# Knee problem - below knee cap, near the outside



## Francis Cebedo (Aug 1, 1996)

I've had knee pain for the last two months.

During and after a big climb, I feel pain right under my knee cap. After the ride it gets worse and I had a hard time walking after thanksgiving. It's right under, above and on the inside of the left knee cap.

Early diagnosis was Patellar Tendinitis. Then possibly Patella Femoral syndrome

So I've rested it for two months doing only beginner rides once a week. I've done a lot of stretching and foam roller.

It is better but I'm not 70% and still in pain. I did a 2000 foot climb at an easy pace yesterday at Emma and I was hurting by the end of the ride. I have to be dialed before Sea Otter.

I've had an MRI done now and they did not detect anything wrong. I've been prescribed to do a lot of flexibility stretching of the hams and hips. My hams and glutes are supposed to be strengthened as well.

I feel though that I'm not closer to the problem. I went on an easy ride yesterday and I'm in a lot of the same pain today.

I feel like not having perfect fit on my bikes is the problem. Also, I pedal a lot with my dropper post not fully extended. Finally, I've been doing a lot of pump track sessions and my left knee is the forward one.

47 years old btw.

Anybody experience something similar.

fc


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## AC/BC (Jun 22, 2006)

Ive had this problem a various times throughout the years. I've tried strengthening excersizes in the offseason and that has helped some but the pain seems to creep back later in the season as I get stronger. More recently i've thought about getting professionally fitted and have my pedal stroke analyzed. The pain only happens in my right knee so maybe i need to add spacers to my cleat or shoe. I was thinking one of my legs might be a tad longer then the other. Look forward to hearing some more responses as I try to figure out the problem as well.


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## irishpitbull (Sep 29, 2011)

Bike fit and stretching. It made a world of difference for me.


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## Varaxis (Mar 16, 2010)

I'm younger, but when I had a knee ache after doing hill climbs with my 1x10 (32 and 11-36), I decided to use my trigger point roller on the outside of my legs, above the knee, but that seems to be more for the IT band. Don't want to end up where you are at. Rolling it f'n hurts. I heard stretching doesn't really reach many of the muscles you use for climbing, so I'm relying on the roller. 

Actually, after this posting this, I decided to work on the inside of the leg with the roller too. 

Speaking of MRIs, I also had one for when I had runner's knee (basically what you were diagnosed with). I ran no matter the footwear, more in my work boots than in running shoes, and the MRI tech basically said they only detected wear and tear from use, but nothing out of the ordinary. Basically switched to a good deal of my running with cycling when possible then, to reduce the strain, and thought that was it. Seems to only come back after heavy strain.


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## irishpitbull (Sep 29, 2011)

This guy is awesome. Foam rollers are sweet but a bit soft for really getting down in the tissue.











Varaxis said:


> I'm younger, but when I had a knee ache after doing hill climbs with my 1x10 (32 and 11-36), I decided to use my trigger point roller on the outside of my legs, above the knee, but that seems to be more for the IT band. Don't want to end up where you are at. Rolling it f'n hurts. I heard stretching doesn't really reach many of the muscles you use for climbing, so I'm relying on the roller.
> 
> Actually, after this posting this, I decided to work on the inside of the leg with the roller too.


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## Jkj (Jan 8, 2012)

Hi,

I am 38, I have the same pain on my left knee. I only have this after install the dropper post. After lots of reading, I found myself in the lower riding position more often than the fixed post. So I just keep in mind that always set in a bit higher than usual when not decent and when you needs pedal. 
The pain go away after 2 weeks. But that is for my case and I am might not as serious pain as you.
Hope you can recover soon. Cheers


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## pwrtrainer (Oct 23, 2005)

See a PT that is versed in modern pain science. You likely do not have anything wrong any longer, but now you are in a persistent pain state. Eccentric exercises can help, but the two months off put you into a relative state of de-conditioning. Now your threshold before you cause the pain cycle to activate is much lower, and likely will not increase for a while. Your age is perfect for these things to begin, and time off usually is not the answer. The rollers are good before a ride, but after there is not much quality research to back them up. Again, find a PT and have them assist you in strengthening the muscles that need it and re-train your brain that your knee is likely no longer being damaged, just painful.


