# Knee strengthening exercises?



## San Marco (11 May 2014)

Hello all

Apart from my short commute to work on a hybrid, I've been trying to go out and cycle regularly on weekends on a road bike I bought last August. 

The first few rides went fine, experienced a bit of neck pain after a while but it soon stopped. 

However around October time after a few hours back from my ride I experienced a lot of pain on my left calf. This subsided and eventually went over the next 2-3 days, but it became a recurring issue over the next rides thereafter. I went to see a physio who checked my legs etc and told me I had to stretch properly before and after a ride. This is something I hardly ever did 

Although I started stretching (a bit??) for the next few rides
I went to see the physio again as little had changed regarding this 'pulled calf' muscle pain that lasted 2-3 days after each ride. He checked me again and as he couldn't find anything wrong with my legs/knees, he said the cause of the pain was probably due to the mechanics of the pedaling than with the knee/muscle area. The fact it recovered was a good sign and he suggested going for a fitting session. 

I'm 179cm in height and the bike is a carrera TDF with an 'L' frame size which according to the spec has a 58cm top tube. When I bought it I used one of those on line calculators to determine saddle positioning etc. 

So in the interest to solve this nagging problem and determine my future commitment to cycling I decided to spend £95 (caar-ching !!) and get properly fitted. This was done at a place near my home which used video/software to follow stickers placed on you etc. A few subtle adjustments were done, esp. raising saddle height a bit, rotating handle bars, etc, and the lovely girl also tinkered with the cleat position on my shoes and even fitted some mini wedges on the left one. 







Next time I went out, the position on the bike felt more comfortable, I had no neck pain, etc. However the feel of a pulled muscle on my left calf was still there. Maybe less sharp, but same recurrance. Ohh well, must be that it needs a bit of time to fully recover I thought. And timing-wise it was the right moment as this was X-mas / New year. 

I'm not a fair weather cyclist, but I'll have to say during Jan to mid Feb I didn't go out, it does get icy on some of the roads I use and almost had a fall before Xmas so during this time i used the static bikes at a gym I normally go to. I noticed there was no calf pain when I used these bikes, which was a good sign. 

I was very keen to go out on the road again so I started going out at the end of Feb. I used my hybrid first time and didn't notice calf pain. Two days later i did 50km on my road bike and I was v happy!! . No calf pain. I'd like to stress out I did pay more attention to stretching pre/post ride. 

I was keen so went out the next day again as I was experiencing the bug full on! However half way through this ride, about 50 mins after i set off, i started to feel this sharp pain on the top of my left knee cap. I wiggled it, tried to pay no attention and carried on. Sadly things got worse. To the point that I was still far from home and had to stop. There was something wrong, this wasn't calf pain but pain on the knee itself. I had to come back pedalling one-legged. I couldn't really do much with my left leg. Eventually got home and put some ice on the knee straight away, which helped. 

I thought this was a one off, after all, it was my third ride in 4 days. I'm also in my early 40s, not early 20s any more 

However sadly, and worryingly, this knee pain now appears earlier and earlier into a ride (40 min, 30min), on flat ground, 85/90 cadence. I shake knee, massage it, but there is no choice but to turn round and carefully come back home. Ice. Painkillers. Knee hurts for a few days. 

I'm not happy folks. I feel frustrated, I want to get out there and improve, get fitter, tackle more hills, buy a better bike! , but now the 'old' skeleton and body seems to be throwing curve balls at me. 

OR, should I think this also must have to do with those wedges that were fitted during the expensive fitting session I had? 

After my last curtailed ride last week, in anger, i removed them from my shoe and placed the cleats so they match my original markings. 
Due to commitments I've not been out this weekend so won't know if these wedges were the cause of my pain. If they are, I'll be naming and shaming the place where the fitting got done. 

In the mean time, I've been reading about this type of pain and how it has to do with your VMO muscles, how these need strengthening to avoid this pain, etc. 

Is this something I should focus on from now on??

Thanks for reading guys. Sorry it got a bit long, but I had to write all my ramblings here!! 

Take care

Jose


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## vickster (11 May 2014)

That was an essay! 

Do not just focus on one muscle group if you believe knee pain is due to muscle imbalance - need to work them all, glutes, hamstrings, quads, calves etc. Go back to the physio to get a programme and check that your form is right. You'll probably need to start the stretching after riding again

Do you get any sort of leg/knee pain when not cycling? If so, it's probably time to see a doctor


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## Mark White (11 May 2014)

I've had knee problems on and off for 30 years, mostly caused by badly practised weight training when I was too young to know better. It tended to flare up through sitting in a fixed position too long, like when at a desk or on long bus journeys or drives,

The doctor decided on loose ligaments above the knee and gave me this exercise:

Extend the leg straight, off the floor
Point the foot down
Pull the toes back
Tense the thigh muscle
Relax, repeat

This was probably something like tense for 3-5 seconds, repeat 10 times to start with, and increase as the leg strengthens. 

