For those of you who have gone through this, how did it start? And at what point did you see a Doctor or PT?
No problems at all during the season thus far, but after two 90 min low intensity rides this week (a very normal week for me) I’m feeling soreness on the inner/side edge of my left knee cap. Feels like it’s on the bone, not ligament or tendon, so my quick diagnosis is inflamed cartilage.
Pain is more present when leg is bent and feels better when leg is straight. Also…
I feel better after lower body exercises like squats or lunges. They offer near immediate relief. Pain seems to instantly disappear.
Too much running intensity + volume - I think. I was doing a marathon plan, was 3/4 through, did a 20km race as a test, no issue whatsoever; did a long slow run with friends a week or 2 later, and it started then and there. That was 20 years ago, and it’s still lurking in the back, ready to pounce if I increase volume or intensity too fast, be it on the bike or running. On the other hand I’ve successfully done multiple seasons of half-marathon training and races, keeping the knee happy. I know the symptoms and I’m able to control it whenever it returns: ice, rest, return to training slowly.
Just to chime in as a PT. It is impossible to isolate the VMO without NMES (neuromuscular electrical stimulation, placing the pads directly over it - but this is not how we turn on muscles physiologically - it bypasses how we use motor units).
If you go to a professional who is doing “VMO specific exercises” run away - they haven’t looked at the research in a long time.
The trick is to examine the ROM limitations around the knee (ankle, knee and hip), strength of the muscles (quads, hamstrings, lateral and posterior glutes), and most importantly motor control of the exercise (how a patient moves, the quality of the movement). Motor control work is the final piece once the muscles (or joints) are sufficiently loose, and strength is appropriate.
These are all intrinsic factors that can lead to knee pain with running and cycling. The extrinsic factors require a movement analysis on the bike or while running (for example a bike fit or a change in running footwear). This is when you can determine if shims are needed under the cleats, change of saddle position is necessary, or other changes.
So just strengthen your quads in ways that don’t hurt, stretch what is tight, have a professional examine your movement and help correct it and get a bike fit or running analysis.
I took my daughter sledding last night and as I was walking up the steep hill I felt something in my left knee. It wasn’t anything bad, but after a couple weeks of feeling good it was enough that I noticed.
Woke up this morning with some tenderness along the inner edge of the left kneecap, but had good range of motion and no pain so I did my weighted strength session today that consisted of barbell reverse lunges and squats. No pain during my key lifts, however, after wrapping up the session I went to do single leg squats and they HURT. Pain (7/10) in that knee immediately following my strength session.
Now going up and down stairs, doing knee range of motion exercises, and bending and straightening of that knee causes noticeable pain along the medial edge, bottom edge and underside. Even light pedaling on the bike doesn’t feel great.
By far the worst it’s felt yet. I’m worried that I’ve done something bad.
Here’s my plan:
Take 2 full recovery days, no exercise other than walking.
Continue stretching leg muscles along with foam rolling of the quad and calf.
This usually results from the patella (kneecap) travelling a bit laterally (kicking sideways) during knee flexion especially under load. Most often the cause of the lateral movement is an imbalance between the vastus medialis and the vastus lateralis — with the lateralis overpowering the medialis and tugging the kneecap slightly to the outside. The solution is a process (long and incremental, i.e. no quick fix) and usually is best accomplished by increasing the strength of the medialis and adjusting the Q-Factors (tread-width of your feet) to insure straight up and down tracking through the pedal arc.
Bill Black