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## BoiseBoy (Mar 1, 2006)

pwrtrainer said:


> See a PT that is versed in modern pain science. You likely do not have anything wrong any longer, but now you are in a persistent pain state. Eccentric exercises can help, but the two months off put you into a relative state of de-conditioning. Now your threshold before you cause the pain cycle to activate is much lower, and likely will not increase for a while. Your age is perfect for these things to begin, and time off usually is not the answer. The rollers are good before a ride, but after there is not much quality research to back them up. Again, find a PT and have them assist you in strengthening the muscles that need it and re-train your brain that your knee is likely no longer being damaged, just painful.


pwtrainer hit the nail on the head. 
If you want true medical advice, you need to speak to a medical professional.
You don't go to your clothes cleaner for invenstment advice, do you?


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## Tim22 (Sep 11, 2010)

this has helped me. kinesio taping the patellar tendon. keep stretching the tendon
Kinesio Taping for Patellar Tendinitis - YouTube

and a patellar tendon strap helps when tendon is tender. good luck


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## Francis Cebedo (Aug 1, 1996)

BoiseBoy said:


> pwtrainer hit the nail on the head.
> If you want true medical advice, you need to speak to a medical professional.
> You don't go to your clothes cleaner for invenstment advice, do you?


I've seen three doctors. 

Nothing wrong with sharing experiences and asking for opinions in the forum right? This is a very difficult to diagnose overuse injury and most doctors will just tell you to stop riding.

I'm coming to realize that many folks now are having similar problems and many more will. Part of the purpose of this thread is to help me and to help others that these problems exist and will become all too common. The good paths are strengthening, stretching and circulation.

I've had xrays and mri's done now but there is nothing obvious.

fc


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## Francis Cebedo (Aug 1, 1996)

One thing that I'd like to add is my left foot is my dominant (forward) foot and that's the knee that's giving me pain.

I have a pump track in my back yard and was jumping a lot in 2013. I am starting to realize how much stress and beating my knee takes when I'm pump tracking and jumping.

This whole dropper post trend too puts in a new variable in the mix. I pedal sometimes with the post dropped. And when the post is dropped and I'm carving and jumping, all the stress is on my knees.

From my MRI, most issues have been eliminated. Not tendinitis, patellar tracking, ligaments.

Cartilage irritation and fluid in my knee are the suspects right now.

fc


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## WHALENARD (Feb 21, 2010)

I had Osgood-Schlatter in my knees VERY bad in my early teens. There has been some good advice already but I'll add. In my opinion weighted squats & deadlifts are key to a healthy lower body as we age. Beyond the myriad of benefits these 2 key exercises provide they also thicken your tendons, and increase the surface area or footprint of where the tendon attaches to bone. I would also advocate for some specific supplements. Natural anti inflammatory like turmeric or curcumin in pill form and sulfur like msm. Good luck


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## pwrtrainer (Oct 23, 2005)

You keep mentioning various stresses on the knees. The thing is, you take 1000 men 47 years of age, with and without symptoms, and you will find several hundred painful knees with no positive imaging, as well as several hundred knees with positive imaging and no pain. The evidence is not very conclusive on cycling being hard on the knees and individuals who have pain do not necessarily have anything actually wrong with them. The thing about lots of doctors is they are not trained in chronic pain science to a very high degree. They are fantastic at treating acute pain. Chronic pain can lead to changes in the brain and allow altered input and output signals that lead to pain. You can have pain with no injury, injury with no pain, and everything in between. Ask your father if he ever had knee issues, see if they crept up at age 47, as your pain experience is largely dependent on genetics. There is a lot of hype about neuro-plasticity in the media today. Check out its ugly cousin central sensitization and you might see some signs that may paint a picture for you. The first step I usually take when treating a chronic pain patient when all red flags have been teased out, is to inform them that their pain is likely not related to tissue damage and that they can rest easy knowing that they would likely not cause more harm if they had pain with their favorite activity. I caveat all this by saying my general disclaimer that I am not trying to treat you via a forum and this post serves as advice only and information for you to make an informed decision on. See a physical therapist that explains their management of your condition via reducing the sensitivity of tissue, or use of eccentrics and doesn't try to sell you on making things more flexible etc. because the evidence is again lacking in that arena as well, but that is another story.


