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Paging Dr. Slowtwitch....pain outside of knee
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I have a very odd thing going. I've been very bike focused all summer running 1-2 times / week. I ran 2-3 times / week this spring leading up to a tri.

I want to ramp up a bit again for a tri early September, but I have an issue that a real bugger on the outside of my right knee. No pain cycling, swimming, walking, but I get about 5-15 minutes into a run and bam....sharp pain it feels about right where my IT band connects to my knee. If I try to tough it out it can be almost at point of lockup within minutes. Walk a bit and it will settle down and I can run pain free a couple hundred yards at a time until it hits again.

If I let it get bad the pain can radiate to places in the knee other than just the outside. And outside may not be outside for sure, but maybe the outside of the joint?

Any thoughts on this? I have literally 2 weeks to my tri....and no running isn't real ideal for a 5 mile run in a race.
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Re: Paging Dr. Slowtwitch....pain outside of knee [cmscat50] [ In reply to ]
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Foam roller on IT band(s) several times a day.

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Re: Paging Dr. Slowtwitch....pain outside of knee [cmscat50] [ In reply to ]
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cmscat50 wrote:
sharp pain it feels about right where my IT band connects to my knee.

Any thoughts on this?

It is your IT band. Roll the full length of it 3-4 X a day for minimum 2 mins.
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Re: Paging Dr. Slowtwitch....pain outside of knee [cmscat50] [ In reply to ]
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As said earlier, it's your ITB. Loosen it off a couple of times a week and don't ride if it's flaring up too much. Get a massage before your race if possible.

Immediately after your race, go and see a reputable bike fitter - preferably a physio if possible - and get your cleat position looked at ASAP. Chances are you've got your cleat at an unsuitable angle, placing stress through the pedal stroke.

Do you used fixed cleats? Not a good idea at all except under very specific circumstances. I know that running brings on the pain and causes you to lock up, but the loading that is causing this will be occuring on the bike.
Last edited by: 42x16ss: Aug 25, 15 20:55
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Re: Paging Dr. Slowtwitch....pain outside of knee [cmscat50] [ In reply to ]
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You need to do more bench press.
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Re: Paging Dr. Slowtwitch....pain outside of knee [cmscat50] [ In reply to ]
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How long have you had this particular bike or bike fit? Check your seat height, because pain in that area of the knee is very common with a too high saddle.

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Re: Paging Dr. Slowtwitch....pain outside of knee [cmscat50] [ In reply to ]
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Yep, what you describe is classic IT band symptoms.

The advice here is good, but check out Google for things such as core strength work that can further help to guard against this in the future.

If it's any consolation, when I was suffering the same issues, running off the bike was a lot better than an open run, even when I spent a real good time doing some dynamic warm ups. For me, the bike really helped loosen things up before the run, so race day might not be a disaster, but as others have said, if you have a bad bike fit it could easily swing the other way. Good luck!
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Re: Paging Dr. Slowtwitch....pain outside of knee [42x16ss] [ In reply to ]
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Great info everyone thanks.

A bit of background. I have a severe back injury that I've been managing well. This spring my Dr. found a 3mm or so leg length difference.

1. About a month ago I put a 3mm riser under my right cleat. Therefore I raised the seat that much to accommodate. Therefore effectively raising the seat 3mm for my left leg as well (the now injured knee). I run about a low-mid 140's degree knee angle at bottom of pedal stroke.

2. About 2 weeks ago I swapped my road bike from 175mm to 172.5. Again I raised my seat 2mm to accommodate.

3. I've ridden a lot lately. I ride about 80% of my miles on my road bike and will be almost 1100 miles in August including my first ever 300 mile week.

4. I had ridden thousands of miles with the 175's and no riser in my cleat.

5. I cannot seem to keep my left knee off the top tube. I don't know what sort of adjustment that takes, but it would seem I have a possible tracking issue of some sort. My wife tells me my knee travels straight up and down, but she doesn't have lazers and fit cameras / etc. I've never in maybe 20K miles found the perfect placement for my left cleat....the now injured side.

6. Getting a pro cleat fit may be a good option, but it's expensive and I should probably buy new shoes to replace my old one's first I'd assume.
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Re: Paging Dr. Slowtwitch....pain outside of knee [aw3] [ In reply to ]
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That info starts to explain it. Try lowering your seat by about 5mm, reduce your mileage temporarily.

About knee tracking, many people have success using these:

http://www.bikefit.com/c-1-cleat-wedges.aspx

(No connection of any kind between us and these guys, but I do quite successfully use their fit wedges.)

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Re: Paging Dr. Slowtwitch....pain outside of knee [cmscat50] [ In reply to ]
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You actually had someone measure a 3 mm LLD?

Wow ...

____________________________________
Fatigue is biochemical, not biomechanical.
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Re: Paging Dr. Slowtwitch....pain outside of knee [rroof] [ In reply to ]
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It was done via X-ray using hip tilt. One X-ray showed hip tilt. Next X-ray with 3mm riser under right leg showed level hips. Therefore they concluded my right leg is a bit short.

I rode thousands of miles with no riser. I almost wonder if I'm messing up using the riser and should just go back to the way it was. Ugh.

