About 70 miles into a 100 miles ride this weekend I starting feeling a sharp, highly localized pain on the inside of my knee. This came after a long steep section of hill(65-75rm), it worsened as I rode. The pain is right in the middle of the space between the medial aspect of the patellar and the medial condyle of the femur above the joint line. Another the way to describe it is proximal to the tip of my VMO when I flex my leg muscles. I can run, jump, do calve raises, leg extensions, leg curls, without any noticeable pain. It only shows up when I’m going down stairs or if I squat on one leg, and only then its present if I reach 90deg of flexion, anything less than that and I can’t feel a thing. If I squat on one leg slowly I can feel a twinge or slight plucking where it hurts, again, at about 80deg to 95deg of flexion. My hammies have been very tight and I also wore my old cycling shoes for the first time all season on this ride(they have more float, but also are a three strap vs the two strap I’m using now, and hence I think there was more force on my knee since there is less slipage in those shoes.)
I have a history with this area as well, about two years ago on a 100 mile ride I was pushing the hills too hard around mile 80 and felt a slight click, or pop in the area I have just descibed, I rode home with some discomfort and took it easy for a few weeks and I never had any problems with it.
My guess is that this could be MCL related, possibly a grade I strain, or less, but the pain I feel now is almost in an anterior to medial location, again, about two finger widths from the medial edge of my knee-cap and in the area of the joint capsule, so I’m not sure if the MCL is involved. I don’t believe the meniscus is an issue since this is related to a previous injury. Any ideas?
This sounds like it could be inflammation of the medial plica (which is attached to the medial mensiscus). There is lots of info if you google “medial plica” (although there are some experts who will argue that there is no such thing as a plica). Ice and an appointment with your favorite orthopedic or physical medicine doctor would probably be a good idea.
Yeah I looked at that too and that is a prime suspect, especially given the slight plucking sensation. It is also interesting that prior to that ride my hamstrings were very tight and recently I have noticed that I have lost a little muscle mass in my VMO. It could be that my muscle balance is off and given how tight my hamms were the problem was exacerbated during the ride, thus leading to irritation of the plica, if I have one!
I still think there is a link between the injury I had a few years ago and what happened this weekend, and if that’s the case I’m not sure if plica syndrome is the issue.
Sounds just like insertional tendonitis of the vastus medialis - pull or strain right near the myotendinous junction. Triathletes are tough in that we get it all: shoulder issues from swimming, biomechanical issues from cycling and the myriad of running injuries.
since the VM is usually weaker then VL in runners especially, typical quad strengthening helps “runner’s knee” typical medial knee pain. When the quads get tired, you likely stood in the hills and really pulled the distal VMO insertion. Thankfully, these heal quickly since they are near the muscle. Plica syndrome(s) are always a possibility, but a little more unusual.
Thanks rroof, I think that pretty much pinpoints what’s going on. When I did this a few years ago I was standing and pulling hard, this time around I was seated and working on pedaling in circles in 12-25 up a pretty steep grade. And your right, this healed relatively quickly the first time around, so hopefully I didn’t tweak it too badly this weekend. I’m fortunate that I will be on my honeymoon in a week, so I will be forced to stay off my bike for a good 2.5 weeks. The downside is that I will have lots of free time to get in some extra run miles!!
Well, congrats! Since I’m way past the honeymoon stages of marriage (13 years), I’m sure we’d all like to hear about a more interesting biomechanical issue from …
Hey, how about a nasty back spasm with gracillus muscle pull? Perhaps piriformis syndrome? now get working on that
