# Knee Pain after putting in more miles



## robbo891 (11 May 2015)

I have recently stepped up the amount of time and miles on my bike but have now started to experience pain what feels like bang on centre of the knee cap. After a 46mile saturday and 56mile ride monday i was hobbling about for 2 days. 

Ok you might say rest between rides but I am doing C2C in August so worried my knees will not be up to it.

im 33 and in good shape, i lift weights daily, commute weekdays and do a decent ride at weekends but this is now holding me back and starting to effect my ride.

I have since increased saddle height and moved seat forward as per videos on Youtube (GCN) etc

Is there any exercises anyone can recommend? I would prefer gym based work rather than home stuff.

Cheers


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## vickster (12 May 2015)

See a private sports physio for an exercise programme tailored to you and your condition. Otherwise your knees may not be up to it!

Rest advised, probably upset the patella tendon or similar. Icing may help any inflammation

But seek professional help if not willing to rest to let it recover. Make sure you are spinning not grinding up hills etc

Are you stretching daily after cycling and the gym? If you are anything like me, you are over reliant on your quads and neglectful of all the other muscles in legs and bum!


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## Joffey (12 May 2015)

Maybe your cleats need adjusting? I had a bit of knee pain in my left knee and a quick adjustment of my cleat position sorted me out.


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## vickster (12 May 2015)

2 days hobbling suggests more than a dicky cleat although could be exacerbating the issue

Even with my knackered knees I'm not often rendered a hobbling mess. See a physio. If anything like here, you'll wait 8-12 weeks on the NHS so for an August ride you'll need to pay privately. Find someone with an interest in cycling and a knowledge of cycling biomechanics if you can


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## Dave7 (12 May 2015)

Similar to adjusting the cleats..........when my knees were giving slight problems I adjusted seat height & position (a bit as a time & experimented) and it worked for me. I now get zero actual knee pain.......just the normal "behind the knee" sinewy type things after a long/hard ride.
Not saying it WILL work for you for may be worth trying before spending serious money on physios


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## vickster (12 May 2015)

He says he's done that already  it does sound like only recently so may help, along with rest. Don't want chronic patella tendonopathy as @jarlrmai will attest


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## Crackle (12 May 2015)

Knee pain can be caused by lots of issues from a chronic problem you may have to bike setup and all things in between. You're best bet is probably to visit your bike setup first. See this site for some clues as to what causes problems where

http://www.cptips.com/knee.htm

This site for a good all round descriptor of knee pain and causes

http://www.knee-pain-explained.com/

My own recent knee pain was caused by muscle tension and tendonitis but I've also experienced some pain from bike setup. Sorting knee pain can be a long path but hopefully it's something simple causing it.


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## matiz (12 May 2015)

It could be as simple aa trying to push high gears Instead of spinning


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## robbo891 (12 May 2015)

Cheers guys hugely appreciate the replies! As im fairly new to big miles I have some awful habits I think. Pushing high gears was one (i like a challenge, i like the burn, but i dont like these bad knees). So i now ride more sensibly. These pains are new as in the last 2 weeks so I have looked at my bike setup first and im currently testing different setups. Cleat wise i had no issue for a year, until i did these long mile rides. I had SPD-SL and cheap shoes. I have just made the switch to shimano shoes and cleats so there under testing too lol. 

as Crackle says its probably a long path but Im hoping its something simple.

I will report back as I go on.


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## Dave7 (12 May 2015)

vickster said:


> He says he's done that already  it does sound like only recently so may help, along with rest. Don't want chronic patella tendonopathy as @jarlrmai will attest


Ah yes. Note to self............read OP properly before offering advice


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## robbo891 (13 May 2015)

few short rides out around 13mile each and knees are holding up, with just a little niggle. test will come on a big ride. Touch wood that the seat height and bringing it forward slightly is working!


