Knee Pain - Injury or Out of Shape?

Question

I have been mostly lethargic for the past decade, sitting at a desk 16 hours a day. My brothers got me into mountain biking and it has been helping get me in shape. We've been doing it for about 2 months now.

Over the last month, I've noticed that after each ride, I get more and more pain around my kneecap.

There is some pain at the bottom of my kneecap, it feels like I hyper extended and pinched something, but there was no such incident that I can recall. It zapped me once while standing up doing nothing in particular after I had begin noticing it.

I also have pain around the top corners of my knee cap. It feels like muscle soreness, but I don't think there are muscles there. If Google serves me right, that's where my MCL is.

Both spots seems to just build up as I ride more and more. There wasn't any point where I had pain as though I injured either one at a particular moment, no fall, or anything like that. They just build up the more I ride.

Both are about a 2 on the 1-10 scale, but persist all day.

I don't know whether I should stop riding for a time, for risk that I did damage to something, and to let whatever it is heal. Or perhaps, on the other-hand, if riding just requires my knee to "get in shape", and this kind of pain is to be expected while my joints get used to being used again.

I've made sure my position is as right as I can. Has a few people inspect how I right, and also had a few shop keeps look at me too. Everything seems set up right. I extend my leg to where is is just bent a smidge for my saddle height. I've got the pedals under the middle of my foot.

Any insight? Is this to be expected or am I injuring myself by continuing?

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More info - I'm 43 with no past injuries. They always have creaked a little more than my peers. Both knees hurt equally, although the right knee def more towards the top of the knee cap while the left is around the sides and bottom. The best I can tell with measuring tape, my legs are even length.

Answer 1

I'm gonna start with the standard disclaimer: Don't take medical advice from random strangers on the Internet!

That said, you might investigate patellofemoral syndrome; one common cause can be over-training of the quad muscles relative to the other knee muscles (in particular the hamstrings). This over-training is something that's fairly easy for a new cyclist - who probably isn't clipped in and is cycling with a pure pushing motion - to develop. A physiotherapist can help both with diagnosis and treatment.

Answer 2

Is this to be expected or am I injuring myself by continuing?

You're probably injuring yourself by continuing. Muscle soreness is to be expected when you increase your exercise load, but exercise shouldn't cause joint pain. It sounds like your bike is set up reasonably, so you should probably seek out a sports physiotherapist.

Answer 3

You're describing an overuse syndrome that's causing acute inflammation involving the soft tissues of the knee. As the knee joint flexes and extends repetitively on a bike ride, the tendons, ligaments, cartlidge, and tough, fiberous fascia that encapsates the joint encounter forces and friction they're unaccustomed to. The sliding of these tissues against each other and bony prominences create friction. This friction causes an inflammatory response in the affected area, nerve endings within the inflamed area register a pain sensation. Tendons and associated fascia are particularly vulnerable due to greater forces and greater movement of these structures occur. Tendons connect muscle to bone, store-up and release a good deal of elastic force created by muscle contraction and have a relatively large amount of movement when compared to ligaments, cartlidge and bone. So as the knee joint goes through it's natural range of motion---under the tension of pedalling---these tissues are sliding against each other, eventually with enough repitition to inflame and hurt.

There is a degree of tolerance that develops as physical fitness develops. However, what you describe is more acute inflammation and should be addressed on multiple fronts. A few things you can do today: ice down the knee joint. No need to freeze your knee as a reusable cold pack wrapped in a towel and molded around an aspect of the knee joint will deliver ample cold therapy to the joint. Use of NSAIDS, such as ibuprofen, naproxsyn, or aspirin, if not contraindicated by other health issues typically involving the stomach, bleeding problems, or heart conditions where anti-platelet therapy is being conducted. The goal is to reduce the inflammation and rest is the key ingredient for that. I don't mean be sedentary-- but stay off the bike for a few days.

After the acute phase has passed--evident by little to no pain throughout the full range of motion--begin biking again slowly. Fewer miles or minutes with good technique. A big thing I would focus on is pushing lower gears at relatively steady 80-95 rpm. This involves using your gears more often than you'd think. Spinning it's called. Ease into it while you obtain these specialist evaluations and your form and fitness improve. Good luck.

Answer 4

I've got the pedals under the middle of my foot.

Try putting the ball of your foot over the pedal spindle/axle, IE slide your foot backward a little. This effectively lengthens your leg, so you may need to raise your saddle 5-10 mm to compensate.

This will encourage your shin muscles to do some more work, and may help.

On the flip side, your knees are already sore and it may be hard to detect improvements and changes while they are inflamed.