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Discussion Starter · #1 ·
Well... I've been incrementally increasing my miles getting ready for a metric. Plenty of back to back 20 and 30 mile rides with no discomfort at all.

Today we go out for a 45 mile ride, and everything is fine until mile 35 or so. I notice a little pain on the top side of my knee cap on the left leg (which is the leg I leave clipped in at stops, if that matters). I continue on, thinking, OK, I can suffer a little. I took 2 Aleve.

At the turn around point, mile 30, this has become a persistent sharp pain. I press on. By mile 35 I am at an 8 on a scale of 1-10, 10 being unbearable. I begin to pedal with only my right leg, which does alleviate the pain. Pain only occurs when applying power with the left leg. I take my last Aleve. In a last ditch effort, I adjust my cleat on the left shoe. It didn't make a difference.

At mile 40 I am dying, and afraid I will permanently injure something, so I pull over at Chipotle, and my husband rides the remaining 5 miles to home, gets the car, and SAGs me.

My underlying question is: Does it seem possible that this pain has been here all along, and only showed up at higher miles? I've been riding a lot lately, getting ready for this metric. Lots of 20-30 mile rides, lots of hills. But today was the first ride >30 miles in a while. I've done other 40 mile rides without pain in the past.

The knee still hurts now (2.5 hours poast ride), but not as much. It is across the top of my kneecap that hurts. I can poke it where it hurts.

I really want to solve this before Saturday, which is the metric I'm signed up for.

So... what are my options? Rest the knee? Ice? heat? Go to LBS for some help? (My bike was comfortable, no pain, until today, I've been riding on this set up for 6 months or so). Make an adjustment? It worries me that it is only the left side... should I be worried?

HELP?!?
 

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Loraura said:
Well...The knee still hurts now (2.5 hours poast ride), but not as much. It is across the top of my kneecap that hurts. I can poke it where it hurts. ...

I really want to solve this before Saturday, which is the metric I'm signed up for. ..
You should seriously reconsider doing this 100km ride, only 5 days from now.
 

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I agree with Tom about riding so soon. That said most of the time if your knee hurts on the front your seat is to low. You could try raising it but I would wait until you are pain free.
 

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I'm not an ortho but I have had my deal of knee issues. Your symptoms sound like what I experienced when I continued to ride with a torn meniscus. I did this for about 2 years and never really had significant problems unless I tried to ride the big ring and really mash the pedals. The pain was really bad and actually felt like it was coming from the top of my knee cap. I also felt pain on the interior of my knee. I finally broke down and had the knee fixed (5 months ago) but I could ride without incident as long as I kept the cadence up and the watts down.

I would suggest you try to ride in an easier gear and see if that doesn't help alleviate the pain. The problem is once you aggrevate it on a ride it only gets worse - you can't "ride it out".

BTW good luck with your ride.
 

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Discussion Starter · #6 ·
Hmmm... I did ride more in the big ring than normal today. I started out feeling GREAT and pushed it more than normal. Come to think of it, I rode in the big ring a WHOLE LOT more than normal. I just talked to my husband about it, and he confirmed.

I do always carry Aleve. I carryAleve because I get migraines when the barrometric pressure changes. I get an aura type sensation right at the beginning of a migraine, and if I catch it early, Aleve can keep it under control. If I do not take an anti-inflamatory at the very beginning, I'm screwed for the next 6-10 hours.

I do anticipate pain, unfortunately.
 

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Migraines

Loraura said:
Hmmm... I did ride more in the big ring than normal today. I started out feeling GREAT and pushed it more than normal. Come to think of it, I rode in the big ring a WHOLE LOT more than normal. I just talked to my husband about it, and he confirmed.

I do always carry Aleve. I carryAleve because I get migraines when the barrometric pressure changes. I get an aura type sensation right at the beginning of a migraine, and if I catch it early, Aleve can keep it under control. If I do not take an anti-inflamatory at the very beginning, I'm screwed for the next 6-10 hours.

I do anticipate pain, unfortunately.
Maybe you know this, but an espresso is good for Migraines. I think it dialates the blood vessels. The stronger the better, no decaf, you want all the caffeine you can get.
NOTE: Aleve doesn't help me, nothing does. I just have to wait it out. I get an aura too and it starts and then lasts for about a half hour before the pain sets in. I "know" when I am going to get the head ache and can run for cover sometimes....
I will say that one time just before I was going for a bike ride, as I was walking the bike outdoors, I got the aura, knowing that a migraine was on the way in about a half hour. For some reason it just pissed me off and I got so mad I went for a ride anyway. I was like telling the migraine to f*ck off. To a degree it actually worked. There is so much about pain that is in the head (well duh!) it's not funny.
 

