TMBRA - Rider Board

[nelkins]

Hey Doc,

I recently tweaked my knee while riding. I feel that I was training a little too much. I had ridden a 70 mile road ride the day before the injury and was riding a rough 20+ mile MTB ride when the knee began to hurt. The pain is occurring on the top inside part of my knee. The pain is most noticeable, and intense, when I rise out of the saddle and am climbing. I am able to sit, spin, ride flat areas, and downhill with little pain but when I stand and try to crank up a hill the pain is intense. I am currently icing, wearing a brace, and taking anti-inflammatory medicine. I have an appointment with my sports doctor next week but any advice would be great.

Thanks in advance,

Nick

[The Bike Doc]

The cranked up miles and intensity likely set the stage for your knee pain. With it being on medial side of the knee points medial ligaments or medial meniscus inflammation. Definete back off on the bike and you may need to lay off of it completely for the next several weeks (6-8 weeks) because you do not want to reinjure it. Ligaments and tendons are much slower to healing than bones. Pushing too soon can set you waaaaaaaaaay back. Do see what your doctor says.

Look at your bike shoe set up as well. Pain along the inside of the knee points to the cleats positioning the toes too far out. The feet could also be too far apart and the cleats need to be shifted to the outer aspect of the sole to move the feet in. Do this little test: get barefoot and wet the bottom of your feet and walk across a concrete floor in your usual gate. Look back at your foot prints. Note if you are a toe out walker or a toe in walker. Most people are toe out walkers, though a few will be toe in or neutral with middle toe line with the heal strike. Also note how far apart the balls of the feet are from each other. Position your cleats so they reproduce natural direction the toes fall relative to the heal strike and the distance the feet tend to stay apart at the balls when walking. With the shoes off your feet, adjust the cleat position 180 degrees out of phase to the direction you want the toes to go because when you are looking at the cleats the shoes are upside down so if you rotate the cleat right the toe will go left when you flip the shoes over and clip them in. Clip the shoes into the pedal (still no feet in the shoes) and note the position that the shoe naturally falls. Fine tune the cleat position until the shoe falls the way your feet naturally fall when you walk. Do make sure that the cleat release point is at the minimal amount of rotation to allow release because rotating the heal much past 5 degrees to activate release can put undue strain on the knees. Some clipless pedals do not allow tension adjustment for the release point. This can be a problem as excess tension required to activate release can also cause knee strain.

Thanks,
_________________
Paul K. Nolan, MD
AKA: The Bike Doc

[nelkins]

Thanks Doc! I rested it over the weekend and it is feeling much more stable but also very tight. The pain is very minimal but the knee is much tighter than a few days ago. I can walk, do a squat, and other things with little to no pain but I can definitely tell that it has tightened up. I'm not sure if that is a good or bad sign.

Thanks again,

Nick