# Another Knee Pain Question - Gets Better with More Riding??



## stewie13 (Feb 5, 2005)

So I have another knee pain question for the collective wisdom of the forum. I have reviewed some of the other knee pain posts and there is a lot of good information in there. Here is my situation:

I first developed knee pain exactly one week ago today. I don't have a history of knee problems but did experience something similar a few years back when I took an extended break in the winter and probably ramped up volume and intensity a little too quickly. I suspect the same thing happened this time. I race at a high level so my body is pretty used to big miles/intensity even after a couple of months off with very limited riding but when you combine a quick ramp up of volume, cold weather and probably too much mashing and not enough spinning you have a pretty standard recipe for knee pain. There have been no bike or equipment changes which also supports that hypothesis. This is all pretty standard and rest, ice an stretching is the general prescribed treatment. So here is my specific question and probably a little different from others:

Not only can I ride through the pain but the more I ride and harder the ride gets, the pain diminishes and eventually goes away. As I stated before, the pain first appeared last Tuesday and was pretty bad. I took W/T/F off and had a planned team ride on saturday. Within a couple of miles of the start the pain was back and I was questioning whether or not it would be wise to continue the ride. After 30-45 minutes the pain started diminishing and 90+ miles later there was no pain at all and I felt completely fine. No pain that night, nothing. Next day, another ride, lot of pain at the start, questioning whether it is wise to continue but as the ride gets going and ultimately the pace picks up the pain again goes away. Can someone hypothesize what is going on? I'm not taking any anti-inflammatory meds or any other pain meds so it isn't like I'm just masking the pain. To me it seems like some tendon is probably slightly inflamed but as my whole body really starts to warm up from an increased effort, my knee also warms up and with increased blood flow, the tendon (or whatever is inflamed) beings to track normally and any agitation with the knee goes away.... I guess the other alternative is that as the LOE increases my body just naturally puts the pain out of my mind but the underlying problem is still there.

Has anyone experienced something similar before? When I had this similar pain a few years back this was the case as well and ultimately it just went away. I would say the pain is right behind the knee cap in the middle of the knee. I'm definitely going to continue to monitor it closely and err on the side caution of just resting.

Thanks!


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## Cervelo S-5 (Dec 16, 2011)

Hi Stewie!
I'll try to offer some possible answers, but without a proper exam, it may be a liitle tough. Being that you are a high end rider, I will not even question your set up as you will probably know better than I about that. Forgive me for being trite :blush2:, as it is not my intent, but could elevating years be an issue now with the over zealous ramp up? I noticed these types of things showing up despite "always being able to do it before" in other sports as the years have gone by and although I hate to admit it, we all have to change our approaches as this happens. It does not mean that we stop, but we just follow a different route to get there. 
As far as the knee goes, make sure that it is warmed up well, possibly a knee warmer for a spell, or if more compression is needed possibly a neoprene sock brace may help. The pain may be going away because the area is getting inflammed and as a result the inflamation actually may be cushioning the area. Retopatellar pain that you may be describing could be as simple as a tracking problem with the patella (ie patella-femoral syndrome) which I have commented on in other threads; but this sounds more like it may be what is called chonromalacia patella. (No it is not a contageous disease !) It is caused by the wear of the hyalin cartilage on the back of the patella where it contacts the femoral condyles of the knee. In English, the groove between the big bumps of the femur is where the knee cap will track up & down when we pedal, so if the padding on the back of the knee is in a bit of a mess, then pain will ensue.
If this is the case, then the argument for the inflamation actually cushioning the area is valid; but this will not last forever. As this is a wear and tear type of problem, and you are a high end racer, the pattern at least fits the description. You may be able to work through this (especially if it is not chondromalacia) but I would suggest an exam from a reputable practioner to assess the knee before the season really gets going. Really good quality X-rays may reveal the problem, but advanced imaging like MRI is way better. If it is really bad and progressing, arthroscopic debrisment may be necessary, but let's hope that this is not the case.:mad2:
Sorry that i did not have better news and I truly hope that I am wrong, as this can be a bit of a pain in the ass. 
Best of luck with this!

Cheers, and ride safely! :thumbsup:


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