# Knee pain.



## Absinthe Minded (26 Mar 2008)

Hi all,

I hope some of you guys can help me here.

I started cycling about ten years ago but had a few years of (relative), inactivity due to having kids, moving farther away from work, etc - but I've been making a real effort to get back on the bike REGULARLY of late.

All is usually good but I sometimes get a pain in my left knee, right in the side of the joint at the outside of my leg. If I cycle on it, it gets worse and worse until I can't cycle any more as the pain trevels around the knee and down my leg (it actually forced me onto the train for the second half of my journey home from work today, and I was not happy).

If I wait a day or two, it seems to go away but there's no telling when it will resurface.

My friends say I cycle too far but I don't agree, I do 60 miles a day but it's usually only two or three times a week. Some suggest I take up swimming but I don't want to and I doubt it's much lighter on my joints than cycling is.

Have you any ideas what it might be?

Cheers,
AM.


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## mangaman (26 Mar 2008)

Hi Absinthe

Obviously it's difficult to be sure but it sounds as if it could be ileotibial band syndrome

(linky - http://www.pponline.co.uk/encyc/0814.htm)

A friend who's a marathon runner had it - very similar symptoms
The good news was that it responded very well to physio - hers disappeared after some physio and stretches etc

I guess you ought to see your GP or a sports physio to get a proper opinion though


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## Frazer (27 Mar 2008)

yea it could be ITBS (illiotibial band syndrome). I had this, i forget the exact cause but its down to a ligament 'rubbing' against a bone, causing irritation of the ligament on the outside of the knee.

Go and see a physio and they can confirm it and give stretches or exercises to help. But you're gonna have to reduce your workload for a while, maybe only do shorter rides of 20-30 miles once or twice a week for now.

I don't like to put a downer on it, but with me it got so bad I just had to stop cycling completely for a few months and then gradually build up again. Hope this doesnt happen to you!


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## HLaB (27 Mar 2008)

Yeah it sounds similar to ITBS, I had it last year, a few visits to the physio and excercises sorted it out. The cause of it in me was that my right leg is more bulky than my left. My left therefore trying to compensate had become taught and pulled the ligament out of alignment, so it then rubbed against the bone.


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## Absinthe Minded (28 Mar 2008)

mangaman, Frazer, HLaB,

Thanks so much for your advice and the link.
Looks like that could be my problem so I'll be heading off to get an opinion on it.

Once again, thanks very much and all the best,
AM.


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## Yellow Fang (28 Mar 2008)

Also, invest in a foam roller and a gym ball.

You can use the foam roller to massage your ITB. Lie down sidewards on it with your thigh on the roller, supporting yourself on your elbow. Then roll yourself along it. If your ITB is too tight then it should really hurt. 

You can stretch your ITB slightly by leaning over a table or bench with one leg crossed behind the other so that the back foot resting side-on to the floor, and then placing your weight on your back leg.

Someone told me that pain in the knee region tends to turn some off some of your muscles on your inner thighs. They stop counteracting the muscles on your outer thighs, which pulls your kneecap out of track. There are some gym ball exercises you can do to strengthen the muscles in your inner thighs. Place the gym ball between your back and the wall. Roll the ball down so that your knees are bent. Move your bad knee outwards for ten seconds, trying to keep the knee from rolling. Then move it back in and roll the ball back up. Repeat ten times. There is another exercise where you just stand on one leg, bend it for ten seconds, then stand up again.

I get ITB problems a lot, and have been to the physio many times about it. If you do not have health insurance then expect to pay at least £200 before it's fixed.

Otherwise, you can invest in a sports massage every month or so. These usually hurt very much, especially if your muscles are too tight. They tend to cost about £25 a session.


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## cannondale boy (28 Mar 2008)

I too have knee problems. Both my knees are sore, even when i am not doing any physical activity. About six months ago i went on a hill run which lasted about an hour, after this hill run i've not been 100%. 

The pain seems to happen when i go down stairs or a steep hill. I manage going upstairs not an problem or walking for a long distance. The more i walk the more the pain seems to disappear, which is strange. I've been on and off the bike for the past 6 months and wish i could do more miles. I am only 28 not over weight and hope this is not arthritis. Another thing to mention is that my right knee cracks alot, and sometimes my left knee cracks also. 

Any help or advice would be great, thanks in advance.


