In July & August of 2023 I did a lot of fast group rides and interval running up/down hills. After one particular trial run I started having pain in my knees when walking down stairs. I could ride but running hurt too much. It stayed like this for months. I saw a physical therapist who told me I need to get stronger so I have been doing full body strength workouts during the winter (and XC skiing as I live in Norway). For a while the pain went away but now itās back after being back on the bike for 6 weeks.
Right now itās a bit of a niggle under the knee cap on both sides but itās getting gradually worse. I worry that if I continue it will mess up my season. I havenāt found any cycling specific physical therapists in Oslo, Norway to go to so I figured I would ask here.
Any ideas as to what it might be and what to do? Thanks so much for any feedback!
Edit: Iām 36. 190 cm, 88 kg with 350 w ftp. Been riding for 10 years (never had problems until last year)
I agree with getting stronger but some things are biomechanical too (for me it was one leg is a few mm longer than the other, solved with a shim) and saddle height can help a lot too. If thereās core issues getting stronger may not solve things, mask them at best or perhaps lead to deterioration but certain things getting stronger can solve them completely too and is the best solution A qualified physio should know whatās best for you.
Agree with above. Also suggest you check your cleat position and make sure you arenāt up against the float limit when you pedal. Also check anything else that might have changed last August since you seem to have ridden fine for 10 years beforehand.
Will for sure start foam rolling and stretching. Will also check my cleats to make sure I am not at my float limit (I have always used Shimano blue 2-degree cleats but I did get new shoes last year so worth checking out).
How would you think about continued training? I donāt want to lose my fitness but I also donāt want to get seriously injured
Knee pain is notoriously tricky to diagnose in person without imaging, much less over the internet with (and I mean this kindly) quite a vague description and hx.
That this is bilateral and seems to have had a relatively insidious onset points to overuse rather than acute injury, but thatās based on a lot of assumptions. PFPS would be my guess, but itās just that - a guess.
I would strongly advise seeing a physio with experience in dealing with athletes (they donāt have to be a cycling specialist, just someone used to dealing with highly active individuals) and depending on their findings, potentially proceed with imaging.
FWIW, my chiropractor was the only one who correctly diagnosed my knee pain last year as a bursitis (to his credit, heās a sports-focused chiropractor). I found that kinesio tape helped relieve the pain a lot. I also used a cane for a couple of weeks while walking. Happily, I had very little to no knee pain on the bike but kept it mostly Z2 while recovering.
Between last year and now, I have focused on āgetting strongerā and have a few compression knee sleeves that I use occasionally. Admittedly, using them might be more mental than physical, but whatever.
I received advice from everyone, including some doctors, ranging from IT band issues to āstop runningā to āstop cycling.ā I spent a lot of time with the crew at SoCal Bike PT for specific exercises.
You can continue any activity that doesnāt cause pain while doing it. Clearly, donāt pedal through pain. Foam rolling and stretching is best immediately following your cycling.
Like Dexy23 said, try stem cell therapy. Read here that stem cell therapy is considered a safe treatment option with a favorable safety profile compared to traditional knee replacement surgery.
With the location of the circles, in your pic, I am betting you have āRunnerās kneeā and not an actual structural damage (ie, meniscus) issue. I say this because I have had Runnerās Knee and it bothered me in the exact same location. Also, my knees would bother me walking down stairs. I thought I was strong enough, but a physio tested me and said āare you even trying?ā when he went to push down on my outstretched leg as I was trying to lift the leg up (lying on my side). Come to find out, I had very weak glute medius and minimus muscles. I started doing 25 body weight squats each day, along with glute bridges, and band work (clam shell, sliding or walking sideways with the band wrapped around my ankles). Within two weeks, it was noticeably stronger with a lot less pain.
For the OP: Iād strongly suggest going to an ortho doc and have MRIās taken and see what is going on rather than take and use ideas here. Itās YOUR KNEE, itās a mess of tendons and meniscus. AND it might not be your knee. I was positive, and so was my now retired ortho guy, that my knee was BAD. That I had torn tendons and bad meniscus. Turned out all that pain was from nerve impingement syndrome. And my ex-doc was all ready to scope my knee taking even more meniscus out and potentially doing ātendon repairā that wasnāt needed at all! He swore that Iād need a total knee replacement āin a couple of yearsā of that time. That pain was referred pain from my hip.
My new ortho doc did an MRI of the knee, and hip. Bingoā¦ Saved me needless surgery (on my knee) and found out my hip was garbage. I canāt imagine going through the knee and then a hip replacement. And my knee was fine, plenty of meniscus left.
. For me, it was tight IT band and quads. If I foam roll every night, my issues go away. Took about a week or two to finally see some results.
