Knee pain

[Trevski]

Hi guys,

Wondering if anyone else has a problem with sore knees after a long ride? I've done some searching, and believe my problem is Iliotibial band syndrome - pain on outside of my right knee while riding, more pain when walking down slopes or stairs, and no pain if I walk with a stiff leg. I set my TFT length by using the DF seat height guaging method I've been told - ie leg straight with my heel on the pedal and the pedal at the bottom of it's stroke. What I believe is happening is that as a ride extends into it's second or third hour, my muscles are less able to support the weight of my leg, the angle of my foot to my leg becomes more acute, and so my knee is going beyond the 25 - 30 degree angle usually recomended in the extended position.
I read a web page today (I'll insert the URL here when I find it again) that noted that even some top cyclists (none named though) used a maximum leg extension of 40 degrees, and that this angle prevented the IT band from sliding over the...lumpy knee bit that causes the pain. I'm willing to try anything, because as things stand it's not looking good for my touring ambitions. Accordingly, I've shortened my TFT by 25mm, which has meant a major rethink of how the handle bars and controls are mounted. I've also lowered the seat of my DF mountain bike, which will make getting over the back of the seat to get down steep bits easier as well.
This must be fixed. I rode 60 km of bikepaths Saturday, then 35 km offroad Sunday. If I can't do those distances without crippling myself, how am I supposed to do multi day tours?

Any ideas appreciated.
Thanks,
Trev

 

[OleBent1]

Trev,

There's a bunch of discussion about about knee pain and shorter crank length (<170mm). Not sure what crank length you're using, but if it's more than 165mm, you might get some benefit out of 155mm (or even less), particularly if you've already adjusted your pedals to be closer. This should give you more knee-to-handlebar clearance as well.

I've used the following on-line crank arm length calculation tool, which uses your thigh and lower leg length to compute a "recommended" crank arm length. It suggests that I would benefit from 155mm cranks (using 170mm now), but as I'm really just getting started on my Sofrider, I haven't pulled the trigger on this yet.

http://www.recumbents.com/WISIL/misc/crank_angle.asp

Again, I don't have much experience with this myself yet, but I understand you might also benefit from reducing the pedal force needed by riding to a higher cadence at a "lower' gear. What cadence are you typically at now?

 

[John Tolhurst]

The general rough rule is that pain on the front of the knee is from too much knee bend (so extend the boom) while pain on the back of the knee is from too much extension (so shorten the boom). Pain on the back of the knee can simply mean you are getting old and need to stretch.

 

[Doug Burton]

I'm getting old,

but stretching isn't helping.

I'm still only 5'6".

Maybe I'm stretching the wrong stuff.

:lol:

 

[Trevski]

Thanks for the response guys - maybe I've been doing the wrong sort of stretching too!!

Cranks on my Sofrider 2.2 are 160mm, which felt short with no leverage when I first jumped on, but I spent most of my time just trying to stay vertical while going forward in a straight line so it really didn't matter. I've since learnt to stay 1 gear lower and rev it out instead.

What I've now done is use a formula I've seen repeated many times on different websites to set DF seat height:

X-seam x 0.883 = distance from centre of BB to top of seat, measured up seat tube.

I've set my new mountain bike up to that height, and then adjusted the length of the Sofrider boom to give the same knee bend at full extension. Seems I had it WAY too far out, because the mountain bike has 175mm cranks, but my leg was straighter on the Sofrider. I can't remember if I extended it after my first two 60km pain free rides - but due to age and alcohol, just thinking I may have means I probably did :lol:

Apparently, ITBS is really common in runners and cyclists. I've stayed off the bike this week to give things a chance to settle down. OK, so it's only been four days, but it's felt like a month :evil:
I'm also doing some stretches and something called Walt Reynolds's ITB Special http://www.sportsinjurybulletin.com/archive/0168-knee-injuries.htm which many folks seem to have had success with - 10 reps twice a day at the moment.

