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Another knee pain question
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Hey folks. Sorry that this is similar to the other post but I didn't want to hijack theirs...

A quick history. Started doing tri's in late 2002 after training for a July marathon (had reached about 100km/week) left me with a bit of ITB (left knee) and patella tendonopathy in both (worse in right). I recall symptoms including knees feeling very stiff when trying to straighten after having lay on the couch watching tv etc, and also a clicking in the right knee again when straightening. I was told to stretch quads and ITB (both very tight) and to strengthen VML in right knee.

Taking 6 weeks off running and doing cross training I found tri's and never looked back. Since then I have never really had major injuries. Sure there was the minor stiffness and soreness (and right knee clicking on and off) but nothing that ever had me worrying it was a real injury coming. During that time I have done some yoga on and off, done three HI's and my first IM last November (04).

Had a bit of a break the middle of this year and then came back and did stuff informally (no coach) for a change. Decided I would run three times a week relatively short distances (up to 11km) and go pretty hard (no LSD was a pleasant change and a chance to red line it again!). Things were going fine. Hard to pin point exact moment but I also started riding to/from work a different route which was really just 50 odd minutes that included some decent hills. Figured I would work on some strength in the short amount of time I was on the bike as I havent been motivated to go for the big w/end rides as yet. Also there's been a stair challenge at work (ie try and use them and not the lifts) but pretty sure the symptoms came back before the stairs really picked up.

So I was out running and noticed my right knee feeling rather painful (like it WAS an injury on the way) under/around the kneecap. More central ie not so much ITB. When I ride my knees are basically brushing the top tube and people say it's noticeable how narrow my knees are in relation to my cleats. To look at my feet it doesn't look like the toes are overly in in relation to the heels but my knees are definitely close. Feels as though the outside of the legs are doing more of the work. Thing is I've had pretty much this setup since start of 03 and no dramas. Have changed seats over myself but post height identical and don't think position is really that different.

The clicking in the right knee has returned. Stiffness not anywhere near like it was in 02 but can still feel the right knee isn't all there. Could this riding position really be the issue or is it possibly that during the layoff perhaps the VML strength died off and doing the strength work has accentuated the imbalance and created the tracking issues, leading to the pain? I have the foam roller at home so guess I will get stuck into that and do some one legged squats, lunges etc with foot turned out slightly.

Any suggestions (apart from cracks to shorten my forum post!) would be most welcomed.

Cheers

Mike
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Re: Another knee pain question [mv2005] [ In reply to ]
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Go see a doctor. Now is the time to get something repaired if you need it.

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''Sweeney - you can both crush your AG *and* cruise in dead last!! đŸ˜‚ '' Murphy's Law
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Re: Another knee pain question [mv2005] [ In reply to ]
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Your seat is too high!!! Sorry, couldn't resist. I'd second going and checking with a doctor, with a clicking sound and pain it is likely something that should be xray'd. A couple of thoughts...there is a difference between "below the kneecap" and "under the kneecap." I have had patellar tendonitis in my right knee brought on by having my seat TOO LOW (yes it does happen), having the front tilted down too much (having to push back slightly on each stroke to keep seated in the right spot), and especially from playing tennis for about 3 hours the day after a 100 miler. I don't know the effect of having your knees brush the top tube, I do that too and hadn't had issues after multiple 3000-5000 mile seasons. Now with my seat back up and adjusted right my knee problems are almost gone, but it took about 6 months of being really carefull.


Mad
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Re: Another knee pain question [triguy42] [ In reply to ]
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It wouldn't surprise me if it was something to do with the seat. I have two bikes. A TCR Aero which is my bread and butter all purpose bike and a Kestrel Airfoil Pro which is my race bike. I recently changed over the seats on both because they were getting ratty at the front ends and fraying up my nix (just curious how the HELL is that spelt I never know!). Anyway yeah so I just guessed the seat pitch (ie what sort of felt right) as the two new seats (Aspide triathgel and Fizik Arione Tri) are quite different from the old ones (Selle Italia and Azoto). Pretty sure the seatpost height is identical.

With the clicking it's a little weird as I have had it occur at various times during full training but there's no pain. I just picture some frayed bit of tendon or something snagging on something it shoudn't be! But no pain at all so I just ignore it.

Maybe it's time to revisit my bike setup!

Thanks for some suggestions though
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Re: Another knee pain question [mv2005] [ In reply to ]
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It sounds as if your Vastus Medialis it not as strong as the other muscles in your leg. If your pain was exacerbated by doing stairs, the patella still isn't tracking correctly. A way to check is to sit on the floor with your leg extended and contract your quads. Meanwhile lightly holding the four corners of your patella and watching where it tracks. It should move straight towards your hip joint. If it tracks more laterally then your VM is weak. This would help explain the more centrally located knee pain during running. If you've never had the knee "lock up" or "give out" then you probably don't have to worry about a torn meniscus. Cheers.
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