I am having knee pain that seems to start when ride down hill or making speed adjustments in general to slow down the unicycle so my body can pick up speed to balance on top of the unicycle wheel. The image shows my typical left leg position when making the micro speed adjustments that cause pain.
This pain usually happens while riding my 36inch unicycle. I removed the 36inch tube and replace this with a 29er tube to lighten the rotational weight. I am also considering changing cranks from 125 to 150 for a while.
Has anyone had this issue? Any idea about the muscular / tendon problem causing this?
If you are still new to unicycling it may be necessary to build up some specialized muscles. I do recall riding down a hill early on; I would get a sharp pain around my kneecap when I applied pressure to slow myself. It hurt! I took it easy and continued riding and within a few weeks I could ride down the hill and slow down without any pain. More than a year later I have almost no knee pain even with much more vigorous riding. My advice is to take it easy on the hills and give yourself time to build up some muscles for decelerating.
If you have been riding for a while and this is a new pain, then you should ignore me and get advice from more knowledgable people.
You have the non-expert expert on knee pain. Iāve been battling knee pain when riding for about 3 months now and have read every web page I can find and have been through three knee braces. I can ride flat know for an hour and have been slowly adding idling practice back in with mixed results.
I have had very little luck with knee braces and the best seems to be a simple neoprene sleeve with what goes by the name of a buttress to help with kneecap tracking.
The problem with knee pain is that the pain can radiate making an accurate assessment difficult unless it with a professional who knows how to isolate the injury by squeezing this and twisting that. My budget does not give me that luxury.
I have the same knee pain, pain on trying to slow down or ride up hills. There are lots of names common and scientific for various over use injuries (what you most likely have) of the knee.
Most common is Patella (or Patellar) tracking issues. Most common is the knee cap is pulled to the outside (laterally) by an over developed quadriceps muscle. That would be your rectus femoris and your vastus lateralis. In plain talk the outside of your quadriceps. The answer to this is to develop your vastus medialis and your hamstrings. Also itās good to work your leg abduction and leg adduction as well as your hip flexors, oh yeah and your buttocks.
Wow so many muscles, but the thing with knees is everything from your navel down connects to you knee through some combination of muscles. In general you will be fixing your posture. But on the good side if you have nagging back pain the treatment for bad knees should take care of that as well.
Do you sit a lot? The above also goes by the name Secretary Knee. When you sit a lot your butt muscles get weak and your hip flexors get weak and tight.
Part of the issue is that unlike cyclist who can use clipless pedal and pull up on the back stroke and there by work their hamstrings as unicyclists we donāt have that luxury. Also I believe that most unicyclists have their seat too low for optimum knee health. When the seat goes higher the vastus medialis is at least slightly engaged instead of just goofing off. The vastus medialis is that baseball sized muscle on the top inside corner of your knee. This muscle is worked by knee extensions and by pulling your knee caps up when your leg is straight. This is that muscle that sticks out like a baseball on pro cyclists.
Besides raising your seat, shorter cranks are helpful to complaining knees. You knee goes through a smaller arc as you raise your seat and use shorter cranks.
This goes by the common name of runners knee or cyclists knee and is characterized by pain under or around the patella (knee cap). It also goes by PTFS for PaTellaFemoral Syndrome. Anyone who āstepsā is vulnerable to this. Hikers, runners, cyclists, etc.
But pain around the knee cap can also be caused by Patellar tendinitis. This goes by the common name Jumperās Knee.
Next up is IT Band syndrome or Iliotiba Band Syndrome. This is characterized by pain that comes down the outside of your thigh and connects to the upper outer corner of your knee. Pain is felt on the outside of the knee. The common treatment for this is to stretch the IT Band but this is controversial given that the IT band is very thigh bundle of muscles and not much for stretching. Iāve developed a theory that what really gets stretched is the Piriformis muscle. Anyway look up āPiriformis stretchā and figure-4 stretch to see some examples of stretching for the IT Band. Iām of the mind that the IT band is best massaged and you can do this by laying on your side and kind of rolling your outer quad back and forth on the ground. You will know when you are hitting the IT Band because it will hurt. Like one big long pressure point. If you search on the web you can find videos of people using a foam roll to massage the quads.
