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Advice on large Q-factor and knee tracking
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Hello,

I am hoping I can tap into the expertise on this forum, as I have just started doing bike fits and getting more questions than answers.

I recently did a fit for a female triathlete on a road bike (Specialized Dolce) and was struggling to make the correct decision on medial/lateral placement of cleats or use of spacers.

The lady in question has a large q-angle: very broad hips and thighs deviate medially. Legs are straight. With a laser beam on the second ray it's near the ASIS but the knee tracked within the beam and medially on the power phase of the pedal stroke.

Left leg: On moving the cleats back (for other reasons) the knee, at TDC was on the laser line then moved in medially on the power phase. Does that mean no more action needs to be taken and alignment achieved? No mention of this scenario in Paul Swift's excellent "When the Foot Meets the Pedal…" manual.

Right leg: Knee was closer to the main frame of bike at start, though no indication of hip rotation on saddle. Cleats also moved back (for other reasons) but no real change to initial tracking. Moving cleat outward would possibly make the knee hit top tube of bike. Also rider getting lateral knee pain, location above knee joint indicative of ITB friction syndrome. So moving foot in would make this worse. Rider has very hypertonic glut medius and minimus making her lateral hip very sensitive to touch (receiving sport massage therapy put not from me). It was a lot easier to palpate for the greater trochanter on the right possibly suggesting internal rotation at the hips? ITB is tight too, so could be just because of this. What intervention, if any, would any of you consider? (ps: no LLD, no need for wedges, SOLE insoles used).

Your thoughts and ideas would be greatly appreciated.

Thanks,
Alexander

Serotta Advanced and Advanced Triathlon
Retul Certified in 2011
Qualified sports massage therapists
Last edited by: SteelAl: Feb 10, 15 1:38
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Re: Advice on large Q-factor and knee tracking [SteelAl] [ In reply to ]
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Hey Alexander, only just today read your question.
More questions for you:
What pedal system and shoes?
History of rider - pain? numbness? What solution are you attempting with all of this?
In regards wide Q angle and When the Foot meets the Pedal - Paul would say 'put the pedal under the foot'
A photo would be most helpful

Anne Barnes
ABBikefit, Ltd
FIST/SICI/FIST DOWN DEEP
X/Y Coordinator
abbikefit@gmail.com
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Re: Advice on large Q-factor and knee tracking [ABarnes] [ In reply to ]
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Medial knee tracking is a result of mid-tarsal joint (mid foot joint) pronation, or forefoot varus. As in Paul's Shoe/Pedal Interface course, put a wedge in to accommodate the forefoot varus will stop the knee from diving in toward the frame. You will have to measure the varus and use half of that number to wedge (once again, via Paul's course).
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Re: Advice on large Q-factor and knee tracking [djcotner] [ In reply to ]
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Cheers for this. When I next see her I will check forefoot varus.

However still confused about correct medial/lateral foot placement. See response to Anne's post below

Serotta Advanced and Advanced Triathlon
Retul Certified in 2011
Qualified sports massage therapists
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Re: Advice on large Q-factor and knee tracking [ABarnes] [ In reply to ]
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Hi Anne,

Thanks for responding and sorry for the delay in replying.

Q1.: Pedals Look Keo Classics and Shimano WR60 shoes.
Q2.: Riders gets numbness in both feet, though develops in left foot first soon after the ride begins. Starts at the centre of the ball of feet. She also has the issue already mentioned with the right hip abductors, and lateral knee pain above the right knee. So what I am trying to do is stop both foot and knee pain. Obviously also improve power transfer etc.

I will check forefoot varus and possible use of wedges when I next see client. Obviously this would have impact on forefoot numbness in both feet. However I am ideally looking for clarification on medial/lateral foot placement in relationship to my finding. Having re-read my post I didn't make this clear. I'll try again:

With the laser on the 2nd toe, the knee tracks inside the laser line (between 2nd toe and bike frame). Initially it was doing this at TDC and BTC. When I moved the cleats back on the left foot at TDC it was on the laser line (toe line). Paul's says the "knee near the top of pedal stoke is the driver" - so my understanding is that with the left foot, as the knee line and toe line meet at TDC med/lat placement is correct and no further adjustment needed. Correct?

The left knee then tracked towards the frame and, as djcotner has pointed out, I need to look at forefoot varus for this.

Now having re-read Paul's book an error in my assessment may have been viewing the tracking head on when the client has naturally externally rotated feet. This would in hindsight obviously cause the knee to track inside the toe line. However I don't quite understand Paul's explanation for dealing with scenario: Does he mean not use a laser at all when viewing from an angle? And if so what are you looking at/for when viewing from an angle?

Cheers

Serotta Advanced and Advanced Triathlon
Retul Certified in 2011
Qualified sports massage therapists
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Re: Advice on large Q-factor and knee tracking [SteelAl] [ In reply to ]
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Does the rider have any complaints/symptoms that you feel are related to knee tracking?
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Re: Advice on large Q-factor and knee tracking [davidkohli] [ In reply to ]
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No necessarily, though the lateral right knee pain might be partially caused by the q-angle, however I think other factors associated with hip dysfunction are contributing

Serotta Advanced and Advanced Triathlon
Retul Certified in 2011
Qualified sports massage therapists
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Re: Advice on large Q-factor and knee tracking [SteelAl] [ In reply to ]
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Sounds like you need spacers - http://bikefit.com/...ex-spacers-20mm.aspx

Swifty

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Re: Advice on large Q-factor and knee tracking [SteelAl] [ In reply to ]
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Is the Tailis in Subtaylor Neutral consider a foot orthoses . Control the foot in the shoe then then shim.
If the foot collapses in the shoe shimming will not solve the problem.

Happy
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