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## Francis Cebedo (Aug 1, 1996)

pwrtrainer said:


> You keep mentioning various stresses on the knees. The thing is, you take 1000 men 47 years of age, with and without symptoms, and you will find several hundred painful knees with no positive imaging, as well as several hundred knees with positive imaging and no pain. The evidence is not very conclusive on cycling being hard on the knees and individuals who have pain do not necessarily have anything actually wrong with them. The thing about lots of doctors is they are not trained in chronic pain science to a very high degree. They are fantastic at treating acute pain. Chronic pain can lead to changes in the brain and allow altered input and output signals that lead to pain. You can have pain with no injury, injury with no pain, and everything in between. Ask your father if he ever had knee issues, see if they crept up at age 47, as your pain experience is largely dependent on genetics. There is a lot of hype about neuro-plasticity in the media today. Check out its ugly cousin central sensitization and you might see some signs that may paint a picture for you. The first step I usually take when treating a chronic pain patient when all red flags have been teased out, is to inform them that their pain is likely not related to tissue damage and that they can rest easy knowing that they would likely not cause more harm if they had pain with their favorite activity. I caveat all this by saying my general disclaimer that I am not trying to treat you via a forum and this post serves as advice only and information for you to make an informed decision on. See a physical therapist that explains their management of your condition via reducing the sensitivity of tissue, or use of eccentrics and doesn't try to sell you on making things more flexible etc. because the evidence is again lacking in that arena as well, but that is another story.


Thanks. You are pretty much right on. 3 experts have seen my MRIs and all if them say my knee is sound and without signs of damage.

Yet I go for a ride at 60% effort And I'm limping for the next 24 hours.

So I'm off to therapy and strengthening now. And I'm accepting that the downhill may be the one hurting me more.

-autocorrected-


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## pwrtrainer (Oct 23, 2005)

The good news is you can use some exercises that will help. Several muscles shut off as a defense when you have pain in the knees. Therapy can fix that. You would likely be what I call a "pop tart patient." One that is in therapy for a very short time. I do recommend that you try riding regularly but gradually. And if you do eccentrics only 2 times a week if you really load the tendons. Those exercises are supposed to be hard so it's easy to work too hard. Here in AZ we have canals that make great cyclist rehab tools because they are nice and flat. If you can find that you'll be better off.


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## Cape Codder (Jan 16, 2014)

Go to a good chiropractor and have them check your ankles and hips. That is often the cause of knee issues.


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## BigSteve in CO (Sep 12, 2009)

irishpitbull said:


> This guy is awesome. Foam rollers are sweet but a bit soft for really getting down in the tissue.


4" PVC pipe is a good way to get deep. Maybe covered with duct tape or soft velcro for grip. Not applicable for this particular thread (too hard for joint areas), but wanted to throw that out for anyone that reads this. Killer for glutes and quads.


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## Francis Cebedo (Aug 1, 1996)

BigSteve in CO said:


> 4" PVC pipe is a good way to get deep. Maybe covered with duct tape or soft velcro for grip. Not applicable for this particular thread (too hard for joint areas), but wanted to throw that out for anyone that reads this. Killer for glutes and quads.


Could be very applicable man. Many knee issues are caused by IT band or glutes/Hams tightness or imbalance.

I gave the Trigger Point foam roller but it is a ripoff at $30

-autocorrected-


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## dth656 (Feb 12, 2009)

francois,

i would echo the recommendations to see a good physio therapist--often they have more insight than the actual ortho! 

i speak from experience after breaking my arm a few years ago (and also learned to avoid the ortho's at PAMF fremont)--the ortho would review the xrays, check basic range of motion, and say yep, everything is healing ok. but the PT was the one who really worked to figure out which tendons and muscles were tight, and impact that was having on the arm, and then show me exercises that would help alleviate things.

also, a bike fit can't hurt (i know calmar on el camino does them)


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## pharmaboy (Nov 11, 2005)

Similar but not as bad, I've discovered a few things that make it worse and have been able to modify them

1. Seat height at full roadie efficiency height - less bending of the knee, my last episode was because my seatpost had sunk about 8mm - I kid you not - that tiny distance made a difference.

2. Put cleats back as far as they would go, and centred the bony pertuburance thing over the axle - meant putting my saddle a fair bit forward. ( search it up, it's pretty std setup)

3. Started to rely on fast cadence for speed, not slow power . Spin is easier on your knees

4. Come off rest (injury) periods with slow calculated increases in volume

Ps - the world is full of 47yr olds like us with dodgy knees who have come to cycling because it's easier on the body than most other sports.


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## LyNx (Oct 26, 2004)

I'll chime in and say that you're constantly getting bikes to test and parts and swapping them on and off your bikes, so you may not always have your bike set up perfectly for you, so definitely on the right track there. I'd look at your saddle and it not being back far enough behind the BB - _I loaned a guy my Thomson setback post because his dropper is down for service and used a straight post, thought I didn't really need the setback, was absolutely wrong, with the combination of a just slightly to short 350mm post and straight, I was not far enough behind the BB and my knees were hurting the same in the front. Got back my Thomson and have been good ever since._

You have a dropper post, but don't use it to it's fullest by doing climbs with it partially dropped, WHY? Especially if they're grinder climbs where you're really pushing a gear and not spinning easy. Remember, that not only does a dropper post bring your saddle height down, but also takes the saddle forward as it slides down into the ST, so in essence you're pedalling lower and more forward of the BB than you would with it fully extended.


