TMBRA - Rider Board

[Anonymous]

Doc,

For the past couple of days, I have been having intermittent pain in the area of my kneecap. It usually hits me if I'm standing still or sitting down but not when I'm walking. Every now and then during the day, I get a sharp pain for a few seconds and then it subsides. It is not a severe pain but more of an annoyance. I have not injured this knee at any time in the past.

Thanks,

Terry

[The Bike Doc]

Terry:

With the pain being intermittent and brief it is hard to say what it may be due to. Have you recently cranked up your milage/intensity or done any recent adjustments on your bicycle seat, pedals or cranks? Pain behind the knee cap can come from the seat being too low or too forward, too much big gear grinding, cranks that are too long, malpositioning of the cleats, too much float in the cleats or too much external rotation required to come unclipped. If the pain worsens or persists, seek an evaluation by a sports medicine or an orthopedic physician.

Thanks,
_________________
Paul K. Nolan, MD
AKA: The Bike Doc

[Anonymous]

Hey Doc,

When I first posted this subject, it seemed like the intermittent pain in my knee was random. I have since determined that the pain seems to come on whenever I, for lack of a better term, do a Keegel (I learned this term when I went to birthing classes with my wife for our first child.) What in your kneecap area could be affected by the tightening of muscles in your backside?

Thanks.

Terry

[The Bike Doc]

Terry:

You got me on that one! Possibly when you are tightening your back and buttock muscles doing the Keegle exercises, you may be concomitantly tightening your thigh muscles. If you have some local tendonitis were these muscles anchor on the knee cap or you have some underlying cartiledge damage that could cause some pain but the puzzling thing is that the knee should hurt any time you push it hard such as riding big gears or climbing hills on the bike or climbing stare so I cannot convince myself this is the case. If the problem persists, seek an evaluation by an orthopedic doctor.

Thanks,
_________________
Paul K. Nolan, MD
AKA: The Bike Doc

[Guest]

Could it be a Plica? When the plica tightens it can rub on the femur and inflame. I've had this and it took forever to diagnose. It hurt to stand, ride and ski. It becam chronic, because I didn't rest it, and eventually had it cut out on both knees. No problems since!

[The Bike Doc]

Yes, it could be a plica band causing the symptoms. The plica is part of the synovium, the cartiledge covering of the knee joint, and it is located along the inner aspect. Inflamation of the plica can cause pain that is on the inner, the outer or the front aspect of the knee. However, the tenderness from an inflamed plica is usually persisently tender, and there is often a palpable thickened tender plica band under the inner (medial) boarder of the knee. If that is the case, then an orthopedic evaluation is in order as a plica band that persist with symptoms often have to be removed arthroscopically.

Thanks,
_________________
Paul K. Nolan, MD
AKA: The Bike Doc