# Patellofemoral - Living with chronic knee pain



## nickd111 (Jan 29, 2015)

Hey Guys,

I've been fighting with pain in my right knee for about 7 years now. Over the years I've tried a lot of different stuff (ortho, PT, various levels of bike fit, products, etc) and have of course gone through various phases of grief and anxiety. At this point I've mostly settled into some different routines that help me get on with it and continue riding as much as I possibly can (usually 2 to 3 days a week). Also noticing that sometimes knee pain comes from tightness and sometimes it's from damage and how to recognize the difference.

Things that have really worked for me:

*Stretch every single night.* Stretch hamstrings, IT bands and quads mostly. This doesn't reduce my knee pain from riding, but has substantially cut down on how fragile my knee feels doing day to day tasks. Before I got serious about stretching it was common for me to have to take a week off the bike just from taking one hard step off a ladder or some stairs. You'd feel a slight jolt and know that you were done for awhile. Anyway, stretching has mostly eliminated that.

*Correct saddle height.* Sounds like a no brainer, but if my saddle is a little too low things go downhill very fast so it's worth throwing it up here. I'm probably losing some power here based on how high I have my saddle, but it makes a very big difference. I find I keep my saddle higher than any fit specialist has ever recommended. Obviously you don't want your hips rocking when you pedal. I recommend having a dropper post so that you can ride with your saddle at the proper extension for pedaling and you won't feel like you have to compromise on that in order to get your seat out of the way while riding down.

*Tape and knee brace. *I've had various success with both KT style taping and with a Mueller knee brace. I've done two seasons where I would tape my knee before every single ride and it does help. It is annoying, and it sort of expensive. Maybe not so expensive if you can't ride otherwise. If this stuff is a placebo, then...well I don't care! It may be helping keep the patella located in it's groove. I use the brace if it's not convenient to tape for some reason. Neither is a perfect solution. Sometimes you wear one or the other and you still end a ride with lots of pain. Sometimes you have pain and you tape your knee and it's almost like it disappears. Over all I've got a lot good out than bad.

*Flats. *Flat pedals, I think, have helped me by letting me move my feet around to various positions during the ride. I've read accounts of people feeling like flats lock their feet in more than clipless, causing for them pain. Worth a try I think.

*Recognizing pain from tight knee vs. Pain from damaged knee.* Scenario 1: My knee felt great so I went for a nice ride. My knee didn't hurt that evening, and my knee didn't hurt the next day, and now it's two days later and my knee really hurts. That means I damaged it two days ago, things are tightening back up now and, I assume, my patella is probably rubbing some damaged cartilage and causing lots pain. At this point I rest several days, continuing to stretch as much as possible.

Scenario 2: It's a week and a half after I hurt my knee. My knee hasn't hurt for a couple of days really. It's starting to ache. It's tight. Stretch and Stretch. Go for a ride and *take it easy* at some point and there is a good chance the pain will be gone. Stretching and keeping active helps keep these away.

My son is 1 and getting bigger, which means I've been doing a ton of squatting up and down while holding him, and carrying him up and down the stairs. I'm starting to get some pain in the left as well. This season could be interesting!

I'm thinking about trying an oval chain ring and also maybe moving down from 175mm to 170mm cranks. If anyone has positive, negative, or neutral experiences with these and knee pain please post!!!

Anyone who've had struggles with knee pain please chime in with any of your experiences. Always looking for new ideas! :thumbsup:


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## ovpt (Apr 20, 2010)

good ideas. also check out videos by david butler or lorimer mosely. research has shown a greater understanding of what pain really is helps us feel better. can also google "explain pain"


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## Harold (Dec 23, 2003)

I developed this back in high school from soccer. I was absolutely RUINED back then. trouble standing for more than a few minutes at a time. pain from walking between classes, and I had to quit playing soccer competitively.

I did PT for quite awhile, which helped. I think quitting soccer and the impact from running (what caused it to begin with) is what made the biggest difference. I took joint supplements. My docs and PT were really nervous when I said I was going to start riding a bike because not being active was driving me insane. But the bike didn't aggravate my knees when it came down to it, and that turned out to help a good bit. My problems seemed to be caused by a pretty significant muscle strength imbalance from soccer/running. cycling changed the muscle strength balance in my legs, and seemed to help.

Over a lot of years, my chronic issues abated pretty significantly. Running too much still bothers me, but I don't tend to have a problem with the occasional half hour jog at this point. I don't play soccer at all anymore, though. It still causes my knees to really flare up. Probably related to the lateral stress from making frequent cuts, and the increased impact of being a contact sport, among other factors. It's sad, I like soccer. I could probably handle an "old, fat man's league", but the adult leagues around here I've found throw 18 year old college varsity players out there against middle aged dudes with a spare tire, and that's just not cool.

knee braces never gave me any sort of relief. But I still have one of these that I bought half a lifetime ago when I first started having trouble, and it actually provided some level of relief. Not sure if one of these is something you've tried or not.

https://www.amazon.com/Pro-Tec-Athletics-Patellar-Tendon-Strap/dp/B004AOGA56

In my case, with the whole thing being generated by a muscle strength imbalance that pulled my joints out of whack, caused extra friction in places there shouldn't have been, and wore off a bunch of cartilage on the back of my patella, fixing the muscle strength imbalance is really what addressed the problem. I haven't had my knees checked to see how much cartilage loss I still have, but I probably still have pretty significant loss of cartilage (which would explain why I will still get pain if I play too much soccer). Cartilage inside a joint capsule grows VERY SLOWLY, and I doubt it'll ever get to 100%. I suspect I'll wind up needing knee replacement(s) as I age.

