Do you have pictures and or video from the front?
Hard to discern anything about bow legs from a side shot.

It does look like saddle is too far forward- It is also possible that the long and low stem is pulling you more forward.
It looks to be an aggressive stem angle- More that 6 degree? And long length?

Possible cleats are also too far forward on shoes.

Do you have good arches in your feet? Do they hold their shape?
Any supportive insoles? More or different than stock?
Any wedges under cleats?
Are feet wide or narrow on the pedals?

Where do you live? Sounds like you should find a new fitter if yours is confused by this.

Its hard to say too much, because it sorta depends on what your diagnoses are (side knee pain, front knee pain). The side could be IT band, but it could be something else. Same story for the front of the knee...could be several things. The "fit" solution might change depending....

You need a view from the rear...especially as the knee bends on the upstroke, and just after the knee dives into the top tube. the point being to see the amount of lateral movement of the knee. Ideally, the knee should remain comfortably in the same plane as the pedal, not wiggle side to side.

Also a side view with the knee at the top of the stroke and the bottom would be more useful than what you have here. Pain at the front of the knee "could" be improved by raising the seat slightly....but, only if the photos showed that your seat was too low. The one picture doesn't look abnormally low, but the top/bottom of the stroke is really needed to state that definitively. I don't know that the "knee over the pedal" thing really means much. Its really about the geometry at the max/min extension points regardless of the direction of gravity.

That said...I'm bowlegged, and dealt with ITB pain (and PF pain) once upon a time from riding.

I think what you are describing is that your knee is diving towards the top tube as you come over the top of the stroke and begin to apply downward pressure. I had this same lateral knee motion way back when. The solution for me was 2-fold: 1. Increase the q-factor of my pedals, 2. add a small amount of wedge between my cleats and shoes.

Note these changes were made by a trained fitter who specialized in biomechanical/orthopedic issues and bike fit, at the Boulder Center for Sports Medicine. Not just your average bike fitter.

The other solution to my issues (this was 2001 or so)...was to NEVER ride through the ITB pain. There is a reflex arc that gets triggered by the pain: 1. you feel pain, 2. your ITB tenses up from the pain, 3. the tension causes more pain....rinse and repeat. For me, part of the solution was to stop and do ITB stretches as soon as I began to feel any discomfort.

If I were you (and I was way-back-when) I would get a diagnosis from a sports-med doc. Then I would find a QUALIFIED fitter, knowledgeable in bike fits for the biomechanically challenged and get a proper fit for your diagnosis and peculiarities. There's nothing to say that you have what I had, or that your solutions will be the same as mine were.

NOTE: I probably spent all of 2000/2001 season riding "through the pain". By the time I saw a doc, the pain was pretty well ingrained. It took a while to resolve with PT, bike fit, etc. I spent MONTHS getting over it---and, months more getting back to normal training volume after that.

Thanks for your replies! I think what you, Tom, describe sounds pretty similar to the problems I have. I also have the feeling that it's slowly getting worse and worse. I live in Berlin in Germany and I agree: my bike fitter and also all the sports orthopedists and so on I have consulted all have no clue what they're talking about. They enter the conversation with a sales attitude throwing some fancy buzzwords at you, but if you ask some specific and rigorous questions they will quickly crack and even admit that they have no idea. ;-)


I'm pretty sure I have to look outside of Germany for this one, so is there maybe any online offers from one of the "not just your usual bikefitter" guys that can be recommended? For now, I have attached some pictures to better describe my knee pain and I will upload a video from the front and back as soon as I can.


This is where it all started, this soft part in the outer knees, some pain starting during the training, especially in more intense workouts, and then continuing on during rest:




This is where I would locate the pressure coming from my upper leg and going into my knees:



Now, after a while of the outer knee pain I constantly feel some "resistance" in my knee while pedaling here:



The pain is also getting more "general" as in it spreads around to other places of the knee as well such as the lower front, the inner side sometimes - so this is probably other parts of the knee getting in trouble as well after the initial parts are irritated/weakened now.

Alright, I made some videos!


https://www.youtube.com/watch?v=EaELXUhU8cU


https://www.youtube.com/watch?v=6R8EZFR3YoM


https://www.youtube.com/watch?v=VhzeqiXDCzU




Remember that you can play them at lower speeds as well, might be easier to see then.


