Hoping to get some advice, or maybe just confirmation of what I’m already thinking. I have a race on June 24th, and training was going great until my knee started hurting, right at the tip of my kneecap. It only hurts when cycling, and even though when I Google the symptoms it seems to indicate “Runner’s Knee,” I’ve continued to run 45mpw completely pain-free. Zero pain walking, hiking, etc. But cycling is very painful. I’ve tried riding seated instead of in aero; I’ve tried riding the Peloton instead of my tri bike; I’ve tried raising my saddle; I’ve tried icing and NSAIDs and multiple consecutive rest days and nothing seems to help. With 17 days until race day, I feel like my options are:
Take a full week or two off cycling completely and hope that I get better, although I’m worried that so much time off the bike right before a long race would really negatively impact my riding endurance
Continue to ride through the pain (I’m starting my taper now anyway as my last two “peak” weeks have basically been a wash) and hope my leg holds up for the race
Trash the whole thing, start my off-season early, and resume training in a month or two when I’m (hopefully) totally fine again.
I guess my questions are: first, has anyone had a similar pain or have any idea what’s going on here? The fact that I can run 10+ miles comfortably and do squats with zero pain is confusing, when biking in just Zone 1 feels immediately painful.
Second, do I just go ahead and race? I am traveling in July and so I will be taking a good 4-6 weeks off training anyway. I’m willing to bury myself on race day and deal with a long recovery, but I don’t want to do any serious damage that will be long-term or permanent.
I’ve been grappling with this physically and mentally for a few weeks now, so any input/advice is really, really appreciated. Thanks in advance!
You haven’t mentioned getting a good bike fit done focusing on your cleat position and possibly saddle height. I make this point as you did say you’d changed the height but not when your last fit was done, and if that was with your current shoes.
The may be as simple as getting some insoles in your cycling shoes, possibly a wedge on the cleats. All this can be sorted and still allow you to race.
I’m not a doctor but I heard about and had myself kneepain which is only caused by overload. Not further serious.
Since your race is only 17 days away, I strongly advice to stop biking (you can’t become better in 17 days anyway) and use this time as regeneration what biking is concerned. Swim and run a bit just in a tapering way.
Just race and see what happens. I would wait until after the race to look for a doctor, maybe that will not be necessary at all.
Duncan - I was last fit on my bike in 2012, but since then I’ve ridden a lot and have always been comfortable and have never thought about getting a new fit. Is it possible that my fit could have changed so much after all this time? I’m worried about trying something so new (fit, insoles) so close to race day…
Longtrousers - thanks for the reply. I’m not worried about building more fitness in the next 17 days, more like losing it and coming into the race completely flat. But you definitely have the answer I WANT to hear, which is that I still can race…
Get in to see a PT or chiro as soon as you can. Knee pain usually stems from the inside of the leg (quad/abductors/hamstring/calf) or the outside (IT band). Roll + scrape daily. Would guess some pain is going on in one of those areas. Address it there & it’ll take stress off of the knee. Could be overcompensating on the bike to pedal in a way that doesn’t put stress on the problem area.
Easy and quick potential fix …… how old are your cleats? From personal experience, I know this can cause tracking issues. Worth changing if remotely worn.
If that doesn’t work, go see a bike fitter (not a person in a shop) who can properly check your biomechanics and advise on footbeds etc.
Do you have a stretching program? Do you stretch your patella tendon before and after riding? Hip flexors?
all of the above-cleats, shoes, inserts-most importantly, get a new fit.
also mentioned above, if you compete with a sore knee you run the risk of doing some definite damage-many of us have tried it, then wish we hadn’t!
It’s really a hard decision. If you err on the side of caution you’ll probably be able to fix things. Otherwise you run quite a risk.
Pain is your body telling you that something is wrong. I think you know that.
Thanks so much for all the replies. You’re all telling me what I need (but don’t want) to hear - see a PT (I just scheduled one for Wednesday) and take it easy and get re-fit. I’m amazed that after all these years in the same position, it’s just suddenly stopped working for me, but I guess bodies change over time and I have to accept that. And at 31 years old, I’d hate to really hurt myself with so many good years still to come. I’ll provide an update on Wednesday with what the therapist says for anyone interested, and continue to rest the knee until then.
You might also look into a shorter crank size. I’m more than twice your age, but started noticing some knee pain and went from 172.5mm to 165mm cranks. It’s a world of difference because the knee does not have to extend as far on the downward push and does not have to come up as high at the top of your stroke.