I probably also need to remember that when on tour, most folks don't try to sit on 30 kph....and they sometimes stop and smell the roses!!

Cheers,
Trev.

 

[MrSteve]

I agree that adjusting the length of your TFT to suit you is probably the way to address your knee pain.
---
I have my TFT adjusted to suit my short leg: my long leg has become accustomed to
the greater knee angle it must accommodate.
Even so, I was adjusting my TFT quite a bit the first year!

So, be prepared to adjust your TFT a little bit every now and then,
as you become acclimated/used to the MBB you are now peddling.

Finally, check that your TFT has not crept out of adjustment,
before every ride.

-Steve

 

[Trevski]

yakmurph wrote: I have my TFT adjusted to suit my short leg: my long leg has become accustomed to
the greater knee angle it must accommodate.

Thanks Steve, I suppose time will tell. Do you have clearance issues with the longer leg? I'm considering getting a stem with more 'angle' to raise the bars a bit - I'm almost hitting the gear adjusting knobs at the top of my travel, but perhaps I'm also too 'knees out'...

Trev

 

[OleBent1]

Trev,

30 kph? Wow, now my 14 mph (22 kph) pace on my last ride feels so much less aggressive (it didn't at the time). :roll: I clearly need to work on my conditioning.

I adjusted the pedals a little closer to me early on and found myself just occasionally brushing the handlebar with my knees, but that's consistently inboard of my shifters. I have a fairly narrow frame (not the bike frame, my body), so that may account for where my knees are compared to your situation.

Hope you find relief soon!

 

[Dennis Perry]

The current (May 2010) edition of Bicycling, which is virtually all about DF bikes, has a feature "No more back (or knee, or neck) pain (p38). So knee pain affects all cyclists. At least as Cruzbiker's we're minimising / eliminating, back, neck and wrist pain

I went to a Sports Medicine Clinic about knee pain, before I was doing much riding, and the physiotherapist diagnosed Patellofemoral Syndrome, and noted I had a tight ITB on the affected side. From what I can gather, treatment is all about balancing the relative strength of the inner and outer quads, strengthening the glutes, and stretching the glutes and the ITB, so everything tracks smoothly.

Massage, and / or Self-Myofascial Release (SMFR) are also important. I bought Weight Training for Cyclists (Doyle and Schmitz), given cycling is a non-load bearing exercise, see:

http://www.amazon.com/Weight-Training-Cyclists-Program-Endurance/dp/1934030295/ref=sr_1_1?ie=UTF8&s=books&qid=1272594914&sr=1-1

It has a section on SMFR using a foam roller, with the ITB release as described by my physiotherapist (p93). It hurts!

Needless to say, I'm slack about doing any of the exercises, but knowing what's wrong (and that I don't need a knee replacement), means I approach everything differently, i.e. sitting, walking, climbing stairs, cycling and even resting.

When I built my Silvio I went to some lengths to get my cranks shortened (pun?) by Mark Stonich. I have 154 mm cranks. Mark has an FAQ on short cranks, see:

http://bikesmithdesign.com/Short_Cranks/short_cranks_faqs.html

and there is something like a definitive article on crank length, archived from Recumbent Cyclist News at:

http://docs.google.com/View?docid=d5t5hkm_4hqsfbr

Touch wood, my knee pain is going away with longer rides, some desultory specific exercising, and the occasional stretching session. There aren't enough hours in the day to lead a perfect life; work gets in the way, and random stuff is happening all the time.

My one recommendation would be to seek out a Sports Medicine Clinic and get a professional opinion. I'm lucky to have access to the Alphington Sports Medicine Clinic (which is a bit far from Rockingham, I know), see:

http://www.alphingtonsportsmed.com.au/

This practice has doctors, physiotherapists and so on, and they let me in, even though I wasn't particularly sporty at the time. So perhaps look for something similar in WA.

