After about 5 yrs of exclusive SS riding I got some patella tendon issues, which was down to what lots of others have said – too much seated climbing. I’d been doing a lot of training and had developed quite a bit of power, so found I could do a lot of steep stuff seated. Just because you can doesn’t mean you should! A conscious effort to mix up my style more sorted it out.
I’m about 50/50 geared/SS now but find ssing great for helping with management of a traumatic knee injury from 2 years ago. There’s less opportunity for a weak leg to hide on a SS. And the more I ride the better it feels – best excuse ever, even if it is true 🙂