Knee Pain After Bicycle Fall: Potential Injuries and When to Seek Help

Falling sideways while riding a bicycle and impacting the knee?

Hello Doctor, at the end of February, I was riding my bicycle and lost focus, causing me to tip over.
At that moment, my left knee struck the ground, resulting in superficial abrasions and severe pain.
I was able to walk home by myself, but the next day the pain worsened.
Walking or bending my knee caused discomfort, although I could fully extend it.
After resting for a few weeks, my condition improved significantly.
Now, I can pedal my bicycle and walk normally without discomfort, and I can also stand on my left leg.
However, occasionally, my knee experiences a sensation of warmth and swelling, especially upon waking.
Applying heat helps alleviate this sensation, and there are no noticeable painful points or swelling upon touch.
However, I still experience significant pain when performing the frog kick in swimming, and there is discomfort when bending my knee to its maximum flexion (such as squatting, kneeling, or bending while standing on one leg).
The pain is particularly noticeable when my ankle is straight and my knee is bent, limiting me to about 90 degrees of flexion before pain occurs.
The discomfort primarily arises during additional or sudden exertion.
Although I feel that I am improving and it doesn't seem very serious, I would like to ask the doctor which part of my knee might be injured.
Should I still consider seeking medical attention?

Mr. Zhang, 20~29 year old female. Ask Date: 2021/03/31

Dr. Chen Yongxue reply Orthopedics

Hello, the structure of the knee joint is quite complex and its functionality is high.
If appropriate rest does not lead to improvement, it is advisable to seek medical attention.
Thank you.

Reply Date: 2021/03/31

More Info

After a bicycle fall, experiencing knee pain can be concerning, especially when the pain persists or fluctuates over time. Based on your description, it seems that you may have sustained some form of injury to the knee, even if the initial assessment did not reveal any fractures or severe damage.

Potential Injuries
1. Soft Tissue Injuries: The impact from the fall could have caused damage to the ligaments, tendons, or cartilage in the knee. Common injuries include:
- Patellar Tendonitis: Inflammation of the tendon connecting the kneecap to the shinbone, which can cause pain during activities that involve bending the knee.

- Meniscus Tear: The meniscus is a cartilage that acts as a cushion between your thigh bone and shin bone. A tear can occur during twisting motions or heavy impact, leading to pain, swelling, and difficulty bending the knee.

- Ligament Sprains: The knee has several ligaments (ACL, PCL, MCL, LCL) that can be sprained during a fall. A sprain can cause pain, swelling, and instability.

2. Bursitis: Inflammation of the bursae, small fluid-filled sacs that cushion the knee joint, can occur after trauma. This can lead to swelling and pain, especially when bending or putting pressure on the knee.

3. Contusions: Direct impact can cause bruising of the soft tissues around the knee, leading to localized pain and swelling.

Symptoms to Monitor
- Swelling and Heat: The fact that you experience swelling and a sensation of heat, especially upon waking, suggests that there may still be some inflammation present. This is common in soft tissue injuries.

- Pain with Specific Movements: The pain you feel during activities like swimming (frog kick) or when bending the knee indicates that certain structures within the knee may still be irritated or injured.

- Range of Motion: Difficulty bending the knee beyond 90 degrees can indicate stiffness or a more significant injury that may require further evaluation.

When to Seek Help
Given your symptoms, it would be prudent to consult a healthcare professional, particularly an orthopedic specialist, for a thorough evaluation. They may recommend imaging studies such as an MRI to assess for any soft tissue injuries that may not be visible on X-rays.

Recommendations
1. Rest and Ice: Continue to rest the knee and apply ice to reduce swelling, especially after activities that exacerbate the pain.

2. Physical Therapy: Engaging in physical therapy can help strengthen the muscles around the knee and improve flexibility, which may alleviate some of the pain and improve function.

3. Avoid Aggravating Activities: Until you have a clearer understanding of the injury, it’s wise to avoid activities that put excessive strain on the knee, such as deep squats or high-impact sports.

4. Pain Management: Over-the-counter pain relievers (if not contraindicated) can help manage discomfort. However, consult your physician regarding any medications, especially if you have allergies or other health concerns.

Conclusion
While it’s encouraging that you are experiencing improvement, the ongoing symptoms you describe warrant further investigation. Knee injuries can sometimes lead to long-term issues if not properly addressed, so seeking medical advice would be a proactive step in ensuring a full recovery.

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