On Sunday’s road ride my left knee started to hurt (inner top right of kneecap – approximately 4/5 o’clock as I look at it). The pain quickly went away when I stopped, but I rested it anyway. I changed the worn cleat, but today while warming up on the turbo (first ride since Sunday and a different bike, but same shoes with new cleat) the pain returned almost immediately. I stopped riding and turned to Googled, from what I can work out it’s medial knee pain and there are a lot of suggestions, but I’m not sure where to start. I’m a little concerned at how quickly the pain returned while riding gently. Do I need to rest it longer or see a dr/physio etc? Any advice or similar experiences would be appreciated. Thanks

tbh, a worn cleat will give more float so unlikely to cause knee pain.

I’d look at cleat position, saddle height etc.

But if this is a spontaneous injury and nothing else changed then just give it a bit of time to heal and don’;t change stuff you;ve been ridign with for years and had no problems on.

Cheers wwaswas, I’ll take it easy for a bit and see how it goes (the cleat was well worn and overdue being changed anyway).

My knee pain came from overtight muscles puling on my kneecap.

My physio diagnosed foam rolling and stretches. Over the winter i have also been doing a lot of weights which i think have sorted out a lot of muscular imbalances i had as well.

Its a minefield trying to self diagnose to be honest. If it occurs even slightly regularly i would have it checked by a good physio.

Mactheknife, what strength excersises have you been doing that have helped?

Had a similar issue a few years ago, was pretty worried at the time, I suspect it was partly due to a heavily worn cleat and pedal. It flares up every now and again but stretching (especially hip flexors) and rolling (it band) help a lot.

https://books.google.co.uk/books?id=VB_kAwAAQBAJ&pg=PA98&lpg=PA98&dq=phil+burt+british+cycling+knee+pain&source=bl&ots=Q2XwJCCwo0&sig=s27zLAdcnOQjImDPAzxZTe-xLD0&hl=en&sa=X&ved=0ahUKEwi41t2SmKfSAhUrJsAKHbW9Blo4FBDoAQg3MAU#v=onepage&q=phil%20burt%20british%20cycling%20knee%20pain&f=false

Saddle too low and/or used too big a gear on Sunday?

Hi sorry for the delay in getting back to you. I had pretty weak glutes and hamstrings along with a couple of other issues. A good plan with different combinations of deadlifts, both single leg and normal along with various full body workouts seem to be working well for me. I have been focusing on getting good mobility and strength gains this winter and it’s the first time I have not had any niggles at all. Muscular imbalances are to blame for so many niggles that we as cyclists have.

Apparantly the Kettlebell swing is the best exercise to address muscle imbalances. How to do these, requires a kettlebell and instructions from youtube video’s on James Wilson’s channel (MTB strength training systems and BikeJames).

If you can find it, Andy Pruits medical guide for cyclists is an excellent way of isolating niggles and solving them

Pain behind kneecaps usually means saddle too low.

Another possibility: if there are circular wear marks on the tops of your pedals it means your feet are rotating slightly in a horizontal plane through the pedal stroke. Setting your cleats wrong could mean that at some point during the rotation your feet are pushing up against the float limit, which will exert a slight twisting pressure on your knee. This is enough to cause the kind of pain you describe. In my case it means setting up the cleats so that my heels just miss the cranks but I can contact the cranks if I put twisting pressure on my feet.

I don’t buy all this stuff about over-tight muscles and muscle imbalances; your daily life routine will ensure the muscles work harmoniously. Imbalance might happen if you exercised one muscle group to the exclusion of all the others. As for kettle bell swings, they look like a sure route to injury for anybody who hasn’t got the muscle tone or the correct technique.

Imbalance might happen if you exercised one muscle group to the exclusion of all the others.

This is basically what cycling does.

I don’t buy all this stuff about over-tight muscles and muscle imbalances; your daily life routine will ensure the muscles work harmoniously.

Unfortunately when you partake in any sport or strenuous activity that forces your body to work within a limited range of motion then muscular imbalances will occur. That’s a fact. Cycling as i mentioned before is very quad dominant and although your glutes and hamstrings are used in the pedal stroke its nowhere to the extent that quads are used, there for imbalances in strength occur. Normal everyday life will not sort this but some very easy exercises can help to fix it.