As others have noted, there are volumes written about knee pain. You are not alone, and self-diagnosis may not be helpful.

 

[Trevski]

Thanks, everyone, for all the input.

Mike, 30ish is what I shoot for on the flat. Average....is something else again!! Like on the lower side of mid twenties...

I feel shortening the TFT has been effective, up to a point. No twinges, but I have to keep the gears low and revs up, or it's as John said - discomfort in the front of the knee. Had clearance problems, and since I'm not willing to move the seat and shift my weight further forward, I went to a LBS and purchased a different stem. Now I have plenty of knee clearance...and visual obstruction forward. On the up side, I have a subjective impression of better steering control - I feel more comfortable closer to the curb, feel I can corner more smoothly, and can really pull hard on the bars when sprinting. And after a couple of km, the handlebar closer to the centre of vision seems to be less intrusive. I haven't tried a long ride yet, so that will be the next test.

Cheers,
Trev

 

[OleBent1]

Trevski wrote: ... I went to a LBS and purchased a different stem. Now I have plenty of knee clearance...and visual obstruction forward.

If you get a chance to post a pic or two of your new stem arrangement, I'd be interested to see it.

Mike

 

[Trevski]

Mike, I've posted pics of the new stem under Sofrider and Freerider mods....don't know how to link to it from here though
So far, I've resisted going on any long rides, to let things settle down a bit. The new configuration doesn't seem to have affected my speed, which isn't surprising, as I'm still the bit that sticks up highest!!

Cheers,
Trev.

 

[Trevski]

http://www.cruzbike.com/forums/viewtopic.php?f=8&t=2467

Ha! Knew it couldn't be too hard!!

 

[Trevski]

Well, as of today, I can categorically state that shortening my TFT has not helped alleviate my knee issue. I rode down to a place where I lived as a kid today - about 17km away - because there's an almighty ginormous steep hill on the way in, and I wanted to test myself on the Sofrider going up it before I head for the Darling Scarp to tackle some real hills. I don't know if it was because of the hill, but it was not easy to complete the 40km trip - intense pain on the outside of my right knee from about 25km. I'm going to have to follow Dennis' advice and see the quack. We have one here who's supposed to be pretty good with sporting issues, so I'll give him a go.
And how did the Sofrider go climbing the hill? Well, we managed to reach the top, but if it had been 50 metres longer, it would have been 'The Walk of Shame' for both of us. There's a trail of concrete splats on the asphalt where a cement agitator truck has spilled on the way up, and every time the front wheel hit one it would skip and spin a quarter turn or so before regaining traction. I avoided them when I could, but sometimes traffic meant hugging the curb and taking the bumpy route....I read in one of Doug's posts that he had used a triplizer to add a granny gear - does anyone know who sells them these days? I can't find one for the 110mm PCD on my bike. I notice that there are some tabs on the crank spider that I could drill and tap for a 74mm PCD gear...Hmmmmm........

 

[John Tolhurst]

Trevor, are you stretching your hamstrings after the first five ks? If not, get off and touch your toes for a bit. Probably will help.

 

[Trevski]

Thanks John,

No, the only stretching I do is when I wake up in the morning!! I'll give that a go.
Yesterday I went on an extremely leisurely ride - a figure 8 from the Narrows Bridge, up past the Belltower, across the Causeway, up to the Graham Farmer Freeway Bridge and across, then down the East Perth side and back across the Causeway, around the South Perth foreshore, across the Narrows and back to the car. Because Tiny Trev was along, and he's 6 and learnt to ride his 12" bike at the same time I learnt to ride the Sofrider, we averaged 8kmh, and the trip took over 3 hours with all the playground and icecream stops.
Interesting thing is, the pain started, even at that pace, after about 30 minutes. Even more interesting, it would come and go as I got on and off the bike - eg experience pain - get off, get back on and have no pain. Get off, get back on - pain. Slow down and twist in the seat to look at something - no pain. Sometimes just sitting forward in the seat was enough to flick the switch. I've had lower back problems for a while, part of the reason I went recumbent. In the past it's sometimes manifested as a pain in my right calf. I'm supposed to do exercises and stretches to build body core strength, but only remember at times like this. I shan't be surprised if the doctor shoves this in the same basket.

