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Frustrating Knee Problem

Hi Chaps, not been on here for a while. Hopefully someone else has had a similar problem to what I'm currently experiencing (and hopefully they have also recovered!).

Now, I shall be organising to see a specialist as soon as I can, but just thought I'd ask anyway.

I am very active, don't do mega miles but they are quite intense! About 3 months ago I was running and didn't really do more than normal - got to about 6K and my right knee started to ache.

This was very painful the next day and very stiff, not sore to touch, but felt like it was underneath the knee cap, towards the inside of the knee.

It went after a couple of days, no pain, nothing at all, then after a week, out on a bike ride it flared up - slowly building from a dull ache to a real painful problem. This has been persistent since then - I decided to rest up, my first self diagnosis was possibly quadriceps tendonitis - so plenty of stretching and resting. No bike riding or running for over 6 weeks, then decided to try a run at the gym on the treadmill, great no pain! So, went for a bike ride last week, easy, high cadence to test it - however within 10 mins of pedalling I felt the pain again. I went back to the running machine 3 days later and tried again - no problem.

Really frustrated now, nothing has changed on my bike or anything. My knee hasn't felt right since it happened and I assumed running would have been worse than cycling! Obviously the continuous circular motion is doing something bad. There is a sort 'ping' or 'click' as I squat down over the knee cap, not painful but the left one doesn't do it! It's very very frustrating - hence I will see a specialist to get their input.

I've just not read up about anyone with a similar problem yet.

More annoyingly, my local pool had problems in November and I'll probably get my first swim in 8 weeks or so tomorrow!

I've been running & swimming for about 3 years now, been on the bike for over 6, and never had anything like this.

Any input is welcome! Cheers chaps and Happy New year!


  • Get gait analysis

    Do you wear insoles ? Corrective ones ?

    I bet you have an imbalance that is working it's way up from your foot upwards.

    Collapsed arches lead to collapsed ankles which lead to you compensating in the knee. Etc etc

    I only know this cos i have had knee pain recently, seen a GB Olympic physio and I need corrective insoles.

    Caveat - I know nothing about this stuff just what I was told but it's worth a look. I don't do much distance at all - really I don't - and this just suddenly happended. No pain then wallop. Put me off running tbh.

    Feel better knowing what it is. Only problem is insoles cost £300!

    Good luck & sorry I can't help more
  • shadowone1shadowone1 Posts: 1,408
    Would agree with Ben but he did the right thing insomuch that he sought advice from someone who knows their stuff.

    I on the otherhand when I had knee issues stumbled from one physio to another with varying degree of diagnosis.

    However, commonly the issue is not the knee itself but it is somewhere else in the body. So as ben states it could be the feet, could be the pelvis etc..there is a multitude of answers to where the prob is and the only way you will get to the bottom of it is by seeing the right person.
  • Cheers for looking chaps. Had gait analysis done couple of years back, mild overpronation, used the Saucony progrid Omni's ever since, on my 3rd pair now, should have never posed a problem - never had any problems to this extent.

    One other thing I have considered (only just) is that my pedal cleats have been bent slightly in the past (too much power in the wrong places?) - never caused a problem, just that I felt the difference from my 'worn' ones to some new ones when I switched bikes. This is my current theory - probably one that even a good specialist may have not considered, but I can't see how that could cause such a big problem - my current bike cleats don't appear that bad to the eye. Getting some new ones off a friend soon, swap them and try the turbo to see of there is a difference.

    Its just weird that the problem occurred while running, yet now it is my cycling that is suffering. Just really reaching out to see if anyone has had a similar problem!

    Hopefully get an appointment this week for referral..this is the hardest part, waiting...
  • shadowone1shadowone1 Posts: 1,408
    If you are over extending the knee on the downstroke of the pedal action then you will undoubtedly trash your knee.

    Get someone to look over your fit on the bike to ensure that everything is spot - I use Bridgtown Cycles.Very good place to go.

    your doing the right thing but unfort there is no quick fix as you still need to treat the symptoms.

    good luck in the recovery
  • Hi there

    I also have a pain that appears to be similar to yours. However I tend to get the pain when running not when cycling.

