I’m a long distance ciclist that also likes to swim and run. I hurt myself mid July cycling to my family reunion in rural Georgia. The problem started around mile 40 mile and because it’s impossible for me to stop until the pain forces me to fail, I pedaled another 160 miles for a total of 200 miles in 10+ hrs. (God why did you make me this way?) The pain felt like a sharp sprain on the outer side of my calf behind my right knee where my calf tendons connect to the tibia but the pain is deep and sometimes hard to pin point exactly. The shooting pain was like an electric shock every pedal stroke. It got so bad the last few hours I could really only pedal with one leg. So initial diagnosis is Gastrocnemius Tendopathy. I have very arched feet and really bad right ankle dorsifelxion which means my right calf is always a little tight but that didn’t stop me from going coast to coast the year before.
Ive been in Peru since July for work and been able to see a few doctors ($45 a visit isn’t too bad). MRI, X-Ray for my knee, hip, ankle etc and nothing to worry about (I can email digital image files) Except I can’t walk 5 blocks without the exact same pain sneaking up on me. Sometimes the area feels a bit numb or tingles a little. I think it’s actually getting worse because I can’t even swim anymore.
Let me add that when I say anymore: My treatment could be broken up into 2 stages. The first 5-7 weeks after the injury I was encouraged by PT to continue training cycling and swimming at 70% but no running. Since I didn’t get any better the last 8-10 weeks have been let’s sit and wait to see if anything happens. So no swimming anymore which was the last sport I quit. I hope this doesn’t sound confusing but I can extend my leg no problem no pain, even some weight bearing excersices are o.k. but walking makes me limp.
So, the pain is behind the knee but on the outer edge of the right leg, and it started after a VERY long cycling journey. It very well could be tendon irritation/inflammation of the hamstring (at the insertion area of the knee). People always think of hamstring tendonopathy as being up toward the top of the leg/butt area but it can also get irritated near the knee as well.
Thanks for your insight. For clarification the injured area is below the knee. If the hamstring inserts to the top of the knee that wouldn’t explain why the pain is coming from below the knee?
The pain seems to be coming from below my right knee where the top of my calf inserts on the outer right side. The pain feels very deep. Please let me know your thoughts.
I have done 40+ thearpy sessions. These guys get depressed when they see me walk in. To be really frank I think the PT’s are starting to believe that I’m making up stories. They keep asking me over and over again “you’re resting right, and there’s absolutely no improvement?”
Will never ride 160 miles with intense pain again.
Thanks for your insight. For clarification the injured area is below the knee. If the hamstring inserts to the top of the knee that wouldn’t explain why the pain is coming from below the knee?
The pain seems to be coming from below my right knee where the top of my calf inserts on the outer right side. The pain feels very deep. Please let me know your thoughts.
As JasonHalifax pointed out, the hamstring muscles insert below the knee. The pain can be referred. With what you describe of your pain, and how it happened, I am still betting you have a stubborn case of lower hamstring tendinopathy…how to fix it??? Well, I hope you’ve not been trying to run or bike while it was hurting.
By bad right ankle dorsiflexion do you mean your right foot is more in plantar flexion? No issues with the left?
If we are hazard guesses on the internet, I’d either lower your saddle 0.5cm - 1.0cm or put a few shims under your right cycling cleat. Generally pain behind the knee, especially when cycling is ‘typically’ a saddle that is too high. See if that makes a difference.
Working mobility on your high hamstrings and hip flexors on that right side might help if the problem is starting upstream from your calf/knee.
Weird pains like that can also be nerve entrapments, but those are difficult to diagnose. I feel like I’ve had one on the medial side of my knee for going on 4 years now, and it bugs me when I run.
Disclaimer…not a dr or doc or phd or pt, just been around for awhile so take the above with a grain of salt.
I’m going to pursue your insight and consult with a doctor. I have a hunch you’re right because even though I limp after walking a few blocks, I have no problem doing heavy calf raises with no pain. It couldnt be a gastrocnemius tendonapathy if I can do weighted calf raises painlessly. I bet it has been my lower hamstring all along which may explain why the pain feels so deep behind my knee. I’ll keep everyone posted. Many thanks for everyone’s time and interest.
I’m going to pursue your insight and consult with a doctor. I have a hunch you’re right because even though I limp after walking a few blocks, I have no problem doing heavy calf raises with no pain. It couldnt be a gastrocnemius tendonapathy if I can do weighted calf raises painlessly. I bet it has been my lower hamstring all along which may explain why the pain feels so deep behind my knee. I’ll keep everyone posted. Many thanks for everyone’s time and interest.
Yeah, I agree with ya that I do not believe the gastrocnemius muscle (or associated tendons) are the problem. If this was a “calf attack”, doing calf raises may/wouldhurt, and you should’ve healed from it by now. With your pain being up higher, it’s certainly not related to the Achilles’ tendon. Definitely get an evaluation by a sports med doc, and yes, please keep us updated
Finished 4th therapy session and so far no improvement. Sports doctor is scratching his head, go so far as to say baffled. I’m working the lower hamstring tendonapathy diagnosis but he isn’t biting. It seems there are all sorts of things going on behind your knees as far as muscles and tendons and whatever. My MRI’s are all “go run a marathon clean” but I’m limping after a mile or two. It’s this deep pain I can’t always pinpoint or describe precisely. A numbness that goes from a “starting to get my attention” to “wow this really popping and hurting…now Im limping” within a mile or two. Who would you go to see if you could pick a specialist is there a really good one that’s the authority with this type of sports injury?
Finished 4th therapy session and so far no improvement. Sports doctor is scratching his head, go so far as to say baffled. I’m working the lower hamstring tendonapathy diagnosis but he isn’t biting. It seems there are all sorts of things going on behind your knees as far as muscles and tendons and whatever. My MRI’s are all “go run a marathon clean” but I’m limping after a mile or two. It’s this deep pain I can’t always pinpoint or describe precisely. A numbness that goes from a “starting to get my attention” to “wow this really popping and hurting…now Im limping” within a mile or two. Who would you go to see if you could pick a specialist is there a really good one that’s the authority with this type of sports injury?
As always thanks for your time and effort.
Sorry to hear no relief. That is a bummer.
With the numbness and tingling, you also have to consider issues further up the chain, such as in the spine. I cannot recall if you mentioned it or not but have you had an MRI of your lower spine???
The numbness and tingling is quite rare and minor. It happens very infrequently and is very transitory.
Yeah but any numbness is not a good sign, no matter how long it lasts. I’d see a sports med specialist…and if you are already seeing one, I’d get a second opinion. Also, the thought of checking for nerve issues (spinal, impingement, etc…) should still be considered.
Have you thought about the possibility of taking maybe 2-3 weeks completely off, letting your injury calm down a bit, and then slowly getting back into some swimming, PT, cycling, etc?
I haven’t been able to run since injury mid-June. No cycling for 2-3 months. Quit swimming a month or more ago. Decided to quit gym two weeks ago. I’m driving my family completely nuts. So far, and maybe this will help somehow find the right path to recovery, 0 improvement. I had to make a presentation today and after standing for and hour or so I had to ask for a seat because behind my knees was aching.
I’m starting to think that the inactivity could be making the condition worse. I wonder if the actual “trigger” is just load related i.e. walking or standing. No amount of rest seems to help so far. I’ve read that some injuries don’t respond to any type of physical therapy. My favorite part is when the doctor looks over all the MRI’s and suggests “have you considered Yoga?”
