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Old 08-08-2017, 07:42 PM
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metalheart metalheart is offline
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Popliteus Muscle/Tendon Issue

Anyone had a problem/solution for Popliteus tendon issues?

Short version: Following total knee replacement 8/2015 slowly began ramping up miles in 2016. Increased intensity (climbing and flat speed) about 8/2016 and soon began having sharp pains on the outside of of the left knee with soreness and loud snapping in the area of the outside of the knee. My self-diagnosis was IT band problems. Did multiple rest, ice, elevate sessions over the past year, but each time the problem recurred when I increased intensity.

I adjusted saddle height and fore-aft position multiple times and did some insole inserts in my left shoe. Problem persisted. A month or so ago, had a RETUL fit and seat height was raised and adjusted forward, shim inserted into left cleat, and cleat position adjust so foot is more toward the pedal (Speedplay Light Action).

Saw the ortho-doc today who diagnosed problem as the Popliteus tendon moving over the metal part of the prothesis and getting irritated. He suggested moving cleats opposite from position while problem was occurring and seeing if the pain persists. The fitter did this in the fit session since my cleats were as far outboard as possible. So, if the adjusted cleat position does not solve the problem, then a cortisone shot, and if that does not work, then surgery to fix it, which he says will work. I am not keen on another surgery.

I'm visiting the physical therapist tomorrow to see what I can do on that end, but I'm curious if other cyclists have had any issues with this muscle/tendon and if so how or if it was resolved. Thanks....
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Old 08-10-2017, 06:16 PM
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metalheart metalheart is offline
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I spoke with the Retul fitter and another fitter for whom I have the greatest respect but he is not local to me as well as the physical therapist and here is a summary of some of the advice I received

(1) varus wedge under the Speedplay cleat to address rotational issues in the foot.
(2) move the x axis of the cleats to the center position.
(3) The RETUL fitter suggested cleats with less float whereas the other fitter suggested not changing cleats until varus wedge is tried with the addition of exercises to work on hip flexors, quad strength, and glute strength.
(4) be prepared to lower the saddle in small increments if the wedge and the PT work is not resolving the problem
(5) PT suggested stretching and strength work for hip flexors and specific exercises for the popliteus muscle, split squats for the quads, a couple exercises for gluteus strength, and if those efforts are not productive then the next step is Graston technique deep massage.

I have an appointment in a month with another sports ortho doc for a second opinion about the diagnosis and any possible solutions he might suggest. IN the mean time I am going to increase mileage and intensity, but I'm prepared to back off if there is any further sign of pain and soreness. I would rather ride at lower intensity than not ride at all......
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Old 08-27-2017, 11:31 AM
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metalheart metalheart is offline
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I have increased mileage and intensity in relatively small increments. I did a 50 mile ride at a modest pace with about 1k of elevation gain and experienced to pain during the ride, but afterwards I had definite tenderness in the back of my knee in the vicinity of where I believe the popliteus is located.

In response to the tenderness I lowered saddle height by 2.5 mm and after a day off did another easy 40 miles. No tenderness during or after the ride.

I did a couple of short rides with more elevation gain and some 12-15% grades included. I did a spin up a couple and then used a bit harder on one to test the effect of harder but limited effort. Although I experienced no tenderness, the popliteus tendon did start snapping more often.

Report all of this to the PT and the plan is to increase strength efforts for hamstrings and glutes and Gaston technique massage (ouch) on the popliteus and surrounding muscles.

The strength and massage work cannot hurt and I plan to continue gradual increases in intensity and distance, but I am a bit discouraged since I see this as going toward a surgical solution.

In a long discussion with the PT about his experience with knee replacement patients, his observation is that full recovery often takes longer than a year and that my increase in mileages and intensity post knee replacement was too much too soon. I thought I was being conservative, but I guess one lesson for others knee replacement cyclists is that it may take longer than you think to pre-surgical mileage and climbing.
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