A long term nagging issue that I’ve never got sorted – there’s obviously something ‘odd’ about my right side. I have a some strangeness in the way my knee moves when pedalling with it swinging in towards the top tube. I get some tingling and knee pain but nothing that stops me riding.

I normally ride with Time cleats that have enough float to allow my foot to swivel through my pedal stroke but recently trying to switch to flats I was finding increase knee paid (good soles and pinned pedals don’t have any float!). I also noticed i ended up sitting my right foot further from the crank than the left.

A physio once suggested a possible ITB issue
NHS podiatrist said it’s not a foot problem and the ITB might be the cause but promised physio referall never materialised.
I also get hot spots on the outside of the ball of my foot both cycling and in ski boots which I think suggests over-pronation.

Any recommendations on what ‘profession’ I should see to try to resolve these (and of someone or somewhere to go in London). Is this bike fit? Cleat set up? Physio?

Ill go with Weak core and glutes.. Glutes are surprisingly important for knee stability and tracking.

Try a few weeks of glute and core strengthening exercises.

Ill go with Weak core and glutes..

but I think you’d be wrong. I’ve been going to a personal trainer once a week for that last year and doing a lot of core work and squats. Core is definitely not weak but the strangeness is still really evident.

I need someone to narrow it down to something specific to work on.

Unless there’s something seriously wrong with your bike setup, I doubt it’s a fit issue.

I reckon you’re probably not sitting square on the saddle (which could be saddle height issue as in too high).

Your pelvis is out of alignment which is giving you a leg length discrepancy and hence making you sit skewiff, which means your knee’s gonna struggle to track straight.

Your leg muscles are way too tight. Not just IT band, but a load of others such as calf/groin etc.

myofascial release followed by stretching would be a good start.

Knee swinging in towards the top tube could be cause by your arch collapsing. Do you have a high or low arch on your foot/feet?

Quite a few years back, but I used Crystal Palace Physio and Sports Injury in the stadium for a knee injury. NHS and private, seemed fairly sports focussed. Mightn’t be too far from you.

Edit:

Your pelvis is out of alignment which is giving you a leg length discrepancy and hence making you sit skewiff, which means your knee’s gonna struggle to track straight.

I have this, bought on by above mentioned knee injury. It was misdiagnosed for a long time

Unless there’s something seriously wrong with your bike setup, I doubt it’s a fit issue. I reckon you’re probably not sitting square on the saddle (which could be saddle height issue as in too high).

Agreed. I’ve been riding long enough to know my bike fits me properly and I’d be surprised if saddle height was wrong (i’ve run it lower and higher). Lower gives me more knee pain.

Your pelvis is out of alignment which is giving you a leg length discrepancy and hence making you sit skewiff, which means your knee’s gonna struggle to track straight

Possible. I broke the ankle in that leg not long after I started riding so could be a slight leg length discrepancy.

Your leg muscles are way too tight. Not just IT band, but a load of others such as calf/groin etc.

Quite possible. I’m *fairly* flexible – did Yoga a few times a week for years (although no recently). Can still easily touch my toes. Groin never really loosened up though- sitting on floor and trying to open hips was never something that really improved.

myofascial release

???

followed by stretching would be a good start.

As I say – years of yoga didn’t sort this out.

Knee swinging in towards the top tube could be cause by your arch collapsing. Do you have a high or low arch on your foot/feet?

High arches. I use Specialized insoles which give some arch support and spend a lot of time in Birkenstocks (have their insoles in some shoes)

Quite a few years back, but I used Crystal Palace Physio and Sports Injury in the stadium for a knee injury. NHS and private, seemed fairly sports focussed. Mightn’t be too far from you.

Crystal Palace isn’t far away – ride up around there a few times a week.

GP in the first instance – thats their job.

You can check your pelvis infront of a mirror. Are you shoulders the same height? Or stand with your back and your heels flat against a wall, is one side of your pelvis further forward than the other? there’s some pelvis reset videos on youtube.

High arches; that could mean under pronation (i.e. not enough pronation). Could also mean slightly bowed legs. Could also mean you feel pressure on the outer edge of your foot when you pedal. A tight groin can play a part in bowed legs. Here’s a good groin stretch, easier to do it like this one leg at a time imo, you get a better stretch.

Myofascial release is what you get when you roll your IT band with a foam roller; tha’ts a popular example. But do it on all your leg muscles. You can use a foam roller on your IT band, but you need a small, hard ball and something similar to the U shaped stick in the picture below to cover everywhere the foam roller cant get to. Use a rounded stick shape thing and do the inside of your calves, it’ll probably hurt but it’ll loosen your feet up. Do your arches with a golf ball etc. etc.

Search youtube for some good glute/groin/calf stretches.

