# Question on Knee Injury?



## cbc (Apr 16, 2006)

Years ago I tore "something" in my left knee. It was bad enough that I didn't work for a month. The MRI didn't show anything, and my doctor (at the time) said it was fine to mountain bike. Something is wrong, but nobody knows what (probably unless they tear into my knee- not something I would look forward too). 

In the past couple of years, my knee has been feeling fine most of the time. I went for a really long ride (comparativley) last weekend though, with lots of climbing, and my knee has been hurting a little when I stand on it now. It does not hurt on the bike at all, but there is a small pain just above the kneecap toward the inside. 

Should I continue riding the bike as I have? Or should I take it easy until the pain subsides? I would really like to continue the riding, but I think the knee is more important 
Thanks,
Clay


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## connie (Mar 16, 2004)

As a knee surgery veteran (4x), I'd say that for starters, I'd have someone who really knows what they're doing look at your bike fit.

If you're not getting any other symptoms from any other activity, only long bike rides, that would stand out as the problem. Personally, I just took my new bike over to TOSH Physical Therapy, where they have a therapist trained in bike fitting, and had him get everything aligned just right. I don't know where you are located, but maybe there is something like that in your area.


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## cbc (Apr 16, 2006)

Thanks, I looked into it and found my seat a bit too low. I'll ride this weekend and see how it is 

Thanks again,
Clay


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## AlliKat (Apr 28, 2006)

I second bike fit. Good physical therapy can go a long way. My brother went to the sports medicine at the local college athletic department. They gave him a workout to balance his quads and hamstrings. It was amazing how well it worked.


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## Eric Hoefer (Jan 19, 2004)

Inside front of the knee sounds like a medial meniscus (cartilage) tear they dont always show up on an MRI and tend to be bearable without surgery in alot of cases. I tore some of that when I took a spill skiing a few yrs ago and ended up fracturing my knee in 2 spots straining my LCL and MCL and Tearing my ACL. It wasnt until they went in for the ACL repair the doctor noticed the tear in the cartilage and repaired it. If the pain continues I would reccomend a second opinion from another doctor and definitly have them at least reccomend you a good knee brace.


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## amorphous (Jul 7, 2006)

Hey Clay,

I felt very compelled to reply to this, as this SAME thing has happened to me this spring.

Ok, so about 8 years back I was training hard one spring and POP, left knee pain. I was "loosely" diagnosised by a knee specialist with Patella-Femoral Syndrome - no scope, just from the looks/sympoms.PTS basically means "pain in the inner kneecap area" from improper tracking of the tendon..... As directed, I took a break for 6 weeks, inner quad strengthing exercises, got back on the bike and trained, but never did I ride as hard as before.
Riding kinda went out the window for the next 7 years...i'd ride hard every now and again, but never over about 15 miles or so....

Fast forward to late April this year. The bug bites me, I get a new bike - I take my daughter out with her hitchhiker bike (add 60lbs for her and that) and we hit easy flat stuff for 25+ miles. I was riding my old bike (which was too small) with OLD gear (shoes/pedals). My knee SCREAMED at me! So bad that I could barely walk for a few days. I had no idea what to do, so I basically looked into EVERYTHING from Bike fitment to shoe/cleat fitment to Yoga and Supplements. 

I guess what I'm getting at is that there are MANY things that could be causing your knee pain. Seat height is a good start - Cleat adjustment? I found mine were WAY off. Bike size? I was riding a bike a size too small for me. Even maxxed out w/ a longer stem and seatpost, it kinda fit....but it just wasnt't CORRECT. 

This is the only way to start - REST. It sucks. I had JUST got my Fisher and I had to take the pedals off so I wouldn't be tempted. REST!

ICE - 15-20 minutes 2x a day if it hurts. And don't forget this later, cause as you ease back in, it's a good idea to ICE after you ride longer sessions. 

Brace? Maybe...i tried 3 - they didn't work for me, but the one I kept sure hold the ICE pack on great when driving home from the trail!

S t r e t c h i n g - I cannot recommend this enough. SERIOUSLY. I am so much more flexable now, and it's helped work through the pain. Do this 2x, 10-15 minutes a day. The first week sucks. The second week is even worse because your so sore. The third week is no better, but you can really start to see results. The 4th week you'll find yourself wanting to slack, but keep at it. Stretch your quads, IT Band, hamstring, groin - all of it! don't skimp - do it religiously. 

Ibuprofen. It's your friend for swelling. The swelling is what's causing your pain. I recommend using it at night or when your NOT riding. The last thing you want to do is deaden the pain then ride throught it to another injury. 

