Cliff’s Notes version: Excessive climbing on the bike resulted in sharp, intense and buckling knee pain (anterior and medial) during a hard standing effort which led to 12 day layoff. Could not bike without the same pain. Climbing stairs, standing from a chair, or any 90 degree flex while pushing hard causes pain. Miraculously, I completed a 201 mile ride last Saturday and pushed it very hard - pain was on the edge and I thought I was going to be in bad shape but I made it. Bike position adjusted 2-3 times by a professional fitter. Standing on the bike is still sketchy. MRI of my left knee (specifically Meniscus) is clean, normal. Stepped hard going up a stair yesterday and the sharp pain about dropped me to the floor. No pain at night, at rest, walking, going downstairs, no pain extending/flexing. Simply put, when I push down going up stairs (or sitting/standing) I get sharp/stabbing pain which appears to be at the front/anterior/medial side of the knee and into the joint space. Some referred pain in the quads as well.
I have my 8th doctor visit tomorrow. I have no idea what to tell him or how to direct him to help me fix this issue.
I’ve been told I have Plica Syndrome, VMO tendonitis, Adductor Magnus tendonitis, “bruised meniscus”.
Not asking for an ST or web diagnosis. Asking if anyone has experienced this before and what it was. All I am trying to do is find some way of describing to my doc what is going on.
sounds like you overworked your knees if your MRI was clean. I did hurt my knee on double century last year and they were swollen up pretty bad on the day and afterward (couple days) . Those “Move Free” glucosamine supplement at costco helped and i also try not to push my limit too much… Training helps but we can only do so much…
btw, 201 miles is a long way to ride in 1 day. Congrats that you finished the course!!!
Jim I feel for you. Had both knees redone. One thing you might want to trouble shoot is your IT bands. When I let my hip flexors/IT band/tensor faciae latae get tight it ends up disturbing the tracking of my knee cap and feels just like the pain I had with articular cart damage. Stretch it out…all gone.
Have your MD ask the MRI radiologist to have another quick view of your scan- could be a fissure/ chondromalacia of the medial patellar facet. A small loose body in the joint, hard to see on MRI, could also cause your symptoms.
It sounds muscular to me. Tight muscles won’t show up on MRI. They will cause the symptoms you are describing and will be caused by mechanism you described. Try this http://www.mobilitywod.com/2010/09/episdoe-23-runners-legs/ You should also try foam rolling your quad and adductors. (google search “foam roll quads” and “foam roll adductors”). Before you try one of these techniques, test your knee by stepping up. Then try one of these techniques (find a junky spot and work it out for 1-2 min) then test your step up again to see if it worked.
I had a pain in my knee like you described and it was VMO tendonitis. Relative rest (I would cycle a little, mostly flat and low wattage stuff, and stop as soon as the pain started to build…meaning if it just started to hurt a little I’d keep going and sometimes it would go away…other times it would continue to get worse and I’d stop) and Voltaren gel over a period of about 6 weeks got it back to normal.
I had exact the same issue - knee pain, difficulty climbing stairs, stiffness, but nothing showed up on the MRI. Went to a local guy (John Ball) who works with a lot of pros to see if he could figure it out. Time off, ART on my hip flexors and IT band, and strength training my hips/core fixed it. Made me a stronger athlete, too.
I’ve been lurking around on the ST forum for a few months but this thread made me actually register.
I had issues almost identical to what you’re describing. It started some 6 or 7 years ago when I was still skiing quite hard. The whole career thing, a couple of moves, marriage and other things have periodically taken me away from sports so the issue came and went over the years - always resurfacing when I worked out more. Similarly to you, the knee worked “fine” sometimes - I ran a half-marathon without an issue and then another time I’d fall over at the office when squatting to pick up something from the floor. I only caught the tri-bug this year (hence the lurking) after the pain came back with a vengeance during training for another local half marathon. I did a bunch of mini-triathlons because the knee held up fine when running only short distances.
