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Re: knee pain  Charles Dorman
 Nov 06, 2006 21:15 PST 


Paul,

You asked for the first thing to try, but if Tom's suggestion for
saddle height doesn't help (and here's a diagram showing good saddle
height: http://www.bikefitting.com/English/Theory/
SaddleHeight.aspx ), then here's a list of other things (not
necessarily adjustments) that could help. "Lower front" sounds like
the patella, a tendon commonly injured in cycling and running. You
can Google on "runner's knee" to see if the symptoms describe yours.   
If that's what it is, then in order of what to try next:

1. Stretch hamstrings and calves more: despite being on the back of
the leg, hamstrings can cause more mistracking of the kneecap than a
tight quad; additionally helpful is stretching them each morning
before walking a single block or going down any stairs (if done
carefully, since the muscles/tendons aren't warmed up yet) to keep
the eccentric contractions of early-morning walking when the leg
muscles are stiffest from renewing the patellar damage faster than
it's healed
2. Strengthening the vastus medialis by doing slow leg extensions in
the gym, but 20 degrees short of full extension, since a weak v.
medialis doesn't track the kneecap well at full extension; patellar
trouble tends to come from the vastus medialis not pulling the
kneecap hard enough inward and/or the vastus lateralis pulling the
kneecap too far outward; unfortunately the vastus medialis atrophies
quickly
3. Orthotics that correct for a tilt from level of the ball of the
foot (forefoot varus): orthotics are a solution for walking/running
and cycling simultaneously; a cheaper route is to be fit for
LeWedges; these are very effective, and avoid the crowding inside the
shoe of an orthotic support under the ball of the foot; the LeWedge
site has a diagram showing how forefoot varus causes knee problems
4. Floating pedals, like Speedplay Zeros: for patellar tendonitis,
the float is a far greater advantage than the small platform is a
disadvantage; this also removes the cleat turned in/turned out guesswork
5. Orthotics that provide support under the arch (rolling of a foot
with a weak arch twists the lower leg bones and causes the patella to
mistrack and rub against bone the wrong way); there's a diagram here
showing how something as far away from the knee as flat feet could be
the problem:
http://www.merck.com/mmhe/sec05/ch075/ch075f.html
6. Cover the knees when it's below 70 degrees (
http://www.bikesportmichigan.com/bikes/earlyseasonerrors.shtml );
there's not much blood flow around the kneecap/patella, it gets cold,
and that makes it easier to damage the tendon; this is also why
warming up slower and longer helps too
7. Stretch the vastus lateralis more, so the kneecap is pulled out
less and the vastus medialis can pull it in more; the kneecap moves
in, then back out, in a single contraction -- i.e. the tracking is
arc-shaped, not linear; this back-and-forth motion therefore takes
some coordination between the v. medialis and the v. lateralis; if
the former is weak and the latter tight, the kneecap doesn't arc
through its groove right.

Good luck and I hope you won't need any of this list.

Charles Dorman



On Nov 6, 2006, at 1:39 PM, Tom Rosenbauer wrote:

Paul,

In general, a pain in the front of the knee might indicate that your
seat is
too low.

I recommend Andy Pruitt's Medical Guide for Cyclists available at:
http://www.roadbikerider.com/
bookstore.htm#Andy_Pruitts_Medical_Guide_for_Cyclists_0
... to diagnose this further and help you with any bike fit issues.

Good luck and BTW, I've been there also with knee pain.

Regads,

-Tom Rosenbauer
Eastern PA RBA

----- Original Message -----
From: "paul kramer" <pskr-@yahoo.com>
To: <njrando-@topica.com>; <ran-@topica.com>;
<gara-@yahoogroups.com>; <orra-@tire.patch.com>
Sent: Monday, November 06, 2006 1:14 PM
Subject: knee pain


 Has anyone else ever experienced dull pain on the lower front of the
knee when pushing down on the pedal? Any idea as to which of the many
adjustments (cleat forward/backward/turned in/turned out, seat
forward/back, saddle up/down, etc.) I should try first? Thanks!

Paul Kramer




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