Glucosimine. I'm using it, seems to maybe have helped. I feel like an old person taking it but what the heck if it helps repair tissue. Flax Seed Oil. also good. The jury is going to be in when I kick these supplements and see if the pain stays. That may or may not ever happen!

Fitment - VERY important 'cos when you get back to it, you don't want to re-do it! How much float do your pedals have? are your knees at a weird angle? There is UBER amounts of info on the net. It will make your head spin. I ended up changing to a clipless system with more float and new shoes. This seems to have helped my knees.

Cadence - can't believe it took me so long to remember that! - SPIN! - low gear load, high pedal RPMs. Learn to spin, your going to need to take load off that knee. 

After 6 weeks, I eased on in...and I'm still easing in...the most I've done was 3 days in a row, 6 miles, 12 miles then 14 miles - it didn't kill me, my knee kinda complained, but the pain went away after a day or so. Bring the mileage up slow. Don't expect to do what you did before RIGHT away - you can get there, but ease it in. Knees gotta last you a while!

There is no easy answer, 'cos I looked high and low for it. You have to look at the contributing factors and change the way you did things before.

ok, end of rant - hope your knee gets better - let me know what works for YOU

~åaron


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## SSteve F (Jan 15, 2004)

I would definitely go for a second opinion, and wouldn't listen to any suggestions I picked up on the internet   Seriously, bike fit is VERY important, and shouldn't be overlooked. 

MRI's pick up most things, and if it has been a couple of years, it wouldn't do any harm to go for another. The meniscus is below the knee-cap, so it sounds like it couldn't be that. Upper-inside knee sounds like a soft tissue injury, and can be very difficult to diagnose. I wouldn't trust a GP and would insist on seeing a specialist.

STEVE (4x knee surgeries)

PS Having a knee scoped is no big deal, and may be only true way to find out what is going on.


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## cbc (Apr 16, 2006)

Thanks everyone. I will be taking it easy this weekend, and see how it does. I suppose if the pain goes away I'll just have to gradually push it. The pain started after doubling my climb, as well as shaving 20 minutes off my initial usual climb- so I was pushing pretty hard. It has gotten a lot better over the course of this week. I do have Kaiser for medical now, and will probably make an appointment to have it checked out. I just hate having to go to the doctor 

Thanks everyone,
Clay


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## cbc (Apr 16, 2006)

I took all the advice in today for my ride. Some Glucosamine, streaching, light spinning during the week, rubbing out the muscles... 

Today's ride was great. My knees gave me no trouble whatsoever  No ice, no ibuprophen  Some new trails for me at Annadel, lots of climbing (short sections) and lots of really rocky sections that I almost thought I would not make it through. No knee problems at all. Total of 8 miles in about one hour 45. 

Thanks everyone!
Clay


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## TNC (Jan 21, 2004)

*Your problem is obvious.*



cbc said:


> I took all the advice in today for my ride. Some Glucosamine, streaching, light spinning during the week, rubbing out the muscles...
> 
> Today's ride was great. My knees gave me no trouble whatsoever  No ice, no ibuprophen  Some new trails for me at Annadel, lots of climbing (short sections) and lots of really rocky sections that I almost thought I would not make it through. No knee problems at all. Total of 8 miles in about one hour 45.
> 
> ...


Clay, I happen to know from talking over in the SC forum that you're using a Bullit as an XC bike. C'mon...even Cedric G. would have knee pain trying to pedal that beast as a trail bike...LOL! Well, I'm kidding of course. I haven't had an ACL in my right knee since '81, so I've heard, read, and experienced a lot of knee issues. There have been many good comments here, but until you can get an orthopedic professional to actually identify something wrong in your knee, you'll be playing a guessing game 'til the cows come home.

That said, the suggestion of trying numerous fitment experiments are worthwhile. If you're knee is ultimately going to need surgery of some kind, it's very unlikely you'll do any further injury while trying a few easy experiments. And if fitment turns out to eliminate your knee pain, you've saved a ton of doctor visits. With my missing ACL I have to make sure that my bike fitment, pedaling style, and even component selection are suitable to what works for me. My orthopedic doctor even told me that if I do certain things to stay in shape, he recommended I stay away from surgery as long as possible. Obviously not all knee issues are the same. So try different saddle heights, try different pedaling techniques (maybe more spinning than hard mashing), use clipless pedals, and there are other experiments to try as you go through this. Some might think the suggestion of clipless pedals sounds strange, but the pushing "and" pulling action is much better for knee health and conditioning. On the spinning rather than mashing issue, I even run 170mm cranks on my Nomad for the trail.