Anyway look up some of these terms and you will find guides to knee exercises for various knee issues. I was expecting a quicker healing for my knees but my knees have been hurting for years and I probably am not taking enough time off.
Iāve thrown a lot of terms around so you can do some web searching and read more about these various knee overuse injuries. In your case it might just be rest and then resume riding at a slower pace or like me you may need to work on years of too much sitting and a life of abusing my knees through various sports.
Hmm, ridding downhill and slowing down, technically the same, as you control the speed by putting force on the back pedal when going downhill just like you slow down by putting force on the back pedal. A different muscle set to those typically used on normal bikes is required for this. Iām no expert, but it could be a muscle in-balance. If you have a training bike, turn the saddle around and try riding backwardsā¦ but start on the easiest āgearā first and work your way up.
Other than that, Iād say your seating position looks fine, if not a little too high: your knees should not quite straighten completely at the furthest point in a revolution (only check by ridding, checking whilst standing does not work).
Ezasās search seems thorough, though he does seem to have misread when you are experiencing problems.
Ignoring whether you push on the back pedal or front pedal when trying to control your descent down a hill, letās look at it from the bio-mechanic view point.
Ignoring the role of the hip flexor in drawing the thigh towards the chest, leg abduction/adduction or the lateral rotator group, and things like dorsiflexion of the feet, there are three basic functions of the leg that involve the knee.
A) Extend the leg in a pushing motion. This would be walking up stairs, doing squats, Cycling, etc. (by the way I found that walking up stairs flat footed can help avoid knee pain when climbing stairs)
B) Leg Extension. This is where the knee acts like a pivot and the lower leg is swung in an arc towards a straight leg and to complete the motion the knee cap is āliftedā and the vastus medialis is fully contracted.
C) Leg Curl. Drawing the lower leg up to the Butt and other motions that contract the hamstrings.
While riding a Uni you are not contracting the hamstrings (canāt since most of us donāt run clips) And while riding we are not doing leg extensions.
That only leaves pushing. On which pedal does not matter, itās still pushing/bracing and would be a possible contributor to runners knee or other knee issues.
After my optimistic tone about my knees last night today was a big setback and the return of knee pain during daily activities like getting out of the car (my left knee is the worse) and in climbing even a couple of steps.
Iām still deciding what to do with that info. I did a long stretching routine tonight and tomorrow will be more exercises then stretching. Last night I added footbag (hackey sack) to my rehab routine to work the hip rotator group without just sitting there waving my foot back and forth, which I have done.
Tomorrow night iām going to add inverted squats to work the hamstrings against more resistance than I can do with ankle weights.
I might try to get a ātrialā membership at a gym so I can really blast some hamstring curls and some leg extensions against more resistance than I can get with ankle weights.
āThe vastus medialis is that baseball sized muscle on the top inside corner of your knee. This muscle is worked by knee extensions and by pulling your knee caps up when your leg is straight. This is that muscle that sticks out like a baseball on pro cyclists.ā
How do pro cyclist strengthen the vastus medialis? Do the strengthen the muscle via leg extension excersizes?
Does it happen all the time, or just as you fatigue? Does it hurt when you are not unicycling? Also, where exactly is the pain in the knee? The knee is quite complicated
If the pain starts a bit into a ride it could be what we (in the running community) refer to as Runnerās Knee (described somewhat by ezas above). If it is not present at first then starts up into the workout it can be caused by the inside quadracep muscle wearing out and the stronger, fresher quadracep muscles on the outside pulling the patella laterally towards the outside, as ezas described above. It screws up the tracking of the patella in the knee and causes inflammation. Of course, once you have the problem, it stops showing up partway into the run and usually causes chronic pain (not just when you are performing the exercise that caused it originally). I guess it would depend on how bad the inflammation is. When it happens to runners it is often because of a sudden change in the routine, like moving from flat sidewalks to hilly trails, or a suddenly new (and different) shoe. The general treatment are anti-inflammatories, rest, and gradually incorporating the change that caused it in the first place (e.g, slowly increasing mileage or changing terrain). This allows the body to adapt gradually and build up the necessary stabilizing muscles. I imagine this would work for unicycling as well.
It could be the iliotibial band like ezas mentioned, but that would cause a pain on the outside of the knee or sometimes the outside of the hip. I donāt think unicycling would really irritate the iliotibial band, but I guess itās possible; I have heard of cyclists getting it before.