    I have also been to specialists in hospital and had MRI scans etc that all come back clear and appear to be very little help.

    Currently I'm trying Pose technique for running ie landing each strike with the ball of my foot which takes the pressure off the knee. Previously I could do 3k tops, I managed 11miles the other day with no pain using the new strategy. There is lots of information on this on the web so have a look and see what you think.

    Have you thought about getting a proper bike fit?

    Hope you recover soon
  • All sounds horribly familliar.

    I experienced the same issues as I trained towards my first olympic. MRI etc showed nothing, but the diagnosis was that of "tracking" and the fact that the muscles around the knee weren't holding it in place as I ran.

    I have been working with a new physio for the last 6 weeks, and have been told it will be a slog.

    Running: Banned until further notice - gait analysis showed a good running style, so just need to build up the muscles.
    Cycling: Advised to stay in the saddle when cycling, and work the gears. A bike fit has been discussed but not until further down the line when the base problem has been resolved
    Swimming: As much as I like, stop if it hurts.

    Hope this helps
  • Well, been to the Docs today, and frustratingly I watched as he turned to google for answers....at least the site seemed very informative, I highly recommend it for anyone who is as anal about detail as myself - http://emedicine.medscape.com

    Unfortunately I'm still no wiser, as he simply isn't a specialist (about anything it seems) , held my knee, I extended it a couple of times and described a bit about the problem and he then decided it could be patellofemoral osteoarthritis, then basically narrated the web pages from that web site...I'd said twice that a referral was what I wanted anyway so I could see a specialist through my private health, but he insisted on getting an x-ray first and taking it from there....(I did just want to go at this point as it was 15 mins worth of waffle, and another bloke was waiting before me outside with his young daughter).

    So, within 30 mins I was at my local hospital having a knee x-ray. I asked to see them and the operator was kind enough to let me see the screen, fat lot of good that was, it looked perfect. She didn't have a clue either, then while I was sat at home it occurred to me that should she have known what she was looking for, she would have taken an x-ray looking down through the knee - as if from the person who's knee it is, as this would have shown any indication of lateral movement or if it was excessively close to the femur. Oh well, I'll call the doc next week and see what the report says...then maybe I'll get my private treatment and no doubt an MRI if the specialist can't pinpoint it...
  • How frustrating, it is really annoying how some of these so called "professionals" waste youy time.

    Where do you live, I'm sure between us we could come up with a local recommendation.
  • could see a specialist through my private health
    Why do you have to get a referral from your GP for that ? .

    You can rock up and pay for an MRI now so just cotact your insurance company.

    GP's are shit. And you can't convince me otherwise.
  • shadowone1shadowone1 Posts: 1,408
    I agree GP's are shit

    I wasted 6 weeks because of them when all I was told was to rest and hammer anti inflammatories down my throat.

    Eventually after 6 weeks and a bike ride later when my knee packed in - I went to hospital, got an x-ray which showed dick all. Then made a huge song and dance, eventually got access to a specialist.
  • A dumpy, bad, but correctly publicised town of Rochdale, North Manchester!

    Our insurance (through work, not private so not sure if different) will only take things forward if a letter of referral is given by the doc, then its up to whoever to chose a specialist, if there is someone in particular, you can suggest their name and they decide from there and after a consultation.

    I suppose I'll be a little closer by Friday...maybe..
  • Jack HughesJack Hughes Posts: 1,262
    Yep. The GP tends to be the gateway for all specialist treatment - the insurance won't pay up otherwise.

    You just need to go and tell the GP what you want:

    "Please refer me to specialist for my private healthcare" (which is what you have through work).

    The GP will be, most likely, happy to oblige. It's a tick in their box.

    They'll check for signs of infection etc. etc. but once you explain you are an athlete, and it is an over-use injury, and has been there for 6+ weeks, you shouldn 't have any problem.

    The next step will be a consultation, and an MRI if that is required.