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## yenrod (28 Mar 2008)

Abs: you need some...







http://www.evanscycles.com/product....oogle&utm_medium=froogle&utm_campaign=froogle

And if they're soo bad prior to getting on a bike try periods (weeks) of swimming..for while prior to cycling...


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## Frazer (29 Mar 2008)

yenrod, you are suggesting spd pedals as a solution to ITBS? 

I'm not saying that's a bad idea, but it's interesting because mine only developed shortly after i got spd pedals which I think in hindsight were badly set up. But do you have any reason to suggest they would help with this kind of problem?


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## yenrod (29 Mar 2008)

Frazer said:


> yenrod, you are suggesting spd pedals as a solution to ITBS?
> 
> I'm not saying that's a bad idea, but it's interesting because mine only developed shortly after i got spd pedals which I think in hindsight were badly set up. But do you have any reason to suggest they would help with this kind of problem?



Frazer what I'm saying is with A Time pedal you get


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## Absinthe Minded (1 Apr 2008)

Thanks, Yellow Fang - lots of interesting stuff in your post, much obliged.

AM.


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## Absinthe Minded (1 Apr 2008)

yenrod said:


> Frazer what I'm saying is with A Time pedal you get


I don't get what you mean. You get a ribbon, shaped like a foot? Don't see how that'll help.


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## Tynan (1 Apr 2008)

if it's itbs then cool

but for 60 miles rides I'd want the bike to be set up just right, clipless would help that, if they're set up right, ditto seat, simple mechanical thing first init?


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## Cathryn (22 Apr 2008)

Golly this is a useful thread as I've got ITB issues due to over excitement at being back on the bike. Am iceing and stretching and taking a few days off...it's very annoying. I'll try some of the advice on this thread as well....thanks everyone.


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## Joe (22 Apr 2008)

Itbs is a nightmare, don't try and ride through it whatever you do! I suffered with it and ended up off the bike for a couple of months. I had a fitting and now religiously stretch/massage it and *touch wood* I seem to have cured it. I'd definitely recommend a foam roller, it can be AGONY to use though!


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## Marko62 (4 May 2008)

Absinthe Minded said:


> I don't get what you mean. You get a ribbon, shaped like a foot? Don't see how that'll help.



I think what we are looking at is a diagram of lateral float that there is in this clipless system, I think it 6 degrees of float...


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## Tynan (4 May 2008)

is the bike set up properly? first things first syrely, especially if they're easy to fix

I've just come off a sore knee, I finally realised that my right shoulder injury meant in the drops my right arm was reaching deeper onto the hood while my left was further back, presumably twisting my left leg slightly, I concentrate on keeping my hands level and lo and behold the knee gets better

f the knee is bad so be it but rule out the easy things first init surely


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## alecstilleyedye (19 May 2008)

Marko62 said:


> I think what we are looking at is a diagram of lateral float that there is in this clipless system, I think it 6 degrees of float...



only 6? my looks have 9° of float.


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## Absinthe Minded (22 May 2008)

Just to update you all,

I'm pretty sure it was ITBS, but thought it wierd that it had appeared after all these years of cycling.

So, I took Tynan's advice and had a good look at the setup of the bike and concentrated on the way I felt when riding it. It occured to me that my left heel was being held a little further out from the frame than was natural and so I made an adjustment.

Well, I'm still not riding that regularly as I want to rest my knee, but it definately feels more natural and more comfortable when riding and there have been no knee problems yet!

So, fingers crossed, that's it - thanks Tynan (and all the rest of you), for helping me out.

And Cathryn, I came across these while I was looking into ITBS, just in case they might help you - or someone else.

Cheers,
AM.


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## Kirstie (28 May 2008)

Today I was told that I have tight ITBs on both sides and was recommended a set of stretches by my physio who is really excellent. I have exactly the same symptoms you describe, but they only come on really late in long rides (ie up to 100 miles). To rehabilitate properly definitely go and see a physio. A tight ITB is really easy to sort with stretches. The ITB is the only relevant bit of me I don't stretch after a ride, and surprise surprise, it's the only bit which hurts!

I have also just invested in a completely new set of pedals and cleats as the old ones were really worn, which I think was a contributing factor. I tend to ride more 'heels out' and so it's possible to compensate for this with the cleat position. I also made sure the saddle position on my road bike was appropriate (I use the low tech plumb-line-off-the-front-of-the-saddle method!), so I hope that'll be the last I see of it!