@ezas: You can definitely stretch the iliotibial band, but itās hard to teach yourself to do the stretch ā you almost really need someone who knows how to do it or a doctor to show you. Once you are stretching it, you can definitely feel the stretch (itās a very different feeling from stretching the piriformis). Youāll feel the stretch more on the oustide of the hip and thigh rather than around the knee.
I had a lot of knee pain when learning to ride because I was standing up on the pedals too much. Maybe if youāre trying to go downhill or slow down (basically the same thing) you are standing up on the pedals more than you normally would?
I would try stretching my quadraceps and iliotibial band thoroughly before riding and also maybe switch to longer cranks to give you more leverage.
Also, runners often use foam rollers (you can use PVC pipe or a rolling pin if you want) to massage tight muscles. You might try this on your quadraceps. Iāve been told by a sports medicine doctor that pain on the very top of the knee (right above the knee, almost) can be caused by the quadraceps being tight and pulling on the ligaments. Google āfoam rollingā and youāll come up with a bunch of tips, Iām sure. You can foam roll the ilotibial band as well. I disagree with ezas that stretching the piriformis and ilotibial band are the same thing (ezas: if I mis-understood what you are saying, I apologize). If you want to stretch the ilotibial band, I recommend the following: http://www.rice.edu/~jenky/sports/itband.html Itās the closest I can find to describing how I stretch it.
EDIT: Thereās always disagreement as to whether you need longer or shorter cranks. It depends on the problem, I think. If youāre knee is moving too much, then shorter cranks would help. But since youāre only feeling the pain when putting leverage on the back pedal, I think you would want longer ones so that you can get more leverage with less body weight on the pedals (and in turn less body weight on your knees).
I have considered changing my crank length for 125 to 150. I also will reduce my tire pressure in hopes to make fewer balance adjustments when riding over bumps. I must slow the unicycle down when my body needs to catch up with the wheel for balancing adjustments. The fewer of these adjustments, the better.
Hey guys, I am a physical therapist. I am 3 months new to uni. I am very impressed by the research and knowledge here about the knee. The differential-in-strength theory between the medial and lateral quads to explain maltracking and knee pain is loosing ground in the sports med world. Better said, the conception that you can differentially strengten the VMO vs Vastus Lateralis (with knee extension etc) has actually been disproven with EMG studies. We address tracking by addressing excessive Q angle which is a line from ASIS to middle patella to tibial tuberosity. (Please educate me on what the Q angle is that I hear people mention on a unicycle). I would love to help people here, however identification of the structure that is painful is step 1 and that seems to be missing here unless I didnt see it. Please feel free to answer back with more info about your particular pain. Ezas, doing leg extensions is harmful in a majority of painful knee conditions (especially patela femoral issues). Until you are sure of your condition I would NEVER do them. In the last 6 years I have given them to 2 patients out of thousands. Write back and lets get some pain free riden on!!
I canāt say I donāt know what the off-bike routine is for pro-am riders. I know when I was training on a road bike I did not hear much about weight training but that was a long time ago.
I found this on the Tour of California site. Sounds like there is still not a lot of emphasis on weight training:
"Most of that time is spent riding, but they might spend an hour in the gym a few days a week lifting weights to build leg and core strength, especially during the off-season months (mid-October to mid-January). "
And I found these recommendations for off-season training from a cycling coach:
* Monday: 1.5hrs core stability exercises & 1-2hrs cycling
* Tuesday: 1hr cross training activities
* Wednesday: 1hr core stability exercises
* Thursday: 1-2hrs cycling (big gears, low cadences)
* Friday: Day off
* Saturday: 1.5hrs core stability exercises & 1-2hr of cycling
Sunday: 2hrs cross training activities
My guess is that the development is just from having a saddle height that engages the VM (tired of typing vastus medialis and as yet have not found a common name for the VM except ātear drop muscleā). I rode the other day for 4 miles (and my seat was a little low) and today my VM is still a little sore. If my saddle was a little higher I would have been engaging the VM even more.
Check out the vastus medialis on this guy. I might have to change my wording to grapefruit size muscle. Notice that it seems pretty darn well engaged short of full extension of the knee.
In looking for a picture of a well developed VM on a pro cyclists I came across the page that is the reason why I mentioned massage in my first post.