All that said, my knee problem came back after I switched to clip less and I spent a long while tweaking the right one (left is fine) until I was getting only the slightest discomfort after a ride. And after I did my longest ride a week or so ago, this just went away. So it fits with the previous poster suggesting that the general strength of the leg needs to be in balance and that this comes with time. Though riding with a potentially painful knee is worrying at best, and damaging at worst.

And in the last two days I've driven far too much and my knee is aching. So I know mine is not just bike related, and I've already told my wife I have to get out for a ride tomorrow. Purely therapeutic, of course


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## Crackle (11 May 2014)

Sharp knee pain is what I have at the moment and it's stopping me riding. I'm waiting to see a sports specialist on the NHS, so I'll let you know how I get on. One cause could be your IT band but the knee is a complicated area, with lots of muscles inserting around it and you need an expert opinion, maybe two.


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## vickster (11 May 2014)

Several bones and the meniscus cartilage can be responsible for pain as well as myriad of tendons and ligaments! The knee is the most complex joint there is and you don't want to damage it by overdoing it or falling off a bike


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## albion (11 May 2014)

I'm back on my road bike with higher gears.

Now I did a 100er fine though slightly bonked by misjudging the distance.
Feeling fine the next day I did a local 20 miler, the difference been it was a hilly one.

Both knees were then killing me the next day so any overdoing there was certainly via lack of a granny gear.
The pain was never there in my younger days on a similarly or maybe worse geared bike.


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## JasonHolder (11 May 2014)

Ideally need to work up to distance to get joints used to the stress and adapt accordingly. A lot of injuries are brought on by high motivation and big jumps in training increases. 
Guilty as charged.


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## flyingfish (12 May 2014)

I have been told I have a cartlige problem by my gp. it has got worse over a few months and finally went on a steep hill near here. Sounds similar to what OP describes. I will let you know more after my hospital appointment next week


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## vickster (12 May 2014)

Meniscus cartilage or articular, neither great but former better than latter


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## San Marco (21 May 2014)

Thank you all very much for your responses ! 

@Mark W : thanks. I've been religiously doing the exercises you describe. 

@vickster & @JASON : yeah. Probably i'm guilty by overdoing it. 

I'm trying to ease myself back onto easy shortish rides st the mo. I went out with the cleats positioned as they were before I got fitted (still had the markings on), and my knee felt ok. Only been out for 60 - 90 min flat rides, trying to spin at 85-90 rpm. 
So far so good, but I won't get all exited and try out for a 3.5 hour ride w big hills next weekend! 
Fingers crossed. 
Happy travels to all.


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## Mark White (21 May 2014)

San Marco said:


> @Mark W : thanks. I've been religiously doing the exercises you describe.
> 
> I went out with the cleats positioned as they were before I got fitted (still had the markings on), and my knee felt ok. Only been out for 60 - 90 min flat rides, trying to spin at 85-90 rpm.
> So far so good, but I won't get all exited and try out for a 3.5 hour ride w big hills next weekend!



I hope the exercises are helping, but please don't take what I've said as expert medical opinion :-) If the pain is better, great news and I hope it continues to improve. My weekday rides are similar to yours, but I do get a twinge more after a longer weekend ride, or after pushing harder on a bigger gear on a shorter ride like I did the other day. 

Keep us posted how you get on with the longer ride, and keep spinning :-)


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## flyingfish (21 May 2014)

Good luck San Marco. I have done some short flat rides but go for first visit to the surgeon tomorrow at 4.30


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## vickster (21 May 2014)

Good luck. Make sure you understand what cartilage is being discussed, there are two types in the knee, and if surgery is advised, understand what the longer term consequences might be, especially if it is to trim the meniscus cartilage


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## flyingfish (21 May 2014)

My OH is a secretary to a consultant at the Royal National Orthopedic Hospital. I am going to have plenty of advice before any operation. Luckily


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## vickster (21 May 2014)

Cool, are you being seen there? One of the surgeons did my second knee op (albeit privately at Bushey Spire)


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## Portland2000 (21 May 2014)

Get your physio to write something up using PhysioTools...


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## Big Dave laaa (21 May 2014)

Have you tried a decent ride without using spd? Try a cheap pair of flats to eliminate any float issues. I have a dodgy knee from a skiing accident and struggle with cleat position.