Good luck and I hope it gets better soon.


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## Nick1979 (18 Jun 2008)

So Absinthe, any update on this? Is your knee better now?

I ask because I think I have the same symptoms on my right knee. Interestingly, it appeared on my first long ride after having fitted SPD pedals/cleats. So I think it was related to the angle of the cleats being too 'straight' for my natural 'toes out' position. (see my thread on this http://www.cyclechat.co.uk/forums/showthread.php?t=14042)

My knee still hurts a bit when going up the stairs so I'll stay off the bike for a few days and then will try the new cleat setting.

Regarding the Time pedals, anyone has experience with them? are they better than Look?


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## Cathryn (18 Jun 2008)

Thanks for the link, Absinthe!!

Good news on the old ITBS! I had about four lots of ultrasound on my knee before we went away and it made an enormous difference and I'm pain free. Might be worth looking into if anyone has an urgent reason to keep cycling!!


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## Kirstie (19 Jun 2008)

Hi all,
I've been doing research on this to the nth degree cos I've been getting some niggles, so I'm happy to share what I found out. The first thing is to be careful of what you read on the internet! It can be scary.

Anyway, between talking to my physio and various other people, there are three causes of tight ITBs in cyclists:
1. Poor equipment
2. Biomechanical problems ie excessive foot pronation
3. Poor training regime ie sudden leap in activity level

I have addressed all of these to try and eliminate all the causes. I'm not guilty of 3, so I checked out my pedals and cleats. The cleats were extremely worn and there was movement in the pedal axles, so I bought new ones. I then went to see a podiatrist (at leicester sports medicine clinic) - well that was amazing. I was astonished to discover that my feet don't work properly at all. Without going into the detail, they need radical orthotics. He put some together and the difference is amazing. There's now much less pronation.

In addition to this the physio has given me a really comprehensive range of stretches to lengthen out the calf muscles, which were also tight, and stretch the ITB (this is called the 'Thomas' stretch, which you can look up on the internet). It's all working really well and I managed a big ride last Saturday with hardly any pain at all. 

So there!


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## Absinthe Minded (29 Jun 2008)

OK, another update for Nick, and anyone else that's interested.

The adjustments I wrote about in my last post seem to have fixed things. So, it turned out to be the cleat position holding my heel too far away from the frame.

I've returned to doing around 160 miles per week, and I did the London to Brighton this year, cycling home the next day for the first time. Still no problems at all.

Thanks for the contributions, Cathryn and Kirstie - the ultrasound treatment is interesting! Hopefully this thread might help others out.

Cheers,
AM.


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## Fiona N (1 Jul 2008)

I'm really surprised no one has mentioned weak gluteus medius muscles as a primary cause of the instability that results in ITB problems at the knee. This has been accepted in sports science/biomechanics for a while now and, combined with stretching for the GM and glutes generally, can give very quick recovery and prevention of future problems. The exercises are very precise - it's best for someone qualified to show you how to do them properly as there's no point doing them without correct alignment. If you're familiar with Pilates, the exercise 'the oyster' gives a pretty good idea but you'll need to build up GM strength using Theraband too. 

BTW I've used the Pattstraps as shown in the link someone posted. While they're good for walking/running, I found that they caused too much irritation around the back and sides of the knee when cycling any distance. For patellar support, strapping with adhesive elastic tape worked much better for me as the strapping doesn't have to go round the crease of the back of the knee.


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## Kirstie (2 Jul 2008)

Fiona N said:


> I'm really surprised no one has mentioned weak gluteus medius muscles as a primary cause of the instability that results in ITB problems at the knee. This has been accepted in sports science/biomechanics for a while now and, combined with stretching for the GM and glutes generally, can give very quick recovery and prevention of future problems. The exercises are very precise - it's best for someone qualified to show you how to do them properly as there's no point doing them without correct alignment. If you're familiar with Pilates, the exercise 'the oyster' gives a pretty good idea but you'll need to build up GM strength using Theraband too.



Yes my physio did look at the glutes and established that mine were OK (bit too well developed with me ). It's true that some cyclists have underdeveloped glutes and that this can cause problems. I'd forgotten that part and so didn't mention it. But you're right.


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