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## pharmaboy (Nov 11, 2005)

For height, read this

SEAT HEIGHT ? HOW HARD CAN IT BE? » Bike Fit » Featured » Steve Hogg's Bike Fitting Website

Make sure your fore aft is correct before doing it - it's not necessarily the solution, but it helps a lot if everything is exhausted before you go to a physiotherapist - btw, there are bike fitters around who are also physiotherapists - I would use one of those - they have loads of experience in both the efficiency is and the fitting side


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## Francis Cebedo (Aug 1, 1996)

LyNx said:


> I'll chime in and say that you're constantly getting bikes to test and parts and swapping them on and off your bikes, so you may not always have your bike set up perfectly for you, so definitely on the right track there. I'd look at your saddle and it not being back far enough behind the BB - _I loaned a guy my Thomson setback post because his dropper is down for service and used a straight post, thought I didn't really need the setback, was absolutely wrong, with the combination of a just slightly to short 350mm post and straight, I was not far enough behind the BB and my knees were hurting the same in the front. Got back my Thomson and have been good ever since._
> 
> You have a dropper post, but don't use it to it's fullest by doing climbs with it partially dropped, WHY? Especially if they're grinder climbs where you're really pushing a gear and not spinning easy. Remember, that not only does a dropper post bring your saddle height down, but also takes the saddle forward as it slides down into the ST, so in essence you're pedalling lower and more forward of the BB than you would with it fully extended.


Correct and correct. As a bike tester, I now have to be religious about fit and body placement. I don't do it too much unless it's my own bike but now, any shoe, pedal, bike test needs to be treated seriously for fit.

As for dropper post, it is one of the modern day dangers of pedaling in the non-optimal position. I would pedal sometimes on flat or rollers with my saddle at half height. Why? Cause it's more fun, more flowy and it doesn't interrupt my carving of the trail. Also, I thought I was just building up my leg strength. But now I see that it can come with a higher expense. So I have to minimize it.

I now see that the dropper post will expose many knees to non-optimal pedaling positions.

And what about my dirt jump bike and pump track??  Ahh the joys of the aging mountain biker.

fc


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## Francis Cebedo (Aug 1, 1996)

I had a decent revelation today as I hiked with my daughter in the morning and I rode in the afternoon. No pain at all.

It echoes what a lot of what my PT is saying: I have to strengthen my glutes, hams, IT band, core, etc.

In essence I have to do other things aside from my 100% riding in the last 12 years. 

And it doesn't all have to be in the gym. It could be as simple as hiking up and down hills. I'll do some yoga too btw.


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## HEMIjer (Jul 17, 2008)

Francois,

Some good mtn bike specfic strengthing programs out there.

I have been using the coach james workouts for a bit now and should have done it sooner (after knee surgery), from experience I went through wata you are going through now but always went to a normal dr, at some point knee couldnt take it ended up with ortho and knee surgery, from there I recovered got my riding form back and started more core work for better stability on the bike. Now for last couple weeks have been trying to get strength up in general it helps (I will admit now that riding season close to full swing,more ridng less strength workouts so I have identifed the exercises in his plan that I really like and seem to help me and concentrate on those)

http://www.bikejames.com/

http://forums.mtbr.com/xc-racing-training/mountain-bike-james-users-discussion-840577.html

Maybe you can get us all hooked up with code or something and test his products on MTBR! But seriously even if you dont go this route look into some conditioning programs that strengthen muscles you dont use onthe bike regularly and it could help.


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## Tubedriver (Sep 19, 2008)

francois said:


> I had a decent revelation today as I hiked with my daughter in the morning and I rode in the afternoon. No pain at all.
> 
> It echoes what a lot of what my PT is saying: I have to strengthen my glutes, hams, IT band, core, etc.
> 
> ...


I am about your age and have been dealing with ITB pain for about 2 years. I have backed off in intensity and duration of rides and that works but if I start hammering to hard or for too long it hurts.

One thing I have noticed, is that if I lay off biking for a while, the first ride is always painful. When I ride more frequently, the pain is reduced (up to a point).