Looking forward to hearing your thoughts.

I would say that you are knocked kneed- Bow legged would be knees out.

Do you have supportive insoles in your shoes?
Ever try varus wedges under the cleats?

It's definitely bow legs, there are different kinds of bow legs apparently, and it's common that the knees touch the frame with (some kinds of) bow legs. You can read more about it here: https://www.hss.edu/...-correct-my-bowlegs/

I haven't tried wegdes, but I would assume that insoles would have the same effect? Or does it make a difference if it's below or above the shoe sole? If insoles make sense, do I need support at the inner or outer side? Tom, what kind of wedges do you use?

Cheers

Technical terms- I guess what I was trying to say is that your stance on the bike is knock kneed- knees in.
Insoles more help to keep the feet from flattening out- This may or may not be an issue for you.
I would use wedges outside the shoe- Like Bikefit wedges (yellow ones for Look/Shimano or purple for Speedplay).
Thick part on the medial side of foot.

Someone with similar problems wrote me a message asking if I found a solution. Here's my recommendations:

• Make sure your saddle is not too far upfront. You can see on my picture that my right knee is quite far ahead of the foot/pedal. I moved the saddle back to the point where my calve is pretty much orthogonal to the ground at the pedaling position in the picture. Make sure you adjust the saddle height accordingly as moving the saddle back will increase the distance to the pedals if you do not adjust the height as well. I would say it is generally agreed on that this position is always reducing the stress on the knees and reducing imbalances (because it increases the involvement of the glutes and the backside of the upper thigh). However, most people also agree that moving your saddle further to the front is superior from an efficiency and performance point of view. But your knees must be able to handle the extra stress and apparently mine weren't. ;-)
• Make sure you're not sitting too high on your saddle (many people do). I don't think you can see it well on the picture, but at this point I was sitting a bit too high. Your knees don't like having to "reach out" for the pedals on every stroke. Lower the saddle to a point where you can comfortably reach the lowest point of the pedaling strokes without having to fully stretch your legs and while being able to keep your hips straight (if you notice your hip is moving to the right when trying to complete the pedal stroke on the right in order to facilitate reaching it, you're sitting too high). Also note that your feet should remain parallel to the ground while doing this, so trying to rotate your feet (tips down) in order to extend your reach does not count either. ;-)
• If you have bow legs you may tend to move your knees very close to the top tube of your frame, sometimes touching it on every pedal stroke. This may feel "natural", but some people believe this is something that should be corrected. They argue that while it cannot and shouldn't be attempted to be corrected statically (e.g. while standing), you can and should correct it dynamically (while pedaling). Other people argue that while this may solve some knee problems, it will cause others and in general will be worse. I went with the first recommendation and trained myself to pedal in a straight line "as if I had straight legs". ;-) I feel like it sometimes caused me some new knee problems, but at the moment I'm fine and feel like it was beneficial. In the end both positions might be somewhat correct and we just have to accept that we have screwed up legs. ;-)
• Think about what other conditions may be causing this. Knee problems often have complex causes. In my case I later figured out I had osteitis pubis (in the pelvis). This caused my whole ab/glutes/"upper upper thigh" area to get really stiff which reduced this area's ability to absorb the impact/shocks during running, so the lower upper thighs had to handle that and at some point the knees got affected. Osteitis pubis takes forever to get rid of, so I'm still not completely free of it (but mostly). So, who knows, maybe now I could totally move my saddle back to the front and my knees would be totally fine? ;-) No, but I actually prefer it that way as it feels more balanced and I'd rather protect my knees instead of trying to optimize that last bit of performance. I'm not a pro athlete and I don't think it's not worth the risk!

I have very noticeable bow legs and have had the best luck with increasing my q-factor. I use Shimano 4mm+ pedals on 2 of my bikes, and 20mm pedals extensions on 2 others. You can use a couple pedal washers and moving the cleats out to get an ideal of what is comfortable. For my shoes, I also like some angle out so use the yellow cleat wedges. Much more comfortable now and no knee pain.

This ^^^^^