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## NorthernDave (13 May 2015)

I pushed too hard and injured both my knees by pushing too hard in high gears rather than spinning when stepping up to longer rides. Are your knees noisy (grinding / popping when bending), or just painful?
GP confirmed patella tracking and advised me to do VMO exercises to strengthen them and bring the patellas back into line - no cycling for TWO WEEKS, then build up starting with 15-30 mins at a time. I'll need to continue the VMO exercises and it could be up to 12 weeks before I'm back to normal if everything goes according to plan (ie after most of the good weather...). I asked about physio and was told there is no need as things stand.
I'm allowed to use an exercise bike on the lowest resistance setting (boring but at least it's keeping me ticking over) and otherwise it's anti-inflammatory painkillers and icepacks when needed .


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## ayceejay (13 May 2015)

I think this is one of those Less is More situations. You need to curb the notion that whatever the problem it can be cured by MORE exercise when it seems that you are already doing quite a lot. Obviously get your bike fit sorted but then have a look at your pedaling technique.


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## robbo891 (17 May 2015)

Knees still holding up well and done about 10mile every day for the last week on average. Still yet to test a big ride but this could be awhile now as from next week I'm away so no excercise at all (probably due a rest week).

I love pushing the harder gears so I've probably applied this to my big ride and it's caused me these issues. I will learn to ride more sensibly now. 

Northern Dave sorry to hear about your problems. hears to a speedy recovery!!


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## Cringles (26 May 2015)

I have the same issue to Northern Dave. My right knee patella is maltracking. I'm on my 3rd week of physio, and over the last week, VMO exercises have really made a difference. No longer get the pain going down stairs. I'd urge any cyclist to do VMO exercises if they aren't already. It really sucks taking 2-3 months of the bike.

I couldn't stand up on the bike, and spinning hurt. Big gears, big hills, fully loaded touring bike. Amateur mistake  I think I'm gonna have a professional bike fit when I'm better. Planning to tour around Ireland in August. Don't want my amateur set up knowledge causing me another injury.

Good health to all \o/


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## NorthernDave (26 May 2015)

robbo891 said:


> Northern Dave sorry to hear about your problems. hears to a speedy recovery!!



Thanks - three weeks in and I'm starting to see some progress. Best of all is that I've managed to get a few short rides in, simply being back on the bike is great news.
I'll keep taking it steady, but hopefully a slightly longer ride might be on the cards this weekend...


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## Cringles (30 May 2015)

Can I ask you what VMO exercises you are doing Dave? I've been told mainly to do the 'squat with ball between knees' exercises, and foam rolling. I'm still not on the bike just yet.


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## NorthernDave (30 May 2015)

Cringles said:


> Can I ask you what VMO exercises you are doing Dave? I've been told mainly to do the 'squat with ball between knees' exercises, and foam rolling. I'm still not on the bike just yet.


I'm doing these at the moment: http://www.howcast.com/videos/510309-how-to-train-your-vmo-vastus-medialis-knee-exercises/


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## Cringles (31 May 2015)

The issue is really annoying me. Some days my knee feels like it's progressing, and today it feels like it gone again. Had my 4th treatment this week, and next week I'll have shock wave therapy I think. My knee always gets sore after any VMO stuff to. Not sure if that's normal.


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## screenman (31 May 2015)

How much stretching are you guys doing?


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## Cringles (31 May 2015)

I was told to do the squat and squeeze ball stretch twice a day, 30 reps. But I've added in 10 reps of leg lifts to. Not sure if I'm over doing it. Each person will be different. I actually thought I'd get out on the bike this week, but then the pain walking down stairs came back again, so scrapped the idea.


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## NorthernDave (31 May 2015)

screenman said:


> How much stretching are you guys doing?



Lots, now... 

I think I'm making some progress, but I'm only 3 weeks in to a 12 week process. At least I'm able to get out on short rides again now...


