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  1. #1
    High Speed Botanist
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    Knee Pain - any suggestions?

    So i have been dealing with this re-occuring knee pain since last summer. The initial feeling is a gravely/grinding on the outside of each knee, primarily my right. The more i ride the rougher the grinding is. This can be felt on every pedal stroke if i touch the side of my knee. The end result of this is pain above the kneecap on every downward pedal stroke. I am riding a Cannondale road bike with SPD's and a Mountain Cycle San Andreas with Eggbeater's. I am working on changing different height/seat positions to see if this will help. Anybody have a similar problem with their knees? Any input would be much appreciated.

    Lou

  2. #2
    A Guy Who is Going Places
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    Quote Originally Posted by lswing
    So i have been dealing with this re-occuring knee pain since last summer. The initial feeling is a gravely/grinding on the outside of each knee, primarily my right. The more i ride the rougher the grinding is. This can be felt on every pedal stroke if i touch the side of my knee. The end result of this is pain above the kneecap on every downward pedal stroke. I am riding a Cannondale road bike with SPD's and a Mountain Cycle San Andreas with Eggbeater's. I am working on changing different height/seat positions to see if this will help. Anybody have a similar problem with their knees? Any input would be much appreciated.

    Lou
    Its hard to say without seeing you on the bike, but your cleats could be set up too far inboard, which would cause your knee to cant inward through the pedal stroke. The seatpost should be set such that at the bottom of your pedal stroke you have almost full leg extension WITHOUT locking your knee. If you can rest your heel on the spindle of the pedal and and then rotate the cranks down until they are in line with the seat tube, your knee should just barely lock out.

    Fore/aft saddle position should be set such that with the cranks horizontal and the ball of your foot over the pedal spindle, a plumb line dropped from the end of your femur (just behind the kneecap) will bisect the pedal spindle. This si the "textbook" position, and if you are having knee issues it might be a good place to start.

    Otherwise figure out which bike shop in town does the best fitting and see if they offer a Pedal System Analysis. This will dial in the bike fit from the waist down and should minimize any chance of knee over use sydrome injuries.

    Hope this helps,

    A

  3. #3
    KgB
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    bike fit issue

    is usually the culprit.
    spend some time at the lbs.My bike is like knee therapy,after years of contracting my knees would hurt at work and be rejuvenated by riding.

    Is this your only bike?
    Did you always have this problem with this bike?
    Have you changed anything?
    Do you push too hard of a gear?
    I've been inside too long.

  4. #4
    Part-time rider
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    Illiotibial band

    Pain in the lateral side (outside) of your knee may be from your illiotibial band (ITB), especially if your feet have flat arches. I have chronic problem with my ITB, and I get around it by stretching and using superfeet inserts in my shoes.

    K-Zero
    "It's not how good you are, it's how good you want to be"

  5. #5
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    Yes, I was going to say Iliotibial stretching as well. I taught...

    Quote Originally Posted by K-Zero
    Pain in the lateral side (outside) of your knee may be from your illiotibial band (ITB), especially if your feet have flat arches. I have chronic problem with my ITB, and I get around it by stretching and using superfeet inserts in my shoes.

    K-Zero
    ...this stretch the way I do it to a guy in the road bike club I used to ride with. Although he moonlighted as a karate instructor, he had not heard of this stretch. His pain went away soon, and his cycling became enjoyable agian.

    There are many ways to do this stretch from the passive type, all the way up to the ones in yoga. I suggest you search online and start with the more passive ones. Generally, you work your way up from the laying position, to sitting, standing while leaning, and free standing.

  6. #6
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    Pain on the lateral side of the knees is often caused by the IT band. Thisis common with cyclists. There will often be a clicking noise as the tendon snaps over top of the lateral femoral condyle. There has been a lot of posts on IT band and what you can do for it. Stretch, ice, rest, don't mash and use a smooth peddle stroke.

    Grinding in the knees can often be attributed to a patellar tracking problem. This means that the patella does not glide in the path that it should over the joint. This could be caused by improper fit and you made need to adjust your bike and shoes.
    It can also be caused by a muscular imbalance in your quads. If your lateral quads are relatively stronger than your medial quads or vice versa then this can pull the patella off to one side.
    Does your knee grind at other times when you are not on your bike? Like if you squat down. This could mean that it is a muscular imbalance. If it only bothers you when you are on your bike then it is likely a fit problem.

    Either way you want to make sure that your bike is set up properly for you.

  7. #7
    I wonder why?
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    The key in dealing with knee problems is understanding the cause.