Do you know what ultimately caused your patellofemoral problems? I hope it wasn't biking.


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## ovpt (Apr 20, 2010)

hi harold

unfortunately it is impossible to know what exactly causes pain of durations beyond normal healing time frames.

when looking at the modern neuroscience research on pain, it appears the actual structure (joint, tendon, ligament, etc) has only about a 10% factor in determining a painful output. granted, this 10% is the largest contributer but that leaves many other factors which eventually determine whether something is deemed painful.

hardest part is to get comfortable with uncertainity.


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## ovpt (Apr 20, 2010)

https://www.sott.net/article/280753-58-Cognitive-biases-that-screw-up-everything-we-do

since pain is a neural output like any other feeling or thought, it is subject to all of the biases in provided link.


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## nickd111 (Jan 29, 2015)

Hey Harold, I've always been jealous of people that found relief from cycling! I discovered my knee pain while hiking. Didn't think much of it at the time. A couple years later it cropped up after my first season of road biking and it's never went away. I dealt with it for several years and ultimately gave up road biking for several years before trying mountain biking on a whim. It doesn't seem to aggravate it quite as bad for some reason. Maybe because I'm not pedaling as much as the road bike. Not sure. Either way it's a constant fight and I'm always looking for new ideas to try. Excited about the oval chain ring/shorter cranks possibly helping.


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## Oh My Sack! (Aug 21, 2006)

nickd111 said:


> Hey Harold, I've always been jealous of people that found relief from cycling! I discovered my knee pain while hiking. Didn't think much of it at the time. A couple years later it cropped up after my first season of road biking and it's never went away. I dealt with it for several years and ultimately gave up road biking for several years before trying mountain biking on a whim. It doesn't seem to aggravate it quite as bad for some reason. Maybe because I'm not pedaling as much as the road bike. Not sure. Either way it's a constant fight and I'm always looking for new ideas to try. Excited about the oval chain ring/shorter cranks possibly helping.


Perhaps I missed it. Have you had an MRI done? I have a similar issue with my left knee. I get pain at about the 10 mile mark on the MTB but virtually none on my road bike. I saw an Orthopaedic Surgeon that specializes in knees at a one of our well known local group of orthos and I have no obvious defects aside from a Plica which a significant portion of the population has from birth. I did PT and they targeted Gluteus medius and hip flexors to help stabilize the knee. It was somewhat successful but I still suffer from it though knowing it's not damaging and everything is good inside, I just push through it.

Reducing your crank length to 170 will work, I bet. It was great for me but I suffered in performance output on techy, rocky climbs. That 5mm of leverage on a 26" bike was amazingly and unexpectedly important. It may be different on a 650b or 9'r which I'm now on. My problem is not so debilitating that I went back to 175's and the pain came back. I just deal with it. If it ever becomes a sidelining issue, I'll drop my crank length and deal with it.


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## nickd111 (Jan 29, 2015)

Ah, that makes me think twice about jumping into 170s. Most of our trails here are short techy climbs/obstacles. Maybe I'll try the oval first and see how things go from there. 

I did have an MRI done the first year I had pain. The doc said it just looked a little swollen in there. X-rays as well. That ortho (first of two) said that I would always have knee trouble based on the x-rays, and that 26 was about when your body starts to go...I'm 33 now and have been dealing with it since. The doc made it sound like I could just ignore it and take pain reliever, but I find that it's not something that goes away when I'm done riding, and will compound into more and more pain the more I push it. Eventually not being able to walk without pain without weeks of rest. So, I have kept looking for more small ways to take the strain off while riding.

The second orthopedic surgeon basically proscribed PT. It didn't seem to have much effect, but at the time my knee was in pretty bad shape and probably needed more rest than anything else. I should do myself a favor and try to get back into some PT appointments.


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## Clyde250 (Oct 18, 2013)

For me it was using a Graston technique to improve the tissue quality of my quads. 4 bike fittings, 1 surgery, months of PT, KT tape, braces and it was a youtube video that fixed it. Or it was the copper infused undies Now I rub my quads out with a 3/8" steel bar and a piece of flat bar steel that I've beveled. The problem was up by my hip fwiw.


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## thumbprinter (Aug 29, 2009)

i recently got a new-to-me bike and it had 170 crank arms vs the 175s on my old bike - i was concerned about the change and was thinking i could raise the seat 5mm to compensate but the minimum insertion on my dropper post forced me to keep the seat at the same height. several hard rides on the new bike/cranks and no pain at all! my left knee is usually sensitive after a fit-related injury 6 years ago so i am thrilled that it hasn't flared up with the new setup. i don't notice any difference in power when climbing; i'm getting up steep and/or rooty hills just as well as before, if not better. /my two cents


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## ovpt (Apr 20, 2010)

any change can produce a positive effect. adjusting biomechanics through bike fit, pedals, crank arm, etc can have a large effect. trying to achieve better mechanics is always a good idea.


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