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About four or so years ago, I hurt my knee on a fairly long ride (~150km or so). It was really my own fault, as I hadn't been training regularly, and I pushed myself a bit too hard. By the time I arrived home, my left knee had swollen up and was in quite a bit of pain. I stopped riding for about a half year, and when I started up again I took things lightly and tried to train more regularly.

Fast-forward to today. I am riding 20km per day, and am spinning at high cadence when I ride. I try to stretch both my knees before/after riding, but I still feel some soreness or pain when I ride. Although I haven't yet experienced anything as bad as the original injury, I'm worried that if I will get injured on the next long-distance ride that I take.

What are some good exercises that I can do to prevent re-injuring my knees during future rides? Are there any particular stretches which are helpful in loosening up the knee before riding?

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You haven't mentioned this, but if you haven't had a proper bike fitting done, I highly recommend it. Sounds like you have the cadence down, but position is also pretty important. –  bikesandcode Aug 26 '10 at 17:56
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6 Answers

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The problem with diagnosing knee pain is there are multiple possible causes. The original cause may not even be in the knee itself! I have a cyclist friend whose knee seized up. He went to a physiotherapist, who explained that the real problem was an extremely tight lower back. The tightening back was tugging at his gluteal muscle (buttock), which in turn was tightening his hamstring - which was pulling his knee out of alignment! His body was actually acting against itself, as each muscle struggled to retain its preferred position. The physio pummelled out his back and glutes, he did back stretches for a few weeks, and everything relaxed.

I've had ITBS for almost a year, caused by a combination of incorrect seat height and an over-aggressive cycling schedule. The iliotibial band is a tendon-like bit of muscle which runs down the outside of the thigh and connects the hip and knee. When it tightens, it pulls at your knee-joint and rubs painfully against the bone, becoming inflamed.

For this problem, stretching has been surprisingly effective. I stretch the IT band itself, my hamstrings, and my lower back and glutes. The stretches I do are:

IT band - Standing stretch. Stand upright and cross one foot behind the other. Then lean towards the foot that is behind the other. Hold this stretch for about 15 to 20 seconds, and then repeat it 3 to 4 times on each leg.

Hamstring - Standing stretch. Basically, try and touch your toes, although I do this with legs crossed one behind the other. With this one, if you let your upper body just hang loose, you will feel the stretch increase naturally after a few seconds.

Glutes/lower back - Seated twist. This is an effective stretch for the big muscles in your buttocks.

Glutes/lower back - Supine spinal twist. Great for the lower back, and your hips.

Obviously, these exercises may or may not be helpful for you, depending on the exact cause of your problem. Only a doctor will be able to correctly diagnose your issue. But they're easy to do, safe, free, and may be helpful.

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What do they mean by Maintain zip and hollow and breathe in? –  intuited Aug 9 '11 at 1:44
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I did something similar a few years back...I hyper-extended my knee and it was swollen and sore for a few months. Never saw a doctor and continued riding once the pain went away. A few months later I put a foot down and my knee popped. Went to see a doctor this time and my ACL was shredded. After surgery, doc said it looked like a frayed rope and had probably been torn for years.

Morale of the story, your knee pain could very well be something more serious. The most important thing is to get the cause of the pain diagnosed so you can treat it properly. To me, it sounds like mild cartilage damage. After a lot of friction on the joint it starts to flare up in an attempt to protect itself.

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I don't think that stretching is the most important thing for preventing this injury from reoccurring in this case. Stretching after the exercise is certainly a good habit to keep. But, as you pointed out, what caused the original injury in the first place was the 150km ride with no proper training.

What you have to do now is to build up the distance more slowly. Maybe 20 km is still too much for now. If you cycle 5 days a week, that's already 100 km a week, which is a significant training volume for beginners. For now, reduce the distance to a point that you're comfortable with, i.e. no pain. Then you can increase the distance every week, but no more than 10% per week.

If that doesn't help, go and see a doctor or physiotherapist.

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Thanks for the advice. Although 100km may sound like a lot, I've been riding that amount for 6 months or so. Most of the time, my knees feel fine, but sometimes they flare up. You are probably correct in that the distance should be slowly increased... although I'm commuting to work, so in my case, the distance is constant. ;) –  Nik Reiman Aug 26 '10 at 11:54
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Like ire_and_curses mentions above there are multiple causes of knee pain. Solving a knee pain problem is entirely dependent on the cause. Stretching, strengthening, physical therapy and surgery are all possible solutions. If the cause is tightness, then stretching can help; if weakness is the cause, then strengthening the relevant muscles can help; or if torn/damaged tissues, then perhaps surgery.

I think you have gotten some good answers, but personally I would not seek a prescription on a web forum. I would strongly suggest that you see a physician and get the injury diagnosed properly. The knee is a complicated joint and the wrong solution can easily make it worse.

In my own case through physical therapy, I was prescribed hip strengthening and targeted stretches. When I started experiencing knee pain several years ago, I decided to do knee strengthening exercises + some stretching. Wrong. It didn't get better, so I went to the doc who referred me to a physical therapist. The therapist put me on a hip strengthening routine coupled with specific stretches and targeted use of a foam roller. Much better now! (According to my therapist, hip issues can often be a cause of knee pain, and in my case that's what it turned out to be.)

Anyway, bottom line. Get it checked out.

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I have also done some damage to my knees. I have found that using a knee brace greatly helps to keep my knees working well. I find that even the extra heat from the knee brace dramatically helps to keep them running smoothly. I bought mine for $20 at the drug store. Best bike investment per dollar that I have ever made.

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Personally, I find that the best warmup for my knees is actually just riding. Spinning very easily for 10-15 minutes, putting very little pressure on the pedals works far better than any stretching or exercise I've done before getting on the bike.

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