# Mysterious shin pain



## vickster (1 Oct 2014)

I don't know if anyone might have experienced something similar, but I am having pain in my 'good' right leg about 5cm below my knee, lateral side (left leg is the one that got injured in mid Feb). It aches while sitting (desk job), while lying and is especially bad in the morning. It is also a little twingy while cycling (more so on hills and when I start to tire), and using the rower and recumbent in the gym. There isn't a specific 'sore' spot, and no swelling or pain in the knee. 

As documented elsewhere on CC, when knocked off my bike in Feb this year, I developed a massive haematoma over my tibia which got infected and had to have IV antibiotics and surgery to clean it all out. Slowly getting better, waiting for all the scar tissue in the void left by the cleaning out to go. I lost a lot of calf muscle, and I developed some lumbar back pain / sacroiliac joint pain as consequence of the weakness in the leg and probably cycling too much too soon with the weak leg! 

My left is sore to kneel on (have a couple of meniscus tears and cartilage damage), twist etc, but right now less of a bother than the 'good' right

I'm cycling (probably around 70 miles a week) and in the gym (4-5 times, normally a 3000m row, 20 minutes on recumbent bike, maybe some weights and 15 minutes of leg, arm and back stretching). The physio doesn't think it's down to over training, less issues with strength now (the muscle is slowly coming back in my left calf)

My physio has had a good look at it yesterday, moved the joint, prodded around the patella, done all the various tests for ligament and meniscus, looked at my hip etc and is stumped as the pain doesn't seem to be coming from the knee! She wondered if it might be shin splints, but I can't run, don't walk terribly much, all of my exercise is non weight bearing! 

She is contacting the orthopaedic surgeon (who looks after the knee and did the shin surgery) and is thinking an appointment with a rheumatologist might be in order just to rule out possible causes - I just have general soft tissue aches and pains that are nagging and annoying, but not usually bad enough to need medication. I feel broadly fit and well otherwise (not even an autumn cold yet)! We discussed trying a sports massage, and although she thinks it might give some temporary relief it's probably not a solution.

I don't think it's a bike fit issue, although the saddle is maybe a little lower than it might be (from the Retul fit) but I like to have some chance of touching the ground when clipped in as I ride mostly in trafficand it's not specific to any bike from what I can tell

Anybody had anything similar and found a solution?

Thanks for reading


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## Ian A (2 Oct 2014)

I have a similar issue and am hoping to find a solution. I was knocked of my motorbike at low speed in the spring. A few knocks and a graze on my right knee. A week later the graze unsealed (?) and I didn't notice. It got infected but nothing serious like you had. Oral anti-biotic did the trick. I'd cycled 40 hilly miles the day it flared up and functionally everything felt fine. After thay I felt problems in my right shin. I was running the kind kf distances I hadn't previously run before so the bike Ccidenr may be a red herring.Tried rest for a few weeks and no change when I started training again. I did a hilly ironman a few weeks ago and something a little over a half ironman in the French Alpes this summer and my leg/knee seemed fine in that my legs work and I felt a bit of pain towards the end of the run. It felt the best it had in a long time after the ironman but I did walk a good chunk of re run . A sports masseur in France suggested I may have had hip alignment problems after being knocked off my motorbike but he didn't have much time to investigate as he was working for a race organiser providing free service to athletes. Still flummoxed. I'm waiting to be seen by a private sports masseur who is very highly recommend and I will also go the physio route if it continues. Very confused as I've put my legs through hell on two occations six weeks apart and things are no worse, maybe a little between in fact at the moment.

That's not much help but you're not the only one. I'd like to get to the bottom of it as I'm worried about making things worse or any underlying issues causing it.


