Annoying chondromalacia patellae and then I tried...

[Gearoidmuar]

Cycling 40+ years.
Have had episodes of chondromalacia patellae down the years. That's characterised by pain behind kneecap going down the stairs. Usual treatment for me was some knee contractions with straight leg (tensing quads) and standing while climbing. It wasn't going away though mild after an initial bad dose of it.
I ride 5 different bikes but mostly a gravel bike.
Yesterday I thought back to the old saw, that raising the saddle eases problems at the front of the knee and lowering it, problems at the back.
Raised my saddle 5mm. Doesn't sound much but it has a fair effect.
Did a 28m ride yesterday with some serious climbing.
Knee is perfect today.

[Gearoidmuar]

It came back and I tried a different approach. Avoiding bending the affected knee much by going down stairs sideways. After 4 days it was gone...see other post.

[Tricyclebell]

Shorter cranks helped mine (along with some other problems). That way you do not end up rocking from side to side with a higher saddle height.

[gbnz]

Ceases problems at the front of the knee and lowering it, problems at the back.
Raised my saddle 5mm. Doesn't sound much but it has a fair effect.
Did a 28m ride yesterday with some serious climbing.

Useful info, think I'll try lowering the saddle 5mm, even 10-15 over the next few months. @ 51yr's, left knee issues have become apparent this summer - have found walking those few, 30% + climbs on the moors has been of benefit.

Have been surprised at how quickly those 1 a ride, 30%+ sections can be walked - the worst is only a 10 minute walk. Hardly an issue during a 40-70 mile ride

[LittleGreyCat]

This is sounding something like my current problem.
Pain behind the kneecap, worse when climbing or descending stair.
Also when climbing hills on the bike, especially when tired.

I do have the occasional bouts of knee pain but they generally go away as the joints loosen up through exercise.
The pain and stiffness can come back over night.

This time it is definitely under the knee cap.
I cycled when exhausted last Thursday and had knee pain for the last couple of miles.
I am guessing that I misaligned my left knee because the muscles were very tired.
My left knee is my weaker knee.
It is slowly clearing up but I am avoiding riding for the moment.

I go down the stairs backwards first thing in the morning, but when my joints ease off I can go up and down normally.
At the moment I can feel a stinging pain in the knee when climbing stairs during the day, but can still climb.

I felt as if my riding position had changed slightly on the second half of the last ride, with the saddle possibly slightly too low.
I will check once I am cycle ready again, but I have no idea how or why this could have happened.
The saddle has been in that position for a long time.

[531colin]

LGC……that sounds like patello-femoral syndrome.
Pain behind the knee cap on the outside .
It’s on the outside because of the arrangement of the quadriceps group: 2or 3 muscles pulling on the outside of the patella, only one ( vastus medialis ) pulling on the inside of the patella…and Vast. Med. only contracts when the knee is almost straight. This unequal pulling means the patella doesn’t track straight down the middle, but towards the outside
Straight- leg isometric quads exercises recommended. To “ balance up “ the muscles and improve patellar tracking

[cyclop]

Shorter cranks helped mine (along with some other problems). That way you do not end up rocking from side to side with a higher saddle height.

Chapeau for finding a comfortable way to ride the bike.If you were rocking side to side,I,m pretty sure you,re savvy enough to have tried lowering the saddle as a first port of call.If the cranks were too long for your leg length,the lower leg might,after lowering the saddle, have been ok at the lowest point and not ok i.e.your knees would be too high at the highest point of crank rotation.Was this the case?

[Tricyclebell]

I am only 4ft 10 inches tall and had ridden too long a crank for many years (did not know it at the time). Eventually went onto 160mm cranks which served me well for quite a long time but as arthritis developed in my knees and hips I decided to use the formula to find out which length crank I should really be riding relating to my leg length....145mm !!! Took the plunge and have been riding comfortably with these for four years. They allow me so much more power particularly on the climbs, now I can sit in the saddle and pedal, even on the steep bits. There has been a lot of research done on crank length, I suppose today cycling is so much more scientifically based.

[Gearoidmuar]

LGC……that sounds like patello-femoral syndrome.
Pain behind the knee cap on the outside .
It’s on the outside because of the arrangement of the quadriceps group: 2or 3 muscles pulling on the outside of the patella, only one ( vastus medialis ) pulling on the inside of the patella…and Vast. Med. only contracts when the knee is almost straight. This unequal pulling means the patella doesn’t track straight down the middle, but towards the outside
Straight- leg isometric quads exercises recommended. To “ balance up “ the muscles and improve patellar tracking

I don't think it is. There's no tenderness under the patella on either side, which there should be and vastus medialis strengthening had no effect. I think it's patellar tendinitis. It's settling down and I'm going to take it very easy and build up the miles slowly. If I do pinch the ligament side to side just under the patella, there's some tenderness which isn't on the other side...

[531colin]

LGC……that sounds like patello-femoral syndrome.
Pain behind the knee cap on the outside .
It’s on the outside because of the arrangement of the quadriceps group: 2or 3 muscles pulling on the outside of the patella, only one ( vastus medialis ) pulling on the inside of the patella…and Vast. Med. only contracts when the knee is almost straight. This unequal pulling means the patella doesn’t track straight down the middle, but towards the outside
Straight- leg isometric quads exercises recommended. To “ balance up “ the muscles and improve patellar tracking

I don't think it is. There's no tenderness under the patella on either side, which there should be and vastus medialis strengthening had no effect. I think it's patellar tendinitis. It's settling down and I'm going to take it very easy and build up the miles slowly. If I do pinch the ligament side to side just under the patella, there's some tenderness which isn't on the other side...

Very interesting but my post is addressed to LGC…Little Grey Cat

[Gearoidmuar]

I'd tried everything... taking it easy, taking two weeks off, walking sideways down the stairs etc. It would come back.

Having tried the easy approach I decided to go hard at the knee itself.
I started doing Bulgarian Split squats and squatting down fully before going cycling. And after...

It's been gone for a week! Fingers crossed but I did a hard hilly route two days ago, maxing pulse at 182 and there was no reaction.
I thought I'd never get rid of this injury.
I'll let you know if it recurs, or not.

[Gearoidmuar]

It's working so far!

[Gearoidmuar]

Perfect today. Hard hilly route, 29 miles 1600 ft climbing. No reaction at all.
The natural course of recovering soft tissue injuries is a slanting jagged course. Hurts less and less till it hurts no more.
Like the steps of a stairs.
Took five months...

[Gearoidmuar]

Definitely better.
Message:
Patellar tendinitis causes pain below kneecap, when bad, walking down stairs but also upstairs.
It differs symptomatically from chondromalacia patellae in that that will hurt also when you sit down for a while.
What worked for me was gentle squatting before and after easy cycling, gradually getting harder.
These soft tissue injuries have a common recovery pattern. They go, and recur but less severely until they're gone. So it's a kind of steps of stairs phenomenon. I've had that with this injury, with tennis elbow, with achilles tendinitis and with biceps tendinitis

[Gearoidmuar]

If I take it easy, it goes away. Effort seems to cause it. Easy miles don't really. I've done various exercises like VM strengthening, hamstring exercises, gluteal exercises etc. I think the real answer will come from the perfect saddle height. I've used the same height for decades, but maybe it's a little off.