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## Crackle (1 Jun 2015)

Cringles said:


> Each person will be different


That's key. It took me nearly 6 months to understand my knee problem and be able to distinguish what worked for me and what didn't. It was this understanding and subsequent exercise modification which got me rehabilitated rather then the generic exercises I'd been given. Of course all the physio input helped but it was me who eventually put it together in the right order.


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## Cringles (1 Jun 2015)

I do find foam rolling helps to. My knee feels better after that than when doing any VMO stuff. Always have to do it after exercise. PT did mention my IT band right as it joins the knee is very tight. It's the main area she works on. I might have to bring a tennis ball or two if I'm going on a cycle tour. Can't be carrying a foam roller


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## vickster (1 Jun 2015)

Depends what the issue is. I've got a small bone spur (exostosis) on my right fibula (so not technically my knee but close) which causes inflammation in the surrounding muscle and irritates the nerve... I've been told not to over stretch it nor to do any sort of deep tissue massage (so no foam rolling). A bizarre unresolvable issue, just have to hope it settles. I have one on the other leg too which doesn't give me the same grief!


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## Racing roadkill (3 Jun 2015)

Don't 'spin' on a long ride. It's as bad (if not worse) for your knees as overgearing. Keep using your gears to allow you to find a ring / sprocket ratio that allows you to keep your cadence at a fairly steady rate, depending on terrain at the given time (you don't want big variations) between flats and climbs.


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## robbo891 (3 Jun 2015)

Just done 28mile tonight and its back! well tbh it probably never went away. This was the first time I have had chance to do some miles as Ive been away.
Gutted tbh, its not painful as such as i could do more but its niggling. it feels sore right now 1hr after riding. Im totally lost as to what it could be.


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## Crackle (3 Jun 2015)

robbo891 said:


> Just done 28mile tonight and its back! well tbh it probably never went away. This was the first time I have had chance to do some miles as Ive been away.
> Gutted tbh, its not painful as such as i could do more but its niggling. it feels sore right now 1hr after riding. Im totally lost as to what it could be.


Time to see someone, this probably won't get better unless you actively sort it. See if you can find someone with a good reputation, unless there's an underlying chronic problem then the NHS might not be of much help unless your GP can refer you to a muscular-skeletal clinic, which is possible, they do exist but expect it to take some time for an appt.


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## vickster (3 Jun 2015)

Go see a doctor or a physio if you are happy with the set up of your bike. 
don't ignore knee pain


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## Cringles (7 Jun 2015)

Week 5. Been asked to cycle 1 mile. Which is fine, but I still feel the tiniest thing. Not pain, but since it's been almost 3 months, I'm now just constantly focusing on my knee, I pay attention to it more with everything I do. Still can't get out of the saddle. Only take's a few rotations to know that I'd make things worse if I keep going.

At this point, I think I'm gonna have to cancel the 1,200 mile bike trip. Can't imagine getting healed and enough training in before August 1st. 

Is anyone else improving?


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## NorthernDave (7 Jun 2015)

It's slow going, but there seems to be a little improvement.
The knees are still as noisy as ever, but less painful and I'm able to cope with 30 minutes or so of steady cycling a few times a week. This is good in a way, but still incredibly frustrating as I was doing 30 plus mile rides prior to the injury.
I suppose the point is to remember you only get one pair of knees and be grateful for any improvement. Hopefully keeping at it will get things back to normal eventually.


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## velovoice (8 Jun 2015)

NorthernDave said:


> I suppose the point is to remember you only get one pair of knees...


Or you can put a brand new titanium set on your Christmas list.


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## robbo891 (8 Jun 2015)

I feel your pain guys and it sounds like you definately worse off than me. I have made more adjustments so waiting to see how that goes! after that its physio and a professional bike fit. Coast to coast is in serious danger of cancellation!


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## Cringles (13 Jun 2015)

Just back from a 11 mile trip. Took it easy, averaged about 10mph. Stayed in saddle for the few hills. Defiantly a massive improvement. Tiniest little niggle in the knee, and a tightness above the knee on the way home. Haven't been doing any exercise, so I think the quad tightness might be down to that, as I've never had that before. Hopefully I don't jinx myself now. I'll give it 2-3 days before I try the bike again.

