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Thread: Knee pain

  1. #1
    Inspector Gadget
    Reputation: abeckstead's Avatar
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    Feb 2012

    Knee pain

    Not sure where to ask for help on this, thought I'd try here first.

    Fairly recently I've been having pain on my inner right knee, which I think is from riding. I've done some reading around here but having trouble diagnosing what is causing my problem.

    I've messed with my seat height/placement and it doesn't seem to make it any better or worse. I read somewhere that inner knee pain could be from wrong cleat placement on clipless shoes? And pain behind the knee is from wrong seat height?

    Any help is appreciated

  2. #2
    mtbr member
    Join Date
    Jun 2012
    CYCLING PERFORMANCE TIPS - gives a basic run-down on what pain in various parts of the knees tends to mean. A reasonable guess would be that your cleats are toed in too much. But there could be other underlying issues as well.

    The best thing is to see your doctor and go get your cleats fitted at a shop that has the equipment to do it right.

  3. #3
    B A N N E D
    Join Date
    Apr 2007
    Some stuff I posted once before that might be worth reading:

    Info on Knee Pain and How to get correct Bike Fit.

    Knee Pain

    One of the most common complaints from cyclists is of sore knees.

    Usually knee pain 'creeps up' on you but sometimes seemingly out of nowhere, it can suddenly start for no apparent reason.
    However, investigation will usually reveal some contributing factor...

    Poor Technique
    The main cycling muscles in the thigh are very powerful and can 'overload' the knee. Pedalling in too high (stiff) a gear is the most common cause of this. The answer is to pedal a lower (easier) gear but pedal faster. Look at Tour de France riders and you will see that their legs seem to whizz round. The load on the knee is reduced by using this technique. Medical research has also shown that this higher speed 'spin' is also aerobically more efficient.

    A Sudden Increase In Training Or Mileage
    This is especially common at the beginning of the season and in Europe is sometime called 'Easter Knees' as this is often the first opportunity for overuse of the knee. It can also happen after illness or other time away from cycling...
    In our enthusiasm to get fit again we can do too much too soon. Rest then try again - more gently.

    A Sudden Increase In Climbing
    When the route rises and you run out of gears sometimes the only thing you can do is sit (or stand) and push hard on the pedals. If you are not used to this then the same overuse type of injury can occur. If you are going to cycle in the hills get some practice before you go. Attack that hill on your ride to work!

    Saddle Position
    Having your saddle in the wrong position can also give you knee pain. Too high and too low are both wrong. Too far forward or back is also a possibility. Ask your friendly local bike shop for advice on getting the right saddle position or check out our Step by Step Guide to Setting your Saddle Position.

    Pedal Setup
    The advent of clipless (SPD etc) pedals has been great for cycling. One major difference between clipless and traditional pedals is restriction of movement (float) allowed in the foot. Foot position naturally changes while pedalling. If the foot cannot move, this movement is transferred to the knees and the hips. If you have knee or back problems or just a tendency to knee pain you may not get on well with clipless pedals.
    If you have clipless pedals Set Them Up Right!
    Old fashioned clips and straps still work fine - they are still used by World Champ track riders because they never release accidentally no matter how hard you pull!

    Non-Cycling Related
    # Sometimes knee pain felt while cycling is brought on by some other activity; A new sport.
    # A session at a badly set-up workstation.
    # A cramped journey in a car or bus.

    Misalignment Of The Knee
    The alignment of the knee and kneecap can be affected by many things. Any imbalance in the muscles of the thigh can pull the kneecap out of position. The action of pedalling can cause an imbalance in this muscle group.

    If your knee pain does not subside with rest, see your Doctor or a Sports Physio and get checked out. Check if your local Cycling Club can recommend a Sports Physio who understands the peculiarities and common problems of cycling.

    Bike Fit

    The most overlooked aspect of riding is a proper fitting bike! With department stores offering little or no advise for sizing your bike, many people end up riding a poor fitting bike. Regardless of what kind of bike you own or what type of riding you do, the most important feature is that your bicycle fits you properly. Improper bike size and set-up can create knee, neck and back pains, making riding uncomfortable. Conversely a proper fitting bike will make cycling easier and more enjoyable. The best thing to do is head for a real bike store (or cyclery) and ask to be fitted to your existing bike, or be correctly fitted to a new bike. Many bike shops will adjust seat and handlebar height and angle, some even offer a detailed fit procedure called a "Fit Kit" this is designed for the more advanced riders to improve performance, but will benefit anyone who rides.

    Fit Basics
    There is no standard sizing or fit, everyone will be different. The right fit for you will depend on your body geometry and how aggressive you want to ride. To get the right bike fit, you have to do 2 things:

    1) Spend some time riding and testing different set ups. Move the saddle and handle bars into a few different positions. Then try each one with a short ride, this leads to the second thing to do.

