# Knee pain after a difficult climb



## flynbryan19 (Sep 9, 2010)

I have developed some knee pain recently after a riding trip I took where there was a rather steep/short hill that took all my effort to over come. I obviously started the climb quickly and with lots of momentum, but the last 10-15 feet was a very slow cadence and ALOT of effort. Had to do this twice.

After my ride I noticed that the ligaments/muscles below my knee cap have been sore/tender after my rides or spin classes at the gym. This has gone on almost 2 months. Usually the pain comes after the activity not during. I took roughly 2 weeks off of riding anything and the pain went away. I started back again yesterday at the spin class and though not as severe the pain seems to be creeping back in. Should I rest longer? Are there any stretches or therapy I can do to solve this issue? I've NEVER had any knee pain in 3yrs of riding before now. I'm hoping I haven't done permanant damage.


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## Blister Butt (Jul 20, 2005)

It's very likely a seat-height issue. It's either too high or too low. I forget which one. Probably too low. There are lots of threads on adjusting your seat height properly. The one I like is to sit on the bike, put your pedal at the 6 o'clock position, place the heel of your foot on the pedal and adjust the seat height so that your knee is very slightly bent. One eighth or one-quarter of an inch does make a difference, particularly if you are getting older or did not grow up on a bicycle.

Best wishes.



flynbryan19 said:


> I have developed some knee pain recently after a riding trip I took where there was a rather steep/short hill that took all my effort to over come. I obviously started the climb quickly and with lots of momentum, but the last 10-15 feet was a very slow cadence and ALOT of effort. Had to do this twice.
> 
> After my ride I noticed that the ligaments/muscles below my knee cap have been sore/tender after my rides or spin classes at the gym. This has gone on almost 2 months. Usually the pain comes after the activity not during. I took roughly 2 weeks off of riding anything and the pain went away. I started back again yesterday at the spin class and though not as severe the pain seems to be creeping back in. Should I rest longer? Are there any stretches or therapy I can do to solve this issue? I've NEVER had any knee pain in 3yrs of riding before now. I'm hoping I haven't done permanant damage.


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## flynbryan19 (Sep 9, 2010)

I would be inclined to think that possible if the problem hadn't have just developed. Again, prior to what I believe was over exertion I've never had knee pain and I haven't adjusted my seat position.


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## edubfromktown (Sep 7, 2010)

I had ACL replacement surgery and torn meniscus repair 9 years ago. Note: I am not a medical professional so don't cut off your toes or anything else drastic because some hack (like me) on MTBR suggests it 

I'd rest longer for starters and then gradually build up intensity to a spin class or masher climbs.

You didn't mention if you use clipless or flat pedals.

For either, you should consider the angle of your foot on steep climbs. If your heel is down lower (which is common) you exert more stress on the knee. I focus on "stepping" more than pedaling (particularly when riding single speed) on slow steep climbs if that makes sense... 

If you use clipless pedals, you may want to adjust your cleat position back a few mm further and see if that helps.

If the pain persists after longer rest and slowly increasing the level of intensity, I'd get it checked out by an orthopedist just to be on the safe side.


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## flynbryan19 (Sep 9, 2010)

edubfromktown said:


> I had ACL replacement surgery and torn meniscus repair 9 years ago. Note: I am not a medical professional so don't cut off your toes or anything else drastic because some hack (like me) on MTBR suggests it
> 
> I'd rest longer for starters and then gradually build up intensity to a spin class or masher climbs.
> 
> ...


Thanks for the response. It just might kill me (lol), but I'll try to take it easy a little longer. I do use clipless pedals and I believe they are closer to the ball of my foot than the toes far as the adjustment is concerned.


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## leaftye (Dec 27, 2007)

Muscles imbalances are usually to blame. If you aren't already doing them, try some exercises that hit your legs differently than cycling does.


