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Knee Pain While Riding
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Background: I am new to cycling, started in September 2017 when I bought a good road bike (Cervelo) and got a professional fitting. I rode it outside a few times that fall, then bought a smart trainer and moved inside for the winter. Spring rolled around and suddenly I started having knee pain in my left knee when I biked. This continued all summer. I did 4 triathlons in that condition, but the knee pain was really limiting how much power and how long I could bike. The only correlation to the time frame of when the pain started was that I swapped out my Shimano pedals for a set of PowerTap P1's in early April before heading back outside. I also did go to an ortho doc (who is also a triathlete) and he doesn't think there is anything structurally wrong with my knee, but we never did any imaging to confirm that.

This past fall, I bought a tri-bike (QR) and again got fitted. Road that bike on the trainer all winter with the shimano pedals and had knee pain all winter. I even went back for a fitting specific to this issue and we adjusted the cleats some but no help long term. Finally in an act of desparation, my coach suggested that I just put flat pedals on the bike. So I went to walmart and bought a set of $10 flat pedals and within a few rides the pain was gone. I could now ride for an hour pain free.

I looked at how my feet were sitting on those flat pedals and I tended to be a bit toe out. I rode on the flat pedals for 2 months and last night I put the PowerTaps's on my tri-bike on the trainer, adjusted the cleat so that it was a bit more toe out and rode for 45 minutes. Almost immediately the pain was back in my knee.

Summary: Left knee pain when clipped in, no pain when using flat pedals. Bike or type of pedal (shimano or powertap) doesn't matter.

As you can imagine I am frustrated and looking for suggestions.
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Re: Knee Pain While Riding [duluthians] [ In reply to ]
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I am no expert here and I'm sure they'll chime in, but I think where the pain is could tell you where it stems from (inside knee vs. kneecap vs. outside knee). For me, I found that when I had knee pain, my seat was too high. The stack on the cleats could be smaller than the flat pedals.
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Re: Knee Pain While Riding [Conky] [ In reply to ]
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Good comment/question. My knee pain starts on the upper inside part of the knee, then radiates downward throughout the knee. Not patellar. The last bike fit I had specific to the knee we put the seat in the middle (height-wise) of the typical range.
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Re: Knee Pain While Riding [duluthians] [ In reply to ]
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Do you pull up on the pedals?
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Re: Knee Pain While Riding [Tom_hampton] [ In reply to ]
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I don't pull up on the pedals consciously. If it happens, it is happening without me trying to do it.
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Re: Knee Pain While Riding [duluthians] [ In reply to ]
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When you clip in, you pull up with your VMO which I believe to be your problem. Without the clip in, you can't pull on the pedal so you don't engage the VMO as much. For me strengthening VMO helped in the long run, but to get rid of it short term, I had du lower the saddle and move the saddle back. You'll find a lot of exercises for VMO if you google it. My favourite the top part of leg extension where you use 5sec up and 5sec down really heavy. 3 sets, 8 reps, 3 times a day.

Education is important. Triathlon is importanter.
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Re: Knee Pain While Riding [duluthians] [ In reply to ]
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Schnellinger is potentially right. It was the point of my question. A lot of new cyclists think you are supposed to pull up, rather than just "unweight" the pedal. Usually, people will answer that question with a "yes, I thought I was supposed to..." in cases where the VMO is involved. Although, it doesn't specifically have to be the VMO attachment that is irritated...the knee isn't designed for TENSION, there are several tendons and ligaments around the knee that can complain about being pulled apart over and over.

Improperly adjusted cleat float, inadequate float, or other degenerate cases of ankle motion can also cause pain in the same area. New cyclists often need more float because they have more total ankle/foot motion to take up due to inflexibility in other areas. New tight cleats that won't rock, and/or hitting the float stops can cause either lateral or medial knee pain. Incorrect Q-factor, or improper wedging of the cleats can also cause pain the same area.

Its a hard thing to troubleshoot over the internets. Video of you pedaling from the front and the side would probably help a fitter on here see what might be going on. Posibly both with the platform pedals and your cleats.

Thoughts:

1. Does your knee stay in-plane with your ankle during the entire pedal stroke, or does it move inward or outward at any point (particularly over the top, and as you begin to push down)? A lot of people will flare outward as they approach the top of the stroke, and then the knee dives into the top tube as they start to push down.

2. Do you EVER notice rotating your foot enough to feel the limits of the cleat float? Do you notice your cleats using lots of the float range, even if you don't feel the limits?