My self diagnosis is that there is some scar tissue that is setting and then getting broke up when I ride after a period of no riding. Have you noticed the same thing?


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## jeffscott (May 10, 2006)

francois said:


> From my MRI, most issues have been eliminated. Not tendinitis, patellar tracking, ligaments.
> 
> Cartilage irritation and fluid in my knee are the suspects right now.
> 
> fc


Cartillage irritation and/or wear very difficult to pick up on the MRI an arthroscope was how they found my wear...cartillage wear and tear under the kneecap...

BTW that causes swelling which as near as I can tell is water on the knee.

Hope you don't need a scope in the near future.....you can count on it in the long run.


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## Poe4soul (Nov 18, 2012)

francois said:


> I had a decent revelation today as I hiked with my daughter in the morning and I rode in the afternoon. No pain at all.
> 
> It echoes what a lot of what my PT is saying: I have to strengthen my glutes, hams, IT band, core, etc.
> 
> ...


Sounds like golf might be in your future again. I'm sure the guys at Golf Review Forum could give you some pointers...

Just in case you forgot the address... here's the linky

Golfreview.com Forums


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## Prop Dude (Jun 20, 2013)

francois said:


> I had a decent revelation today as I hiked with my daughter in the morning and I rode in the afternoon. No pain at all.
> 
> It echoes what a lot of what my PT is saying: I have to strengthen my glutes, hams, IT band, core, etc.
> 
> ...


I have had a similar breakthrough. Was off of the bike for about 8 months from anterior knee pain and also dealt with the Dr's, MRI, PT, etc. My only form of real exercise came from cycling. One day I decided to hop on the wife's treadmill and run for a few just to see what happened. Knees were just fine, no increase in pain at all. You would think the pounding would amplify the issue but it actually seemed to help.

Shortly after I found a local sports med doc/posture specialist and he found my glutes and hamstrings were in horrible shape, very tight and weak. Not to mention the general muscle atrophy from inactivity. I was prescribed a series of exercises and stretches and it has really made a difference (you would think a high bar back squat with 75% body weight would be hell on the knees!) I'm back on the bike now and feeling great, almost 100% I would definitely look towards strength training for help. It was the long awaited silver bullet for me. The rest, stretching and traditional PT did nothing but prolong my condition. Get those muscles balanced and strong!


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## trailbrain (Feb 22, 2005)

Francois,
This is a couple of months late, but I had similar issues with my right knee about 4 years ago. 39 now. After I found a good sports med ortho he prescribed the less invasive option of PT first. I did that for a few months and it did help however I still had pain and inflammation on the lower knee cap at what felt like the inside under the patella tendon. I let that go on for a while and then went back to see doc. He was about 98% sure it was a fat pad impingement at the bottom of the kneecap causing the inflammation and pain. Riding always made it worse. Not willing to give up the bike I elected the surgery.

Low and behold he had to trim back the fat pad and while he was in there found that I had fracture the knee cap at some point causing a piece of cartilage to hang. He cleaned everything up and about 2 weeks later I was on the trainer. 4 weeks after that I was doing easy rides outside.

Hope this helps. Quite honestly I ran across this thread as I was looking for discussions on meniscus tears as I may have F'd my left knee up a few days ago off of the bike.


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## snowgypsy (Jun 5, 2011)

My knees have been a mess - actually, just one knee. An ACL tear and then scar tissue gone wild have resulted in numerous surgeries and more time/money at the PT office than I would like to admit. Recently, I began having issues with my patella tendon. I'd be riding along just fine and then be struck by a stabbbing pain in my knee or just below it. It had gotten to the point where I couldn't walk at times. 

My doctor recommended another knee surgery. I opted, instead, for yoga. Yes, laugh. But it actually has been amazing. Bikram or heat yoga is fabulous for joint and tendon issues. The room is heated to about 105-110 and the poses are designed to increase flexibility, strength, and blood flow. After about 4 weeks, I was able to remove the brace and begin skiing/biking again like I was before. Working on strength, flexibility, and balance in very specific areas (hamstrings and glutes) and working on forcing my quads to fire (not an easy thing a few surgeries down the road) has improved and even eliminated a lot of my pain. Also, my instructor and I have slowly begun breaking down scar tissue with specific exercises. Painful, but amazing.
Surgery, in some cases, can be necessary. However, there are other options out there that are less evasive and what's more, celebrate what you are capable of. After two years of surgeries the hardest thing was constantly feeling inferior, injured, etc.
Find a way to heal that empowers you and your mind/body will do the rest.


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