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## irishpitbull (Sep 29, 2011)

Sounds like some patellar tendonitis. Ice your knee even if it does not swell, 3 times a day till the pain stops. Give yourself a nice 10 day break and ease back in to riding. If you don't rest and ice your knee this injury can get much worse.

As mentioned above, move your cleats a bit back.


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## Moonshine Willie (Oct 21, 2009)

I had this very thing happen to me. A period of overexertion called attention to the fact that my seat wasn't properly adjusted and that singlespeeding wasn't the best thing for me. I took two weeks off, adjusted my seat and made the wise decision to return to a geared setup. My knee has been fine ever since.


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## flynbryan19 (Sep 9, 2010)

Moonshine Willie, which way did you have to adjust your seat?


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## Moonshine Willie (Oct 21, 2009)

I adjusted the saddle fore and aft so that my knee was properly placed over the spindle and the ball of my foot and also I think I raised it a little bit. I think those things helped a lot because now even if I climb in a harder gear, I don't get the twinges that I used to get.



flynbryan19 said:


> Moonshine Willie, which way did you have to adjust your seat?


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## LyNx (Oct 26, 2004)

Pain in the front of the knee means your saddle is too low, pain in your hamstring means your saddle is too high, learnt this early on when I started riding - _remember, if you move your saddle forward you generally also have to raise it and if you move it back lower it_. I'd say besides the saddle probably being too low that IrishPitbull has it right and you've probably aggravated your tendon by pushing so hard with your saddle too low_ (assume you remained seated on the climb)_ and it needs some time off and care like he said - have done this myself and the only thing that will cure it is rest, icing, maybe some anti inflamatories.


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## flynbryan19 (Sep 9, 2010)

Thanks for all the insight guys. When I (believe) I injured it I was standing and "mashing" on the pedals to make it to the top, so I honestly don't believe my seat was to blame. Just me trying to hard and being stubborn instead of just getting off the bike and walking the last 10ft. I have been icing when symptoms come up, staying off the bike aside from my two spin classes (which I have taken it easy on), and using anti-inflamatories only after my classes. Hoping to see some improvements soon!


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## XRaptor (Mar 23, 2011)

WOW this sounds exactly like me. I'll have to check my seat and cleat placement. Thursday was my last ride and had no problems during the ride it was after that I had a nagging pain just under my knee cap. The following day it felt like it was more of a nagging pain from under the knee to middle of my shin. Last 2 days I've been pain free but I did use lots of ibuprofen and ice'ed it down a few times. Still going to wait at the very least a week to hit the trails again. Glad I found this thread.


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## flynbryan19 (Sep 9, 2010)

An update to this... Today I am almost 8wks into this trial and I have some positives and some negatives to take away from it all so far. To start out with I have been diagnosed with Chondromalaysia (or a knee cap tracking issue). I took up PT after my diagnosis and as much as I hated it STOPPED biking. A LOT of PT, ice, and advil later and my left knee feels to be very close to if not 100%. My right knee has been the nagging one and I'd say I'm around 70-75% with that one right now. 

What I also have going on on top of the tracking issue is the fat pad below my knee cap has gotten swollen/inflamed and it is VERY difficult to get rid of. The left one seems to have subsided, but again the right one is taking more time. It does seem to be improving though. As I've read others comment on the MANY threads I've read about this issue, I can't stress enough.... If your having these symptoms STOP RIDING! I know its very difficult for us since we enjoy it so much, but your knee(s) will NOT get better till you give them time to rest and build up your VMO.

I feel I'm on the slow road to recovery and the end is in sight, but it has been a very tough process. Its important not to give up and don't get discouraged. This can be beat. It just didn't happen over night, so we can't expect it to get better over night.


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## Gundam168 (Dec 19, 2012)

flynbryan19 said:


> Thanks for all the insight guys. When I (believe) I injured it I was standing and "mashing" on the pedals to make it to the top, so I honestly don't believe my seat was to blame. Just me trying to hard and being stubborn instead of just getting off the bike and walking the last 10ft. I have been icing when symptoms come up, staying off the bike aside from my two spin classes (which I have taken it easy on), and using anti-inflamatories only after my classes. Hoping to see some improvements soon!