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## vickster (2 Oct 2014)

Thanks Ian. I definitely need to get to the bottom of it as it's now keeping me awake  I expect to get a response from the physio / surgeon in the next few days. I have private healthcare so once the medics have decided whom I should see, things should move quite quickly

I might yet try a sports massage even if it is temporary as a relatively small outlay, although they won't be able to do much with my left lower leg due to the pain around the wound


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## vickster (7 Oct 2014)

I have received the physio letter to the surgeon. She asked him to see me and have an appointment on the 18th. Bupa have kindly signed off X ray and MRI so plan is to have those in advance of the appointment if the surgeon thinks it necessary

The more I do, the more it hurts...although it is a bit random. I have a nasty feeling I've torn the meniscus - ah well, a matching pair in the two knees 

I went to Amsterdam for work yesterday - it hurt driving to and from the airport, on the plane and traipsing around the behemoth that is Schipol It was niggly at the gym just now too...taking some painkillers bah


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## ColinJ (7 Oct 2014)

At the risk of triggering off another series of behind-the-scenes complaints about me mentioning the subject again [thanks guys - I _really_ appreciated that! ]... Have you considered DVT? If you have a DVT, the _last_ thing you want to do is have somebody massaging it and breaking off clots which end up in your heart/lungs.

The fact that you were immobilised for some time and underwent surgery are risk factors.


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## vickster (7 Oct 2014)

Cheers Colin, but no, I don't think so - the pain is at the side of the leg over the head of the fibula

I was immobilised with surgery 7 months ago now, and wore compression stockings for a couple of weeks after


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## ColinJ (7 Oct 2014)

vickster said:


> Cheers Colin, but no, I don't think so - the pain is at the side of the leg over the head of the fibula
> 
> I was immobilised with surgery 7 months ago now, and wore compression stockings for a couple of weeks after


I think in my case it took a couple of months to go from initial damage to major problem, but I admit that 7 months would be an awfully long time for a problem to manifest itself!

Well, I hope you find out what it is, that it isn't serious, and that it is easy to sort out.


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## vickster (7 Oct 2014)

I obviously did have a clot in my other leg...ooh about the size of a grapefruit  but that got evacuated (first attempt while awake , done properly a few days later under general anaesthetic)!

Hopefully the MRI will show something non serious or nothing! I really don't want more bloody orthopaedic surgery this year (or ever but given the state of my other knee that's unlikely)


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## vickster (16 Oct 2014)

I see the orthopaedic surgeon on Saturday, not had any imaging yet as he wants to examine the leg first. It's getting worse, sitting and especially driving seem to piss it off most...Cycling's not great either if I'm honest . Sigh


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## vickster (18 Oct 2014)

Well as suspected by the physio and confirmed by the specialist and X ray, there's something going on in the bone on the head of the fibula, not sure exactly what yet, MRI scan to be done. Hopefully just good old degenerate arthritis (at the ripe old age of 42) . Sigh 

Surgeon was impressed with my muscly cycling legs though! However, I have to cut right back on the riding...could be the power through the legs causing issues with the bones...sheesh


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## ColinJ (18 Oct 2014)

Oh, that's bad news!

I hope there is something they can do to sort it out.

How about riding much lower gears so you are putting less force through your legs?


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## vickster (18 Oct 2014)

That's the obvious, but I think it'll be many less miles which will happen as it gets wetter and colder...he looked a tad perturbed when I said i was probably riding 70 miles a week

Today I've done 15 on the SS, weirdly better as I am not tempted t push big gears to move quicker...because there aren't any 

Treatment probably rest and suck it up, possibly a steroid shot. Depends on what the scan shows


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## ufkacbln (19 Oct 2014)

Pain in this part of the leg associated with exercise can be a sign of "Shin Splints"


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## vickster (19 Oct 2014)

It's the fibula head rather than further down the leg/shin, pain is lateral, about 2cm below the knee. Surgeon didn't suggest it and although discussed with the physio, I don't run etc so seems unlikely

The shadow is right at the top of the fibula (and the pain upon prodding), which googling seems to indicate is quite an uncommon spot for arthritis, well it would be wouldn't it!