When riding in the aero position, this has allowed me to maintain or avoid having my knee come so close to my chest on the top of the pedal stroke. If/When you get a bike fit, my recommendation is to have the fitter adjust the length of your crank arms to see if it helps.
Daft thought but considering you run pain free, do you run toe in or toe out and how does that match to your cleat position. I’m not an uber anything, but I did notice a difference when I changed my cleats to slightly toe in as I am a natural forefoot striker when I run.
Ok. So you’ll have been doing quite some mileage in training and in those 12 years you have aged, kit has worn (or changed) and your bio mechanics I undoubtedly altered from the training.
I had similar 5 years ago where my feet became agony in last 30mins of bike despite years of 5 hour weekly rides, etc etc. Was down to the insoles wearing out. I also had issues after swapping from the original sworks to sworks 7 shoes. Same brand and model but the cleat setup needed to be very different. And lastly, the difference in pad thickness between my tri shorts and normal cycling bib I can feel on my knee after a couple of hours (why I now train in a tri suit on my tt bikes).
The reason I stress the fit approach is that could be an instant fix for the race. If it is a physio issue then in 17 days highly unlikely you can build the flexibility/strength or rest the body to be pain free.
What you describe is possibly some inflammation under kneecap or of ligaments. Which could be from tight quads pulling on it or from the shin. Which isn’t just in one vertical plane, but could be twisting (toe in/out) as already mentioned or ankle rolling. This gives lots of options to reduce that perk stretch by a small amount in tweaks to fit, even as a temporary thing to get you through the race.
Longtrousers - thanks for the reply. I’m not worried about building more fitness in the next 17 days, more like losing it and coming into the race completely flat. But you definitely have the answer I WANT to hear, which is that I still can race…I had a similar issue some years ago when I was in my 30. Knee pain due probably to overuse and a big race (a stage race) a few weeks away. I took a couple weeks super super easy - no training level, just very easy rides or no rides. A few days before the race I did my longest/“hardest” ride in weeks - about 2.5 hours with friends pretty mellow with some moderate (level 3) efforts uphills. My knee felt fine.
Then the race: I was a little flat and in suffering mentally the first day but by the last day (it was four stages over three days) I was riding like superman.
Looking back I was very very fit for the time off, which turned into a slightly too chill taper.
I’ve had similar experience - unexplained sudden knee pain when riding. In my case, it turned out that the one cleat on that shoe was positioned wrong - like it was a solid 1/4" further back than the other side. I had recently purchased new shoes and the shop had incorrectly installed the cleats, failing to make sure they were in the same position as the previous shoes and even with one another. I repositioned the cleat and the problem went away.
Thank you all for your advice about my knee - it seems like the consensus is new fit (shorter cranks, cleat position, seat height, etc.) and that is definitely going to be a priority for me in the future, although I don’t feel comfortable getting refit so close to such a big ride.
As promised, my update - went to a Doctor of Physical Therapy today, and she put my knee through the paces, felt all around, stretched me out, rubbed an ultrasound wand on the area, etc. She said that the ligaments felt good and my range of motion felt fine, and she thinks it’s likely an irritation of the tissue around that area, possibly as bad as a sprain. Probably caused by the repetitive movement of cycling and that specific knee bend, which would explain why it hasn’t bothered me when running/squatting/living life.
She is very (her words) confident that a) it isn’t anything worse and b) riding is very unlikely to make the issue so much worse in just a single day’s ride/race and c) I very likely will not do permanent damage. She said I also can just chain NSAIDs throughout the race and I wouldn’t ruin my stomach lining or anything like that…
So this consultation gave me a lot of confidence, and I was very clear with the PT that if she legitimately thought I’d do real damage, she should absolutely tell me not to do the race. She did not tell me that. She suggested starting to reincorporate easy biking over the next few days (I have not ridden at all in 10 days and the race is 12 days away) and seeing how my knee holds up, while continuing to taper my run and swim.
But she’s also not a long distance triathlete, and you are. Which is why I ask all you - thoughts? Proceed as planned with the race? Bag it all? Help!
Be careful with the NSAIDs on race day. 8 did that in 2020 for my back and the problem I had is that I ended up not suggesting any nutrition on the bike. So got to start of run and had stomach full of sloshing energy drink and gels and no energy.