The story of my knee pain

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I’ve been dealing with knee pain on the bike for pretty much all of the last year. After multiple rounds of taking time off the bike, 3 different MRIs, Physical Therapy, massage, cross training, and Voodoo, I think I finally have it kicked this time around. This is a writeup of what I went through, and I feel that over the last year I’ve sort of become a mini-expert on biking and knee pain, so if anyone has questions about theirs, feel free to ask.

(This came out a little long, so if you are just interested in what worked for me, skip down to the last couple of paragraphs)

When I first got into biking a couple of years ago, I came off the couch and was super out of shape. I had no muscles in either the upper or lower body and just started riding. I didn’t do too much riding as I was tiring fast, and I ramped into it pretty well and somehow managed not to hurt anything. Being an analytical guy, I got a professional bike fit from 55Nine Performance (Wobble Naught fit methodology) and figured I was fine. At the end of 2011 I ramped up my hours greatly and did a 50 mile endurance race and 6 hour race over a 2 week span to end the season. After those last two weeks, the pain came fast and totally took me off the bike. I couldn’t even turn the pedals over without intense pain in my knee cap. I took some time off the bike and and got my fit rechecked (patella pain is usually a seat that is too low). Surprisingly, everything was fine with the fit and I couldn’t figure out what it was. I had some MRIs done, went to a orthopedic doctor and they said everything was “fine with my knees”. They couldn’t explain the pain.

I took 6 weeks off the bike, and got back into it. I could bike for 2 hours on the local trails without pain but as soon as I went to climb some mountains, the pain came back with a vengeance. I got more MRIs with the same results, so I decided to take more time off the bike. I even got another bike fit from a different brand (Retul this time) which ended up putting me in the same 100% exact position as Eddie’s original fit. The bike fit was not my problem for sure. I ramped up my training after this next session of time off and long story short everything was fine until I did a longer race towards the middle of the year. Terrible knee pain again.

This time, knowing the MRIs weren’t the way to go, I decided to see a number of Physical Therapists and finally found a knee specialist that started looking PAST my knees to find where the actual problem was. Within 15 minutes, he had me diagnosed. I had a muscle imbalance in my quads. Since I never had leg muscles before biking, with how I’m built, I naturally developed my outer quad which led to that muscle being actually too strong, and over a longer ride/harder effort pulling my knee cap sideways, resulting in my pain. No matter how much time I took off, as soon as I got back into it, I re-hurt my knee.

This time, I took a few weeks off the bike to get everything calmed down and started doing Physical Therapy exercises specifically targeted at the VMO (Inner Quad muscle) as well as CrossFit. The below wall ball exercise has been key in getting VMO strengthened and along with full squats (Don’t stop at 90 degrees, cover the calf with the hamstring when doing squats as seen in the video below) I’ve completely rebuilt the muscles in my leg.

I’m happy to report that I’m now 6 months into no knee pain and have done a number of long mountain rides and hard efforts. My legs also look balanced where before my outer quad completely dominated. I’m hoping that continuing to build CrossFit and VMO targeted exercises into my training throughout 2013 will keep me 100% knee pain free.