The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: CARLB3 on August 01, 2011, 09:09:42 PM

Title: Medial knee pain
Post by: CARLB3 on August 01, 2011, 09:09:42 PM
Had this inner knee pain for 18mths. 2 MRI scans show nothing wrong. Never goes away totally but cycling same bike/setup I have used for 5 years brings unbearable pain sometimes 2 days later then takes at least 2 weeks to subside to a dullache and stab. Running out of question, pain straight away. Tried VMO strenghening, hip flexor, quad, hammy stretches, ITB rolling, glutes you name it to no avail. Had bike fit and fitter placed otho in front of shoe to stop flat foot pronating. Now the pain has started in right knee medially too. Am i missing something obvious here? also had test for rheumatoid arthritis...negative. Booked in to see surgeon end of Aug, 11th hour suggestions welcome before I push for scope. I asked for plica to be looked for on last MRI, negative. If it is misalignment due to flat feet, would a CT scan show it, what else should I push for? Surgeon I am seeing is Ravi Goyal, Lancashire NHS any success stories? Sorry for braindump format. Carl
Title: Re: Medial knee pain
Post by: Clarkey on August 02, 2011, 10:42:18 AM
Hi Carl,

You cannot rely on a MRI scan always to show up a knee problem and sometimes miss out a potential problem inside the knee. I also had 2 MRI scans on my right knee and both showed up no problems but was still feeling pain and catching on the lateral side of my knee. I tried physio and had 2 cortisone injections before they decided to scope my right knee to see if there are any problems. It was all on the NHS and was well over a year of going to the Hospital before my OS decided he will scope my knee. I then had to wait 18 week for the actual surgery.

I had my medial plica removed and fat pad trimmed which got rid of the catching. Could be a number of problems causing the pain in both knees and your OS should be able to figure out what knee problem you could be having. It could well be maltacking problems  if you get pain in both knees and think a CT scan can pick up maltracking problems but not certain if I am right or not. Flat feet will cause some tracking problems and can see a Podiatrist for custome made insoles, also seeing a physio can be helpful if you have matracking in both knees.

I would only have surgery as a last resort if all conservative methods have failed as it is a big trauma for the knee and takes a while to recover fully and your knee is never quite the same again.

Nick :) {2011} :)
Title: Re: Medial knee pain
Post by: Fathead D on August 02, 2011, 11:56:31 AM
Your knee issues sound very similar to mine.  I am an avid cyclist when my knees aren't killing me.  I have gone through 2 scopes (one on each knee) and my pain is now worse.  I finally found a surgeon who thinks he has it narrowed down.  He thinks it is either a rotational issue or my IT Band is excessively tight.

I would make sure you find an OS that knows what they are doing.  If they don't do a CT scan to check for rotational issues be wary.  Make sure the OS checks out your IT Band for tightness.  Don't be too quick to jump into a scope.  It may make things worse.
Title: Re: Medial knee pain
Post by: CARLB3 on August 02, 2011, 04:42:27 PM
Thanks for advice, maybe i havent done the physio as thoroughly as I should. I will see what surgeon suggests and give strengthening/stretches another go. Just don't understand how something has gone weak/tight after 30 years of cycling without problems or injury.
Title: Re: Medial knee pain
Post by: Clarkey on August 02, 2011, 05:26:23 PM
Hi Carl,

I think it was 18 months of seeing my OS before a scope was decided and went to the gym 3 times a week to work on my leg muscles that really helped after my scope as you will recover a lot more quicker. You would think you should have strong leg muscles after 30 years of cycling which does not put too much strain on the knees. Jogging on a hard surface is far worse for the knee then cycling.

My Physio always told me to go swimming which is an excellent way to build up the quads and puts no strain on the knees. An OS will not do a routine scope until all other options have failed if he/she cannot spot the problem straight away.

