Weird knee problem, advice for a broke college student?

[petereps]

Thanks for all the suggestions guys.

A little backstory before my update:
I trained for half a season with no problems before seeing a really well regarded fitter for a 4 hour session that tweaked a lot about my position. Including but not limited to a tad lower seat, shims on my left foot for discrepancy, and spacers at the pedal spindles to widen my stance a bit. I continued the season training a ton and was more comfortable than ever. Towards the end of the season I sold this bike and set a new one exactly as before, taking longer cranks (2.5mm) into account. But I also got new shoes, and was unable to replicate the cleat angle, so I just kinda did what felt right. I then experienced minor pains in my left leg so I went to this new fitter to get a different opinion. All he did was lower seat height 5mm and adjust my left cleat more toe in than before. I then continued to train for about 2 weeks with 0 pain and felt great. Took 2 weeks off, then 2 days of training and bam knee pain. Hope that clears some things up.

Today on my ride it started fine but the pain got worse and worse. I thought why not try to replicate my fit BEFORE the very first fit from the new fitter as mentioned above. I raised the seat ~6mm and slid the cleat all the way in, giving my foot room to bring my heel in without hitting the crank arm. This seemed to help a lot, as the pain disappeared for awhile. After my ride its a bit tight. So my final thoughts are: Overuse with a mix of too little float, too low a seat. So I think I just need to ramp up slower, leave my cleat with room to pedal toe out. That fix seems a little more logical, given too low a seat is common to cause kneecap pain. And a cleat angle that restricts the foot from moving heal in would cause outer kneecap pain. I might get a second opinion from a different fitter, just really don't wanna spend the money. I'll see if this fixes it for good first.

[grover]

I might be harping on the same stuff. But if you like toe out it's likely that your preference is to pedal in relative external rotation of your hip. This shortens the glute muscles that ITB attaches to and is likely to decrease a lateral (outside) tracking bias of your patella. Forget the foam roller. You need a spikey/squash/tennis ball and release your glutes.

Something like this.
https://www.youtube.com/watch?v=TmrtgSqfIiI

Speedplay with lots of float will be nice in this early phase so you know that your leg has room to rotate to where it needs to be. You should be able to tighten up the float as you improve though (if you can't get used to the skatey feeling).

PS raising your seat would have helped as it decreased the length required of the glutes, which decreases tension through ITB.

[alcatraz]

I don't understand how a few mm of seat/cleat position can make that much of a difference.

A healthy person doesn't have the kind of pain you describe and they sometimes have horrible fitting setups. I'd focus more on trying to get to the bottom of the cause rather than trying to search "the needle in the haystack" with going a few mm here and there. All that does is postpone the pain a bit. Sure you can use the pain to optimize your setup but it will never treat and cure the pain. Seems a bit feeble putting too much hope in that..

When you do stretching exercises, are you not able to reproduce the pain/tension in the same area where it appears when biking? I'd focus on trying to reproduce that in your living room and then doing that exercise in a focused and controlled manner for 90 seconds before the ride. There should be some significant pain when you hit the sensitive area and then lean patiently and firmly on it for a looooooong time. Did I say long? I mean loong!

Have you done an xray yet to exclude like "disc" punctures and that sort of thing?

/a

[TheDarkInstall]

Deep stretching, and muscular release sorted me out when I had the same issue.
I

[Mr.Gib]

Do a search in this forum for Patella Femoral Syndrome. Even if that is not your problem, the physiotherapy protocol for dealing with it is helpful for most athletes regardless of the condition of their knees.

[petereps]

I might be harping on the same stuff. But if you like toe out it's likely that your preference is to pedal in relative external rotation of your hip. This shortens the glute muscles that ITB attaches to and is likely to decrease a lateral (outside) tracking bias of your patella. Forget the foam roller. You need a spikey/squash/tennis ball and release your glutes.

Something like this.
https://www.youtube.com/watch?v=TmrtgSqfIiI

Speedplay with lots of float will be nice in this early phase so you know that your leg has room to rotate to where it needs to be. You should be able to tighten up the float as you improve though (if you can't get used to the skatey feeling).

PS raising your seat would have helped as it decreased the length required of the glutes, which decreases tension through ITB.

