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Pain?

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Hello Pedal Room! I wanted to start a thread about any pain or biomechanical dysfunction you may be experiencing, while bicycling or with other activities (possibly preventing you from riding). I'm a physical therapist and wanted to offer my skill set to fellow like minded individuals (fitness/cycling enthusiast). Please feel free to post to this thread and I'll try to identify the cause and treatment options. Thanks so much, hope to hear from you guys. Ride safe!

Dr. A, PT, DPT
     
October 3, 2016 11:53 PM
I have had IT band issues in my left leg. Sometimes so bad that its basically impossible to ride a fixed gear and if I'm on my road bike I can only handle like 100 watts.
     
October 4, 2016 12:42 AM
babychris
From: Boulder, CO
99 posts
2 bikes
Can you give me explicit details? Where are you feeling pain? How bad is it? How long? What motions increase pain? Try to be as detailed as possible

Thanks!
     
October 4, 2016 12:43 AM
Outside of the left knee. I can go for 20 min without feeling any pain then I'll get a shooting pain from the knee up the quad (sometimes it happens within a couple minutes. The pain will persist in the knee afterward. Sometimes I can get in a good pedal stroke where I can manage to at least keep a high cadence. Occasionally I feel it going up stairs. Its bad enough to prevent me from pedaling altogether (occasionally I have to get off the bike and wait a minute), and the persisting pain is bad enough that I dont put any power through my left leg, I just keep it spinning. Any resistance hurts. Whenever it happens I just turn around or take the quickest way home as it basically disables me from riding
     
October 4, 2016 12:59 AM
babychris
From: Boulder, CO
99 posts
2 bikes
IT band starts with two large muscles (groups), the glute (glute med/min/max) group in the back of the hip (simplified anatomy), and the tensor fascia lata in the front of the hip. I would suggest stretching the IT band, foam rolling, followed be strengthening into what's called hip abduction. I'd do it in standing, focusing on core and quad recruitment (I.e. Keep leg straight/core and pelvic floor musculature contracted). You can do it with a rubber band or cable at the ankle. bias the TFL by hip abduction performed anteriorly of midline (midline of ant/posterior from profile view), bias the glute group by hip abduction performed posteriorly of midline, I would also suggest stretching your hip flexors. All soft tissue stretches should be performed 15s.-30s. 4x-6x. The video below provides a basic idea. You should be challenging yourself with stronger resistance. Do both hips too. Stretch first, strengthen second.

https://youtu.be/iVn7O95tKBE

Hope this helps. Perform 3x weekly. Get back to me with any questions and changes in symptoms.

Oh, and ICE too!
     
October 4, 2016 01:11 AM
This is a great idea for a thread, since many of us probably don't have insurance or can't cover the bills even if you do. Hope this keeps going (which is strange to say for a thread about physical pain as it relates to cycling).
     
October 4, 2016 07:05 AM
stalag13
From: City of Lost Children
145 posts
7 bikes
I've been beat all up and down my body. Purity of heart and strength of mind are invaluable when pushing through the pain and breaking barriers and shifting paradigms in an iconclastic way, beating your fastest times and capturing the hearts of your peers.
     
October 4, 2016 07:59 AM
Pushing through pain is not a good thing (unless the pain is coming from lactic acid build up and or delayed onset muscle soreness), and even then you are promoting further biomechanical dysfunction and future injury.
     
October 4, 2016 01:03 PM
i enjoy this thread, thanks atombomb that's sick
     
October 4, 2016 02:59 PM
moose
From: southern california
475 posts
6 bikes
Ive been getting patella soreness lately. Its not debilitating pain, but soreness after a long hard ride, occasionally while still on the bike near the end of a ride. Ive been riding for 6 years, racing for 4, and this has only popped up in the last ~4 months. Ive tried to identify and remedy it with fit, but i don't think fit is the primary culprit. What do you think? I could give you more details, or some of my other personal theories, but i'd like to hear your first thoughts before i start complicating things. This is a cool thread idea! thanks for expertise!
     