Cheers,
Trev

 

[Trevski]

Hi Folks,
I thought I'd

Hi Folks,

I thought I'd better give an update on this. It looks like my last post has fallen off the wagon, though, because I mentioned how I'd done two off road metric centuries, on consecutive days, on a diamond frame mountain bike, without the knee issue cropping up (but everything else hurt like hell!). This seemed to support my hypothesis that the problem is related to issues with my back, that show up when I spend several hours riding with my weight supported on my butt above the sit bones. First I get a cramp in the upper squishy bit on the right hand side, and within 15 minutes the right hand knee is in full song. Not good.
My solution was to make up a wedge of closed cell foam, which raises the front of the seat pad around 60mm. With the wedge in place, all my weight is back on my sit bones. So far, so good, time for a ride. I did another metric century today. The butt pain is banished - with my weight back on my sit bones, and all the extra padding, it's like riding around on a well stuffed couch. Brilliant!
It's only a partial success with the knee issue though. I started to feel some discomfort around the 66km mark, and by the 70km mark I was ready to bail out and head for home. I decided to persevere, because even if I'd gone straight home it would have been around 90km for the day. I backed off the pace, and concentrated on keeping the gear low and cadence high - in the 90 to 100 range - in the meantime coasting often so I could massage the knee, and with the occasional dismount and walk around to completely change the action. I was very slow going up the hills in Kwinana and Baldivis, with the aim being to keep as little pressure on the joint as possible. Pulling on the pedals rather than pushing seemed to help as well. The end result was 103km for the day, with no butt pain, and the knee pain able to be managed to keep it from being a show stopper. I'll have to go for another ride tomorrow, to see how far below the surface the knee pain is hiding.

Update: 'Tomorrow' has been raining all day, so instead of riding I've spent the day in the shed cleaning up an old circa 2001 Giant Cypress that had been put out as kerbside waste. A pretty good bike for the missus, who refuses to let me spend $400ish on a bike for her, when she could have a perfectly good Huffy for half that price...... I could still feel in my right knee that I'd had an issue yesterday. Left leg good as new, right leg tender. Obviously, more thought required.

Cheers,
Trev

 

[leakyduck]

I started riding bents about 6 years ago. I had a delta trike with sugino cranks. Life was good but my knees hurt. I had been reading about short cranks and decided that maybe that was what I needed. Found a machine shop that would cut and re-tap my cranks. He told me mark where you want them tapped and I'll do them. While I'm marking them I thought about the fact that my left leg is 1/4" shorter than my right, so I made the left cranks 1/4" shorter. By the time I got home my left leg was hurting. At first I thought I had ruined a good set of cranks, then I realized I was using muscles I hadn't used in years and kept riding them. to make a long story short, within 6 months I no longer needed to wear the brace and my knees didn't hurt

 

[Tarmac Terrorist]

I have problems with knee pain and cadence was the only issue. If I keep it above 60 I am fine, anything below that and I can't walk up the stairs after a 10k ride.

 

[Robert Biegler]

I read that the people making the Greenspeed trike had tested cranks as short as 100 mm, because they wanted to fit a better fairing for racing. They found no difference in power output over the whole range. Combined with claims that shorter cranks are better for the knees, that persuaded me to swap the standard 170 mm cranks I had on my bike for the shortest I could find: 140 mm. Those felt a bit odd for the first two minutes, but now I love them.

I see that my new Quest comes with 155 mm cranks, already shorter than the standard. I'll try those, but may well go shorter still. I have a second 140 mm set.

Regards

Robert Biegler