Pain behind the knee caps

Would be my recomendation

You need to see Martin Krause at Back in Business Physiotherapy, North Sydney. When you go see him, take your bike. He has a trainer to drop your bike into so he can see you pedal.

I had a number of pain-while-cycling issues to do with riding position, core strength, and my particular neuropathy that he helped me solve, and I was a rather complex case.

Martin was recommended to me by Steve Hogg, the bike fit 'guru'. The best advice Steve gave me was "Don't give medical professionals undue respect. Respect has to be earned." Martin is very good, and he has a lot of elite cyclists on his client list. He has a long waiting list because he is so in-demand, so you'll need to ask if you can get in on a cancellation.

Ah OK, sweet. Sounds like a plan. I might see my Step mum first, (she's a physio also) as it's free. See if she can see anything first. If she can't, then I'll definately make Martin my next port of call. He sounds like he's the man to see. Cheers Hawk

Junkie, Yeah, I have actually. Although I did get the pain in the previous setup, but this last ride i did on Tuesday. When I got home it was really bad. Fine to walk etc, but the squat and steps were seriously a killer!

I've changed my seatpost and my seat. I had literally a 15 yr old seat that had been through the wars on my bike. It had bent rails and tears all over it. I was starting to get a sore lower back on one side after a ride, and put it down to the seat being on a lean due to the bent rail. So I bought a S/H Thomson Elite post and a WTB Pure V seat. My old seating arrangement was very far back. It was at it's rearmost extreme position. It's where I felt comfortable climbing. However, with the 170mm forks I was constantly lifting the front wheel off the ground. So when I put my new seat on, I moved the seat to about half way through it's adjustment. I run a 40mm stem, which I love but I think for what I mainly use the bike for it's too short shifting alot of my weight rearward.

Cheers

Tark

Pretty much all knee/back/etc problems are position related.
Steve Hogg is the ultimate fit person in Sydney.
There are others, but confirm their credentials, you don't want some kid with the latest computer fit system in a bike shop who doesn't understand physiology.

As someone else said, fix the injury AND the problem.

I also recommend Martin Krause's practice. I have been going there too, but see Sarah Attree, who is also very good.

There are plenty of good books and info on the net about basic bike fit, so you can at least get close to the right position.
W.

I've no medical experience but a couple of things you can check whilst waiting for your appointment with the physios..Did you increase the seat height when you brought it forward? If not I would think your legs won't be straightening out as much as they were before at the bottom of the pedal stroke because when you think about it you've put your seat closer to the bottom bracket. Might be enough to affect your knees? Maybe put the seat up a centimetre (can't imagine it needing much more than that) and see if that makes any difference. Also do you stretch your hammies?

The bad news is that if you increase your seat height your back will get worse! Head for the physio mate..

When I put the new seat on (which is when I changed the position of the seat), I put the new seatpost on as well. So it all got setup again. I set it up, by putting my heels on the pedal and rotating the pedals backwards. I make sure I have a slight bend in my knees (when the pedal is down) and that my hips don't roll from side to side when pedalling backwards. Ands that's where I leave it.

I don't stretch literally before I go for a ride (I know i should... lol) But I do stretch when I finish my ride. I stretch my calves, quads, hammies and I sometimes to a couple of back stretches if it's a bit sore. But mostly, since the new seat, my back is sweet and haven't needed the back stretches. I normally have quite annoying back pain (work hazard) but riding has helped heaps with it.

Cheers

Tark

I was told that moving cleats back takes the load off your calf muscles, and reduces the amount of force your quads supply stabilising the calf. I understand this brings the glutes more into play.

I don't know how that affects your symptoms?