October 4, 2016 06:48 PM
Zeb_pepperoni
From: San Diego, CA
780 posts
9 bikes
Hey Pedal room threaders :)

If you all could be so kind as to include the following with your posts

Length of symptoms
Severity of symptoms (none 0-10 worst)
Location of symptoms (BE VERY SPECIFIC - "right knee" isn't helpful) maybe even include a picture?
Actions that aggregate
Actions that relieve

Helps me out quite a bit

Zeb - give me this info and I'll try to help you out. I already have an idea, but need more info
     
October 4, 2016 10:37 PM
Right knee only, front-inside of my knee. Just rode today, and it started irritating me after just a few minutes of riding, shortened my ride and soft pedaled the whole way, but still wanted to ride my bike. I did have a hard ride last night and didn't feel anything while riding. it's very low on the scale of 1-10, maybe a 2, but its definitely there. I do have flat feet, and experience slight inward knee tracking as i pedal, and haven't been able to remedy it with normal fit stuff. Suspecting some sort of strength training to help with stability is probably important, but don't really know where to start (am also very bad at doing anything else besides riding).
     
October 5, 2016 12:59 AM
Zeb_pepperoni
From: San Diego, CA
780 posts
9 bikes
Alright now we're talking. couple things I'm thinking. Tight hip flexors, weak hip abductors, and over pronation at your foot. Your flat foot lends me to believe that your arch is collapsing during weight bearing (down stroke in cycling). Because of this, moving up the leg, your experiencing what's known as knee valgus (your tibia i.e. Lower leg is moving away from midline, while your femur I.e. Thigh bone is moving towards midline), causing pain towards the inside of your patellar region. Since you are experiencing knee pain below the patella makes me think your hip flexors are also tight (common with individuals who assume a forward flexed trunk position observed with sitting and cycling). You also MOST likely have weak hip abductors (most people do) which, in combination with your flat foot, is causing your symptoms.

Strengthen your hip abductors (see previous YouTube video posted)
Stretch your hip flexors (google standing hip flexor stretch)
Get some arch support!

I'm pretty sure if you perform a hip flexor stretch (15s-30s 4-6x), prior to your rides, your symptoms will decrease or even disappear. If they don't, move on to the other suggestions.

Hope this helps. I look forward to hearing from you.
     
October 5, 2016 01:24 AM
Thank you so much! will definitely get to work on this! Any specific recommendations on an arch support for cycling shoes?
     
October 5, 2016 01:36 AM
Zeb_pepperoni
From: San Diego, CA
780 posts
9 bikes
I recommend those doctor SHOLS (sp?) foot stations that will pressure map your feet.


Try hip flexor stretches first. May knock out the problem right off the bat. Let me know what happens.


     
October 5, 2016 01:44 AM
Did the stretches last night and before a 70 mile endurance paced ride today. Also took 400mg of ibuprofen to help what could have been painful. But honestly i don't think the ibuprofen was necessary! Even after my somewhat discouraging ride yesterday, i felt great today! Now 3 days of easy riding (just my short commute) and we'll see how it goes this weekend. Thanks a lot!
     
October 5, 2016 08:59 PM
Zeb_pepperoni
From: San Diego, CA
780 posts
9 bikes
Most people who are feeling pain in the front lower part of their knee its due to tight hip flexors (iliopsoas/illiacus) and tight quad muscles (vastus lateralus, intermedalis, medialus and rectus femorus) which tendon sheath integrates the patella and anchors at the tibia tuberosity. You can probably see from the picture below exactly where your pain is presenting. A hip flexor stretch will lengthen all those muscles to the appropriate length-tension relationship, despite hip flexors being more responsible for flexing the hip (duh) and the quad muscles being more responsible for knee extension.

Gotta work on your hip extension! :)
Attached Photos:
Post photo
     
October 5, 2016 09:46 PM
I saw a post here a few days earlier about a bike crash but it seems to have disappeared? Please repost if you would like to. I apologize for my tardiness addressing your concerns, I was in Portland, OR for a long weekend trip. INCREDIBLE CITY
     
October 11, 2016 09:03 PM
Atombomb,

Slammed into a car standing at a red light, tried to swing left to avoid, but no luck.
Right side of my body took the impact: right arm stretched on the roof, head slammed onto my right shoulder/arm. Ribs, hips, and armpit took the full impact of the hatchback car.
Doc said it was a rib injury, nothing broken, gave me Metamizol-Natrium for the pain.

2 weeks now, and I still have sharp pains between my shoulders, under my right shoulderblade, bottom of my neck and mainly where my ribs meet my spine (back).
Right side pretty bad, left side enough to be annoyed.
It's at its worst when I turn my torso, lift up my shoulders ("shrugging"), or when I turn/tilt my head left (not right). If I lift my left arm above my head the pain is all over my right backside.