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So many choices. But coming off arthroscopic surgery(also had torn meniscus) in Aug I've had to deal with quite a few issues. One of them was a very sharp pain that would appear on the front of my knee(surgery was behind). I was told my knee cap was tracking poorly and rubbing the bone above the knee. This disappeared shortly(now gone entirely), but yours could be aggravated by the overuse from pushing too big a gear. Essentially muscle on outside of knee tightens and pulls kneecap that direction. Even strengthening of the knee muscles is the best cure. I also did the most bizarre PT, strengthening my right leg to help my left knee problems. Weird, but it worked.You can add this to the list of possibilities, hope things work out for you!
 

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I've been working through some knee pain this winter. Seems to be gone now. I think mine came from a combination of strain (longer/harder ride than normal) and cold weather. Here's what I did to fix it:
- aggressive rehab with ice (15-20 minutes; 30-45 minutes off; 3x a day; sometimes for a few days in a row)
- no riding or VERY LIGHT riding (best on a trainer when you can stop IMMEDIATELY when you feel any pain). I learned this the hard way as I "see sawed" for weeks; resting for 5-6 days than doing a long/hard ride and re-injuring all over again.
- YES do get a bike fit. I swear by the Specialized BG fit system and, in particular, the 3D system (tracks your position as you move). Worth the money.

Hope this helps.
 

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Get a copy of Andy Pruitt's book Complete Medical Guide for Cyclists. He covers various types of knee problems, their treatment and ways to avoid future problems. I am not a doctor, but from your description and looking at the book, your problem could be "Spring Knee". Treatment for many knee problems include ice three times a day for 15 to 20 minutes. Stop riding for a several days. Take an anti-infammatory. The suggestion to raise saddle is a good one, raise it 3cm. Use a lower gear to increase cadence and lower pedal pressure. Wear leg warmers or tights in cool weather.
 

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If one knee is fine, and you've got lots of miles on both knees without pain, it's most likely a positioning problem with the left knee. If you never clip it out at stops, maybe the cleat got out of whack. You said you adjusted it on the ride, but that may have been too late if you kept hammering in the big ring.

So I'd say, check the left cleat. Make sure it matches the right one. Tomorrow, take a nice easy ride in low gears and test out the knee. If there's significantly less pain, go with easy gears on training rides up to the event, and when doing the event stay in gears your legs can "stay on top of." Don't try to push big gears until you're sure the knee problem has gone away. Chance are very good it will, once the fit problem is solved.

I've been there, and I don't push big gears anymore unless I can maintain at least a 90 rpm cadence, or am resting on a downhill. Get away from pushing. Learn how to spin at an energetic cadence, legs not pushing, but following the crank around, and I can tell you from my own experiences, your knee problems will go away.
 

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mds said:
Get a copy of Andy Pruitt's book Complete Medical Guide for Cyclists. He covers various types of knee problems, their treatment and ways to avoid future problems. I am not a doctor, but from your description and looking at the book, your problem could be "Spring Knee". Treatment for many knee problems include ice three times a day for 15 to 20 minutes. Stop riding for a several days. Take an anti-infammatory. The suggestion to raise saddle is a good one, raise it 3cm. Use a lower gear to increase cadence and lower pedal pressure. Wear leg warmers or tights in cool weather.
The advice is probably sound for any athletic injury, and the book (which I haven't seen) is probably excellent for teaching us about these things so we can be a more active agent in the solution of our problems.

But it's always frustrating to me that non medical people actually give advice over the internet to someone they don't know, symptoms they really don't have anywhere near a complete picture of (there's more to pain and injury assessment than the simplistic report given in OP), and usually based on their own single experience or something they've read in the popular literature. You'll probably note that on these sort of subjects, actual qualified medical people rarely if ever give advice because of these factors. It would be foolish.

The only good advice is: see a qualified sports medicine person or at least an orthopedist or other physician qualified to assess knee injuries. Do not accept or follow any advice given in forums like this. At best it won't harm you, at worst it will harm you or lull you into thinking you've received legitimate medical advice.

Again, I happen to think the above advice is good generic advice, but it risks that the OP will actually think it's what should be done, and only what should be done. OP you need to see someone, period, if you're serious about fixing this.

And it won't be fixed before your century unfortunately. You might be able to limp through it, but you should be fully prepared to end the ride as soon as you feel pain. Riding through it could turn what may be a simple "treat with ice, exercise and NSAID's" into something that will take you months to fix, maybe worse.