Happened to me too. Especially when I'm mashing up a hill. I like going uphills and also the occasional sprint. Curiously, it doesn't happen when I use my full suspension bike. Always on the hardtail. I'm using a patella band/patella guard on my left knee whenever I'm biking. At first I just used a make shift garterized velcro strap as suggested by a PT friend. The result is like night and day. I eventually bought a real chopat (Patella strap) and voila...no pain. 
No strap = pain. 
Wearing the strap = no pain.

Patellar Straps: Are They Effective for Knee Issues? | Breaking Muscle

Also, riding full suspension helps. No suspension on the bike means your knees are the suspension.


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## flynbryan19 (Sep 9, 2010)

I have another PT appointment tomorrow and I'm going to be talking to the Dr again. My left knee is 100%, but my right knee just will NOT give up the ghost.... Just walking up and down stairs yesterday and doing 3 sets of squats made it start hurting bad enough that I had to take advil again to get the swelling/pain to go away. I've been fighting with this since mid Nov. and we're now in the beginning of April. I've been off any kind of "real" bicycle since the beginning of Feb. I'm so over this.....


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## Bdabike (Jan 27, 2013)

Not to heist your thread, but my pain is on the inner side of my right knee. I was doing some trail running and I believe i may have strained my MCL. Didn't go to the dr, but started riding after it felt 100%. It is now bothering me after bike rides. I think doing my pre-ride stretches, I felt a little tinge of pain. During the ride it was fine. After the ride, it is annoying. Do you think my riding is going to damage it any more than it is?


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## flynbryan19 (Sep 9, 2010)

Well, after two months of PT for the Chondromalacia I feel that my knee cap tracking issue is resolved. I have for probably about the last month though dealt with pain in my patellar tendon in my right knee. After it screamed at me when I tried to return to squats and lunges I decided to go get a second opinion on the knee. Sure enough..... Tendonitis.  Been wearing a "runners knee" strap and and a neoprene brace when just walking around and its getting MUCH better. I also stretch every day and continue to do my leg exercises for both the chondro and the tendonitis 2-3 days a week. I think I'm FINALLY getting this thing licked!


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## Stalk (May 24, 2005)

What exercises are you doing? Problem with strap is that it would start irritating tendons on the outside of the knee. My solution so far trading power for cadence and no standup sprinting. Taking few month off the biking didn't helped.


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## flynbryan19 (Sep 9, 2010)

Stalk said:


> What exercises are you doing? Problem with strap is that it would start irritating tendons on the outside of the knee. My solution so far trading power for cadence and no standup sprinting. Taking few month off the biking didn't helped.


Interesting. The strap has made a MAJOR difference for me. On top of the strap, I've also been doing ALOT of icing, stretching, foam rollering my IT bands, and the first exercise in this video. Knee Strengthening Exercises - YouTube The exercise I use starts at 45 seconds. I tried doing the exercise after where you sit down and then stand back up, but that was hurting my tendon. The first one w/ the rubber band seems to be working GREAT!


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## Stalk (May 24, 2005)

Strap indeed works but after prolonged use I got side effects. I'm trying tape right now, its uses only surface tension and doesn't irritate tendons.
In video guy seems to train all muscles that will be active with biking anyway. One of friends went through PT and was told to do lateral resistance training, so muscles got more balanced around knee area. Seems helping a bit but not completely solving the issue. That's why I was curious on what training you getting.
I'm trying to find a way to get rid of strap/tape completely.