And in looking for the common name of Vastus Medialis I came across the Wiki article which talks about the contribution of the VM to the lateral tracking of the knee cap and mentions that itās role may be over played)
There is a good diagram of the upper leg muscle anatomy.
Scroll down to Piriformis to see a good diagram of the rotator group for the lower leg. The piriformis along with the IT Band can be trouble makers for the knees. But I lean towards the group that says the IT band cannot be āstretchedā. And unless the lateral (outside) of your knee is sore or the length of the side of your thigh is sore itās probably not IT Band syndrome. But I think it is good to be aware of.
Actually this is a very good page in general in giving a head to toe picture of the muscles that hold us up. (posture)
Notice how even the Lats works their way down to the lumbar and sacrum. The sacrum is the base of your spine and is attached to your hips via the sacroiliac joint. (a joint that I have a problem with)
Hip bone connected to the leg bone. Leg bone connected to the knee bone . . .
It is difficult to pin point the pain at times. I would have to say the middle of the knee to the inner knee.
What is really strange about this is that I can do leg extensions and single leg presses very well without any pain. These excersizes were very painful at first BUT I then started doing leg extensions slow enough to avoid pain. Sooner or later I was able to do leg extensions and leg presses at a more normal rate without any trouble at all. It is almost like I had to teach my muscles how to work without pain.
I can have knee pain from uni riding one day and go in the gym the very next day and do leg extensions and leg presses with ease. Very strange to me. Can you explain that?
The Q factor from unicycling is probably referring to the crank arm Q-factor which is the angle between one end of the crank to the other.
GREAT post and thanks for the counter points. Thanks for bringing more information to the discussion and thanks for the clarifications on some on my points.
While Iām on the fence on the IT band I still do stretches (four of them) that target different areas of the IT band and surrounding muscles. I I wish I could do the āPigeonā stretch but it puts too much pressure on my knee no matter how I adjust my leg position.
I totally agree about the variance of crank length and that shorter is not always better. The other day when I irritated my knees so badly (but no pain during the ride) I was running 114ās for the first time. But I also was riding on a saddle lower than I like and I was not pedaling on the balls of my feet which I have found to work better for me. Hard to say how much the shorter cranks had to do with it.
My dilemma now is how much time to take off from riding. I tried taking 8 days off and come back easy but both Idling practice and my 4 mile ride were irritating to my knees.
I know where my body/legs need more work so I will just keep on chipping away at tight joints and weak muscles. I just hope that at some point I turn the corner to healthy knees.
The wiki article mentions Toe-in riding as a contributor to IT Band irritation so Iām thinking that riding in clips might be one of the antagonizers and why we donāt see much complaining about it on the Uni forum.
I went to buy one of the foam rollers for the thigh massage and it was $25 US for a hunk of foam so I didnāt buy it. Right now I have better uses for $25 dollars.
Thanks again for helping me get some information out there that could help others (and me). Iām still a knee pain sufferer and will take any help I can get.
Scha,
My first comment to you must be on the leg extensions. Dont do them, pain free or not. The number one question prior to performing exercises is to know why you are doing them. If your goal is to strengthen your quad do squats, wall sits, lungesā¦ These are referred to as closed Kinetic Chain exercises. They are FUNCTIONAL and will contribute to your function. In general open chain exercises like leg extensions are not functional and will not contribute to your function. Also patella femoral pressure with leg extensions are through the roof. Also remember as stated in previous post, you can not seletively strengthen any one of the 4 quads and therefore you can not affect pat tracking with leg extensions. One exception to open chain is leg (Ham) curls. They are useful. Have you had anyone look at your knee. A diagnosis certainly is the first step. Is it patella tendonitis, is it pat fem syndrome, is it arthritis?
Q-factor is also a term used to describe the width of the hips and to a lesser extent the angle the leg emerges from the hip socket.
Iām in guessing territory now but Iāll throw some things out there.
Pain in the middle of the knee (as opposed to under the knee cap) makes me think ACL and PCL which are two thick tendons that cross the knee. But these are usually injured from a traumatic stress. But like I said in my first post, knee pain can radiate, meaning you feel pain away from the area of inflammation.
Which reminds me are you are you putting ice on your knee? If not you should be. Natures aspirin they call it since it reduces inflammation.
