I’ve been getting awful medial knee pain from mountain biking and have had to reduce my miles to less than 70 per week or it gets worse. Also have to ride slower than I’d like, as riding at high effort aggregates it.
Tried foam rolling, hasnt worked so far, have had my bike fitted ages ago. I always spin and don’t mash as mashing makes it worse. Standing pedalling in a high gear makes it worse.
Don’t do much exercise other than biking. But walking up stairs, doing unweighted squats and jogging cause the same symptoms perhaps worse, but I don’t do these regularly at all, just try them now and again.

Tried a few physiotherapists and dont seem to have found a good one as the exercises theyve given me dont work or they aggravate the symptoms ( esp squatting.)
I haven’t got the time to ice it 4 times a day unless I go on the sick at work.
Anyone know what it could be?

Seat to high, well was for me. Could also be incorrect spd cleat position. Theres a few things to try to eliminate the cause, you just need to try each individually (plenty of info on various sites).

Took three weeks of cycling as well as taking it easy standing up from squatting, easy up lots of stairs etc and it went within a couple of months.

Not sure, but my knee pain started to go when I had an osteopath straighten up my hips, stretched my calves, stretched my thighs by kneeling on my haunches, changed back from wearing shoes to walking boots for the walking part of my commute, and got a dropper post so I cycled with a full height saddle for most of the time.

Tried a few physiotherapists and dont seem to have found a good one as the exercises theyve given me dont work or they aggravate the symptoms ( esp squatting.)
I haven’t got the time to ice it 4 times a day unless I go on the sick at work.

It’s not the physiotherapists who are not good, it’s the patient – you are the problem. I’m sure that if you did exactly as they told you you would get past your medial knee pain problem. It can’t be that bad if you’re still riding 70 miles on the mtb in a week. Toughen up princess.

Well I said “less than 70 miles” most weeks only see 50 or 60 miles on the mountain bike. Worried I might have to reduce it even lower. What’s worse I feel like I have to ride at 50%-60% effort all the time to avoid aggravating it too much.

Some of the physio’s were telling me to do squats & lunges but they felt like the last thing I needed – made the problem feel worse, so had to stop.

I had one physio who seemed to be a bit better but she went on long-term sick so I got moved on.

Through mithering the NHS they’ve finally agreed to give it an MRI scan so hopefully should find out why from that, but have not been given a date for the scan yet so could be weeks off yet.

If it’s that bad you need an MRI, then surely you should be cutting down big time on biking to give stuff time to rest and get better ?

OP
Try the following buy some zinc oxide tape place the first piece of tape under your knee cap stick it to your skin (press hard!) then depending on leg pull it tight and upward and the stick it against the side of your leg. Then place another piece of tape below the first (just touching) then once again pull it up on a diagonal and stick it to the side of your leg.

Basically your pulling the skin etc to the outer side of your bad leg. If this eases it you have the same problem I have and need phsyio. It’s basically the tendon in your leg not running straight over you knee cap.

When I first got it I was out on a ride and could hardly make it back it’s like some one sticking a knife into your knee cap and VERY pain full.

It took 3 doctors appointments and 2 NHS physios before I found someone who knew what the issue was (a knee specialist Physio). Then 6 months of physio.

I now HAVE to ride my bike if I don’t within 2 weeks it starts to come back.
It’s cause by a mussel mismatch and the mussels in your thighs need strengthening in order to pull the tendon back straight.

*****NOTE I’M NOT A DOCTOR OR PHYSIO. So get professional advice.*****

OK I may try some of the suggestions.
However, the MRI scan that I’ve been waiting for is tomorrow so hopefully I should find out what’s wrong from that.