Cycling has been the best thing ever for my knee. Remember that knee therapy for injuries and/or surgery almost always eventually involves a stationary bike regimen. So try the fitment experiments mentioned. If you get no relief, then start the process of finding an orthopedic doctor who knows something...or give up biking.:nono:


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## Krause (Jun 21, 2006)

Something to rember, my old physical theripist told it to me (had 3 knee sugeries :/)
Building up muscle around problem joints wil help releave them of the load and also keep them in place.

The best thing to do for joints that hurt like that is to just build up the muscle, either from slowley getting back into riding and using that to gradually build up the muscle, or better yet using machines to target them at a gym, as your prob lookin for a bit of mass, not as much crazy toned muscle


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## cbc (Apr 16, 2006)

Heh, TNC, ya caught me  Honestly, I got the F/S bike to relieve strain on my knees & back. It's worked quite well, but last weeks ride was like 4 times my normal ride. With the adjustments I've made on the bike, I really feel great this evening (except for some sore muscles...). I will continue on this path for now, as I have entered for the Hellride... what happens if I win.... Oh man...

Thanks everyone,
Clay


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## cocheese (Jan 12, 2004)

When I read this post, I thought I must have written it! This is my EXACT position. I injured my knee in my very first mountain bike race back in 1997. It hurt so bad that I couldn't even think about riding for years. I went to the doctor, had an MRI and it showed nothing. The doc wanted to scope it. I decided to give it some time. I gave it a few years with no cycling and then decided to try it again. Man, something about the cycling just brought the injury right back. I went to the doc again and another MRI showed nothing. I recently decided to give it another go with a singlespeed...read LOTS of mashing. Anyway, it came right back. After one good ride on the bike it was back to hurting. I am going to go back in next week to see what we can do. I love cycling too much to even think about another sport and the years I have missed here are just piling up. I'm imagining that they will start me with some sort of physical therapy and I am VERY hopeful that this will work. I just can't help thinking that after this long (10 years) that it would have fixed itself if it were going to happen. Surgery may be the only option, but I am going to exhaust my options first before resorting to scoping it.


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## amorphous (Jul 7, 2006)

cocheese said:


> I recently decided to give it another go with a singlespeed...read LOTS of mashing. Anyway, it came right back. After one good ride on the bike it was back to hurting..


I'm no expert- but I *think* that is your problem = mashing. Get back to the gears. Spin.

P/T exercises and stretching have got me back to where I want to be w/ riding - It's when I do 20+ miles like 3-4 days in a row that the knee will act up - even then it's not as bad as it was this spring. Hell, I think my kid's soccer practice is usually the reason any pain returns!

BTW- since my last post, i've seen a specialist - negative on the MRI - nothing obvious - it's just rough cartilidge from bad tracking and unbalanced muscles. There is no fixing it without the risk of it actually getting worse. I opt to just take care and build muscle.

i have a hunch that this whole single speed/fixie trend thing is gonna bring about more knee injurys. Why go backwards technologically?

aaron


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## dru (Sep 4, 2006)

Ah the knee, you poor bastard! I have had 2 surgeries, with the last being the replacement of my ACL. I am 43 now and the surgery is 16 years old. Surprisingly though, biking has allowed me to keep walking, since most of the inside meniscus on my bad knee has been removed. Foolishly I ran for awhile against the surgeon's advice and wore out what was left of my meniscus. A couple years back my knee was swollen for 18 months and I limped. Now I get pain off and on, but none when I bike. The knee is delicate, yet can bounce back. I can sprint or mash, it makes no difference since riding actually makes my knee pain go away, if it has been bothering me. Biking can certainly cause problems for the knee too, but I have not experinced this aside from pain caused by the saddle being too low. When this has happened my knees usually feel better within a day of moving the saddle up. Bike position is very important so pay a lot of attention to this first, and then look into medical advice. Don't be scared of the knife either, if you have a problem related to injury many of the fixes are excellent. I originally tore my acl in 85 and there were no repairs back then. I dislocated my knee 5 times before the acl was repaired which is why my meniscus is in such bad shape.

Good luck,

Drew


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## Psykosus (May 28, 2005)

just to add on, as i've had one knee surgery, and so far, have avoided needin' a possible second with the help of bikin': MRIs are very inconclusive, and almost worthless in my opinion.. i slipped in the kitchen two years ago, and my right knee bent laterally as i fell.. my MRI showed no damage, other than my knee cap was out of place by about an inch. after five months of physical therapy (i was apprehensive about surgery, my sister's had three on her ACL, and she still can't go back to softball), my doctor convinced me to let him "look in my knee" (arthroscopic surgery) to fix a suspected torn meniscus.. he was right about the meniscus, and was surprised to see that my ACL was torn too.. The MRI didn't show the damage, but i got to see the pics from the surgery, and it was pretty bad.. so if you're still havin' pain, my advice is to make an appointment to see a good orthopedic doctor, who will probably recommend physical therapy, or surgery if it doesn't help..

my doc fixed my meniscus and patella, but i never had the ACL worked on out of paranoia; but i'll tell you, bikin' has been the best thing for me.. i have the most knee trouble the weeks i don't get a chance to hit the trails.. ridin' the right bike with the proper fit, should only strengthen your knees... good luck..