The pain feels like sore muscles, a really bad "burning" feeling.
Sleeping is though, only on my left side is really comfortable.

The pain has been constant; I feel no progress, wether I rest completely (no movement, careful walking etc) or when I go cycling. After cycling it is better for an hour (the pain almost disappears) but then it hits hard after. During Cycling I feel a lack of stability while sprinting, but other then that, all normal (?)

I am 190-something cm tall, weigh around 94kg, and ride 200km avg per week on my trackbike with 53x18 gearing. I am quite fit yet have a history of back problems. My daily 30km morning training is what has kept me backpain-free for the last 1,5 years.

Thank you so much for your time.

RRR.
     
October 12, 2016 09:49 AM
Hey there. Good to hear you weren't more seriously injured. Couple things stick out to me. First and foremost, soft tissue healing guidelines....6-8 weeks. You are still two weeks out. Expect some pain for at least a month if not a bit more, take pain meds as needed, ice and heat can both help with pain, personal preference. Ice will help with swelling, heat with blood flow.. If you don't dramatically improve by then, get further imagine. At that point in time soft tissue has remodeled and pain becomes chronic, meaning something else is going on. Unfortunately, pain is normal at this point in the game.

Broken ribs don't usually get a lot of attention (surgery or immobilization) unless they are displaced, and it seems like your x rays have ruled out fracture. if you have some bruising, some superficial vessels and tissues hemorrhaged. lots of joints and muscles got stretched passed their safe range of motion, for tissue level micro trauma. Try to find positions of comfort (spinal joints prefer midway between flexion and extension, biasing slight flexion), pain relief with modalities(ice, heat), keep moving. Try to get steroids, those will fix you up real good, per MD of course. I'll post a movement pattern I think you should go through, it's origional intended for golfers but it's based on Orthopedic spinal Health concepts and should help you get better, faster. Follow it within a pain free ROM. Give it some time and ease into activity.

https://youtu.be/xPTZeetrClA
https://youtu.be/k9tVpZb_nec

Follow these 3x weekly. Don't rush. Go through pain free range of motion. Hope this helps. Also, you left out one of the most important pieces of information. Age. Single most predictor of even cancer, I've "read & heard". Hope this helps.
     
October 14, 2016 02:47 AM
Hi Atombomb,
Thanks for your answer.
I've been doing the exercises, especially the second video, seems to help loosen things up.
The pain has lessened since my first post.
I'll keep you posted on how things evolve.


Thanks again.
RRR
     
October 18, 2016 11:20 PM
Hi Atombomb,

I've recently have been getting a bit of pain on the lower area of my right knee. It's not too painful but it is definitely unpleasant will persist when I'm off the bike as well. I did a 20 mile ride yesterday and the pain was there through out the day until I went to bed. Also flared up again about 20 minutes into my commute this morning. I attached a photo showing about the general area where I feel the pain.
Attached Photos:
Post photo
     
October 19, 2016 07:40 PM
Hello! I would have to say you have a weakness in your R hip abductors, and tight hip flexors/knee extensors. You may also have some weakness or hamstring muscle imbalance that is pulling your lower leg into increased rotation.

Stretch your hip flexors
Strengthen your hips AWAY from midline (sidelying clamshell/standing straight leg hip abduction)
Stretch your hamstrings

some of the videos I've already posted could help. Try a hip flexor stretch first, if that doesn't change symptoms, I'd start thinking hip, hamstring, and ankle/foot. Get back to me after you try those things mentioned, I'd expect changes right away (any reduction in symptom). Try a 3 way hip driver before you jump on the bike.

Ice always helps both sensation of pain and inflammation, limit time and put a moist barrier (wet cloth)
     
October 20, 2016 12:27 AM
Hey, I tried the 3 way hip stretch and hamstring stretch this morning before my 30 minute commute and my knee felt a lot better. I stretched afterwards as well and the pain did come back about an hour after my ride but it was very mild. I'll continue to stretch and do the hip strengthening exercises and go for a longer ride this weekend and see how it feels.

     
October 20, 2016 02:00 PM
Glad to hear. What percentage of change did you feel? Stretch 15-30s. 4-6 x daily/every other. Dynamic stretch always safer than static stretch. Please let me know if your symptoms resolve completely. Cheers!
     
October 20, 2016 08:50 PM

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