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## flyingfish (21 May 2014)

No Vickster I have my initial appointment at Spire Harpenden. If I have an op that's where I want it to be


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## vickster (21 May 2014)

Don't know it, I got referred to Bushey for a big op that never happened (as insurers wouldn't cover local surgeon), just had an arthroscopy, pita place to get to. I am back with my local surgeon who's a star (and operated on my injured shin in Feb again)


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## montage (22 May 2014)

Crackle said:


> Sharp knee pain is what I have at the moment and it's stopping me riding. I'm waiting to see a sports specialist on the NHS, so I'll let you know how I get on. One cause could be your IT band but the knee is a complicated area, with lots of muscles inserting around it and you need an expert opinion, maybe two.



This is the best thing for it - online diagnosis is far from ideal.


I had to have knee surgery some years ago. It took ages to diagnose.

Best money I have ever spent in my life - I paid for a consultation with a private knee surgeon, then continued with him on the NHS...playing the system a bit, but worth it.
Not cheap - but don't skimp when it comes to knees! Hopefully it won't come to anything near that for anyone on this thread - the other thing I would add is that self diagnosis is nearly impossible. The first thing a physio will try to rule out is flexibility, so best to start that now and save some time. Particular attention should be paid to the hamstrings (if you cannot touch you're toes, you are far too inflexible!!

Post op physio included leg extensions and one legged squats. Leg extensions started whilst still bedbound - roll up a towel under the knee. Eventually progressed to the weight machine. These really hurt the knees at the time. One legged squats progressed from holding onto the wall to doing it on top of one of those silly half balance balls with weights. Range of movement in the squats also progressed from not much leg bend to 90 degrees.

Just a note to add to the hamstring stretching - if you are not flexible, you need to hit this hard. It's about as painful as things get - don't be a pansy about it, get those tears rolling. We aren't talking about eliminating a bit of DOMS, we're talking about really lengthening the muscles. 10-20 minute stretching session a day (yes it is a large chunk of time, but we're also taking about saving your knees here, what is 10-20 mins in comparison to a life time of hobbling?). Ideally warm up to the best of your ability before you stretch.

Foam rollers for IT band is another useful investment (when I was younger I had a rolling pin inflicted upon me as a cheap substitute - seriously, invest in foam rollers). At best, stretching and foam rolling will eliminate your knee pain, at worst, you have eliminated it as a possible cause and saved some time with the physio, whilst making yourself a better, more flexible athlete in the long term.


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## montage (22 May 2014)

Big Dave laaa said:


> Have you tried a decent ride without using spd? Try a cheap pair of flats to eliminate any float issues. I have a dodgy knee from a skiing accident and struggle with cleat position.



Have you tried speedplays?

standard SPDs also have lots of float, as do eggbeaters - both are cheaper options


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## Acesand8s (22 May 2014)

What im about to say is an opinion and might sound ignorant as im not sure if you have already tried this: try sticking to tow clips or straps, it sounds lame but you got into the clipless game late, as it sounds, thus your body was too old to properly adapt. At 15 or younger you can adapt your knees to them but the lateral stresses with clipless are notorious for causing knee pain and injury. Either switch to speedplay which give you lots of float (lateral play) or just give up on the clipless. Also if your average RPM or cadence isnt already 75+ than get it up there. Otherwise try doing backwards resistance on an indoor spin bike or a fixie. A light backwards pedaling is good for knee recovery. Also cross-train, do walking running or other. And remember folks, always get more than one doctors input.


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## Berties (22 May 2014)

I can only tell you about my experience of a situation similar to this I went to a biomechanics Physio who recommended orphotic insoles in my shoes,the knee pain was a tight quad ,I do stretch after rides and warm up and down ,
I have specific loading stretching exercises that stretch my leg muscle groups ,this does hurt,and has increased my range of movement
My calve pain was secondary ,basically my body defending my knee and putting load onto my opposite calf


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## San Marco (23 May 2014)

Big Dave laaa said:


> Have you tried a decent ride without using spd? Try a cheap pair of flats to eliminate any float issues. I have a dodgy knee from a skiing accident and struggle with cleat position.



If the problem persists I'll try that ( if I can take the pedals off, I think they've ceased!! ).

Two 45min 90rpm rides this week before kids bedtime and still ok. The wife wasn't as 'that is not the time to be going out  ', pahhhh... It was sunny!!


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## San Marco (23 May 2014)

montage said:


> Have you tried speedplays?
> 
> standard SPDs also have lots of float, as do eggbeaters - both are cheaper options



Hmmm... Not heard about speedplays or eggbeaters. What's the difference ? Do you still need cycling shoes with those?


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## vickster (23 May 2014)

San Marco said:


> Hmmm... Not heard about speedplays or eggbeaters. What's the difference ? Do you still need cycling shoes with those?