I saw a few doctors over the time and also had 2 MRI’s - both inconclusive. The most recent one was this summer. I’ve tried PT, stretching, ice, antiinflamatory drugs, glucosamine, yoga and lots of rest. The doc was at a loss and said there are a couple things that won’t show on scans that could be wrong. I decided that taking a look would, at worst, leave me where I was + 2 small incision under the kneecap. I had an arthroscopy last week and when I woke up the doc said that I had plica syndrome and he removed the affected tissue. When I read up on it - it read like my personal knee health history. I walked out of the hospital without crutches (with a limp, though) and so far I’m recovering rapidly. Today is one week since the surgery and I can walk up and down stairs already, almost no limp left. I start PT next week. I won’t be sure that the procedure worked until I try running again but so far I’m cautiously optimistic.
Of course we can’t tell what is wrong with your knee but I figured I’d share my story. Good luck!
OP should take notice of your post. I think synovial plica is included in his doc’s differential. Other knee conditions with similar symptoms are: internal fat pad impingement, loose bodies, chondral tear, and meniscal tear.
OP should take notice of your post. I think synovial plica is included in his doc’s differential. Other knee conditions with similar symptoms are: internal fat pad impingement, loose bodies, chondral tear, and meniscal tear.
Noted and thank you. Recent hands-on last Wednesday resulted in little/no plica tenderness (whereas it was fairly tender before). Pain has moved more anterior in nature. Doc and I flipped through MRI and reviewed in detail. Also noted that plica and a few other things are not visible on MRI. Would be very hard for me to believe that I could ride 201 miles last Saturday @ 20 mph avg with some efforts @ 120-150% FTP and have an issue like plica syndrome, loose bodies, fissure, etc and not have it stop me in my tracks. Last 30 miles of the ride were touchy with the knee but not unbearable. Working on the PT route right now. Don’t really need/want any NSAIDs at this point. Still believe that this thing is related to VMO which was badly strained. Do I believe there’s no way it’s plica - no, not for a second - it could very well be plica…but I need to try some conservative stuff on this before doing a simple “two incision” scope. Thank you for the post and the support on this.
I’ve found that doing knee extension exercises at the gym have solved this issue whenever I have gotten it. Quad stretches are a good idea as well once you are warmed up.
Also, for what it’s worth, when I’ve been taking Hammers tissue rejuvenator I’ve never had the climbing stairs/knee pain issue. My wife had some so I started taking one a night for a bit to see what happens.
I generally think supplements are horseshit, but there we go.
the Mark’s Daily Apple Weekend Link Love has something this week about hiking and stairs and a good way to put less stress on knees. I haven’t read it but you might check that
I’ve found that doing knee extension exercises at the gym have solved this issue whenever I have gotten it. Quad stretches are a good idea as well once you are warmed up.
Also, for what it’s worth, when I’ve been taking Hammers tissue rejuvenator I’ve never had the climbing stairs/knee pain issue. My wife had some so I started taking one a night for a bit to see what happens.
I generally think supplements are horseshit, but there we go.
Funny you should mention this…I climbed on a leg extension machine this week and much to my surprise, was much weaker than I expected compared to the opposing hamstring and gluteal strength. Maybe there is something to this gym stuff for ‘antique preservation’ purposes
Have you tried therapeutic knee taping or a strap? Did your doc question referred pain from, for example, the hip?
No on taping or strap. Doc did investigate hip area but I don’t remember how much in depth he went.
Also, doc injected joint space with cortisone last Thursday. No real change in symptoms which makes me further believe that the source is more likely quads. Although I have no idea if a joint space injection would help plica if it is plica.
Intra-articular cortisone should dampen pain from all infammatory causes, so the problem might not be the knee joint. Did doc suggest elsewhere? Taping for distal quadriceps strain could be diagnostic. However, there should be tenderness on deep palpation. Long shot: radicular pain from lumbar nerve root?
Doc beleives it to be a combo of VMO and quad strain/weakness, larger than normal fat pad and general PF type overuse pain. I’ve considered L3/L4 as the cause but have had zero pain anywhere in low back and no tingling, numbness or shooting pain. Pain is reproduced when palpating high end of VMO “just right” and sends toothache type pain to joint space. Same as when climbing stairs. Have run twice in last 3 days for 2’ On and 4" Off 4X with no pain. Just weakeness. Quad is noticeably atrophied. Can see it in the mirror. Doing full on PT for quad and hip strength. Zero pain at rest, night or walking. None. Have not tried taping. I’ll give that a shot too.