The only thing above I'd question is "raise the seat 3cm"?. Really? 1-1/4 inches?? That's really a huge amount. Unless the saddle is ridiculously low, but with the riding experience OP has I guess I'd be surprised if it wasn't at least close to good. I've never messed with my saddle height in more than .5 cm changes at a time and for me at least, final height has never been more than 1 cm off from the normal rules of thumb (which I'll assume OP has used).
 

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Discussion Starter · #13 ·
Thanks, everyone.

I do think, after putting it all together, that pushing too big a gear was the root of my trouble. My bike setup hasn't changed, and I haven't had pain anywhere in a long time. I'm leaning toward a "stupid rider, not bike set up" diagnosis.

I'm going to ice and rest the knee for a few days, then try an easy low gear spin and see how I do.

It's ironic that we purposely tried to pick an EASIER ride to go longer on, and due to the change to easy rolling hills, I pushed too hard and screwed it up. If we had stuck with the steeper hills I'm used to, I wouldn't have injured myself. Lesson learned!!
 

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Camilo said:
The only good advice is: see a qualified sports medicine person or at least an orthopedist or other physician qualified to assess knee injuries. Do not accept or follow any advice given in forums like this. At best it won't harm you, at worst it will harm you or lull you into thinking you've received legitimate medical advice.
Camilo, I agree with you 100%, not only what I quoted above, but your whole post. I considered the issues you raised before posting, but decided to go ahead anyway. Sorry. Clearly the best suggestion is to see someone qualified. And regarding raising the seat, 3cm is a typo. 3mm is actually the book's suggestion.
 

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Loraura said:
Thanks, everyone.

I do think, after putting it all together, that pushing too big a gear was the root of my trouble. My bike setup hasn't changed, and I haven't had pain anywhere in a long time. I'm leaning toward a "stupid rider, not bike set up" diagnosis.

I'm going to ice and rest the knee for a few days, then try an easy low gear spin and see how I do.

It's ironic that we purposely tried to pick an EASIER ride to go longer on, and due to the change to easy rolling hills, I pushed too hard and screwed it up. If we had stuck with the steeper hills I'm used to, I wouldn't have injured myself. Lesson learned!!
i didn't notice it posted, but did you check your cleats? may one got loose or move a little? more time in the big ring could be a big reason. especially if you aren't used to it and if your bike fit is off a bit.
 

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Loraura,

I used to run to stay in shape and I had the same pain you describe. It got so bad that I had to give up running. I just bought a bike (2009 Giant Defy 1) so I could get back into shape.

Anyway, my Doctor is well known. He told me this is what I have:

http://www.pamf.org/sports/king/condromaliciapatella.html

I am not saying this is what you have. But it is a possibility. Go see an orthopedic surgeon that specializes in sports medicine.

Hope you get it figured out.

S-
 

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A theory.....

You added too much distance and effort at once AND your seat is too low.

On your normal (shorter and hillier) rides the problem didn't show up as much since you varied your pedaling effort and likely stood up some PLUS you didn't ride for as long. You may have even stopped more often for a short break on your hillier rides.

On flatter rides you don't stand up or coast as much and it sounds like you were using harder gears on the flats than normally do.

You just over did things a bit, you will recover and be fine (but raise that seat a tad).
 

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Another non medical ;-) opinion

One of the things to ask your doctor is about an IT or illio-tibial band issue. This connects the hip to the knee on the outside of the thigh. When it becomes irritated, the pain is generally on the top outside of the knee. Can be fixed with rest and specific stretching and strengthening exeercises.

Again, not a diagnosis, but a possibility.
 

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i bet it is your seat or cleat position. if only 1 knee hurts it could be leg length discrepancy too. Andy Pruitt book is very good as recommended earlier. Pain in front of knee is likely seat too low or seat too far forward or both. If (for example) you used KOPS to position your seat fore/aft you are just as likely to get it wrong as to get it right which is to say dont use KOPS or any other formulas, go by what feels comfortable under load.

It could also be knee tracking problem - fixed by a varus or valgus wedge from BFS (formerly LeMond LeWedge).

Apart from seeing a doctor I think a visit to a really good bike-fitter is recommended. I would also get a medical person to measure your legs for any bone discrepancies, the one that hurts might be somewhat longer. You can also lift the seat up by ~3mm and see if it feels better. Good luck. I have been there. Riding a bike should NOT hurt/injure you if you stay upright 8^)
 
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