Knee pain - Kill blow!?

Discuss light weight issues concerning road bikes & parts.
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by wingguy

I’m not convinced it’s likely to be ITB. The marked Xs look a little too high up, ITB will be right at the middle of the side of the knee. Of course the pics aren’t entirely reliable - a basic rule of thumb test for me is if a symptom is that if you can’t walk downstairs normally after a ride (there’s a real specific jabbing pain in the side of the knee when you bend your weighted leg) then it’s ITB.

Otherwise if the pain is higher, like in the outside top half of the kneecap, then it could often be a slightly too high saddle (leg length or flexibility discrepancy making it manifest on one side only) or a clear position angling the toes too far in.

Obvs this is not based on any observations of you riding, so take it for what it’s worth. Which isn’t much :P

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by spartacus

Try riding a casual bike with flat pedals

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by addictR1

Wheelsonfire: where are you located? If in the states, search for physical therapist based bike fitter.

A buddy of mine is a PT and he fitted me on my bike that was giving me all kinds of issues, from numb balls, knee pain, back ache, wrist pains, the whole enchilada. After he fitted me, I was good to go anytime at any distance. But too bad he moved out of state so now I’m trying to find another good fitter or fly my bike there for a fit.

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by alcatraz

When I had knee pain that I let develop quite severely I noticed there was one important upside.

As I was trying different stretching exercises I could feel when I hit a sensitive spot. After finding what exercise best covered the spot I just focused on that for about a week and the relief was amazing.

The stretching was so painful it'll bring tears. I think that means you're doing it right...

I used to do 60-90 seconds in each spot.

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by rpowell

i purchased new shoes once and the additional stiffness of the shoe stopped allowing natural heel float and caused quite a bit of pain. did you make any changes to equipment or fit? any small crashes?
i ended up just using flat pedals for a month until it healed and went to cleats with more float.

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by knightskid

Not sure is it related to your knee problem as shown in this video whom the guy talk about cleats positioning.

By the way, i post it, is due to his video i found few days ago when trying to solve my hand numbing problem, and manage to solve it by fitting myself based on his video.

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by Djakninn

Yeah, you can't stretch the IT band (that's why i noted in my other post not to foam roll it either), but you can stretch the TFL that attaches to it, and the hip flexors and the glutes and the....well you get the point.
Everyone should do some type of stretching everyday if they're active and want to stay active - 20 to 30 mins everyday is nothing. Sure you'll get folks that say that they've never stretched and they're ok, but i'd rather spend a bit of time to keep myself from having to stop doing things should a niggle raise it's head. Also, if you do a bit everyday and you do get a bit tight, a little bit extra on the affected part for a day or 2 usually puts it to bed.
Also, as far as any PT i've had, strengthening is always done after you have got rid of the pain.

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by 939

I had serious knee issues before, they were mainly due to bad cleat placement. Moving the cleats towards the back of the shoe (almost 1 cm) in my case solved them permanently.
My advice is twofold:
- Move cleats back of course (their center should be a few mm behind the round bone at the bottom of your foot)
- Make sure your fit is within all the measurements as per:

The above fixed everything immediately.

Good luck.

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by wheelsONfire

From what i get here, is a too fast going higher saddle height. This is the time when i got knee pain. It kind of started off feeling superb, but after awhile it felt like i was off-tracking. From knee to foot was off. As i was out riding, without tools i ofcourse biked home.
(Possibly it began here.)
This is the only thing i can see right now. In the past, i haven't been having issues with things like this.
Only issue i had in the past was perineum pressure and rear back pain.
Why did i even lift saddle, i was feeling i didn't take stance from saddle.
Maybe this was the start off something, it would seem like it.
Also, during winter when i rode trainer only, i had quite much setback.

First thing i have yet to grasp is if i should keep off working muscle on this leg and region until it feels good doing so?
TP told me i should go for training. It feels like it's a bad idea (listening to body).
Don't know about the stretching part.
Maybe i should for a second opinion at somehwere else?

What annoys me mostly is that i actually don't know what the issue is to 100%. Now it's several ideas which all have a point.
Second and what seems reasonable, is going back to a position that didn't cause an issue.

I am well aware of the consensus - go to a bike fitter..

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by dricked

When you move the saddle up it also moves back which is what causes me knee pain.

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by corky

Cleats?....loadsa probs can be traced to poorly placed cleats. Try them right back, then fully left then right....... Do you walk like a duck?, heels in.....or like a pigeon, heels out......if so your cleats should mimic this orientation.

Adjusting cleats costs nothing except,time....... good luck

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by RocketRacing

I figure i have vastis medialus imbalances.

I have developed R medial knee pain. Nothing serious yet. But man does my knee click with every extension of my knee (i can palpate it). It is painless, but after a long ride i feel it as a general pain behind my patella, mayne more medially focused.

