was the sudden onset of my injury when nothing had changed in my setup for months.

Natural Ankling, I have once hurt my back, when I was 17 or so in a sledging accident. I landed hard on my coccyx...Would this manifest itself in outer thigh near the knee?

[Smudgerii]

Thanks very much 531Colin for your very detailed post. I have read a lot of Steve Hogg information before and cross referenced my bike fit with it after I had it. I have thought for a while it could be fit but what made me think that was less likely was the sudden onset of my injury when nothing had changed in my setup for months.

Natural Ankling, I have once hurt my back, when I was 17 or so in a sledging accident. I landed hard on my coccyx...Would this manifest itself in outer thigh near the knee?

Thought I'd done my knee, Doctor said it was my back then proved it when he moved my leg and the pain in my back was incredible.

Disc pressing on a nerve was giving me pain in the knee but no back pain.

[adamr100]

How long did it take to heal/what was the rehab?

[531colin]

March is pretty early season? Most cycling injuries are what they call "over-use" injuries....that doesn't mean you turned the pedals more times than Wiggo, just that you turned the pedals too many times for your state of fitness. Or that there is something wrong with your set-up, but in the previous August you were fit enough/with enough miles in your legs to do twice that distance, and the winter lay-off means your body can't hack the double stress of a less than perfect set-up and an early season big ride ?....possibly?
Injury at 100 miles....... another 70 miles home may not have been your best ever decision, your body might have thanked you for getting a taxi.
(I was 25 once, I can remember what it was like to feel invincible. I carried on doing some fool things a long time after 25. I have slowed down a bit now, live to ride another day, and all that sort of thing. A good thing is that at 25 your body has truly wonderful ability to heal itself, you can recover from anything.....but, patience, time.....)
If you can throw some money at it, find a "musculo-skeletal specialist" ....I can get you a recommendation in the Leeds area, if that helps at all.
Incidentally, 170 miles is a pretty big mileage. What discipline was your bike team bike fit for?

[adamr100]

It was early season but I had trained through the winter and the milage wasn't a sudden increase. I had done events in the prior weeks if similar/greater distance.

I know pushing on home wasn't the best option but I had not many other options and at the time I thought it was just a niggle - you live and learn...

I have already been to two local physios, both well known in the local area with good reputations but without any results so I am slightly reluctant to possible throw more money away. A musculo Skeletal specialist sounds like a good idea, I am based in Clitheroe so not too far from Leeds.

My bike fit was for long days and to provide comfort rather than a specifically racey, aggressive set up. 170 is a big milage but I was averaging close to 450 in the weeks leading up to it.

[NATURAL ANKLING]

Hi,

Thanks very much 531Colin for your very detailed post. I have read a lot of Steve Hogg information before and cross referenced my bike fit with it after I had it. I have thought for a while it could be fit but what made me think that was less likely was the sudden onset of my injury when nothing had changed in my setup for months.

Natural Ankling, I have once hurt my back, when I was 17 or so in a sledging accident. I landed hard on my coccyx...Would this manifest itself in outer thigh near the knee?

My opinion Yes.
I was going to say its not damage to you actual muscles but your nerves and brain reading..

I suffer a lot of pain / discomfort from my hip to lower legs through an old injury which affected my sacrum.

BUT I must say that normally exercise will relive any pain / discomfort, Unless your exercise is aggravating the old injury.
Coccyx damage is a serious problem I know but cannot shed anymore light on that.

When do you suffer pain
Do you ever suffer when sitting? and does it fade when standing and moving around say at home etc?

I did not read all post that well so I might of missed some detail there.

[531colin]

Adam, I'll Private message you the man's details.

[adamr100]

I have thought is it just phantom pain...I'm pinning a lot on the MRI scan showing something, I'm terrified about it showing nothing.

My coccyx injury wasn't bad, just a jolt that hurt for a week or so.

In terms of when I suffer pain - always! When I exercise it gets worse. It hurts sitting, walking driving just a constant ache.

[Smudgerii]

How long did it take to heal/what was the rehab?

Never really heals... But intensive physio and core strength work helped in the long term.

I foam roll each day to keep the muscles loose as any kind of tighness in my lower back/glutes has an impact.

[NATURAL ANKLING]

Hi,
If I don't do physio exercises every day I really suffer so bad I cant sleep with the nagging pain.

You need a fully qualified NHS physiotherapist assessment, they will tell you where the problem lies.
If you are paying then it might be a long ride round the block.