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## jarlrmai (20 Oct 2014)

Pain below the knee could be the patella tendon.

Does the knee swell up after exercise?

The MRI will reveal more, mine is in a weeks time.

I've been going to a sports injury guy who's been doing massage and trigger point releases on my leg my kneed is getting steadily better over the weeks.


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## albion (20 Oct 2014)

This might not be relevant but when my knee injuries stopped me cycling I took to walking and developed shin splints amongst other pains in the lower leg. (bad cardiology did not help)
Anyway, my knees and hips never worked so I abandoned walking for care cycling via spinning which worked.
My extreme Achilles pains took 12 months to disappear and it was certainly the spinning that did it.

So maybe reduce the weights on the legs from gym, cycling, walking etc if you want recovery


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## vickster (20 Oct 2014)

jarlrmai said:


> Pain below the knee could be the patella tendon.
> 
> Does the knee swell up after exercise?
> 
> ...



No swelling, no. The pain is nowhere near the patella (relatively, it's closer than my left earlobe for example ) It is very definitely lateral, over the fibular head

MRI is on Thursday pm, hopefully report will be done afterwards and I'll have a better idea soon thereafter

It's been on fire all day, so no cycling or gym for a bit. Walking is not completely avoidable. Gig tomorrow night, bouncing to be moderated!

Not helped by having tweaked something (adductor most likely) in the gym yesterday  Hot bath later should help


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## DooDah (20 Oct 2014)

To me this really sounds like shin splints. I had these many years ago, just in my right leg, and the pain varied from just under my knee to about midway down my calf. The pain was never excruciating or specific, but it hurt when jogging, cycling or walking. At the time played Hockey to a high standard, and it did not seem to hurt then, but maybe that was just adrenaline. After some time off exercise the pain when away.


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## vickster (20 Oct 2014)

From my reading, shin splits affect the tibia though?  The position is very specific, a couple of centimeters below the knee and round to the right. Tallies with the shadow on the fibula head on the X ray

About where my finger is!


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## vickster (29 Oct 2014)

I saw the specialist 10 days ok. I've had an MRI and am awaiting results, also had an x Ray which shows early degenerative changes in tibulo fibular joint with spikes and osteophytes  once I know what the mri shows we can see if there's any treatment. Otherwise I shall continue to grow old disgracefully! Apparently oodles of arthritis among females on my dads side so perhaps I was always doomed to this  weirdly the specialist thinks that power through strong leg muscles while cycling could be stressing the bones. Great! Damned if you do, damned if you don't!! :/


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## jarlrmai (29 Oct 2014)

I would take that with a pinch of salt, get your MRI's and diagnosis and see. Don't be pushed into surgery and see a few sports injury people once you have your MRI.


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## vickster (29 Oct 2014)

Take what with a pinch of salt - X ray findings? No surgery has been mentioned

If there are bone spurs, no a lot a sports specialist can do beyond an orthopaedic specialist. According to my physio, her experience of sports physicians (is that who you mean?) is that they medicate. I have all sorts of cartilage damage in the other knee, so I'm not entirely surprised. It does hurt though


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## jarlrmai (29 Oct 2014)

I guess I mean just consider all your options, I'm sure you will.


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## vickster (29 Oct 2014)

jarlrmai said:


> I guess I mean just consider all your options, I'm sure you will.


Indeed
The ortho specialist is a good guy and knows me and my lifestyle / activities pretty well...it'll also depend on what Bupa will sign off


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## vickster (31 Oct 2014)

Apparently I have some ulceration behind the fibula causing the pain - what I don't yet fully know is why and what to do about it (might be as simple as rest and pills)


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## cyberknight (31 Oct 2014)

vickster said:


> Apparently I have some ulceration behind the fibula causing the pain - what I don't yet fully know is why and what to do about it (might be as simple as rest and pills)


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## vickster (11 Nov 2014)