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## flynbryan19 (Sep 9, 2010)

I will say I don't wear the strap constantly. I only wear it when I'm going to be exercising my legs or riding bike. Otherwise I've been wearing a neoprene knee brace. I could see where it would cause issues if you wore a knee strap constant. What kind of taping are you using? Kinesio tape? I've read of people using it w/ good results. I've been reading basically ANYTHING I could find lately about these two issues since I've had some much down time. lol


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## milehi (Nov 2, 1997)

I also have patellar subluxation that can go hand in hand with chondromalacia, which was the result of crashing in a DH race using clipless pedals. I also received two meniscus tears that had to be cleaned up. Oddly, my knee hurts only if I'm off the bike for extended periods. And the best thing I did to get myself back on the bike after surgery was yoga.


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## Stalk (May 24, 2005)

KT Tape, but I guess any sport medicine tape will work. I'm applying it for medial knee pain in a way for it to push patella to the inside. One ride on it so far and it felt better.
Strap was causing irritation while only applied for the bike ride but ride for 4-5 hours is quite a regular event, or whole day on DH runs at resort.


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## flynbryan19 (Sep 9, 2010)

I see, so it sounds like you have the same combination I had. Knee cap tracking and tendonitis. I also have yet to ride for 4-5hrs so that might make a difference too in the comfort level of that strap. I personally went out and bought my own McConnell tape for my knee cap tracking issues and would address that myself. At first I would leave it on for a couple days at a time and as I built up my muscles (VMO) and stretched out my IT band's and other related muscles I was able to only tape my knee cap when doing exercises. I now don't have to tape the knee cap at all. I'm just working on addressing the tendonitis. I still do my chondromalacia and tendonitis exercises twice a week. Basically your gonna have to just do trial and error to see what works and it sounds like your on your way with that.


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## flynbryan19 (Sep 9, 2010)

In case your interested, here is the tape combo I used. You can get it on ebay cheap.
Leukotape P Combo Pack Sports Tape Cover Roll Bandage | eBay

And the procedure I used when taping.
Patellofemoral McConnell taping - YouTube

This made a big difference for me. Please take note for anyone reading... I am NOT a dr. Just did my homework and after going to a PT for 2 months learned how to address the issue myself. Things are improving each day and I'm very grateful.


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## Stalk (May 24, 2005)

Head ups on tape use. Two weeks riding with KT Tape and seems working fine. Pain control similar to strap but no pressure and irritation on outside tendons.
Since I know which direction I need to move patella I'm using single strip starting under knee going around with tension and finishing above. It pushes patella instead of pulling it directly like in link posted above.


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## flynbryan19 (Sep 9, 2010)

I'd be interested to see a pic of how you do that. My issues are now the patellar tendon and not knee cap tracking, but it'd be good to know.

I'm currently up to 40min rides with out pain. I have some muscle fatigue (sore) the next day and a little bit of joint soreness, but nothing "hurts". I'm thinking its just the fact that I didn't ride AT ALL for 4 months and now I just have to build my body back up to it again. It seems to get better over time. I started out w/ this soreness after only 20mins in the beginning and now I can double that time before it sets in, so I believe I'm making headway.


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## Stalk (May 24, 2005)

Its shown here: KT Tape: Full Knee Support - YouTube
Since its full support it uses 3 strips, in my case I end up with single strip going around outside of knee cap.


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## 450VoltsDC (Jul 5, 2010)

Moonshine Willie said:


> I adjusted the saddle fore and aft so that my knee was properly placed over the spindle and the ball of my foot and also I think I raised it a little bit. I think those things helped a lot because now even if I climb in a harder gear, I don't get the twinges that I used to get.


Got a "new to me" bike last month and been riding harder. 2 weeks ago I began to feel tightness from my kneecap to my thigh when laying down. Last few days my knees began to hurt when walking so I came here and found this thread.

Yesterday I moved my seat forward 15 mm's, rode for an hour, and all symptoms are gone.

My knees will be 66 years old tomorrow so I'm especially grateful!