Quote from a site my physio sent to me.

Imbalances Between The Muscles Of The Leg
The last common problem I will mention is an imbalance between the muscles of the leg. This is less common that some of the others but can certainly cause or contribute to knee pain. The basic story is this – the muscles in the front of the leg attach to the front of the shin, the muscles in the back of the leg attach to the back of the shin. Therefore, the muscles on one side are stronger or tighter than the muscles on the other side, they are able to create a pulling force on the knee which can move it out of optimal position. This means, similarly to the last point, that there is more stress on certain areas of the knee that are designed to rub together.

The solution to this is to strengthen the muscles that are weak and/or stretch the muscles that are tight. Again, I prefer to use as ‘functional’ a movement as possible for this so would prefer a front squat or a lunge to strengthen the quads as opposed to a leg extension, but some people could benefit from isolation exercises at certain times.

used too big a gear on Sunday?

I think this may be the culprit (I’ve had a bike fit and no issues in the last 2-3 years so doubt its the seat height etc). It was a fast flat-ish ride and although I’ve been trying to increase my cadence over the winter I think I reverted to type and pushed too high a gear. I’ll keep resting and take it easy for a bit, then keep trying to increase my cadence and work on some more stretching and strength exercises to try and protect my knees (if/when I get it wrong again!).

Go to a physio, dont go to a standard GP.

Went to a GP, told me I had this and that wrong, no exercise for 12 weeks let it rest etc etc.

Still in agony 16 weeks later

Went to a physio, diagnosed correctly as a LCL, told me stopping exercising was the worst thing that I could have done as my muscle mass decreased and aided in de-stabilizing my knee further. now 6 weeks of physio its starting to resemble something like my old knee before, still bends far too easily but defo worth a trip to a decent physio if its long lasting.

In theory, all because I’ve spent the past 20 years sitting on my leg on the chair and over stretching the ligament.

KNEE PAIN

Sports like badminton cause my knees to ache (right knee especially) but I’d been fine on the bike until last Summer when I took the HT on a relatively flat 40 miler. It didn’t ‘go’ as such, the pain just started to build up and lasted a number of weeks. I put it down to the seat being too far back as I’d just bought an offset post. I took it off and I’ve been fine since, I always take ibuprofen with me though just in case. Worth a try moving the seat forward?

Speedplay Frog pedals and cleat further back ( by default with the cleats) solved years of pain for me immediately.

To add a little, hopefully good advice.
Towards the end of last summer my re-occurring knee pain of 25years plus, I’m 51, had come back to the point where I thought my cycling was all over. I had retired from my previous sportingly life at 27, literally at the top of my world, because the pain was so bad and persistent I struggled to stand, let alone perform. Since then I have used cycling to take the load off and balance my legs.
However over the last year I had gone seriously backwards. I am certain of my position on my bike, but still regularly check it, but through last year both pain had increased, and power decreased.
Last October I decided to find a good Physio to see if I could get some releif, if not improvement. I genuinely thought I had got to the point where my previous life had caught up and I was going to be left with nothing other than creaking around!
Move forward six months and the difference is remarkable! Through little more than massage, specific stretching and some patience, I am close to my levels of a year or two ago.
I can thoroughly recommend getting a good Physio, it is a very worthwhile investment. Suggest you don’t listen to, oh it could be this or it could be that. Just go get professional advice, and as said above, don’t go to your GP. Go direct and just accept you have to pay. My guy is on thirty pounds a session, and only every three to four weeks, so not a significant investment!
Hope that helps!
Sniff!

Does your seat need moving forward or back? With your feet at 9.15 i.e. horizontal the front of your knee cap should be perpendicular through the axis of your pedal if your seat is at the correct height for most people. I await being shot down in flames!

I found I had cleats too far forward and my saddle on my commute bike too high.

Randomly, adjusting my position at my desk at work and getting a foot-resty thing worked wonders, too…

Inbred456 – Member
…the front of your knee cap should be perpendicular through the axis of your pedal if your seat is at the correct height for most people. I await being shot down in flames!

