TMBRA - Rider Board

[Anonymous]

Doc,
I have been riding/racing since 2000. I have 3 bikes, which I have not changed their set up: pedals, saddles, post, shoes, all the same. My riding position has maintained a normal position. I am currently training for Leadville and have experienced knee pain on my rides, both road and mountain. After riding for 45-60 minutes, the outside head of my quads start tightening up and it in-flames the ligament across the top-outside of my knee. Vastus lateralis or tensor fasciae latae???? I can ride with the pain and the knees are a little sore for a day or two, but no nagging pain. I thought it was my t-band, but that is not it. I had a massage and was told that my quads are just too tight and I need to stretch more. I took 2 weeks off the bike, jogged 3 times, yoga twice, swam twice, and strechted out daily. I rode yesterday for the first time and 32 minutes into the easy ride, my knees fired up again. I have trained with a greater amount of miles and intensity in the past and I am reluctant to train through this pain. Ibuprofen has zero effect. I am 31, male, 5'9", 163lbs.
What can I do?
Thanks DOC! You ROCK!!!

[The Bike Doc]

nonstop:

Since your bike set up has been stable and well tolerated over the prior three years and you are still a relatively young so your body has not stiffened up to where it can no longer tolerate your bike fit, I doubt that bike set up is the culpret here. It may well be that the higher miles you have been pushing to get ready for the Leadville 100 has inflamed your your ileotibial band (ITB). Pain to the outside of the knee could comfrom an ileotibial band sydrome. This type of problem requires more than just simple stretching. Physical therapy with deep heat, ultrasound and deep massage may be of significant benefit. The therapist can show you specific stretching exercises to help loosen the ITB. Additionally, an evaluation of your foot possition may be of benefit as individuals whose feet tend to roll out are more susceptible to this problem and may benefit from an orthotic that helps realign the foot.

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

[Anonymous]

Knee update: I have started to work through the ITBS with stretching and massage from my therapist, using ropes and different positions. I am taking Mobic, anti-inflammatory, and ibuprofen to ease the swelling and damage I have done. I went to www.itbs.info for a great deal of education on the subject. I have also ordered and used the PattStrap from www.fabrifoam.com will reasonable results. The hardest part of my training for Leadville is to keep everything at a minimum level as I build back up.

Thanks again and welcome back to Texas. I have heard good things about Palo Duro and look forward to riding it.

[The Bike Doc]

nonstop:

Thanks for the update. PDC is a good halfway point to Leadville, though you won't want to ride it on the way back, but it would be a great warm up ride on the way out. You will find out what people rave about. Only a couple of short tough climbs, most of it is gently rolling, screaming fast with great water bars to catch some air off of (The Trail Docs know what I am talking about just don't tell my wife!).

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