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## flynbryan19 (Sep 9, 2010)

Well, I'm happy to report that I believe I have finally beat a 6 month long problem.  I have gotten back up to 1hr long bike rides without pain. My tendonitis seems to be steadily improving and though I'm still using neoprene braces when I ride I no longer have issue with the swelling I had. I still take some advil after my rides and ice as soon as possible, but probably will for quite some time just so I don't have this happen again. I was at one point up to 2 1/2 hr long rides on my road bike, but hopefully by the end of the summer I can approach that again. My goal now is to train the rest of this year and be ready for our local spring/summer xc mtb series next year. Just wanted to let everyone know this IS something you can recover from if you give yourself enough rest and gradually build yourself back up to riding again.


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## Mark_BC (Sep 19, 2012)

Ooh, patellar tendonitis .. I was out for a year with that, on crutches for about 4 months. You gotta take it seriously. Long story, but another injury sidelined me for a year and when I got back into action my quads were totally atrophied (your patellar tendon is an extension of your quads) and I pushed it too hard too early and put myself out for another year. Pretty sad when I think about it, I basically lost 2 years of my life, if you can believe it.

I found the that physiotherapists just made everything much worse, maybe you have a good one, I don't know. They didn't like the fact that I was able to do my own internet research. I really should have sued the ass off mine because she is what started the whole downhill spiral, turned a simple minor structural sports injury into a major problem that threatened the future existence of my leg.

Anyways, I did lots of research on patellar tendonitis. I discovered that the best way to rehab it is with eccentric exercises, basically you stress it while the tissue it's lengthening, not contracting (concentric exercise). This means that you would put force on your leg when you go down a squat, but not back up. It seems to do amazing things. Google it.

Me, I'm basically up to 100% now, I totally rebuilt my scar-tissue laden, almost non-existent patellar tendon. Tendons are not like muscles because they have very little blood flow and they take a long time to heal, whereas a muscle heals in weeks or even days. Be thankful that you haven't screwed up your knee ligaments because you never fully recover from that, but a patellar tendon can be totally rehabbed.

At least the silver lining to all this is that I now know everything about tendonitis, how to recognize it before it gets out of hand, and to deal with it, so I can say I'm never going to have another tendonitis problem again!


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## flynbryan19 (Sep 9, 2010)

Mark its ironic you say your patellar tedonitis was started from atrophy, because I believe that's what may have happened with mine. Though they were sore/painful for so long I don't 100% remember the initial pain I was feeling I believe my tendonitis came after I was doing PT for my kneecap tracking issues. I tried a couple different times to explain to my PT that I felt my pain was NOT from the tracking, but they brushed it off. 

I finally ended up going to another Orthopedic doctor that would listen and was indeed diagnosed w/ tendonitis. My tendonitis issues didn't start getting substantially better till I stopped doing my knee cap tracking exercises and if I had simply listened to my original PT and not done my own research I believe I would STILL be regressing instead of improving. In short though most doctors are very intelligent with MUCH more education than myself, but you also need to have a mind of your own and explore ALL potential options.


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## Stalk (May 24, 2005)

Glad to hear. With tape and foam roller I had improved symptoms a lot. My goal was to enable 4-5 hours rides pain free and with tape on no issues. If I forget to apply tape I'm good for an hour or so but then pain starts coming back slowly. Also what makes it worse is wearing armor. Spent week in Mammoth, and pedaling with knee pads brings pain fairly quick.
Hope I'll be able to fully recover in the winter. Right now riding is just too god to slow down.


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## flynbryan19 (Sep 9, 2010)

Got a little over-zealous two weeks ago and did 3 days of riding in a row. Felt fine the first two days and didn't hurt during the activity the 3rd day, but come the fourth day I had some pretty good knee pain again. Took a full week off and started back up again yesterday. So far no pain. I guess I'm just gonna have to stick to my on one day off the next routine I've been doing. With ice each day and advil(ibuprofen) after my rides I seem to be good to go.


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