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Author Topic: Knee pain *only* when biking  (Read 2133 times)

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Offline bjaspan

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Knee pain *only* when biking
« on: September 09, 2010, 08:35:50 PM »
I've had what seems like an unusual knee problem for the past 15 years. I ski, rock climb, kayak, hike, jump up and down, etc. all with no problem at all. However, if I pedal a bicycle as little as a few hundred yards, my right knee starts to hurt. It is very slight after such a short distance but from experience I know if I kept going it would become severe and hurt for several days at least.

15 years ago and again 3 years I saw an orthopedic surgeon. He took MRIs and declared that I have some cartilage damage in the patello-femoral joint. That makes sense: When biking my knee flexes extensively and frequently, so any damage is going to cause irritation and doing is 90 times per minute the irritation will build up quickly. I've lived with this theory for 15 years. Given everything else I able to do pain-free, surgery has not seemed like a reasonable risk.

Last weekend I went on the biggest hike I've done in years. On Sunday, 2100 ft elevation gain; on Monday, 3500 ft elevation gain. These were difficult hikes with lots of scrambling on rocks, high steps, steep climbs and descents, etc. I was bending and working my knees A LOT. My legs got very tired, but my knee joints never hurt at all.

This left me wondering. How can pedaling a bike only a few hundred yards, during which I can't make more than a few hundred strokes at most (and probably fewer) trigger the beginnings of knee pain, but hard hiking with many full knee flexions and extensions over the course of many hours not trigger anything?

Here then is my real question: Who is the best person, or where is the best facility, to have my actual knee problem diagnosed for real? I've had it with local surgeons, PTs, etc. who do not seem to know what they are talking about. I'm willing to fly anywhere. Where should I go?

Thanks,

Barry

Offline TwoBadKneesUSA

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Re: Knee pain *only* when biking
« Reply #1 on: September 09, 2010, 09:24:45 PM »
This may sound silly but have you been to a bike shop?  Have them check your seat height etc.  It could be as simple as that.  If my seat is too low I get terrible pain.  Worth a check?
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Offline bjaspan

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Re: Knee pain *only* when biking
« Reply #2 on: September 10, 2010, 03:43:06 AM »
Thanks for your reply!

Yes, I saw a highly respected professional bike fit specialist in Boston. He made some minor tweaks but I had already read about proper bike fit and adjusted my bike appropriately.

He worked with me a little bit on exploring clipless pedal fitting. I used some test pedals with unlimited "float" (allowing foot rotation parallel to the floor) and when we put back on the normal pedals afterward I could absolutely feel additional torque into my knee on every stroke without the float. This was several years ago and I no longer remember the full details but I did not come out of that session thinking, "Great! If I come back for a full clipless pedal fitting it will solve my problem." So I certainly could try that but I do not think it is a 100% solution.

Anyway, that isn't what I'm currently searching for. I want to find "the best sports knee specialist out there" who will figure out what the real problem is. I'm hoping someone here will have a recommendation for that person/doctor/specialist.

Offline arthriticknee

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Re: Knee pain *only* when biking
« Reply #3 on: September 10, 2010, 09:20:50 AM »
I too would look immediately at seat height.
Rather than get a bike shop to fit your bike to the ideal cycling position I would raise the seat as high as you can while still being able to peddle normally.
See if this makes a difference as it will decrease your peak flexion angle.
If it helps a little or allows you to go for longer without pain it is likely that high flexion angles are the cause.
If not then ?????
Remember that any advice on an online forum is of a general nature.
You are always advised to be assessed by a medical professional so your individual situation is addressed.

Offline LenaKnee

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Re: Knee pain *only* when biking
« Reply #4 on: September 12, 2010, 03:24:33 AM »
Stanford Dr Jason Dragoo. Avoid UCSF I heard many negative stories about their chief. There is also an MD who posts on this board he seemed to have helped so many people here.

Offline eaglemom

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Re: Knee pain *only* when biking
« Reply #5 on: September 12, 2010, 04:24:53 AM »
I don't want to sound negative but most all of us on this board "want the best........." to be working on us.  That is a very personal decision.  I'd just start going to ortho's and asking questions - you will be very frustrated doing this but that way you've made the decision which ortho you are seeing.  Make sense?  I had 1 ortho do my right knee - but he had the personality of a dishrag so didn't use him on my left. Instead I went to 2 more othro's and choose "the best knee guy around" for my right knee.  That surgery was ok - but I was simply a number in his office.  When I started questioning pain, etc he said "go elsewhere because I did my job." Guess what, I went elsewhere.  My new knee guy is big city practice, etc and took quite awhile to get in but he does listen, sometimes! I'm recovering from surgery now - its a slow process.  My point is the right guy for my might not be the right guy for you.  Having said that exactly where are you located.  At least that way maybe someone can tell you whom not to see.  I wish I could help you out more. eagle

Offline bjaspan

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Re: Knee pain *only* when biking
« Reply #6 on: September 12, 2010, 01:36:38 PM »
Thanks for the replies, everyone!

I'm in Boston.

When this problem first started 15 years ago, I saw MANY orthos, PTs, OTs, podiatrists, sports specialists, etc. all over the Boston area, at least several in every category, and generally I saw the practitioners that everyone told me were "the best around". In hindsight I got nothing but useless advice because, really, none of them truly understood the actual cause of the problem (neither did I, of course). The most encouraging ortho I saw told me he could do surgery and with 98% probability I'd be as good as new... but he could not really explain why biking is a problem but all the other knee-flexing activities I do are not. I still actively consider whether to just go back to him and have the surgery, I haven't ruled it out, but I'd like more information.

I realize I'm in a pretty decent situation, much better off than many people---I'm 100% whole and capable except for biking. So I'm not complaining. But if there is some true guru our there with the most advanced imaging technology, an instrumented bike for measuring exactly what causes the problem, or whatever, I'd like to go see him or her.

I did a little research online last night and several sources pointed to http://www.heidenortho.com/ in Utah. Apparently former Olympian Eric Heiden became an orthopedic surgeon. I have no reason to think a former Olympian would make a better surgeon, but either he or his partner Dr. Max Testa seems to be the team physician for USA Cycling, which at least is a promising reference. Anyone have comments on these guys?

Thanks again!

Barry

Offline LenaKnee

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Re: Knee pain *only* when biking
« Reply #7 on: September 12, 2010, 06:07:32 PM »
Hi - I don't know anything on the MD in Utah. If I were you I would never get surgery for this problem. The recovery is long and horrible, and you risk ending up with more problems than before the surgery. However it is a good idea to seek out the opinion of a few knee specialists who are the best in their field so they can identify what is going on. Good luck