Knee pain

[figbat]

I have sought professional input but given the broad and deep experiences across this forum I thought I'd seek a second opinion.

Around 3 weeks ago I developed a sore knee whilst riding. Everything about the ride was typical of previous rides - the bike, setup, pedals, shoes, route, terrain, weather etc. It started after about 6 miles and came on gradually - no sudden twinge, no apparent event that set it off, no recent falls or other physical trauma.

It presented as a dull pain, like a bruise, across the front of the kneecap. It didn't impact my ability to ride, didn't reduce mobility or strength and once off the bike no amount of manipulation of the limb could 'provoke' it. Poking around the kneecap I could isolate the location of the discomfort under the skin but there was no swelling, no lumps or any other issues, and poking it simply highlighted the location, it didn't cause any further pain.

I rested it for 4 days, during which time it disappeared in normal use, then tried again and the same happened again - same pain, same distance, same outcome. I had an online consultation with a physiotherapist who diagnosed a disorder of the patellofemoral joint and gave me some IT band stretches and foam roller exercises to carry out, stating it was a 'tracking' issue likely caused by tightness elsewhere. I can believe this as I am not a very flexible chap and tend not to stretch out after riding, and I have been riding more this year than previous years.

The thing is I am not convinced it is working. I can occasionally still feel it in day-to-day life and I'm concerned that riding will just bring it back again - I am planning a short ride today to test it out, as suggested during the consultation, but I'm concerned that it will hamper my year's riding plans (such as they are) as well as my weight, fitness and mental wellbeing (cycling is the only exercise I get and I usually enjoy it).

Anyway, anybody had anything similar? Is it a case of being patient and giving it a chance? I will continue with professional input and treatment if required but value the crowd wisdom here, if only for reassurance from a like-minded (and unlike-minded... or dislike-minded...?) audience.

 

[vickster]

PFS can take many weeks if not months to resolve unfortunately so yep, patience and diligence needed. If something makes it hurt, don’t do it usually a result of overuse, leading to inflammation exacerbated by a mechanical issue.

If wanting to keep fit, perhaps get in a pool and swim (crawl or backstroke, your knee probably won’t like frog kick) plus do walking, squats, stretches etc in the water
see the physio again if getting worse

There’s a forum dedicated to knees here, lots of info on PFS in the learning portfolio and in posts
https://www.kneeguru.co.uk/KNEEtalk/index.php

 

[Once a Wheeler]

I have had a couple of incidents like this. I agree with you that you need to go through all the medical routines but in the end they do not always bring about a resolution. On the first occasion I was afflicted it got to the point after nearly a year where the doctor said that there was nothing obviously wrong with the knee so he had no additional treatment to offer. I suggested that if that was the case I could return to my old exercise routine without fear of making the situation worse. He agreed; adding, 'With care'. So I returned to full exercise and within a week the problem disappeared. On the second occasion, the exercise routine given by the physio cleared up the problem in a couple of months. Let the professionals flag up any dangers and within those limits follow your intuition. All the best.

 

[vickster]

Physio led article here on knee pain in cyclists. Anterior knee pain of relevance
https://www.physio-pedia.com/Cyclist's_Knee

It’s actually extremely hard to effectively stretch the IT band as it’s super tough. Get that foam roller warmed up for effective self torture (or pay for an hour long sports massage or two and prepare to hurt )
You could also pay to see the same physio (assuming not nhs) and get some proper hands on examination and treatment

 

[figbat]

So, results of tonight’s ride…. it’s still there. 🙁 It seems to be just the reciprocal motion of the knee that does it; under light load it comes on however if I put more effort in it appears to go away, or at least I can’t feel it. Example - I deliberately did a short ride tonight but included a climb to give it a good test. The first 4-5 miles was flat, gravel and hard-packed bridleway, I was on my hardtail. Easy riding but the issue started again. I then reached the climb which is on road, not especially long or tough but breaks a sweat. As I was climbing I was monitoring the knee and trying to form a correlation between effort and discomfort. I pushed harder and harder and it felt better and better, such that I accidentally set a PR on the climb segment. Then during a subsequent descent on rutted hard-packed chalk I was freewheeling out of the saddle and, again, it felt fine. Only during low output spinning did I really notice it again.

Thanks for the inputs above - all sage and useful advice and information. I have private medical cover through work so will get back onto them to see what next.

 

[figbat]

Update - possibly getting a little better, but not fixed yet.

I've had two F2F sessions with a physio now - one to test and diagnose further and the next was a torture session deep massage. After the test the physio believes that the kneecap is being asymmetrically supported, putting pressure on one of the small ligaments. This is likely as a result of my increased riding intensity coupled with a slight, natural outward turn of the affected leg. He found no major weakness or instability of the ankle, knee or hip joints. He believes that the fact that it improves with working harder suggests that under load the knee is getting better support from the muscles around it but under low duty the slight misalignment flares up. I have some strengthening exercises (squats, lunges etc) and stretches to do, which I am.

He also suggested I try a high-load cycle ride to see how it goes. I went out on Saturday on a route that was a short ride to the nearest climb, then I did 4 circuits of up the climb and down the adjacent descent. During this time it felt fine so I pushed on and added a longer loop to return me home, whereupon the symptoms started. Maybe less than before and they have cleared up perhaps quicker than before, although this may be wishful thinking. Physio again tomorrow so we'll see how it goes. My GravelX ride in the Sherwood Forest next month looks in doubt though - I am hoping the Exmoor MTB ride I have booked for July will be OK.