Another thing is cleat position. Chances are, it’s different for both feet. Steve Hogg has a good method of finding where your cleats should be (it involves taping a cable end crimp onto your MTP joint and then putting your shoes on and marking it on the outside).
https://www.stevehoggbikefitting.com/bikefit/2011/01/why-bikefitters-shouldnt-chew-their-nails/

You also said you get keen pain if your saddle is a bit too low; do you point your toes when you pedal? As this is something that can put too much pressure on your knees, may also be a result of having to high a saddle and trying to point your toes to reach for the pedals. Try and “fall” into the pedals with your arch instead.

HTH

London Podiatry Centre in Lewisham is good. You can get a full 3D gait analysis with 50+ points on legs, hips and feet to work out what you are doing wrong. You can then work with physio / pilates / biomechanics / personal trainer to build up / work to fix issues.

I’ve always found physio is better to fix an actual injury where data + personal training / pilates etc is better to fix pain through imbalance / bad habits. You need to understand the problem in detail first though, rather than smashing the glutes / core as it is often more complicated.

Knees / hips can be due to ITB, bad tracking, arches, pelvis imbalance and more. Hard to know without solid analysis and spending some money to get this done.

David up there knows his stuff. I have posture issued resulting in my pelvis out of alignment mine is rocked forwards this causes knees to point in, arches to collapse and feet to point out. I find foam rolling does very little for me, I have a hockey ball I use with a kettle bell to weight or a nasty painful stick.

Btw I’m also very flexible and can place the back of my hands on the floor stood up, doesn’t mean you don’t have tightness in your hips and groin

davidtaylforth: thanks – is this what you do? Are you ever in London? Could I book a session to see you next time I’m in Cumbria?

You can check your pelvis infront of a mirror. Are you shoulders the same height? Or stand with your back and your heels flat against a wall, is one side of your pelvis further forward than the other?

I think this stuff is ok but difficult to self-assess

High arches; that could mean under pronation (i.e. not enough pronation). Could also mean slightly bowed legs. Could also mean you feel pressure on the outer edge of your foot when you pedal. A tight groin can play a part in bowed legs. Here’s a good groin stretch,

I’m pretty sure my legs are bowed – I do get pressure on outside of foot when pedalling. Really noticable in ski boots as well – feet don’t want to sit flat on floor. Pain on outside edge from boots. I think you’re right about the tight groin.

So how do I get this properly assessed? What do I ask for?

I would see a good sports physio (I can recommend one on the Midlands but no use to you in London) and get an assessment. From that, you can then work out what you need to sort the problem. Anyone any good will recommend who to see, be that a podiatrist or whoever.

I’m thinking this looks like the right sort of analysis?

http://www.londonpodiatry.com/podiatry/sportsinjury/cycling

No, this is not my area of expertise. I had “issues” a few years ago and saw several physios, all who didn’t have a clue. I think it’s a bit like the bike fitting industry: there’s a few good physios out there who are very knowledgeable, but loads who don’t have the knowledge or thinking required to diagnose you properly. I’ve just had quiet days in the office though, so often ended up reading about “best stretches” etc.

TBH, I dunno how you find someone who can tell you how to fix yourself, word of mouth?
Thing is, you risk finding someone who will just tell you generic stuff like you’ve got tight hamstrings and to just stretch them or whatever. Whereas in DT78’s case, I’ve read loose flexible hamstrings can actually exacerbate the problem of your pelvis rolling forward, and the muscles that you should be stretching are your quads/hip flexors (as these are actually what’re pulling your pelvis forward).

I’d do some youtube watching/reading and a bit of what I suggested (myofascial release can work pretty much instantly). Hopefully then you’ll get a better idea of what the problems are yourself, then you know what questions to ask if you do go and see a physio.

CP sports injury clinic. (Think they are called ‘Balance’ now) was recommended to me and sorted a knee tracking issue after being strung along at the expensive physio in Clapham that didn’t tell me the cause of the issue but wanted to keep me coming back and paying.
The building may not be snazzy but the service they offer is centred around getting you fixed not paying for glass bricks and twirly twigs in reception.

GP in the first instance – thats their job.

Lol. At troll post

CP sports injury clinic. (Think they are called ‘Balance’ now) was recommended to me and sorted a knee tracking issue after being strung along at the expensive physio in Clapham

By CP you mean Crystal Palace? Appears to now be this place http://www.cppg.co.uk/

There is a physio in Clapham called Balance – http://www.balancephysio.com/about/

well you have found out the name of the posh place that was expensive and failed to solve the problem (due to my naming mixup) . cppg is where you need to go.

GP in the first instance – thats their job.

Really ? Not IMO or in IME.

OP you need to see a specialist physio with knowledge of cycling. My issue was always London prices £100 (admittedly West End) whereas I pay £30 in Paris for a better quality of treatment / diagnosis (knee buggered)

A long term nagging issue that I’ve never got sorted – there’s obviously something ‘odd’ about my right side. I have a some strangeness in the way my knee moves when pedalling with it swinging in towards the top tube. I get some tingling and knee pain but nothing that stops me riding.

This sounds like a bike fitting issue; can often be caused by incorrect cleat rotation, saddle shape relative to your needs (causing your pelvis to twist), saddle height and fore/aft, leg length discrepancy, or the knee just simply swinging in/out by mid foot collapse when loaded?