PEACE

PSY


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## cocheese (Jan 12, 2004)

Thanks for the info guys. I'm making an appointment today to see an orthapedic specialist about it. I've been limping around on and off for a few weeks here and it's just not worth it. I'm 34 and should have a lot more life in these joints! I'll check back with the diagnosis and treatment. I think he will probably stick to some sort of physical therapy to begin with, though I suspect that I'll have it scoped sometimes this winter if nothing else works. I have had friends who have gotten knees and shoulders scoped and they have all had good things to say about it. 

Again, I appreciate the comments here.


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## cocheese (Jan 12, 2004)

Went to the physical therapist today. She is perplexed as to what the exact problem could be. I don't seem to have any obvious issues that she could find. I'm plenty strong and structurally, from what she could tell, thing seem ok. My ACL checks out fine too. 

I have 2 sessions per week for the month and she said she is going to look into a patellar femoral alignment issue first. She first asked me about my bike fit which echoes what has been stressed in this post. (There a person in their office that specializes in bike fit issues.) She put me on the bike and then taped my knee cap towards the inside and had be get back on the bike. I didn't notice a huge difference, but it certainly felt different. So far, things are inconclusive. I'll check back after my next session.


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## cocheese (Jan 12, 2004)

I went to the PT for my next appointment and she gave me LOTS of stretching excercises to do. It turns out that the IT band on my left side is very tight. It is puzzling as the knee pain is on the inside of the knee, not the outside. Anyway, she also taped up below my knee in a criss-cross pattern saying that it might relieve some of the pressure on the knee cap as there is some swelling under and below the knee cap. After doing the stretches a couple of times, I can already feel a difference. As to whether it will help my knee situation, I'll probably know this weekend after my Saturday ride.

There was a fellow in the gym at the PT that was recovering from his 3rd shoulder surgery. He was icing and lifting some weights. He is looking at returning to work some time next year. He stressed to resort to surgery as a last resort only. I'm going to take his advice for sure. If I exhaust all physical therapy options and there is still significant pain, then I will look at having it scoped.


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## cocheese (Jan 12, 2004)

After more stretching and taping and testing, the PT thinks it is a meniscal issue. I am now icing every night and massaging the area to try and stimulate the movement of the meniscus. I am not so sure that I am noticing any marked improvement. In fact, after the PT was pushing around in there the other day, the pain has gotten quite a bit worse. We have done some deep massaging as well as some ultrasound, which will continue for the remainder of the month until my appointment with the ortho specialist.


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## jdp526 (Apr 21, 2006)

My gf had surgery on the meniscus a few weeks ago. She was walking/jogging on asphalt trails at local park while I was riding on dirt trails. She later complained about some soreness and minor swelling. Drs she works with thought it was tendonitis but after a couple of months there just wasn't much improvement. I urged her for months to get an MRI which she eventually did only to reveal a torn meniscus. She recovered quite fast but hasn't resumed hard/ fast walking just yet.


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## dru (Sep 4, 2006)

*meniscus repair*

Don't be scared about getting it cleaned up as it is an outpatient procedure. I don't know your age but wear is age related. I gobble glucosamine daily to ward off surgery though, since I don't want to know how little is left of mine-a surgery would be the third one. Most often you will get small tears on the surface or edges that fold over causing a lot of pain. That is what happens to me; if I leave it alone and take it easy for a few days it settles back down. The surgery is simply shaving off the rough bits. Big tears are a problem though since they don't heal well even if they are stitched (therefore no one does this). There is simply too little blood flow to the joint cavity. You would know if tore your meniscus badly, as your knee would swell up like a grape fruit.

Drew


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## dr.dirt (May 4, 2004)

*MD's, Phds interested in mtb research*

whoops wrong button


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## cocheese (Jan 12, 2004)

I've actually had mine MRI'ed twice and they found nothing major. I know that there could still be a tear or something that warrants a scope, but I'm going to finish with the PT and see the dr. and see what he suggests. I certainly have some swelling post ride or post run, but it is mainly internal in the form of stiffness/tightness. I have yet to see any visible swelling from the outside.

I'll have to try the Glucosamine/Chondritin thing. My stepdad has noticed a difference with his knee post op after taking it.


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