While often recommended I am not a fan of over the counter pain/anti-inflammatory meds. For me, I like to have the pain reaction so I know when Iām doing something that is irritating to the joint. But Iām in the minority on that view point. Itās just something I picked up to help me in the martial arts to keep from re-injuring the same thing over and over.
My symptoms are different. Any kind of knee extension is painless but almost any kind of pushing with my knee causes pain. But what you have noted is a bit strange but not one I can address with my limited knowledge.
My guess, and it is a total guess, is that the reason why you have pain on the uni and not while pressing weights is the angle of your feet while pressing. But it could be some other aspect of your bio-mechanics.
This has not been brought into the discussion yet.
Do you know if you pronate or supinate when you walk?. Most people pronate and only about 10% of the population supinates (also called ārigid footā).
Pronation is normal and it is part of our shock absorption while we walk.
A real easy way to see this is to stand with your feet about 18" apart and then bend at the knees. Drop straight down letting your knee go over your toes.
Watch your ankles and feet. If you pronate you will see your ankles drop a little bit to the inside and you will see the arch of your foot flatten. If you supinate your foot will roll outward of feel like it canāt move at all. Most people who supinate know it bacause it often (always?) goes with high arches.
If you over-pronate your fix may be as simple as some better footbeds in the shoes you ride with.
Superfeet is the most well known brand and is what I use for walking, riding and skiing. But there are other brands. A google search on footbeds and cycling will turn up discussions of the use of footbeds for cycling.
In you have a New Balance store near you they will give you an assessment of your gait. As will any serious running shoe store. They should ask you to walk away from them and will have you flex your knees like I explained and they also may feel your knee while you flex your knees.
They will give you an idea of if you have normal pronation or mild or severe over-pronation. I would not buy shoes/footbeds that you are offered but instead take this information home and decide how to proceed. (f your finances are in good shape a good fitting, appropriate shoe and/or foot bed is helpful to anyone)
Alternatively you could have an assessment by a podiatrist, but all but the most ethical will try to sell you custom orthotics or sell you foot beds at inflated prices.
Back to the Uni. Do you feel any particular strain in your leg/knees while you ride? Not pain but are you making any kind of effort to hold you foot a certain way on the pedals?
I find I try to pull my feet in because my feet splay out and my calves rub on the frame, but that is getting better as I do more stretches for my ankles and my hips. I think as I mentioned above (even I donāt want to read my long posts) I found that pedaling on the balls of my feet was easier on my knees.
Im about tapped out for info (plus Iām tired of typing) so Iāll be doing more reading than writing from here on.
The thoughtful, in-depth responses that have been offered seem a bit overly-complicated to me. My experience is much like Scottās. Iāve had similar knee pain with increased intensity, increased riding time, and especially with increased wheel diameter. In fact, the new 36er had me wondering whether I was doing serious damage to my knees, just by riding it. As Iāve improved muscle & tendon strength it now clearly takes more intensity to cause the pain, and easier rides no longer cause any pain. (For instance, the old knee pain came back after last Sundayās 20-miler, but not after the previous weekās 10-miler.)
So, based on my own experience, and in agreement with Scottās reply: just take it easy, especially with hills & distance. And, I might add: give your tendons time to recover from the inflammation that naturally comes with āoveruse.ā Over time Iāll bet your pain will decrease as you build muscle & tendon strength.
And yeah, and I found switching to longer cranks on my 36er did help. I swapped out the 150 Nimbus Ventures that came on my Nightrider for 137/165 KH Moments I had on my Muni and have kept the pedals at 165 due to both the hills in my neighborhood, and my relatively weak leg muscles & tendons. Iām now considering putting the 150s back on, but I may have been spoiled by the extra control offered by the 165s. (Who knows, maybe Iāll just throw caution to the wind and see what 137s are like, since I have that option with only a turn of the pedal wrench.)
You didnāt single me out, but I will respond since I did most of the ātalkingā
You are probably right. I did a brain dump that was probably not needed, an amateur one at that, but opinions were asked for and I was available and have some knowledge based on my own experiences and study.
Iām pleased to see that UniTrac has stepped in to this thread, however . . .
Itās a whole different world at 54 than at 19.
I hope that all Scha needs is some recovery time and a few adjustments (longer cranks, lower seat whatever).