This is all a bit over my head since I never spent the time to research muscle groups but I think you're right. Just got back from a sports therapy massage and the guy said I have some of the tightest leg muscles he's ever seen. Said specifically my glutes, quads, and hamstrings were crazy tight and likely caused the knee issue. I feel a bit better after, but not riding til tomorrow so that's when I'll really see. Thanks for all the help grover.

I don't understand how a few mm of seat/cleat position can make that much of a difference.

A healthy person doesn't have the kind of pain you describe and they sometimes have horrible fitting setups. I'd focus more on trying to get to the bottom of the cause rather than trying to search "the needle in the haystack" with going a few mm here and there. All that does is postpone the pain a bit. Sure you can use the pain to optimize your setup but it will never treat and cure the pain. Seems a bit feeble putting too much hope in that..

When you do stretching exercises, are you not able to reproduce the pain/tension in the same area where it appears when biking? I'd focus on trying to reproduce that in your living room and then doing that exercise in a focused and controlled manner for 90 seconds before the ride. There should be some significant pain when you hit the sensitive area and then lean patiently and firmly on it for a looooooong time. Did I say long? I mean loong!

Have you done an xray yet to exclude like "disc" punctures and that sort of thing?

/a

Can't replicate the pain/tightness off the bike. Just got back from a sports massage therapist and said that I have really tight muscles causing the knee to be overused (or something to that manner, was a bit confused). Either way I think you're right that bike fit isn't the root of the problem. Going to start stretching as much as practical as it seems to help. Thanks.

[grover]

I doubt you'll be able to replicate it off the bike. What I'm thinking of is an irritation of the interface between the patella and the femoral groove it slides in as the patella is tracking off to one side or tilted. If it gets worse you may be able to reproduce it off the bike with repetitive deep squats or doing lots of stairs. This type of pain would not be reproducable with static stretching, there needs to be movement of the knee joint.

[petereps]

I doubt you'll be able to replicate it off the bike. What I'm thinking of is an irritation of the interface between the patella and the femoral groove it slides in as the patella is tracking off to one side or tilted. If it gets worse you may be able to reproduce it off the bike with repetitive deep squats or doing lots of stairs. This type of pain would not be reproducable with static stretching, there needs to be movement of the knee joint.

He said something about tension or irratation where the patella connects to the shin. So sounds like this is it. What's your opinion on training through this? Hasn't been getting worse, so I assume its fine. In fact seems like it should be gone within the next couple days.

[grover]

Tension where the patella attaches to the shin sounds more like Patella tendon. Different to what we're talking about. Pain would be more below patella rather than to the outside of it. However it often occurs if your seat is too low or too far forward...and raising your seat helped. Either issue can be very hard to get rid of if you don't nip it in the butt early.

You need to stop and let it rest if
- it gets worse
- it is still limiting your riding and not getting better
Keep going with the loosening stuff of glutes/hamstrings/quads/calf during this time

I'd keep going if
- it was slowly getting better
- it was not limiting my performance

Most people will experience patella tendon pain or medial/lateral discomfort every so often on the bike. Usually when it's colder and the tissues are stiffer. I know I do. It doesn't limit me, but it doesn't have to get too cold before I wear knee warmers and that'll be the difference between a comfortable ride or a bit of knee discomfort.

If it's not too warm where you are now maybe wear knee warmers, see if it helps. Or roll around on a tennis ball in your glutes pre-ride. Try one thing each ride and see what works.

[petereps]

Tension where the patella attaches to the shin sounds more like Patella tendon. Different to what we're talking about. Pain would be more below patella rather than to the outside of it. However it often occurs if your seat is too low or too far forward...and raising your seat helped. Either issue can be very hard to get rid of if you don't nip it in the butt early.

You need to stop and let it rest if
- it gets worse
- it is still limiting your riding and not getting better
Keep going with the loosening stuff of glutes/hamstrings/quads/calf during this time

I'd keep going if
- it was slowly getting better
- it was not limiting my performance

Most people will experience patella tendon pain or medial/lateral discomfort every so often on the bike. Usually when it's colder and the tissues are stiffer. I know I do. It doesn't limit me, but it doesn't have to get too cold before I wear knee warmers and that'll be the difference between a comfortable ride or a bit of knee discomfort.

If it's not too warm where you are now maybe wear knee warmers, see if it helps. Or roll around on a tennis ball in your glutes pre-ride. Try one thing each ride and see what works.