3. Does your knee ever get close to or touch the top tube?

4. if you stand on one foot and squat, what does your ankle do? Does it bend inward or outward, or does it stay in line with your knee/toe plane?
Last edited by: Tom_hampton: Mar 29, 19 7:44
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Re: Knee Pain While Riding [Tom_hampton] [ In reply to ]
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I wonder what's your cadence most of the time. Below 85?
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Re: Knee Pain While Riding [s13tx] [ In reply to ]
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I had similar issues and my fitter realized my knees didn't track properly with standard pedals, thus I needed to get Shimano pedals with the 4mm axel to help my knees better track pedaling. This made a world of difference for me. I have since swapped them out for the Assioma pedals, which aren't 4mm but pretty close when adding both spacers. I have also improved my cadence and I get less knee pain when I'm at 85+.
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Re: Knee Pain While Riding [s13tx] [ In reply to ]
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My cadence is generally 80-90. I rarely pedal slower than that.
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Re: Knee Pain While Riding [Tom_hampton] [ In reply to ]
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I don't know what my knee does during the stroke. I had my wife shoot some video of me once to try to find out and it was inconclusive as it was hard to see. My knee doc thought that might be a cause too but I have been unable to verify. I don't notice my knee moving a lot and it doesn't get close to the top tube. We tried to measure where my knee goes relative to the centerline and whether it moves just by having me stop at the top and bottom and see if there was a difference, but again it was inconclusive. I feel like I need one of those motion capture studios to see what it is doing.

As for float and limits, the last fitting I had we focused on that a lot. Trying to get the cleat in the spot where I feel comfortable but not at or near the float limit. The P1's I put on for a test yesterday seemed to have a lot more float than the Shimano ones I could move my foot a lot though I don't think I was near a stop I might have been. I felt last night that I was moving my foot a lot within the float.
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Re: Knee Pain While Riding [duluthians] [ In reply to ]
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You can't look at what you do while static on the bike. Knee motion through the pedal stroke at normal power/cadence is the only way to see it.

I think the fact that your foot is pivoting a LOT on the pedal platform is a strong clue. I went through the opposite problem 20 years ago (pain on the outside, with lots of foot/knee motion). My solution involved making several pedal axel, pedal, and cleat geometry changes to stop the excessive ankle rotation and knee motion. My changes were specific to my particular lower-leg peculiarities.

More float can help, but it really only masks the problem. Once you get everything right, the foot shouldn't need to pivot all that much...then you shouldn't need a TON of float.

I think you probably need a "specialist" fitter, who understand pedaling dynamics better than the average bear. If you post your location, someone on here can recommend a FIST fitter with that type of equipment and knowlege to be able to help more than the internets.

Note I may be biased because of my own particular experience.
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Re: Knee Pain While Riding [Tom_hampton] [ In reply to ]
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Tom_hampton wrote:
More float can help, but it really only masks the problem. Once you get everything right, the foot shouldn't need to pivot all that much...then you shouldn't need a TON of float.

I was thinking the same thing. What kind of cleats do you use? Shimano Yellows give you a pretty good float. If you are already using Shimano yellows or something similar, I would slight move the cleat location on your shoe so your hill moves inward or outward and see.
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Re: Knee Pain While Riding [s13tx] [ In reply to ]
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Yep Shimano yellow is what I am using.
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Re: Knee Pain While Riding [duluthians] [ In reply to ]
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If the fitter is not addressing the function of your foot off the bike, focusing solely on the cleat interface will not address the problem.

Cleat movement is entirely medial to lateral (float) sagittal plane. Cleat placement is only fore aft and is a structural support to the bones of the foot.

Knee joint pain comes from obliquity at the foot, and can be either forefoot varus, calcaneal inversion or eversion, or excessive navicular drop.

Wedges address medial drop.

Anne Barnes
ABBikefit, Ltd
FIST/SICI/FIST DOWN DEEP
X/Y Coordinator
abbikefit@gmail.com
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Re: Knee Pain While Riding [ABarnes] [ In reply to ]
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So if I go back to my fitter, what specifically should I be asking them to do or look at? I feel a bit more educated about what is potentially going on which is incredibly helpful. My fitter asks me how things feel but my gut tells me that I can’t go by “feel” as I may have residual pain and that we need to be more “scientific” about it.
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Re: Knee Pain While Riding [duluthians] [ In reply to ]
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Observation and analysis of your boulders that make up your heel joint as well as assessment of the forefoot.




Anne Barnes
ABBikefit, Ltd
FIST/SICI/FIST DOWN DEEP
X/Y Coordinator
abbikefit@gmail.com
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Re: Knee Pain While Riding [duluthians] [ In reply to ]
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I had the exact symptoms and physio helped identify it as, believe it or not, tight quadriceps. Stretching and rolling fixed it...after months of pain any time I'd push more than 70% FTP.

Apparently the tight muscles pull the femer into the knee and cause grinding and dull pain.

Worth a shot.
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