Member Case Study: Knee Pain?

author : AMSSM

comments : 0

What can I do to solve this problem. I took a month off cycling to let it get back to normal, but as soon as I got back on the bike in the aero position, felt it.

Question from lifeisgood:

Some History: About 2 months ago I got a new bike. I was riding a road bike with no aero bars for a while and this new one is a tri-specific bike with aero bars. It was time to take the plunge. I got fitted at the bike shop and from what I had read, the guy seemed to take his time and measured all the right things and explained everything to me. I felt confident that it was a good fitting. I started some short rides and then some long rides shortly after (3 hours). The bike felt good, my body felt good, but towards the end of a 3 hour ride, I started feeling a pain in the outside part of my left knee.

Two weeks later, I raced my first Half IM and it was great. Knee was a touch tender, but not really bothersome at all (could just be the adrenaline). In fact I didn't feel it at all on the run. I then took 3 weeks off hoping to let everything get back to normal (plus I was traveling a lot). Next, I went for my first ride (1 hour) in 3 weeks, and 30 minutes into the ride the same knee (left) started bothering me.

The pain is not sharp, but kind of dull. I have had ITBS before from running, and it is definitely not the same pain, but it is in a similar location. From what I know about anatomy, it seems to be my biceps femoris tendon rubbing against the head of my fibula. There is an actual 'clicking' sensation (visible as well) when I do a deep knee bend while standing. It is only in my left knee. I have tried a lot of things on the bike and concluded that the pain was much worse when I was in aero position. I fiddled with seat height and didn't feel any difference, but when I got out of the aero position I felt a relief. Maybe my aero is too aggressive?

My question is, what can I do to solve this problem. I took a month off cycling to let it get back to normal, but as soon as I got back on the bike in the aero position, felt it. Not painful just yet, but I know I am heading in that direction again. Thanks!

Answer:

Knee pain is a common complaint in avid cyclists. Many anatomic and mechanical forces contribute to recurrent pain, and a sports medicine physician should evaluate these. This could be the IT band syndrome you’ve previously experienced, but tendon and bursa irritation in that area are common as well. Rest will calm your symptoms, but irritation will return if the causative positional and mechanical factors continue.

The height, forward positioning and incline of your seat often cause the lateral knee pain you describe. Other possible contributing factors include your foot and aero bar positions. Since you’ve tried to some adjustments without complete success, you need to be assessed and adjusted by your sports physician or bike shop staff. Until you’ve been accurately evaluated, rest from cycling and keep up your fitness level by doing other aerobic exercise. Ice massage to the affected area is a good anti-inflammatory, and pain reliever and will help stimulate healing.

Ken Bielak, MD
Knoxville, TN
Member AMSSM
 
Dawn Mathern, MD
Trinity Sports Medicine: Minot, ND
Member AMSSM

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date: January 1, 2006