    2) Pay attention to any aches or pains as you ride. For example, back pain may be caused by leaning to far forward, sore knees are due to a saddle adjustment.

    The following are some suggestions for fitting your bike properly, which should provide you with a starting point. If after adjusting your bike you still feel un-comfortable, maybe you should visit your local bike shop for more help.

    Step #1 - Check your frame size
    Please note these are good guidelines for initial set up and fit, but should not be considered precise or exact in any way. Again everyone's body is a little different and having a good bike shop fit you is still recommended. The first thing is 2 rules of thumb to determine bike height. To determine this yo must step over top of the bike and stand with one leg on each side hands on the handle bars. In this position you want to gently raise the front end of the bike up until the top tube is touching you. For road bikes the clearance from the floor to the tire should be roughly 1 to 1-1/2 inches, for a mountain bikes generally 2 to 3 inches. Again this is just a rough guideline and will help narrow the search. Note that on Mountain bikes the full suspension bikes tend to ride higher and will sit 1-2 inches.

    Step #2 - Positioning your saddle
    Saddles move in 3 directions, up/down, fore/aft, and Tilt. Everyone's saddle position will be different because of personal preference, riding style, and body geometry. The following three positions will greatly affect your riding. You will need to try a few different positions to decide which is best for you. Remember if you feel any discomfort chances are your positioning is wrong, try again or seek the aid of a professional bike shop employee.

    Saddle Position #1 (fore/aft)
    The fore/aft position of your saddle can have a significant effect on your body position while you ride. To check this, sit on your saddle using a stationary object to keep yourself balanced and rotate your pedals until they are horizontal (at the 3 o'clock and 9 o'clock positions). You will need a piece of string about 30 inches long with a weight tied to the end (like a pencil). Now using the foot in the 3 o'clock position place the string on the small bony bump just below your knee cap and let it hang straight down to the foot. With a properly positioned saddle the pencil should line up with the axle of the pedal. To adjust this simply loosen the seat post binder bolt and slide your saddle forward or backward, then re-tighten the bolt securely before riding.

    Saddle Position #2(height)
    Correct saddle height will provide you with hours of enjoyable riding. It will lower the stress on your knees and provide the most power to your pedals. Your saddle height should be set so your legs almost (but not quite) fully extend at the bottom of each pedal stroke. To check for correct leg extension, rotate your pedals to the 12 o'clock and 6 o'clock positions (while sitting on your saddle). The bottom leg (6 o'clock position) should have a slight bend in the knee.

    To adjust your saddle height, loosen the binder bolt (or quick-release lever) located where the seat post and frame meet. Slide the seat post up or down in the seat tube as needed, being careful not to raise it beyond the "minimum insertion mark" (already etched into its side). Straighten out the saddle and re-tighten the binder bolt ( or quick-release lever) securely before riding.

    Saddle Position #3 (tilt)
    When it comes to saddle tilt some cyclists prefer a forward tilt, or a backward tilt, and some people like their saddles completely level. To find a tilt position that works for you, start with the saddle completely level to the ground (horizontal) take a few test rides, try some different angles. To tilt the saddle, simply loosen the binder bolt directly under your saddle, make your adjustments and re-tighten.

    Step #3 - Positioning you handlebars
    Handlebar position will effect your comfort while riding. There are 2 positions to consider for handlebars
    1.) Height - this will determine how upright you sit, a taller handle bar will allow you to sit more upright, for a more comfortable ride. a lower handle bar will give you a more aggressive handling bike, good for off road trails.
    2.) Length of stem - this will determine how stretched out your upper body will be, a longer stem will cause you to stretch out more.
    Again everyone's positioning will be different! Depending on the type of riding you do, and your body's geometry. To find the best height for you, start with your handlebar about 1 inch lower than the height of your saddle. Ride for a while with the bars in this position, and see how your body reacts. If your lower back starts hurting and you may want a more upright position (raise your stem slightly).

    Adjusting your handlebar: (For standard quill style stems)
    1.) Loosen the stem expander bolt located at the top of your handlebar stem (the bolt head should be clearly visible) until it's about 1/4 inch above the top of the stem. Be careful not to loosen this bolt any further, or the expander nut (hidden inside your stem) may stay inside the forks

    2.) Tap the top of the expander bolt, sharply with a rubber mallet (or place a block of wood on top of the bolt and use a regular hammer). You should now be able to rotate the handlebars and move the stem up or down.

    3.)Align & Re- tighten Holding the front wheel in between your knees, reposition the stem and handlebars up or down as needed, then re-tighten the stem expander bolt firmly.