I’d suggest finding an experienced bike fitter who understands proper foot correction – ideally someone trained as a “Bikefit Pro” as the basis of the entire system is focused on foot correction before moving upwards

The majority of cycling foot beds on the market (whether stock or aftermarket including the BG Fit ones) do not offer anything like enough “arch” support (plantar fascia) and its not available far enough forward for most people.

A good fitter can apply a foot bed system like G8 Pro Series 2620, which will be modified over time as your body adjusts and you plantar fascia strengthens (its very weak in many cyclists)

Physio appointment booked for Tuesday – I’ll update with how I get on.

I’d suggest finding an experienced bike fitter who understands proper foot correction – ideally someone trained as a “Bikefit Pro” as the basis of the entire system is focused on foot correction before moving upwards

Foot correction just masks the problem though, better to sort out the root cause rather than spending £200 on a bike fit and £80 on insoles. High arches and bowed legs would probably suggest he’d require some form of cleat wedging, which you can’t do very well with MTB cleats, and not at all with flat pedal shoes!

@davidtaylforth

foot correction does not “mask anything”, but actually forms the foundation of good bike fitting practise as numerous studies show 95% of riders will benefit from mid foot and rear foot correction.

Without correction, riders compensate, which tends to cause asymmetry as all our patterns of compensation work by simply increasing our inherent tendency to favour one side of the body to the other, often leading to pain and injury as well as poor performance.

You can actually provide correction in 2-bolt SPD systems as cleats with varus tilt built in are commercially available (I should point out that any forefoot correction is actually indirectly providing rear foot correction, very few riders present with forefoot varus).

For flat pedals, I ride Giro Jacket flat pedal shoes fitted with Shimano custom footbeds with modified arch support and Bikefit wedging initially ITS for forefoot and now heel wedging.

To qualify my statements, I have over 200 successful fits on clients including Ironman triathletes, National time trialists and recreational road cyclists (the most challenging group!) with Red Level II professional certification from Bikefit, Giant Powerfit and several years of using BG Fit.

I was lucky enough to train with one of the best in the world, who is currently responsible for a World Tour Pro Team

Interesting contrast of views. EsherShore – where do you work from?

foot correction does not “mask anything”, but actually forms the foundation of good bike fitting practise as numerous studies show 95% of riders will benefit from mid foot and rear foot correction.

Without correction, riders compensate, which tends to cause asymmetry as all our patterns of compensation work by simply increasing our inherent tendency to favour one side of the body to the other, often leading to pain and injury as well as poor performance.

You can actually provide correction in 2-bolt SPD systems as cleats with varus tilt built in are commercially available (I should point out that any forefoot correction is actually indirectly providing rear foot correction, very few riders present with forefoot varus).

Of course, but you can’t stick a big stack of spacers under a two bolt cleat if you’re trying to correct a functional leg length discrepancy. It’s better to address the root cause which is likely at the pelvis.

How did you get on OP?

I’m not brilliant on anatomy but I think the prognosis was massively underdeveloped Gluteus mediums and minimumus but very strong maximums. My guess is it goes right back to my broken ankle – all those muscles got weak when I was on crutches and I got back on the bike and got strong very quickly but only the max. That’s been compensating for the others all this time. Knee problems come from the excessive movement in the knee that results.

To start with just simple side leg raises and single leg squats (focusing on keeping the knee in line.)

We’ll see how it goes from here. Pain on outside edges of feet might just be how I’m made but I’m tempted to work on both legs and see if it makes a difference.

jambalaya – Member

GP in the first instance – thats their job.

Really ? Not IMO or in IME.[/quote]

Yes. In the UK system the GP is the gatekeeeper who holds the ability to refer you on to other professionals as required
sometimes yo can self refer to physio but rarely.

This guy is pretty good – especially with regard to posture restoration / pelvis realignment

PRI

Yes. In the UK system the GP is the gatekeeeper who holds the ability to refer you on to other professionals as required. Sometimes yo can self refer to physio but rarely.

I’d agree that’s completely true. However, it does depend on your GP. Some are not that helpful if you’re not really ill – I’m probably in the fitted 5 or 10% of the population (as most of us on here are). I cycle 100miles + in a typical week, run. I’m not in pain. It’s not unreasonable for them to take the view that the limited resources of the NHS are more needed by other people.

It looks like my problem started 17 years ago. I’ve had a few goes at sorting it out in that time – I think once with a physio and twice with podiatrists. None have correctly diagnosed it – i reported to a physio with knee pain and they diagnosed an imbalance in the muscles above the knee (completely missing the glute problem).

The first time the podiatrist said it wasn’t a foot problem. The second they said it was something higher up and they’d refer me to a physio but that referral never came through (which is why I posted on here).

Now I know what the problem is I’m thinking I’ll go back to my doctor and try to get an NHS referral so I don’t have to keep paying myself (can potentially get referred to the same place)