Knee niggles...

[EdinburghFixed]

I seem to have developed a niggling pain in one knee - possibly as a result of taking time off for illness and then coming in too hard.

I get mild pain on the outside of my left knee, around the top of the little bone (fibula?) that you can feel there. It's more to the rear of the side, than the front of the side for whatever that's worth.

I can provoke it off the bike by pointing my toes out, and squatting. With my toes in, the motion is much less troublesome.

I haven't changed my saddle, cleat, or anything else position but it's possible I suppose that some long-term mistake in the setup is starting to bite. If anything I have wondered for a while about raising the saddle a few mm.

As I depart for LEJOG in two weeks, I'd quite like to figure this out beforehand! Is there anything that I can do to narrow down what might be wrong, or any stretches etc. that people recommend to loosen up this area?

Thanks..

[Jack]

I don't know the answer myself but in Bicycling Medicine by Arnie Baker it gives the following possible causes & solutions for pain at the outside of the knee:



Causes Solutions
Cleats-toes point in. Solutions:- Modify cleat-toe out

Floating pedals. Solutions:- Limit float to 5 degrees

Feet too close. Solutions:- Modify cleat position - apart
--------------------------Longer bottom bracket axle
--------------------------Use cranks with more offset
---------------------------Shim pedal on crank 2 mm


Mind, I use gears to ease my knee problems

[thirdcrank]

I'll suggest hammering up steep hills in a big gear. (Serious suggestion, not a joke.)

[EdinburghFixed]

I might try moving the left cleat forwards and towards the instep. If I understand properly I think this will ease the pressure on the outside of the knee by helping to turn the foot out (cf. Jack's post) as well as effectively lengthen that leg.

I'm supposed to be going for a fairly long ride tomorrow (at least 80 miles if I can manage it) so I guess I will soon know whether it's happier or not!

It's funny because before getting back on the bike, I fitted my 48x20 gearing (low 60s) which is very spinny. I would have more expected a problem with riding a huge 90" gear, than the opposite.

[CREPELLO]

I had a similar problem a few years back, which does recur very briefly sometimes. My knee pain has been in exactly the same place. The first year I dealt with it by using a neoprene/Velcro support, which really helped stabilize the pain. I'd recommend the one with a hole for the knee cap as it can better support the knee with this. I still take it on tour for emergencies and don't think I've used it since.

Eventually I was referred to the Orthopedic Hospital. My right foot was shown to be pointing outwards somewhat and both feet were defined flat. I was provided with corrective shoe insoles and told to do stretching exercises 2-3 times a day to lengthen and strengthen the tendons. I did these religiously, until I went on tour (I should really continue these exercises but have so little problem with the knee/s these days I forget). My understanding is that the tendons holding the knee cap in place often get weak, so require strengthening with corrective excersize.

[DaveP]

Well you have three main options: rest it some more, exercise it some more or surgery !
I've had similiar pains occasionally. The timings never been critical and its cleared itself up in a few days. If the bike was ok before then it would seem likely that you have overdone it in some way, so that taking things a bit easier might be all you need. However, with two weeks to go you dont really have time to mess about, so I would recommend trying for professional advice as soon as possible, even to the extent of a private physio consultation

[gilesjuk]

MTB pedals are more forgiving than road pedals. Especially eggbeaters, time or look quartz. No cleat angle adjustment required, just forward/backward positioning of the cleat so it's under your foot in the right place.

[EdinburghFixed]

MTB pedals are more forgiving than road pedals. Especially eggbeaters, time or look quartz. No cleat angle adjustment required, just forward/backward positioning of the cleat so it's under your foot in the right place.

I ride with SPDs (the off-road sort) but they do go side-to-side as well as up and down. I was wondering if they were too far to the left of my left foot, thus causing a tiny twisting motion on the down stroke (relative to them being further to the right).

It might just go away. But on the other hand, it could be something genuinely wrong, that having some time off the bike has stopped me from being habituated to.

Ah, the body! Such a mystery...

If I can't get by ok tomorrow than I'll book in a session with the physios who sorted my shoulder. It's a lot of £££ but you only live once!

[Cliff]

I think pain in the outside of the knee is a classic symptom of IT band issues (I haven't got my Pruitt guide to cyclists injuries to check). This is pretty common and, if it is the IT band, some stretches might be all you need. Only problem is that the IT band is quite tricky to stretch!

Here are some stretches:
http://www.howtostretch.com/iliotibi.htm

I do the seated one in a chair.

More good stuff here:
http://runningtimes.com/Article.aspx?ArticleID=6099

Cheers
Cliff

[beachcomber]

Ensure you stretch your leg muscles well pre and post ride. It is easy for them to go out of balance and pull the knee joint out of alignment. this could be the cause of the pain you described.
Cycling and running both cause the hamstrings to shorten. I find this is a good place to start when knee pain starts. Stretch hamstring and IT band which runs down the thigh on the outside.
Although climbing in a high gear might work for thirdcrank, I would be cautious of that approach as you may make the problem worse.
It would be worth seeing a sport physio, or get a massage done by a pukka sport/remedial masseur.
Be careful when desending stairs as this can often overload the knee joint if you have cartlidge damage.
I hope it quicly resolves it's self before LEJoG.

[EdinburghFixed]

Well, the good news is that I managed the ride comfortably enough (just under 45 miles to my parents in 3 hours, then 3 1/2 back into the wind). However this morning I'm suffering even more than I was before - off to the physio this week I think!

I did that plumb-bob test and my knee is noticeably behind the axle at the 3 o' clock position. I think when I moved the cleat forward, that perhaps I should have adjusted the saddle too, or something.

Of all the times to get your first riding injury, this is not a good one. I'm too stubborn to postpone...

[patricktaylor]

... Of all the times to get your first riding injury, this is not a good one. I'm too stubborn to postpone...

That's bad luck. If you're going in less than two weeks, I would lay off cycling altogether until then and rest your legs as much as you can. A few days lay off before a big event is a good idea anyway. I'm sure you're fit enough by now. The physio visit is a good idea too. I hope it clears up before the off.