Still get the swollen fat pad below the knee, no pain, but still a sign it's not 100%. Still have a tight IT band, so hopefully back to normal mid July. Dry needling does wonders.


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## stoatsngroats (13 Jun 2015)

vickster said:


> Make sure you are spinning not grinding up hills etc



I can't comment on physio support, but I totally agree that this may help - i have a similar issue, and have had x-rays to identify problems, but none exist, so i tried spinning , and have much less pain, In fact, I sometimes have pain if I don't cycle much, which then clears as a result of cycling.
I hope you either get this sorted, or find a work-around!


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## vickster (13 Jun 2015)

X-rays won't show much unless you have arthritis or like me a random bone spur which irritates the surrounding muscles.
An MRI is much more likely to show something, but rather more costly (there are places which will do for around £250-300)


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## jarlrmai (15 Jun 2015)

Cringles said:


> Just back from a 11 mile trip. Took it easy, averaged about 10mph. Stayed in saddle for the few hills. Defiantly a massive improvement. Tiniest little niggle in the knee, and a tightness above the knee on the way home. Haven't been doing any exercise, so I think the quad tightness might be down to that, as I've never had that before. Hopefully I don't jinx myself now. I'll give it 2-3 days before I try the bike again.
> 
> Still get the swollen fat pad below the knee, no pain, but still a sign it's not 100%. Still have a tight IT band, so hopefully back to normal mid July. Dry needling does wonders.



I'm interested in your swollen fat pad, care to share photos?, your issues and treatment plans seem very similar to mine.

Do you get a "Chinese burn" type soreness in the fat pad swelling area? I often get this if I feel like I maybe pushed things too hard. Walking or standing for too long.


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## vickster (15 Jun 2015)

The fat pad is full of nerves. Any impingement or irritation will hurt. I had much of my right Hoffas fad pad removed in February, cortisone can help, didn't for me as I had a tatty lateral meniscus too and a raggedy kneecap. Having the fat pad excised to have removed the knee pain. Shame about the nasty bone spur irritating my lateral shin muscles


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## Cringles (15 Jun 2015)

I've no feeling in that fat pad at all, just the flesh squishy bit below the patella. I get dry needling in it to reduce swelling, but I don't even feel the needle in there at all. My main issue seems to be a very tight IT band right at the side of the knee. I'm currently back commuting 6 miles to work. Spinning has reduced pain massively. But I'm just back from the cinema, and sitting for 2 hours has made my knee feel stiff again. But 10 minutes of foam rolling has made it feel normal. but I still have the swollen fat pad.

Tried to get a picture, but nothing does it justice, sorry. No Chinese burn sensation either. The only pain I get is a sharp pain when my knee moves into a 90 degree angle really. I could do maybe 3 squats before the pain kicks in. IT band is pulling the patella a bit, just enough to irritate the area, which causes the fat pad to swell up a bit. No pain when walking or standing at work all day either.

I've never had an x ray, so I don't know if there is another issue.


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## jarlrmai (16 Jun 2015)

This is my knee the green section is where the swelling (noticable over the other knee) is you can see it's just below the knee cap. It used to be bigger than this, then it shrunk a bit.


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## Cringles (16 Jun 2015)

My legs are just to pale too get a decent picture haha. But how your knee is in that picture, is how mine is at it's most swollen. I cycled home today, and so far no swelling at all. I think my swelling comes mostly from anytime I'm sitting down for a bit.


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## jarlrmai (16 Jun 2015)

You get it in the same place?