Doesn't seem like there's anything to do except wait. Rest as much as possible for 3-4 weeks, and I guess that's me off the bike (although I will go to the gym for non impact work outs, use the static in front of the TV). Here's hoping for torrential rain and snow for the foreseeable  I've also made an appointment with the GP to discuss pain management as I can stay off the bike but I do still have to sit at a desk, go to the office, drive to the airport, travel for work

This is not going to be good for the waistline

Spoken to physio, nothing she thinks I can be doing other than as little as possible 

Anyone want to rent a bike or three for the next month


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## coffeejo (11 Nov 2014)

vickster said:


> Anyone want to rent a bike or three for the next month


Got any in black? 

Seriously, hope the month flies by and you're back on two wheels asap.


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## vickster (11 Nov 2014)

Lol no, red, white and minimal black is as close as I get 

It's a bugger as I barely ride in the winter, this could have come a month later...although as it's down to overloading/overuse most likely, it makes sense it is now. Just need to hope it clears up and I can start training for Ride 100!


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## coffeejo (11 Nov 2014)

Well, given the forecast, you're not missing much.


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## vickster (8 Jan 2015)

Saw specialist again as pain constant even with strong anti inflammatories

Meniscus tear, steroid injection given, probably need surgery, banned from cycling

Bloody marvellous


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## ColinJ (8 Jan 2015)

Oh dear ... 

It took over 3 months for them to find that ...? 

I hope that surgery is not required, but if it is, that they get on and do it and fix the problem ASAP - good luck!


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## Pat "5mph" (8 Jan 2015)

vickster said:


> Meniscus tear


Hi Vickster, I got that injury in my knee, got it through a repetitive movement at work years ago, with wear and tear thrown in too.
According to the consultant, no surgery will help, only an eventual joint replacement, I'm too young for this under the NHS.
My tear happened about 9 years ago, had to give up work for a few months - my work is quite active - because of the pain.
It took about 2 years for the pain to be negligent.
Since starting cycling it has disappeared completely, and I'm more a grinder than a spinner.
I've also lost about 3 stone, maybe this has helped too.
It will get better, try not to rotate the knee.
I never took any medication, just did the phisio's exercises.


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## vickster (9 Jan 2015)

I think it was in the mri, just not clear in the report. He does say it is relatively small. Ive not seen him since the MRI, I had a letter which said there was nothing major but to be aware of the knee. He evidently felt that with some rest it would settle. On prodding, the pain is directly over the lateral meniscus. And he showed me the tear and surrounding inflammation on the MRI. Seems pretty conclusive.

Who's to say it's not got worse since the mri? I have degenerative tears in the other knee too, had lateral menisectomy in 2010 after previous bike accident (locked, buckling knee) 

He may have been kidding partly about the cycling but considering he's been trying to treat my other leg for the last 5 years following to cycling accidents, I can't really blame him!

Cycling hurts, there's no enjoyment, I guess I need to get away from the denial. The meniscus has little blood supply so I'm not sure how gentle cycling would help, they don't heal on their own. They settle, this hasn't. Cycling and other exercise can help with arthritis by improving lubrication in the joint but that's different cartilage, not meniscus.

The pain has been getting steadily worse since and is pretty much constant whether walking, cycling, sitting at a desk for work, driving a car, despite anti inflammatories and pain killers. This is why I had the appointment.

Everyone is different. Frankly it's making me miserable, it's getting worse, whatever I do or don't do. I seem to be prone to orthopaedic niggles that get worse. The knees, tennis elbow, lower back, I am seeing the gp about pain in my left hand that isn't getting better. I assumed tendonitis but again the naproxen taken for knees isn't helping at all!

I'll have the surgery ASAP once squared off with work as I am damned if I'm going to pull out of ride London again!


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## vickster (9 Jan 2015)

ColinJ said:


> Oh dear ...
> 
> It took over 3 months for them to find that ...?
> 
> I hope that surgery is not required, but if it is, that they get on and do it and fix the problem ASAP - good luck!