‘Should’ is a strong word…

Has anyone mentioned crank-length yet?

Cleat position. Feet pointing out a little too far, and we are unfortunately talking the odd mm. This over extends the tendon.

I have 10-to-2 feet and used to set my cleats to the same pointing out orientation. Now I have a slight lower saddle and feet pointing straight ahead, with cleats set to widen stance. When I replace a cleat and don’t get the correct alignment, I get the OP’s discomfort inside top of kneecap on just the one leg. Moving cleat to point dead ahead not at and angle removes the pain.

Resting it will also help. Remember cycling is low impact but very repetitive. So small misalignment do matter.

Another vote for seat height here.

I locked my knee several years ago, after several very painful episodes, and had to have an op to free it. I saw three separate physios. Third one lucky, and he told me to drastically up my seat height, way above what I’d ever envisaged. And it worked for me.

I can thoroughly recommend getting a good Physio, it is a very worthwhile investment. Suggest you don’t listen to, oh it could be this or it could be that. Just go get professional advice, and as said above, don’t go to your GP. Go direct and just accept you have to pay. My guy is on thirty pounds a session, and only every three to four weeks, so not a significant investment!

This. So much this. Ask around for recommendations and then go see someone who can actually look at your knee and asses what is wrong rather than tell you what was wrong with someone else’s knee.

I hurt my knee at BBD (overgeared and cramped)

I internet self diagnosed patellar tendonitis the cure for which is rest. Having trained for a long time (as in years) for a 12hr race I was gutted.

I went to my physio. After 30minutes I was diagnosed with an upper leg muscle imbalance that was pulling my knee cap out of alignment causing it to hit stuff and become inflamed. Treatement was some exercises, stretches, gradual rebuild of training with ice. I was able to race 2 weeks later and achieved my 3 year aim. Best money I’ve ever spent.

I’ve had knee pain before. It was medial knee pain. I had a bike fit done for £15, tried my best to keep everything in the same place since then, and not had it since. It wasn’t due to muscle imbalance. I think it generally is due to bike fit rather than muscle imbalance. Maybe there is a muscle imbalance if you spend more time cycling than walking, on average, every week ? But that is quite rare ? I find it hard to get in 8 hours cycling per week. But just doing day to day activities including work, I’ll almost certainly spend more than 8 hours walking in a week.

This. So much this. Ask around for recommendations and then go see someone who can actually look at your knee and asses what is wrong rather than tell you what was wrong with someone else’s knee.

I have to agree with these guys. See a good cycling-specialist physio – ask on here for local recommendations.

I had that – went to bike shop for a bike fitting. They moved things a small amount – seat height, cleat position etc and knee pain stopped. It was a new bike bought from the shop and they did it for free. I’ve never had a problem before that bike and had no issues since. To be fair it was a road bike and I think the continuous repetitive nature added stress where mountain biking doesn’t (mainly due to the standing around chatting nature of it!).

I had exactly the same problem as the OP 2 years ago. It came on randomly after years of riding the same bikes in the same setup. The only two influential factors I could think of were either a) pushing too hard up hills on the singlespeed or b) some softshell bib tights pulling/pressing the kneecap as I rode.

I saw a physio who said it could be muscle imbalance and proposed stretches (mainly quad stretches) and some exercises to help. One of the main ones I focused on was leg extensions (using the machine in the gym). Just doing the last half of the extension and focusing on using the inner quad muscle. Running also seemed to use that muscle well.

After about 2 months and many frustrating aborted rides it went away and never came back!

I find mountain Biking easier on the knees than Hiking (knees hurt on the descents) and any sort of running (can’t even do 5K on the flat before I have to start walking due to knee pain). Since the bike fit I’ll do 40-50k or more on the mountain bike without knee issues

Last physio session last night, could happily tell the physio I was pain free and it was a weird thing not to feel pain there anymore. Still going to keep up with the exercises he gave me to give more stability to the knee but best £95 I’ve spent not including the bike fit I previously had last year 🙂