    You may just get punted straight to a physio by the consultant, with lots of exercises to do.
  • Yeah, I asked the Doc twice that I wanted the referral, but wanted his opinion first - but in hindsight I shouldn't have said any more! Just over two weeks now since I went for an X-Ray, and finally I managed to get back in touch with the doc (after numerous attempts) and he reckons the doc examining the X-ray has seen two things:

    1 - there is damage to the kneecap (for sure, thats why it hurts! :roll: )
    2 - More worryingly, there could be some part of the quad tendon not completely attached to the bone!

    How they spotted this on an X-ray I don't know, but now he has listened properly, I should be getting a call from my local private clinic. Something tells me I'll have to call them though.....
  • Finally got an appointment to see a specialist on Monday!
  • Specialist wants an MRI scan, as expected!
  • Jack HughesJack Hughes Posts: 1,262
    It's progress!
  • jn46jn46 Posts: 7
    meniscus tear? I suffered a similar sounding pain last year. Did an olympic as final prep two Weeks before Roth. Nothing untoward til slight pain day after. Tried going for a bike ride and had to stop after 20 mins as pain too much to bear on downstroke. Never had anything more than tight itb before so was a bit perplexed. Even my wife, who is a physio (albeit not a sports specialist) couldn't diagnose. Did the Ironman popping ibuprofen to get me round. Month of rest later and still no better so went to see specialist sports physio who diagnosed it as minor horizontal meniscus tear. said it would take 6 months to heal, if at all. That was August and it's still not right. running fine and aerobic cycling fine but any big gear work at intensity flares it up. Worse on the tri bike as I think the increased use of the hamstrings affects it.with hindsight, two days before the olympic race mentioned I was out for a trail run and jumped my right leg up onto a log, loading the knee and pushed off at an angle. I've been reliably informed this is what probably triggered an underlying weakness. so caused by running, but pain only presents when cycling. Missus says an MRI should pick it up if it's a meniscal tear. Unfortunately the only real option to fix is surgery as there's limited blood supply for healing. I may just have to learn to live with mine, which is now more of a discomfort than pain. Forking out of my own pocket for a decent private physio saved Weeks of NHS referrals. my missus is still an NHS physio and says GP's are fairly clueless about physio matters and just refer patients on. The knowledge of the physio you then get can also vary greatly, so if you can get to a specialist private one straight away to avoid the hassle. Hope this helps.
  • Thanks for your input people, still more to come on this - I had the Scan, but need to book another appointment with the specialist to discuss whatever he has / is to deduce from the scan.

    I think I'm in a position whereby at some point in the future I may end up doing more damage so its better to get it checked now and hopefully sorted now. Unfortunately I have a few things going on, so surgery within the next 2 weeks may not be good, and after that I really don't want to miss the Manchester 10K, my times and fitness are getting better!

    Regarding the possible meniscus tear, I think I've already decided against that, and with cycling, it makes absolutely no difference what gear I'm in - even pushing a high cadence it ends up hurting just as bad.

    A medial collateral ligament problem may well exist, and according to the doctors report re-read by the specialist, it appears that from the xray, some bony fragmentation (osteocyte?) may have formed due to debris (from worn cartilage) under the knee cap causing the eventual 'grinding pain'. The specialist also said that cycling would hurt more simply due to the bent position of the knee causing more direct pressure on the knee cap.

    He also decided that physio trying to build up the leg muscles would not be worth it as my quads are already 'well developed' in his own words.

    Still, at least he is a knee specialist and also would be the surgeon doing the work if it came to it - which seemed like what he was insinuating, with keyhole surgery - a good look around and 'clean up' any loose bits!

    Hopefully I will have more answers soon...
  • My wrecked Knee diagnosis!

    Saw the specialist tonight, seems like I've been waiting months! Lots of info, but fortunately no serious problems, however there are 2 issues that are suspected from the MRI:

    One, is that a small patch of the cartilage is pretty much worn out, which has lead to the second problem of a cyst formation in that area.

    This is the area which starts to ache somewhat after long exercise patches, towards the inside of the knee. No doubt the loose cartilage is floating about under the knee cap causing the aggravation too.

