Sunday, April 25, 2010

How I fixed my knee pain


About 7 years go, in the early days of my first road bike I blasted it and got knee pain. I rested and it went away. Then it came back. For years it was coming and going. Sometimes it moved about to different areas of the knee but usually it was at the front of the knee. I don't ever remember pain at the back. I went to the Doctor. He didn't know but I got referred to a physiotherapist. She said the knee was unbalanced or something and gave me some exercises. That never really did anything. I went to the hospital. He suggested a small op to see what was in there and that there was probably a tear in the cartilage.

Sometime the pain was sharp. It certainly felt like a structural problem. A bit of damage.
Two winters ago I decided on a plan. I had a month or so off the bike and then I started riding again, but very gently and for 30 mins only. Most of the riding was on the turbo as that was easy to manage and it would stop me charging up hill. The cycling was very weak and pathetic but even though I wanted more I would get off. The next day I did it again.
After about a month of this feeble exercise I upped it a bit. I used my heart rate as a guide and did maybe 10% more effort. This lasted a couple of weeks. I then continued to build up the effort slowly over the coming weeks until I was back to a normal level of effort.
It seemed that that was it. Pain was gone.
Well, not quite. I did find that I occasionally got a sharp pain just below the knee cap. I traced this down to the vastus medialis muscle.


I may have this all back to front because I am NOT medical. I discovered this fix by massaging my knee when it hurt. I noticed that when my knee had the sharp pain, the vastus medialis was tender if I poked it. So kneaded it for a while and noticed the sharp knee pain went away. That was really handy.

One other VERY important thing I have done is improve my pedal stroke. On the trainer and the rollers, I concentrate on pushing at the top of the pedal stroke and pulling back (like scraping dog poo of the shoe) at the bottom of the stroke. I do this without thinking about actually pushing down in the stroke. That will come naturally and takes care of itself. Doing this for a couple of weeks pays dividends. And finally, the last bit of the jigsaw is the cadence. It's hard to do when on the road, but when on the turbo trainer I try to increase the cadence. You can pretty much get the same power from high cadence but it means you don't strain the muscle as much.
Lot's of small muscle presses = fewer heavier strains.
This is lighter on the knee. On the road though my cadence drops off as I forget this.  Stopping the mashing (just press, press, press...) is a really good step to better knees.

There are other issues to consider. Getting the cycle fit people to video the pedal stroke and then fitting the wedges under the cleats can only be good too. But, I had this done before the above so in its self it didn't fix my problem.

Note about image: The copyright for this image is not mine. I did not ask permission to use it. With hindsight I should have remembered where I got it and asked permission. Sorry if it's yours. It may have come from http://www.hughston.com/hha/a.extmech.htm

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