Nagging, Dull Recurring Knee Pain

By Dr. Dorrie Martell | 09/28/11

Pierre Honeyman, “One of these knees” July 18, 2009 via Flickr, Creative Commons Attribution.

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Voler E-mail list member Bernard Hernandez is our 83rd winner of a $20 VeloWear gift certificate! His training question that follows was answered by Dr. Dorrie Martell, a physical therapist, as well as Marilyn Trout's former teammate from Team Ultimate. Winner of the '91 Killington Stage Race, a '95 New England TT Champ, and 2nd place finisher in both the '97 NE District Road Race and Mt. Washington Hill Climb, Dr. Martell is an experienced cyclist, and an accomplished physical therapist as well. She received her Master's degree in Physical Therapy in 1993 and a Doctoral degree in Physical Therapy in 2007, both from the University of Massachusetts. Dr. Martell is passionate about helping others through education and hands on healing.

Nagging, Dull Recurring Knee Pain

Hi Coach,

I have a question related to a nagging/dull knee pain that I had been experiencing in the past and now again recently. My left knee has been aching after long rides, usually after my weekend group rides that involve hills and some accelerations. Normally during my shorter rides of 20-25 miles during the week, I do not experience this dull ache in this knee.

I have never had a MRI on this knee, to help determine the condition of the meniscus tissue in the knee - in case there is a tear. But I really do not suspect a tear there, because when I try to move the knee cap around, there seems to be some rough/scraping feeling in there. And to me, it feels like that is the area where that dull pain is coming from. I have read a little about persons with knee tendinitis problems, I would like to know if you can recommend some exercises that would benefit my condition with my left knee to alleviate this dull aching pain that I have been experiencing recently.

I usually can relief most of the pain with ice-therapy after those long rides, but when I can't apply the ice after some of those long rides, then the dull ache could/has lasted all day.

Thanks for the help with this Coach,


Your subjective complaints of pain and discomfort under the kneecap sound like Chondromalacia. This type of knee pain often increases with stairs, cycling, running, jumping, getting out of a chair or when participating in other activities that put weight on the knee. You may notice a grinding feeling and/or sound when you try to straighten your knee. And as a result of the inflammation you may notice some swelling.

Normally in the knee, there is smooth cartilage enabling the femur (thigh bone) and the patellar (kneecap) to glide smoothly over one another. Sometimes this cartilage becomes irritated or damaged and begins to deteriorate. This is what happens in chondromalacia. The cartilage can become irritated or damaged by regular wear and tear or by repetitive trauma. In a sport such as cycling, some cyclists may be more prone to chondromalacia because of an imbalance in the hip, knee, foot or core musculature. Muscle imbalances in strength and/or flexibility can cause the kneecap to not track in good alignment. Since cycling is repetitive in nature, the normal wear and tear process is accelerated.

I recommend consulting with an orthopedic physical therapist that is trained in manual therapy and has experience in core stabilization strengthening exercises. This healthcare practitioner is trained in evaluating the musculoskeletal system and can detect subtle imbalances that could be contributing to your symptoms. Additionally, it would be beneficial if you had a professional bike fit done. Improper positioning of cleats, seat height or forward/back placement can contribute to the imbalance. Lastly, assessing your training and determining if it is a balanced program both on and off the bike are a must.

Treatment for chondromalacia would initially begin with rest, anti-inflammatory medication and cryotherapy (ice) to reduce the pain and inflammation. A physical therapist may initially use ultrasound or electrical stimulation to decrease inflammation in the cartilage and surrounding tissue. Once the inflammation has been reduced, light aerobic exercise such as easy cycling, will facilitate healing to the cartilage and nourish the muscle tissue through increased blood flow. This will prepare it for specific strengthening exercises aimed at correcting the imbalances. Core strengthening exercises in combination with specific lower extremity exercises would also be helpful in improving the patellar tracking.

Dr. Dorrie

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