    Most knee problem are caused by repetitive movement and poor musculoskeletal mechanics. Chronic problems arise over time while acute symptoms manifest with sudden increases of activity levels. In either case, excessive stress (tension or pressure) is generated on, or at, a specific tendon(s), cartilage or ligament(s) and is caused by poor alignment, resulting from, and/or imbalanced muscle use. Poor structural mechanics of the foot’s arch system (flat foot or collapsing arch) can also, upon weight-bearing, cause the leg to rotate medially (to the inside) which increases the stress on the inside and outside of the knee, as well changes the tracking pattern of the patella (knee cap). IT band problems, as others have mentioned, are also common and exacerbated by poor mechanics (fit?). Sometimes the stresses generated by the poor mechanics result in a build-up of internal scar tissue––this needs to be treated by a medical professional (ultrasound, etc.).

    Cycling typically involves greater effort from the quad (thigh) muscles than the hamstrings which results in an imbalanced tension at the knee and can contribute to knee problems. This imbalance can be further magnified by locking your feet into one position, i.e. clipless pedals with limited float.

    The key to preventing and eliminating knee related problems is to:

    1) Make sure your feet provide a stable platform inside you shoes. If you have a flat feet or collapsing arches try using one of the customizable footbeds made for ski boots. Just make sure they are made (sanded) as thin as possible to fit into your cycling shoes. Orthotics are typically, too bulky (thick) and too costly.

    2) Once you are sure your feet are stable try to use a cycling shoe with a lot of toe spring (with your heel flat on the ground the toe rises), the higher the better. This helps the bones achieve optimal stability. Also don’t tighten your laces or Velcro straps too tightly as this causes the arch to collapse and results in a weaker less stable structure. A good rule of thumb is to raise your big toe as high as possible (which raises your arch) and snug laces or Velcro straps to that point. This allows the bones of the foot to align naturally to the forces involved while your pedaling and dramatically reduces the repetitive stresses at the knee.

    3) Try to use a clipless pedal (if that’s what you use) with the greatest degree of float. This will also help reduce the repetitive strain caused by having your feet locked in one position.

    4) If you do a lot cycling it is also important that you balance the tension between the quads and hamstrings, i.e. increase you’re hamstring activity. Hamstring curls at the gym is a great exercise. A great at home exercise is to take an old inner tube and hook it under the leg of your sofa (or something heavy), and hook the other end around your heel, while sitting in a chair or on something stable, and far enough away from the sofa to tension the inner tube with your leg extended. Then simply pull your heel toward yourself with your foot an inch or so off the ground. Do as many repetitions as possible until you can’t pull anymore rest a minute or so and repeat again two or three more times.

    In addition, non-cycling footwear and activities can impact on knee problems and can contribute to or be the initial cause of many problems. For some of the most up to date info on the musculoskeletal mechanics check out http://www.barefootscience.net/footc...s/a_cover.html

    By applying some or all these suggestions you can safely continue riding. I hope this helps.

  8. #8
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    Don't take this the wrong way, but maybe you should see a doctor.

  9. #9
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    If this keeps on going like that I agree with the above post, a visit to a reputable ortho doctor might be helpful.

    You really don't want to permanantely mess up your knees.

    Clep

  10. #10
    High Speed Botanist
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    wow, thanks

    There is some great input that i will certainly put to use. I have seen a doctor about the problem and the tracking of the patella tendon could be an issue. I am riding with clipless pedals with a decent amount of float. The problem developed last year when i was riding on platforms, and therefore very locked in to one position. Shoe inserts seem like a good idea, i have spoke with someone about that before. I have high arches in my feet and when i ride it feels like they collapse and my foot wants to go to the inside. Also the issue of quads getting too strong and having a lack of muscular balance seems right on. The more riding i do and the stronger my legs get the more pronounced the problem is. I shall certainly strart doing some hamstring exercises. And yes, the grinding is prevelant all the time whether it be stair climbing or squats. Thanks again all!!

    Lou

  11. #11
    Your Customer Sales Rep
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    Hi,

    Don't know about Eggbeaters ... but I had to spend some time feeling out SPDs (namely the cleat position and orientation - toe in versus toe out versus straight ahead) before my knees felt completely at ease. If this persists, you should get professional help, either someone who knows about bike fitting and/or a sports doctor or one who rides. (Doctors are fine, but you want to talk to one who has some knowledge in this area). D.
    You be you. I'll be riding.

  12. #12
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    Sure test of IT band

    First thing is have you been doing any running? Sure test of IT band is to walk downhill or down some stairs while your knee is bothering you. If either of these causes EXTREME discomfort, it's probably your IT band. There is also the "IT hobble" as I call it. It's the inability to bend the leg at the knee due to the pain.

    Check some we sites, there are stretches for this. Be sure to warm up before stretching, and if it is the IT band, it takes some time to get through it.

    About inserts, I have been riding w/ the Superfeet inserts from REI for some time. The angle of the foot on the pedal is important. Specialized addresses this issue with their body geometry shoes.

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