    NOTE: Be sure NOT to raise your stem beyond the maximum insertion mark etched into its side. Also some types of brakes may need to be readjusted each time you move your handlebars. Bikes equipped with the "Ahead" style stems have a limited amount of adjustment and may require a new stem or handle bar.

  4. #4
    mtbr member
    Reputation: theMeat's Avatar
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    Jan 2010
    i'd put some big platforms/flats on there to see if it's even bike or pedal position related. Once you figure out where you like your feet to be you can go back to clipless and will better know where the cleats should go
    My .02
    Round and round we go

  5. #5
    Inspector Gadget
    Reputation: abeckstead's Avatar
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    Feb 2012
    Quote Originally Posted by theMeat View Post
    i'd put some big platforms/flats on there to see if it's even bike or pedal position related. Once you figure out where you like your feet to be you can go back to clipless and will better know where the cleats should go
    My .02
    That is a good suggestion!

    One thing that stood out to me is about pushing taller gears... I've been doing a lot of climbing in my middle ring up front and 2 or 3 on the back. Maybe I've just over done it with that? I will try some of these things out and see what happens.

    Thanks for the help guys!

  6. #6
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    Jun 2012
    Had the same issue - had the shop RAD my shoes/cleats and it fixed the problem.

    They did it for free.

  7. #7
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    Reputation: abeckstead's Avatar
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    Feb 2012
    I haven't ridden in 5 days now (been sick) Anyhow I started thinking that I put new pedals on a month or so ago and wondered if they were different. So I compared them to my previous pedals (different model) and the locking mech is a few mm different between the two. So the new pedals moved my feet inward towards the BB a few mm on each side. So I moved the cleats on my shoes to compensate. My knees aren't hurting since I got some rest days... going for a ride today and will see if the pedals were the problem.

  8. #8
    thread crapper
    Join Date
    Feb 2008
    For me, it's due to a couple things. I have absolutely destroyed my knees with too many running miles on pavement. I've had 3 ACL surgeries on my left knee, one with the MCL. The other thing I've noticed is that it's usually at it's worst when I've been riding for a few weeks after having been off the bike for an extended period. I find myself using a bad technique where I'm bow legged when I'm driving the pedals down. I think it could be my old moto days where I rode that way a lot to allow me to maneuver the bike. I do it a lot on descents still, but find myself doing it sometimes when I'm climbing and have to consciously bring my knees in.

  9. #9
    mtbr member
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    Jul 2013
    Newbie here, but been riding road for quite a while.

    Knee pain is not to be taken lightly. Connective tissue doesn't heal itself like muscle tissue does. Once it's damaged, it'll never be the same. Right now, your knee may just be inflamed and that sounds like it has passed. If you don't get this resolved, you may have some trouble down the line.

    If your knee pain doesn't go away after your pedal change, I would highly recommend a professional fitting. The body isn't symmetrical, and you may find out something you didn't know about yourself in a fit. I found out I have a tilted pelvis. This issue was almost resolved with a thick as hell shim, as well as slamming my cleat forward all the way. They actually ended up switching one crank arm to one 5mm shorter and all is well now, though they even said that this is ill advised except only under extreme circumstances, like mine.

    I've always had knee issues that came and went with seat position adjustment, but I could never seem to get it right. As a result of riding this way for years (without knowing this about my body, it's impossible to get a good fit on any bike), it's slowly been tearing one knee up. I'm on week six of physical therapy and have been given the OK to start riding again. Physical therapy is expensive and it is painful. (it doesn't help at all that I get mouthy when I'm in pain, so my therapist makes me do a couple of extra set of reps in friendly retaliation )

    After this ordeal, I'd recommend anybody experiencing joint problems to go in for a pro fit. I'd recommend it if you AREN'T having problems as well. If I had known, I'd have paid an astronomical amount for a fit years ago. It's worth every penny; it'll prevent injury, and it's nice to have your bike set up just right (we got some stem height and length issues taken care of at the same time, my ride is super comfy now) My knee issue didn't disappear after my pro fit, but that's because I already wrecked my knee. Now I have 30 minutes of stretches and exercises I do every day, and I get to live with patellar tendonosis for the rest of my days.
    Last edited by awdemuth; 07-25-2013 at 07:19 AM. Reason: I Spel gud.

  10. #10
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    Apr 2006
    I was experiencing knee pain a few years ago and thought it was due to fit, cleat position, etc.. Turns out my tight IT bands were causing the pain I was experiencing. Try performing stretch #2 from this link before and during your next ride. It may help you like it helped me. Stretching and Strengthening Exercises for Iliotibial Band Syndrome | Running Times

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