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## craigwend (16 Jun 2015)

are you taking anti-inflammatories before & after?
http://www.nhs.uk/conditions/anti-inflammatories-non-steroidal/Pages/Introduction.aspx

My GP's a 'runner' & swears by them
- as most of my injuries / problems tend to involve my back / shoulder / knees - I've found these (Ibuprofen for me) an excellent short term 'help' until fit again


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## jarlrmai (16 Jun 2015)

All fine until you get stomach problems, dont mess with NSAIDs


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## Cringles (16 Jun 2015)

Yes, I get it in the same place. I found the ibuprofen gel better than the tablets.


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## jarlrmai (16 Jun 2015)

Interesting, how's your VMO strength in that leg these days?

I tend to get soreness and the leg feels weak but I don't get pain anymore. I'm kind of just hoping that once my leg gets strong enough the soreness will go.


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## Cringles (16 Jun 2015)

VMO is coming along, bit stronger, looks a bit more defined. Mainly doing leg raises and wall squats. My knee doesn't hurt as much, but yeah, I also have a feeling of ''my knee feels kinda week''. Knee cracks sometimes, which I'm told is a good sign as it's being pull back to were it's meant to be.

I'm finding my the quads in my right leg/ same leg as knee issue is becoming a bit more tight after cycling, not sure if that means there now pulling the knee. It's more painful foam rolling the quads than the IT band now.


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## RitchieJoe (18 Jun 2015)

Is the pain confined to one location or is it moving around the knee? Have you considered a knee support?


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## Crackle (18 Jun 2015)

There may be a trigger point you haven't found yet. I found with my tendonitis that one of the muscles responsible, the sartorius, attached near my hip. I'd been rolling about two thirds of it before I discovered this and finally rolled an area below my hip I hadn't touched before. It was unbearably painful for a few rolls and then made an enormous difference to the tendonitis in my knee. I know you don't have the same thing but it's often worth looking at all the muscles involved and their attachment points and working all aspects of them.


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## jarlrmai (18 Jun 2015)

That's interesting...


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## Cringles (18 Jun 2015)

Just back from Physio & I've now been told to add quad stretches, as I still have the fat pad swelling. The tightness I felt, was normal. My IT band is doing the heavy lifting when I cycle, so now it feels like my quads are pitching in. My knee pain is gone when walking down stairs. If I did 10 squats in a row it'd raise it's head a bit. Hopefully I'm on the right track to repair.

Also don't need the knee taped anymore. I'll add the rolling of the sartorius. Looks a bit awkward, but I'll give it a go. So much to roll!


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## RitchieJoe (18 Jun 2015)

Cringles said:


> Just back from Physio & I've now been told to add quad stretches, as I still have the fat pad swelling. *The tightness I felt, was normal. My IT band is doing the heavy lifting when I cycle, so now it feels like my quads are pitching in*. My knee pain is gone when walking down stairs. If I did 10 squats in a row it'd raise it's head a bit. Hopefully I'm on the right track to repair.
> 
> Also don't need the knee taped anymore. I'll add the rolling of the sartorius. Looks a bit awkward, but I'll give it a go. So much to roll!



Do you feel that would of been avoided had you had a professional bike fit done? My Physio's colleague works with the English Institute of Sport with British Triathlon and does bike fitting for £175..... Think I should?


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## Cringles (18 Jun 2015)

RitchieJoe said:


> Do you feel that would of been avoided had you had a professional bike fit done? My Physio's colleague works with the English Institute of Sport with British Triathlon and does bike fitting for £175..... Think I should?



If you can afford it, I think it will be worth it. I've been told to wait until my knee is 100% as they'd be watching my knee during the fit. I'm defiantly going to get it done when I can. I like long distance cycle touring, so I need to be as comfortable as possible.


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## jarlrmai (18 Jun 2015)

If your knee is not tracking correctly already a bike fit wont help much, get a physio tracking assessment and a bike fitting.


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## jarlrmai (20 Jun 2015)

Back in schedule with my sports therapist, did some leg strength tests, turns out my rec fem is practically non existent, can barely straighten my leg with the lightest of resistance.


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