Yea I'm thinking its the patella. The pain/tightness is below the knee cap, not really to the outside. Sorry if that was unclear. Did two 4 hr z2 days back to back and seems to hurt worse now. I think I'll just completely shut it down for two weeks and focus on stretching. Would rather be a little less fit than cause a worse injury. Thanks for all the help grover, really appreciate it.

[F45]

Having gone through achilles and patellar tendonitis, here's what I would do: Stop exercising and rest it. Look on youtube for someone who is really passionate about fixing this problem. I found a few videos on how to get over the tendonitis and it worked perfectly. Also I learned what really happened - I worked hard on those areas when dehydrated.

[gtinut]

I had knee pain some time ad and was caused by overtraining
Cycling needs to be supplemented with additional training.
I was instructed to bring back balance to my knees by adductor and abductor training on "girly machine"
After many weeks of work, issue was resolved but your issue might be different (I did not read everything that was posted)
I saw three doctors prior to modified training. Frist requested MRI and told me I need surgery, second looked the results and said the same.
After asking around I found doctor who is triathlete and ironman competitor who told me " your knees are fine, you have to see my knees"
This was over three years ago surgery free and training much harder, raced over dozen of MTB and many CX races.

[petereps]

Update:
Continued training through it and never got that much worse, but definitely never got better. Saw an ortho and he said it looked fine and to listen to my body (ie rest if it gets worse). I decided to pay up and get a second opinion on my bike fit (Nate Loyal, well known in SoCal). And he said my seat was over 1.5cm's too low. This makes sense since front of knee pain is usually from too low a seat, I guess I just trusted my last fitter too much. First ride with the new seat height the pain never came, but after an hour my hamstring was killing me, so since then I've had to drop it ~7mm's to not get the hamstring pain. I think my legs are jacked from a low seat height for years, so now I'm working on hamstring flexibility to be able to ride at the correct height. I think finally after 2 months the issue is on its way out so I'm a happy camper. Side note: anyone else experienced this pain when adapting to new fit? Part of me thinks the seat height he set was a bit high, but not sure if its just part of adapting. Thanks for all the responses everyone.

[TheKaiser]

Update:I think my legs are jacked from a low seat height for years, so now I'm working on hamstring flexibility to be able to ride at the correct height. I think finally after 2 months the issue is on its way out so I'm a happy camper. Side note: anyone else experienced this pain when adapting to new fit? Part of me thinks the seat height he set was a bit high, but not sure if its just part of adapting. Thanks for all the responses everyone.

Sounds like you are on the right track, and that is great that you are working on flexibility as part of your new position. Regarding your side note, there is "good pain" and "bad pain" and every once in a while it can be tough to distinguish between the two. When adapting to a new position, some discomfort that is simply from working muscles in a new way would be "good pain" but discomfort from the new position due to it being biomechanically incorrect would be "bad pain". Many fitters suggest that you do 4ish weeks of easy riding in the new position to help the muscles adapt to the new movement pattern without challenging them with high loads, which can confuse the diagnosis of any discomfort that appears.

[petereps]

Update:I think my legs are jacked from a low seat height for years, so now I'm working on hamstring flexibility to be able to ride at the correct height. I think finally after 2 months the issue is on its way out so I'm a happy camper. Side note: anyone else experienced this pain when adapting to new fit? Part of me thinks the seat height he set was a bit high, but not sure if its just part of adapting. Thanks for all the responses everyone.

Sounds like you are on the right track, and that is great that you are working on flexibility as part of your new position. Regarding your side note, there is "good pain" and "bad pain" and every once in a while it can be tough to distinguish between the two. When adapting to a new position, some discomfort that is simply from working muscles in a new way would be "good pain" but discomfort from the new position due to it being biomechanically incorrect would be "bad pain". Many fitters suggest that you do 4ish weeks of easy riding in the new position to help the muscles adapt to the new movement pattern without challenging them with high loads, which can confuse the diagnosis of any discomfort that appears.

Not sure how to distinguish if it's a good or bad pain. Comes on after a couple hours, then goes away pretty quick if I drop the seat a few mm's, and doesn't return. Seems like it is just adapting to a newer position. I also drop my heals a ton (probably due to low seat height) so the "correct" seat height might be too high if I drop my heels, so working on that as well.