    So, Doc wants to book me in possibly next Thursday, general anaesthetic, knee arthroscopy to clear out / smoothen off the existing cartilage and also, if necessary carry out a 'microfracture' procedure to literally instigate tiny holes in the knee cap to allow blood to flow through in the aim of it creating new cartilage. He won't know whether this is necessary until he is in the knee looking around though.

    IF all is well, I'll be in and out in a day, and resuming normal activities within days, not sure about exercise though, but either way, it ain't going to fix itself!
  • You have an ITB related injury - look it up - muscle from your glutes to your knee is probably too tight.
  • ITB ? Not quite glutes!
  • BritspinBritspin Posts: 1,655
    not a muscle either...
  • I'm not a physio but had similar problems which is why I suggested a look up - the muscles running to my right knee were to tight resulting (aparently) in my knee cap being 'off track' - mine was ongoing until I did the various stretching exercises prescribed (hasn't flared since)
  • Some med speak on it:
    ITBS is one of the leading causes of lateral knee pain in runners. The iliotibial band is a superficial thickening of tissue on the outside of the thigh, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee. The band is crucial to stabilizing the knee during running, moving from behind the femur to the front while walking. The continual rubbing of the band over the lateral femoral epicondyle, combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed.
  • Hi, I've had knee problems with my right knee on and off for a few years - caused according to my physio by not warming down properly so 1) I spend much longer warming down and now use a foam roller - very good! 2) I've found swimming actually helps my knee if stiff - not sure how or exactly why but worth a go. Good luck oh and 3) find a physio who understands and doesn't just want your cash!
  • The ProfThe Prof Posts: 37
    Well, had the knee arthroscopy & debridement as he put it, Thursday 1st march, knee is still swollen a little but getting easier to walk on, not much pain from it at all.

    Need to go back in 2 weeks for stitches out and back in 6 to see consultant to see what he says - thought he may have seen myself after to say what he actually found / cleared out and how quick my personal recovery could be, but no. Oh well, fingers crossed I mend quickly!
  • Good news though - get well quick
  • JacabusJacabus Posts: 11
    I had something very similar to the symptoms you describe. I tried to run/cycle through it, but did a fair bit of damage to my knee.

    In my case the VMO (pear shaped muscle on the inside of my leg just above knee) was too weak, while my quads were too strong. This had the effect of pulling my kneecap out of its normal track. This caused the underside of the knee cap to rub and become inflamed when running etc

    Because it was too painful to exercise, I used a muscle stimulator to get the VMO built up. When the inflammation had eased off I strengthened the muscles on the inside of the leg by doing one leg squats etc.

    This did the trick for me, but took a while before I could get back to full training.

    Hope this helps.
  • The ProfThe Prof Posts: 37
    Quick Update..

    Now been 4 weeks since the op and I went out last week while the weather was good for a short cycle ride, up a local hill, very slowly! The knee felt perfectly fine although I was very apprehensive about putting too much power through it, so it was a very low gear and low cadence all the way!

    Felt ok the day after too, however, there still seems to be an underlying issue that I spoke to the specialist about but I don't think they care that much, surgery = money for them. 2 weeks and I'll see him anyway and see if he takes any notice this time. It's not painful but annoying, like a pinging of a tendon each time I raise my knee on the upstroke - this happened prior to the knee getting real bad, the main thing is that the other knee doesn't do it, so I'm putting 2 & 2 together here, maybe it was / is a cause of the problem I had i.e. worn cartilage?

    I also had my first 3k run on the treadmill yesterday, 16 mins, fairly easy and again, nothing major to report. Hopefully I can build back up to a decent level now and see how it goes, but I'm not entirely happy with the mechanics of my knee, I may have to get some alternative opinions...
  • The ProfThe Prof Posts: 37
    Just an update for anyone interested / searching similar problems;

    This problem has not been resolved, my knee is not right - surgery has removed the irritating pieces of cartilage but the knee feels loose, and cycling is making it ache again. Very frustrated now, time to see someone else.

    I will arrange to see a chiropractor this week coming. I had wanted a pro bike fit too, but I'm afraid to say that the company's incompetence to respond to a simple email has lost them business and my disappointment in their practice / quality of service......
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