If i pont my toes down during the pedal stroke, the click goes away.

I am also looking into a foot assessment as my midfoot over pronates on the rright side, and my arch seems to be flattening. Until then i have added more arch support to my shoes:
Mr.Gib wrote:
Mon Apr 29, 2019 4:43 pm
The two most common problems that may include the symptoms you describe are Patello Femoral Syndrome (PFS) and Illeotibial Band Syndrome (ITBS)

Ryan gives an appropriate description of the latter, but I will add that it is not wearing of the underlying tissue, but rather irritation. There is a tiny area of highly innervated tissue that sits behind the femoral epicondyle that can get irritated and send pain messages to the brain. Usually the pain appears at the side of the knee but it can also extend down the lower leg into the tibialis anterior. Sometimes conservative therapy (physio, stretching etc.) can work but if it does not, surgery is the way to go. The surgery is very simple and has a success rate as close to 100% as is possible for any surgery. It involves cutting a small triangle out or the posterior of the IT band and simply removing the irritated tissue. I have had both knees done - riding in 3 weeks, back to 100% in 7 weeks. Many world class runners have the surgery profilactically so they don't run into problems in an olympic year. Common in runners, less so in cyclists. Make sure your saddle is not to high or too far back.

PFS, now this problem can be a bitch. The symptoms can be almost anything and appear almost anywhere on the knee. Most common is aching of the knee cap area (like it's bruised) and sharper pain in the upper lateral quandrant of the patella. But also the medial side and back of the knee can be painful. The cause is typically dominance and tightness of the lateral quadraceps muscles group and lateral patella connective tissue, and weakness of the medial quad muscles (vastus medialis). The solution is lengthen and soften everything lateral, and strengthen everything medial. The knee cap must float naturally in the groove in which it resides during quad contraction and not be pulled to the lateral side by tight muscles (the cause of the pain). The only solution is physio - surgery is never be an option for PFS (despite what some surgeons may suggest). The problem is you need a really good sports med clinic that really knows their PFS treatment - not enough do. Some of the exercises are not so obvious and yet they are critical. For example here is a link to a medical paper on the impact of the mobility of the patella: ... Ironically, people with PFS are more comfortable with a higher saddle.

But be open minded to other problems as well. See a good sports medicine specialist, preferably one that rides a bike and get a good diagnosis. Try to stay optimimistic. Amazing recoveries are possible. I have had both the afflictions to the point where I was literally unable to walk, and yet over the last three days I have ridden 730km. Everything is possible.

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by Mr.Gib

RocketRacing wrote:
Tue Apr 30, 2019 3:48 pm
But man does my knee click with every extension of my knee (i can palpate it). It is painless, but after a long ride i feel it as a general pain behind my patella, mayne more medially focused.
That click is likely the patella settling into the proper position during extension after hangin a bit on the lateral side of the petallar groove at the end of the femur. You don't want to ride with the click - that can lead to long term damage. There is a physio protocol that can help if this is indeed your problem. You must lengthen the lateral and strengthen the medial.

I start every ride by grabbing my left quad and twisting it over to the medial side. This will cause my patella to make a loud snap as it settles into the correct position. Once there, my knee is good all day.
wheelsONfire wrote: When we ride disc brakes the whole deal of braking is just like a leaving a fart. It happens and then it's over. Nothing planned and nothing to get nervous for.

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by mogwaiboi

I've had patella pain in my left knee for over 2 years now, and tried every sigle stretch and foam roll massage known to man. Saw a physio for a while who did an average at best bike fit which didn't help at all. At it's worst it would occasionally click after or during a ride, sometimes followed by a very quick sharp pain. It was a constant dull ache under my knee cap, and only really aggravated by cycling. I recently had my cleats and position checked by Ken Ballhaus (who r33prman mentioned) so that was some peace of mind knowing at least my postion was dialled and my seat height was right on the highest limit. He had me switch to 165mm cranks which hasn't really helped the knee pain but is better suited to my physiology. The one stretch that has brought about some improvement lately is the hip flexor lunge stretch. Holding that deep strecth initally for 2 minutes was painful, but after 3 weeks or so it doesn't hurt as much and it has definitely helped. I tried all sorts of other hip flexor stretches but they didn't do jack s@#t. Whenever I tried to stretch my quads it seemed to aggravate the patella issue, so I stopped them. Also the glute / IT band stretch lying on my back with left leg crossed over right seems to help, and one leg squats to try and make sure I keep up the strength and balance of the muscles on that side.
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by AJS914

I had similar off the bike patella pain. I self diagnosed it as "Chondromalacia patellae". I fixed it by doing circuit training at the gym. For me, I think it's a muscle imbalance since cycling mostly works the front side and over-develops the quad relative to the hamstrings and gluts.

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