The muscle on the outside of your legs will always be more active and easier stimulated the one on the inside . example squat down like your sitting in mid air and youll notice the inside muscle next to your knee is solid. when you are in a standing, running or cycling position youll notice it is soft. the outside muscle will always be hard which tells you it is always active.
so, this means your outside muscle has too much tension and is literally pulling your knee cap (patella) to the outside and then it pinches the lining underneath(which is very painfull) the lining is called meniscus.
A good physio will stretch the outside of your leg ( Vastus Lateralis and ITB or illiotibial band which sits over the top) and will strengthen the medialus on the inside of your leg and in the process hopefully the imbalance is adjusted and the meniscus doesn't have any tears that need trimming off.
This may not be what is wrong with your knees but it is usually the most common occurrence and the beginning of other problems later on.
I hope you fix them quickly and get back on the bike pain free. Darren.

I'd suggest stretching well especially the hamstrings...when these get overtight...the knee can be painful also in my experience...it may not be the problem but could be a contributing factor... hope that helps.

shane

I had the exact same problem. You need to do some weights with your foot turned out to strengthen the inner thigh muscle. I don't know the technical term for the muscle or the exercise, but the one where you sit in a normal position and raise/lower the bottom half of your leg with a weight on it.

I do this on a machine in the gym (although you could get some hefty ankle weights perhaps?) and raise the weights initially with both legs, then do reps with just the leg I'm working on. I don't take the weight all the way down (ie. I keep the working leg between straight out in front and perhaps 45 degrees) as find this puts less strain on the knee. You'll know if you go too far, the pain will come back.

Remember, do not push weights to the point you're getting this pain behind the knee cap - your body is telling you something for a reason!

Because of the weaker muscle you can sometimes feel and see your knee bending inwards (least that's which way mine goes) when it shouldn't when you ride. I find making a concerted effort to keep it straight kindof trains it to do this. This works best on a wind trainer - it's not very smart looking down at your knees off road

... she found my knee cap is rotating as I flex my quads. My outer muscle is stronger than the inner and it's pulling/rotating my knee cap as it tightens. So I've got a series of strengthening excersizes and a series of stretches I have to do to help it. On top of that, it's shave the Ol' knee and strapping too.

Your knee cap moving under heavy load abrades the tendons below. Abrasion of those tendons wears their protective sheathing down, which causes pain. Lingering pain. Pain which keeps you awake at night. The more you ride the more abrasion you cause, and the more abrasion the more it hurts and the longer it takes to stop hurting. Eventually you will find yourself at a point where you want to go for a ride but your knees haven't stopped hurting from the last ride. You are in serious trouble.

I think you will find Steve Hogg a worthwhile investment.

I also suggest you think about how you pedal. You could probably benefit from riding a gear or two lower and spinning rather than pushing hard - pushing hard uses the leg muscles more and that will move your knee cap (patella) around more, under more load.

If it was high then lowering the saddle height means you are keeping the legs a little more bent and using those unbalanced leg muscles less.

Moving your cleats back reduces the amount of toe effort going into your pedalling, that last little extra toe effort is where your knee cap slides back across so reducing that reduces the abrasion under your patella.

You keep saying "knee" - if one knee hurts more then you are probably pushing unevenly with that leg - practice spinning properly. Use the other leg. Consider some (fore/aft) angle in your saddle that will get the other leg side pushing more.

If it also hurts when you walk after a ride then you have pronation (or whatever they call the opposite) and should look at getting orthotics for your shoes.

I personally found that strapping my knee cap made it hurt a lot more very quickly, so please go carefully

And I still recommend Vitamin I (Ibuprofen).

To get the VMO working (vastus medialis oblique), you need to be applying resistance in the last part of the range of movement of the leg. In other words, if you started off with straight legs then performed a shallow (small leg bend) squat, you place more work on the VMO. As you bend more, the pressue is taken off.

A simple way to get the VMO activated whilst on a bike is find a moderately steep but long hill and try to get up it OUT of the saddle. You should find that you will be going to almost straight at the knee which should be hitting the VMO pretty well. If you feel a muscle pump in that area, you'll know you're getting the right spot.

Of course if you've already got problems, go and see the physio so they can teach you how to squash rolled up towels under the back of your knee!