I have private health care, when it's done is down to me and work


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## vickster (9 Jan 2015)

Looking at tne radiologist report, it looks like he missed the meniscus tear that I was shown in the MRI


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## vickster (9 Jan 2015)

Giving it a couple of weeks to see if the steroid helps (not obviously so far). Tentatively agreed chop day of 12 Feb with boss if goes ahead


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## jarlrmai (9 Jan 2015)

That sucks 

Now i'm worried they missed something in my knee MRI...

My knee seems to be, very very gradually getting better though not as fast as my sports therapist reckons it should.


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## vickster (9 Jan 2015)

I don't think the surgeon did, but he didn't think it was concerning enough to warrant follow up. He thought at the time that I was overloading it through cycling and life, but it's got worse and no response really to naproxen, and less cycling. I've done less than 300 miles in 3 months, whereas I was doing that monthly in summer

Tendonitis is really slow to resolve, did you have any jabs or anything, I can't remember?

You could always ask for a second opinion on the MRI, but if a radiologist and an ortho have reviewed and presumably the physio, I expect they have the issue sussed


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## jarlrmai (9 Jan 2015)

No jabs. and it is getting better but its been over 4 months so far.


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## vickster (9 Jan 2015)

I had the tennis elbow for over a year, steroid helped a bit, PRP not at all. Surgical repair sorted it out (although that arm has been grumpy lately)! Not much surgical for patella tendons unless properly ruptured / detached as far as I know


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## jarlrmai (9 Jan 2015)

Yeah I know I think it will solve given time and the right physio, just frustrating.


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## vickster (9 Jan 2015)

Knee issues are the worst as there are so many structures and almost anything we do has some impact on the knee! Gets worse as you get older too


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## albion (9 Jan 2015)

True, but good use of gears means cycling can be near zero impact.

I've been using my high geared road bike recently and purposely take a long long route round the steep long hills. The only thing I have noticed recently is shin pain. but whilst I had a very slow healing shin problems I suspect its only noticeable because my winter socks are too thin.


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## vickster (9 Jan 2015)

Falling off however seems to not be low impact!


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## albion (9 Jan 2015)

True, reminds me it might have been a month of not cycling that caused my more noticeable shin stiffness.

A very bad cold early December meant I fell out of the habit until just a few days ago.


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## Katherine (9 Jan 2015)

vickster said:


> Saw specialist again as pain constant even with strong anti inflammatories
> 
> Meniscus tear, steroid injection given, probably need surgery, banned from cycling
> 
> Bloody marvellous


Oh dear, I've just seen this. Hope you get some relief soon.  Good luck.


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## vickster (15 Jan 2015)

Steroid jab a week ago, no real benefit. Just as well large needles don't bother me! Trying to get surgery booked for 5 February as want to get done sooner rather than later (want fixed, and is better for work)

Oh and I've got tendonitis in my hand...2 weeks rest and a wrist/hand support, physio if no better...kind of need two hands for the crutches!


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## Katherine (15 Jan 2015)

Hope the hand settles quickly. 
You've got a date for the surgery. Good luck.


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## vickster (4 Feb 2015)

Arthroscopy is tomorrow morning, hoping it helps and I can be back on the bikes by Easter


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## ColinJ (4 Feb 2015)

vickster said:


> Arthroscopy is tomorrow morning, hoping it helps and I can be back on the bikes by Easter


Good luck!


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## vickster (4 Feb 2015)

ColinJ said:


> Good luck!


I don't have to do a lot yet fortunately, just sleep through it


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## vickster (7 Feb 2015)

Pretty sore at the moment, still hobbling around on crutches. Just had a shower, feel better for that for sure! Need to put the lovely compression stockings back on but here's the free leg. I did try to wash the arrow off!


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## Pat "5mph" (7 Feb 2015)

At least it's over and done with.
Speedy recovery!