If we had a couple of beers to talk over, I would try to tell you the depth and breadth of the exercises and stretches I am doing and the adjustments I have made in my riding.
A week ago I took eight days off from riding in an attempt to gain some traction on recovery. A week later a few short idling practice session and one 4 mile ride (on flat ground) Iām sitting here back in the pain that I started with 3 months ago.
Was it the shorter cranks? The lower saddle, or that fact that I rode more flatfooted than on the balls of me feet?
I wish I knew, or knew who could tell me. I guess in my need for answers, I tried to tell Scha everything that I have learned and tried.
My direct observation of knee replacement keeps me from āriding through the painā.
Discouraged does not come close to describing how I feel, or how I feel about the idea of having to give up Uni.
My searching keeps revealing new paths to explore. Tonight I read about something called the deep squat test. In that test you should be able to squat down close to fully with your feet parallel. I canāt do that even with my feet pointing outward. It was suggested on this site to practice with a dumbbell working down to lower and lower weights until the muscles adapted to staying in that position. Apparently a deep squat fires all kinds of muscles and they learn to fire in the right order when bending the leg.
I found this bit of info while reading about āfoot eversionā and itās role in knee overuse injuries.
Fascinating reading. . .
Iād much rather be looking for movies to steal on the internet than trying to find more information that might help me.
I agree with UniTrac that a professional evaluation is invaluable and I tried to hit that point in my first point, but I only mentioned in passing that a professional could isolate the injury.
Well about time to start my rehab routine for tonight. Iām trying to wrap my mind around the idea of no riding for six weeks in an effort to get better results.
I think itās quite likely that the solution is going to be a lot more simple than getting oneās gait analyzed at a running store or weeks of self-prescribed muscle-building physical therapy.
The OP said the pain only happens in certain situations; I think it will most likely be a simple answer of longer cranks or a raised/lowered seat. The location of the pain that is described reminds me a lot of the pain that I had when I was learning (which was a result of standing up on the pedals too much). It shocked me that I could run long distances consistently with absolutely no knee problems, but learning to unicycle rendered me unable to walk up and down stairs.
@scha6645: I know some people have used brakes as a way to take the pressure off the knees when slowing down, too. Some may see it as a cop-out, but healthy happy joints are priceless, IMHO. Itās something to consider anyway, if you canāt find another solution.
@ezras: If your problems are really that bad, it sounds to me like you should go to a doctor. The problem with the internet is that itās easy self-diagnose (as a runner Iām guilty of this as well), but doing so can really cause more harm than good. Itās especially bad if youāre just starting to get active and donāt yet have any firsthand experience with the particular aches and pains and what they mean. Perhaps youāve developed bursitis in your knee, and a prescription of some time off and a cortisone injection could render you good as new in 6 weeks or so? I donāt know, but I bet a doctor can help. I can say that it will make you feel better to visit a good doctor and get your mind put at ease (as well as get you on the road to recovery). Make sure itās a good sports medicine doctor, though ā preferably one that cycles or runs him/herself, rather than just a general physician. Iām an advocate of sports medicine doctors just because I feel that they āget meā more. YMMV, of course.
Being unable to do what you love is really frustrating.
We have a very good āsportā Ortho in our town (an avid cyclist and amateur racer) but seeing him, and the PT he would most likely refer me to is not in the budget and would have to be a last resort.
I have to exhaust my āhome remediesā before considering seeing a sports injury professional.
The fact that rest brings relief an ability to do daily tasks pain free gives me hope. I know where I still need to improve in flexibility and strength so will keep working in that direction.
I will take a real break from riding, not just a week or riding every third day. Iām thinking 4-6 weeks. Deep inside Iāve known I needed to, and just have avoided admitting it to myself so I could keep riding. The internet is filled of tales of cyclists and runners who finally took a real break from riding and recovered from chronic conditions. I have never been good at that, taking time off for injuries.
As for frustration, I just tell myself that my rehab IS unicycling, itās just not on the Uni. Itās off-season training.
All this all body rehab is helping me in other ways so itās not wasted effort if it doesnāt work.
Iām almost as limber as I was when I was in the martial arts and Im adding more drills from the martial arts as my joint strength improves.Iām also going after some posture issues that I have never really addressed fully.
Iām not out of ideas yet. Im really stepping up my groin and soleus stretching, two ares where Iām still too tight.