I just wand to be able to run! LOL.
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Re: Paging Dr. Slowtwitch....pain outside of knee [cmscat50] [ In reply to ]
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Re: Paging Dr. Slowtwitch....pain outside of knee [cmscat50] [ In reply to ]
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Go through all all the functional patterns videos

Dont treat just the area of the pain but the whole body, the reason for injurys is bad posture

https://www.youtube.com/...l+patterns+knee+pain
Last edited by: SamYO: Aug 26, 15 9:39
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Re: Paging Dr. Slowtwitch....pain outside of knee [cmscat50] [ In reply to ]
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Info here:

http://www.runningwritings.com/p/the-injury-series.html


Sounds like IT Band.

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Re: Paging Dr. Slowtwitch....pain outside of knee [cmscat50] [ In reply to ]
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cmscat50 wrote:
This spring my Dr. found a 3mm or so leg length difference.

Curious, what kind of doctor diagnosed this and x-rayed you for this? A chiropractor? Another type of doc?

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Re: Paging Dr. Slowtwitch....pain outside of knee [DarkSpeedWorks] [ In reply to ]
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My back surgeon ordered the X-ray during a routine appointment. The X-ray tech did the actual images using specs from the surgeon. The surgeon then used the computer images to notice the pelvic tilt before and no pelvic tilt after. It did not seem that high tech and they never did any measuring of my actual legs.

I don't even know where to turn to get something precise like that done.

I don't know what to do....lol.
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Re: Paging Dr. Slowtwitch....pain outside of knee [cmscat50] [ In reply to ]
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Wow, that is a pretty solid xray dose in an important and sensitive part of your body for a non-critical medical need (to detect a supposed 3mm leg length difference). You can read more about this (unnecessary xray dosing) here.

In any case, I would suggest that you get a 2nd opinion about all of this, but don't get any more xrays. And, if you had no problems with your knee before adding the lift, take the lift out of your shoe for your cycling. Tiny leg length differences should never cause major issues in cycling, just set your saddle height for your supposedly shorter leg.

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Re: Paging Dr. Slowtwitch....pain outside of knee [DarkSpeedWorks] [ In reply to ]
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The funny part is I've seen 2 different PT's (out of the same business). One of them measured my right leg as 5mm short. The other (the owner) measured them dead on the same....LOL. This was 10 years ago.

So I've been "measured" or whatever 3 different times now and still don't know who's right!

I think I will probably remove that lift from my shoe for now and move the seat back down 3mm.

And yes....I can absolutely detect that 3mm in saddle height.

Thanks.
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Re: Paging Dr. Slowtwitch....pain outside of knee [cmscat50] [ In reply to ]
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Don't forget to rest or at least back off on the mileage until the inflammation goes down, and then test your set up again when your knee is pain free or close to it.

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Re: Paging Dr. Slowtwitch....pain outside of knee [cmscat50] [ In reply to ]
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Hi

I have had ITB issues on and off this year. I saw my physio on Monday and this is how things sit for me:

I overpronate on both feet. I also have glutes (GMed) which don't fire correctly. GMed deals with rotation whereas ITB and connected muscles are stabilisers - in the absence of Gmed handling the rotation ITB etc is forced to compensate and as a result this whole chain becomes tight and leads to the symptons you are experiencing. As a result my knees track inward slightly - this then affects my hips and then lower back. As a result my hips appear to not be level - a different physio suggested a couple of weeks ago that I had a leg length discrepancy. My physio this week performed some 'back cracking' and immediately managed to level out my hips. Coupled with some focused massage on my back this appears to have done wonders. I have a set of exercises to do to ensure Gmed fires correctly and is strengthened.

Interestingly I do bikefitting at a low level and have started experimenting with the wedges that I think DarkSpeedWorks was recommending. I have two cleat wedges under each foot - I discussed this with my physio and he thought it was an excellent idea.

I think all the changes to seat height and crank length etc may be missing the mark - they are dealing with the symptoms rather than the cause (and in the case of leg length discrepancy possibly missing the mark completely).

Get a physical assessment along the lines of what I have identified above.....
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Re: Paging Dr. Slowtwitch....pain outside of knee [studuck] [ In reply to ]
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studuck wrote:
Hi

I have had ITB issues on and off this year. I saw my physio on Monday and this is how things sit for me:

I overpronate on both feet. I also have glutes (GMed) which don't fire correctly. GMed deals with rotation whereas ITB and connected muscles are stabilisers - in the absence of Gmed handling the rotation ITB etc is forced to compensate and as a result this whole chain becomes tight and leads to the symptons you are experiencing. As a result my knees track inward slightly - this then affects my hips and then lower back. As a result my hips appear to not be level - a different physio suggested a couple of weeks ago that I had a leg length discrepancy. My physio this week performed some 'back cracking' and immediately managed to level out my hips. Coupled with some focused massage on my back this appears to have done wonders. I have a set of exercises to do to ensure Gmed fires correctly and is strengthened.

Interestingly I do bikefitting at a low level and have started experimenting with the wedges that I think DarkSpeedWorks was recommending. I have two cleat wedges under each foot - I discussed this with my physio and he thought it was an excellent idea.

I think all the changes to seat height and crank length etc may be missing the mark - they are dealing with the symptoms rather than the cause (and in the case of leg length discrepancy possibly missing the mark completely).

Get a physical assessment along the lines of what I have identified above.....
^^^This^^^

Where are you (the OP) based? If you're in Aus I can recommend a physio in pretty much all the capital cities.
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