Yes, they are clipless, eggbeater 2 bolt, speedplay 3 bolt I think


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## brand (24 May 2014)

Acesand8s said:


> What im about to say is an opinion and might sound ignorant as im not sure if you have already tried this: try sticking to tow clips or straps, it sounds lame but you got into the clipless game late, as it sounds, thus your body was too old to properly adapt. At 15 or younger you can adapt your knees to them but the lateral stresses with clipless are notorious for causing knee pain and injury. Either switch to speedplay which give you lots of float (lateral play) or just give up on the clipless. Also if your average RPM or cadence isnt already 75+ than get it up there. Otherwise try doing backwards resistance on an indoor spin bike or a fixie. A light backwards pedaling is good for knee recovery. Also cross-train, do walking running or other. And remember folks, always get more than one doctors input.


Not sure you entirely right about starting young but would definitely say some peoples knees won't suit anything other than toe clips and even they they may be to constraining. I have had anterior cruciate ligament rebuilt about 12 years ago and continued playing rugby. Got septic arthritis in same knee 3 years ago. X-rays do not show any gap in between joint ie no cartilage left. Had to buy an exercise bike before I could actually cycle on the road again. The advantage of a machine is that you can set the resistance and not the actual terrain. Cycling is zero impact therefore very little pain. I actually get more pain when I have been sitting on bar stool than when I have been cycling.
I am with Acesand8s try clips first still not right go for floats (I assume that means using nothing?) And as I have an arthritis problem, weight bearing exercises (standing up on the bike) results in pain. If you are using a higher cadence that reduces stress as the lower the cadence the higher the pressure on the knee which of course is equal to higher weight bearing. I always cycle uphill sat down (even if it involves contouring).
Uhmmm think I may have gone a little of topic??
Maybe floats first see if that eliminates the problem if so try clips and see if there acceptable to your knee. Also throw in higher cadence where possible as another check.


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## Big Dave laaa (24 May 2014)

My problem was the fore and aft position of the cleats rather than a float issue. I think I've nailed it now and I've also upped my cadence after buying a computer with cadence sensor. Now if I can just remember to unclip I'll be fine


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## brand (24 May 2014)

Big Dave laaa said:


> Now if I can just remember to unclip I'll be fine


That's what always puts me off, specially after a pint!


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## JasonHolder (24 May 2014)

I say you have arthritis. Transition to a vegan diet


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## Acesand8s (24 May 2014)

brand said:


> Not sure you entirely right about starting young but would definitely say some peoples knees won't suit anything other than toe clips and even they they may be to constraining. I have had anterior cruciate ligament rebuilt about 12 years ago and continued playing rugby. Got septic arthritis in same knee 3 years ago. X-rays do not show any gap in between joint ie no cartilage left. Had to buy an exercise bike before I could actually cycle on the road again. The advantage of a machine is that you can set the resistance and not the actual terrain. Cycling is zero impact therefore very little pain. I actually get more pain when I have been sitting on bar stool than when I have been cycling.
> I am with Acesand8s try clips first still not right go for floats (I assume that means using nothing?) And as I have an arthritis problem, weight bearing exercises (standing up on the bike) results in pain. If you are using a higher cadence that reduces stress as the lower the cadence the higher the pressure on the knee which of course is equal to higher weight bearing. I always cycle uphill sat down (even if it involves contouring).
> Uhmmm think I may have gone a little of topic??
> Maybe floats first see if that eliminates the problem if so try clips and see if there acceptable to your knee. Also throw in higher cadence where possible as another check.


Ya... float is the word for lateral play. SPEED PLAY is a brand of clipless pedals, they make the "Frog" which has extra 'float' so your knee is more relaxed. Clips with straps or even just pedal straps can help the problem. I would also think about 165mm crank arms, if you dont already have them.


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## T.M.H.N.E.T (24 May 2014)

JasonHolder said:


> I say you have arthritis. Transition to a vegan diet


Why?


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## Dan B (24 May 2014)

JasonHolder said:


> I say you have arthritis. Transition to a vegan diet





T.M.H.N.E.T said:


> Why?



Because base miles


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## JasonHolder (24 May 2014)

No dairy = drastic change in jointpain.


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## vickster (24 May 2014)

But vegan doesn't mean only dairy free

I would be surprised if all those cakes you eat are vegan


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## JasonHolder (25 May 2014)

Give it a shot 
OP. If it works great, if it doesnt. You've had your 5 a day and are carbs up. My knees and hands are near perfect now


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## montage (25 May 2014)

JasonHolder said:


> Give it a shot
> OP. If it works great, if it doesnt. You've had your 5 a day and are carbs up. My knees and hands are near perfect now



apart from the fact they can still type


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## vickster (30 May 2014)

Oh my lol 

He's not a vegan, he eats shop bought cakes, biscuits and chocolate (forgetting that they contain dairy and eggs and probably other animal products) ...and lots of bananas (Tis that durianrider cult banana nonsense, and he like totally gets it)


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## Spinney (30 May 2014)

This is Health, Fitness and Training, NOT the Cafe! Please keep on topic.


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