Nick :) {2011} :)
Title: Re: Medial knee pain
Post by: Lottiefox on August 02, 2011, 07:17:06 PM
I'm sure I read somewhere that cycling can tighten and strengthen the outer quads and neglect the inners - so knee pain could be triggered even after a long time. Have you had the bike set up checked? I know when I do spinning if I do it on a different bike and don't get the set up right I get terrible knee pain. Get the right bike where I know the set up and I can spin hills, sprints etc and its all fine. (And I have worn out kneecaps). I know you've had the set up for 5 years, we do change as get older - my friend gets his set up checked every year and he cycles about 200 miles a week. He has busted his hip in the past and elbow and both times his set up has changed slightly.

Be careful pushing for a scope if nothing is showing up. Yes, MRIs can miss things but a scope done just for exploratory purposes also might not help. Remember that any surgery is a trauma and that the knee will take a time to settle down. Some people find things are worse. I'm a tad surgery-phobic after getting RSD in my foot after a fusion. (Slowly improving...) Thats v v rare but there are risks to anyone shoving probes in your knee joint. You can also get scalpel happy doctors who decide to do wonderful things like a lateral release for no apparent reason...,....

I did PT for many months before things improved, and I had to see two PTs to get one who understood what was going on. Be diligent in the exercises, stretch LOTs, use a gel such as Voltarol on the sore bits (not alongside any other NSAIDs taken orally),

A CT scan will show a tracking issue with the kneecap if done correctly, but rotational issues need to be checked with X-rays.

Good luck

Title: Re: Medial knee pain
Post by: CARLB3 on August 02, 2011, 07:49:51 PM
Thanks again, yes had bike set up done by sports physio/bike set up specialist. Only thing he noticed was VMO slight wastage and tight hip flexors. He altered cleat psition and added wedge to forefoot and suggested trying to build VMO by cycling out of saddle........I am sat here in third week of pain from inflamming whatever it is by trying this. Back to ice then stretches when things settle. Notice the pain starts knee fully flexed pushing peddle down or even pushing clutch on car.
Title: Re: Medial knee pain
Post by: Fathead D on August 02, 2011, 08:46:32 PM
You may want to also look at your form when peddling.  Are your knees out?  That may also be contributing to the VMO wasting.  I notice a good burn in the VMO when I focus on keeping my knees in tight.
Title: Re: Medial knee pain
Post by: CARLB3 on August 02, 2011, 09:54:28 PM
Good point Fathead D, I did ride a bit knees out for balance off rd, but after a 12mth layoff with pro bikefit/stretches/strength work expected to be able to ride 5miles without pain. Was previously in 2009, riding 3000miles per year on mtb and running a 3hr marathon time. Down to 0 running/0 miles.....depressed. Would not be so bad if I knew cause but MRI show nothing, NHS physio/podiatrist says, pronating foot leg length difference, maltracking due to VMO weakness. Chiropractor contradicts says legs same length, pelvic tilt is problem as did bike fit chap. Other physio says yes you may have these issues but they may/not cause pain as I probably had since birth and rode 30yrs OK. Would like some concrete evidence so I could pinpoint the remedial action........seems some of the "professionals" I have seen give generic WAG advice wild a..sed guess then take your money.
Title: Re: Medial knee pain
Post by: Vickster on August 02, 2011, 10:06:12 PM
Might it be worth trying to see a sports physician (or a sports physio) rather than a surgeon - perhaps ask the OS his advice - sooner or later surgeons like to chop as that is what they do - which as Lottie says may or may not be the right thing, probably not if it's a muscle or gait issue

I have had issues with my knee for about 2 years, two surgeries, but more importantly lots of cycling and hence more strength and flex my knee is feeling as good as it has done since the initial trauma.  I saw a new physio 6 weeks ago who is very sports focused and he checked gait, flex etc and recommended orthotics and daily stretching - saw him again in the week and he can see a noticeable improvement in flex and strength, I am also more painfree and less stiff/achy. 

Check your cleat position, and set up (saddle height, reach etc) as others have said. I have just gone clipless having got a new road bike and am feeling the difference in my legs but any soreness is muscular and not bony, so I think it is a set up thing, need the cleats and bike fit looking at.  I am valgus aligned but can partly correct this with the right set up.

Have you had x-rays to check joint space ir just the MRI (which is much better for soft tissue issues than bony stuff - my MRIs don't show the obvious softening to my lateral cartilage)?

Good luck  :)