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## vickster (27 Apr 2015)

Just a little update on this...

The knee pain itself seems to be better (other than I still can't kneel comfortably on either knee now, ah well) but I still have this ever present discomfort in my anterior shin below the knee  The new cycling physio isn't sure what the issue is, not related to the knee but possibly a tendinopathy or compartment syndrome, so I'm back off to see the knee specialist on Saturday to see if he has any thoughts. 

I do have very tight calf muscles and stiff ankles which might be to blame, I have exercises to do to try to relieve this. I also got a foam roller, but not being able to kneel makes it very difficult to use effectively, and the tendonitis in my right shoulder and trapped nerve in my left hand make it hard to support my weight while using the foam roller!

I've had my bike position (set up is fine) and pedalling assessed which is all ok. I don't activate my glutes adequately while riding and my core stability is lacking so again we've discussed how to work on this. I'm going to try some SPD-SL pedals/shoes to see if the stiffer soles relieve the foot pain I also get

I am managing to cycle 70+ miles a week but not especially comfortably...if one thing doesn't hurt at a given time, something else invariably does (probably not helped by my bizarre tumble off the bike last week) 

All good fun


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## jarlrmai (27 Apr 2015)

If you want muscle release but are unable to use a foam roller effectively then you could try a sports massage therapist.

How are your quad muscles in terms of activation/tightness and your gluteus medius?

You sound like me in terms of your issues with regards to tight everything around the legs.

My biggest issue at the moment is getting a plan of restorative exercise I actually believe in, I have got lots of advice from people some of which contradicts other advice (stretch versus don't stretch, focus on muscles versus work on things a whole.)

So when I actually sit down to do my daily regime I'm not even sure if I'm doing the right things and even then I'm not sure if my form is correct when I do do them.


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## vickster (27 Apr 2015)

jarlrmai said:


> If you want muscle release but are unable to use a foam roller effectively then you could try a sports massage therapist.
> 
> How are your quad muscles in terms of activation/tightness and your gluteus medius?
> 
> ...



I have a series of exercises, hopefully doing approximately correctly! Apparently, I don't cycle solely using my quads (they work fine, a bit tender but not as bad as the shin, similarly ITB) but I could use my glutes much more which should help my back as well

My biggest issue is a complete inability to squat with feet flat and to get knee over toes, which makes going down stairs hard. I have to force myself not to go down sideways!

The physio has tried muscle release but it left me with a lot of tenderness for days after (a week really) so it's not a good idea without knowing exactly what the issue is, hence the specialist. And it was extremely painful in that muscle which isn't normal apparently!

I sometimes think maybe a full hour of good sports massage would help but the pain concerns me!

I know what you mean, finding the right professional is tough. The cycling physio is only really concerned with things that affect cycling directly, so I'm now seeing someone else for the shoulder as it doesn't bother me so much cycling, as it's reaching behind not forwards that is the problem! I seem to spend my life in appointments! I expect Bupa will start screening my calls soon!


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## vickster (3 May 2015)

Well the specialist is certain that the shin pain is due to a bone spur on the rear of the fibula irritating the muscle  this can in extremis be removed, however there is a pesky but important nerve that runs in the exact spot and there is a reasonable risk of nerve damage and resultant foot drop  as well as a pretty big scar! 
So conservative management with anti-inflammatories, hope it improves, try not to inflame further. The pain is more an uncomfortable annoyance than debilitating and unbearable so I'll live with it. He has suggested cycling with my foot further back on the pedal to alter the movement so I'll need to look at that.


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## jarlrmai (3 May 2015)

I would have thought an X-Ray should have shown that a while ago?


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## vickster (3 May 2015)

jarlrmai said:


> I would have thought an X-Ray should have shown that a while ago?


Yes it did, back in October, but it was deemed benign and the feeling was the pain then was more likely referred from the knee (the now trimmed torn meniscus)

I have an exostosis on the other fibula too, but not causing me much grief


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