I wanted to see if anyone out there has dealt with similar symptoms. My wife did a cycling camp in Knoxville about 6 weeks ago. On the first day she experienced pain behind her knee that we frankly thought was just fatigue. 5 weeks later it was still there and now includes calf tightness and hamstring tightness all medial with tightness behind the lateral aspect of the knee and some instability?? We took off 10 days off cycling, no reduction in pain. Finally saw a sports doc who suggested it is tendonitis of the medial gastroc head with a possible cyst under the origin of the gastroc. She is using topical ibuprofen and ice but not much relief. She is not doing anything leg oriented , but her hair is green from swimming. Please help! 
Thanks, g
i have been recently helped by PT using graston and ART, working on quads, soleus and gastroc primarily. my pain more on front of knee but did have tightness behind it.
I would try foam rolling a good bit just to loosin things up.
Grastons and a good sports massage therapist. I have been deal with a similar issue and both have help tremendously.
Physical therapy may be the way to go. This might include soft tissue massage, foam rolling, ice/heat packs, etc. The PT probably will check gluteal strength since the knee is often the “middle man” when there’s a hip and/or ankle issue.
I am suspicious though…did your wife travel to this camp? Was the saddle height set to her same saddle height? Often if the saddle is too high, it will place excess stretch and stress to the hamstrings along with gastroc head. The gastroc acts as a knee flexor in addition to ankle plantaflexor. Also, was this the first bout of cycling she has done this season? Could be that there was too much of a stimulus that may have caused the injury.
Any other changes she made just before or during the camp?
great insight, she did a substanial seat raise last fall and then only road a bit prior to the camp which was 15 hrs in 4 days with climbing galor. She also had her big toes posted with 2 inserts? so her heel was rotated out? The doc said there is some sort of cyst in their but seems unsure and she has tendintis which has seemed to get better with rest and IBU. She says it feels unstable and it wants to go backward periodically when walking? We just dont know what to do but swim !: Thanks for your helo. g
So, 15 hours in 4 days is quite a bit and could have set her up for a flare up. Also, when was the foot posted? Was the insert a full foot insert or only partial? I assume the inserts are “in the shoe” type? With the possibility of a cyst, this may be an ongoing issue.
What feels unstable? The ankle? And, elaborate on the “wants to go backward” please.
A thorough foot evaluation seems in order…
Instability of the knee sounds like an internal problem with the knee. Feeling like the knee will buckle backwards is a classic ACL symptom but thats usually trauma related. What about meniscus/Baker’s cyst? Did she have an U/S or MRI of the knee? Meniscal tears can happen with minimal to no trauma/overuse…
David
Great comments by David…I think he’s correct with his reference to the knee but want to be sure.
Instability could be the patella (kneecap), the joint, or both. David was also great on asking about previous injuries to the ACL and/or meniscus.
I have seen instability before and is fairly easy to treat. Also, the knee has built in hyperextension usually between 4-7 degrees beyond neutral. The actual amount depends on the individual. The correct thing to do is to measure both knees and compare with the uninvolved side determining the reference amount of hyperextension, given that the uninvolved side is “normal.” As long as everything as been ruled out (there are special tests for meniscal tears, ACL laxity, etc), stability exercises may be the best bet for your wife.
Clarify some of the points and lets get her healthy!
One more thing…
The knee moving backwards is called an “extensor thrust.” This can be indicative of quad weakness but needs to be tested out. Of course muscle testing brings a whole other argument…I will assume that given her background that the quad is strong and the extensor thrust is probably a muscle firing issue.
I have worked with a runner with similar symptoms and after several weeks of treatment and her diligence with a home program (and other adjustments), she is now running pain free! this person had knee laxity with more hyperextension than the uninvolved side. She also had significant gluteal weakness with resultant IT band, tibialis posterior tenderness, etc. Stability exercises along with soft tissue massage really helped.
**pain behind her knee…**tightness behind the lateral aspect of the knee
I believe you are referring to pain at the posterier outside portion of the knee where the large tendon (abductor magnus) attaches. I’ve had this for years and is associated with chronicallly tight hamstrings. I couldn’t complete a long course race due to this- it would flare up about 2 miles into the run. For years I went to otho docs who couldn’t figure it out. At the suggestion of a tri coach, I went to her physical therapist who diagnosed it in 5 minutes and prescribed a daily stretching routine. I’ve completed every race since. My guess is that message would help in addition to stretching.
Greg-interesting problem. Certainly cysts develop laterally beneath the lateral head of the gastroc from a host of sources. Readers have mentioned Baker’s Cysts, the traditional popliteal cyst, but don’t forget cysts that originate from the lateral meniscus, although this patient population is usually older (not interested in tri camps) rather than younger in most instances.
Your Sports doc likely has the best handle on this with the ability to actually examine your wife. Maybe you could sit back, think if part of this may be self-induced, yes all of us are guilty too, and see if the combination of icing, exercise, Ibuprofen and a gradual return to cycling isn’t the answer. If not, then in my office,the next step would be x-rays and a consideration of formal physical therapy, likely by a PT who rides bikes! Good luck.
Unfortunately…My husband got it a little incorrect. My pain is more in directly behind the knee and a little in the medial aspect of the knee. I do think the the medial pain is mostly tendinitis and has decreased substantially with rest, ice, ibuprofen. However, I still have pain, swelling, tenderness directly behind the knee even after taking three weeks off cycling and two off running. It hurts when I walk and sometimes feels like it is going to “give out backwards.” I feel the pain more when the knee is extended/hyper-extended. Sometimes I feel radiating pain down my leg while at rest, sometimes I feel a warming sensation down my leg at rest, and sometimes I don’t feel anything at all. I have no idea what it is.
Mrs. Greg-generally, the list of possibilities remains the same and you’ve had this long enough that maybe your Sports Doc could help you both with the understanding of what’s cooking and how to “get out of the woods.” If it bothers you significantly, give 'em a call.
I am 4 weeks post-op from Meniscus surgery. All of the symptoms that you are describing are exactly what I had. I also started my year off by doing bike focused work - which I think lead to my injury. I had 80% of my meniscus removed which really sucks.
Good luck with whatever it is, but definitely get an MRI which will show if there is a meniscus tear.
so how long were you off working out post surgery? Thanks for the info. g
I only had to take one week off the bike - but just came back easy, no hard sessions on the bike for a few weeks. I rode all the way up until I had surgery. Running has been a different story - I’ve tried running but I’m having a lot of pain so just looking at it long term and trying to ease back in to it. Doing lots of muscle strengthening to ensure that my knee to solid when I do get back to running pain free.
Could my wife call you with a question? Thxs. g
Sure. (415) 215-3412
Chris