Clydesdales/Athenas (200+ lb / 91+ kg) - Knee Pain

Yesterday I started getting knee pain in my left knee. I was on my way back from work, and about 6 miles into the ride when my kneecap started to feel like it was going to slip out of place. I'm clipped in, so I unclip thinking that maybe it's the postion my leg's forced into because of the pedals/shoes. It still hurts, so I stopped and called my wife to come get me, b/c I'm not going to get a 'real' injury and be off the bike for a week or so.

I'm a big 380, 5'9" guy. I'm wondering if it was the clipless pedals, or just my size finally getting to me. Anyone have any similar problems or solutions for me? I'm not going to do my commute today, but will ride when I get home tonight in anticipation of doing the commute tommorrow.

Do you spin or mash? Could be the seat height too - but if my knees ache I find I'm mashing a bit more and gear up to spin more.

Go to a local LBS and pay them to set the bike up.

DIY, look up bike fitting on the net, move seat and handlebars foward and back.

Some say a fixed gear will give your knees a more balanced workout. Perhaps toe clips or other system.

Check my sig for fitting threads too if you want to DIY.

Loads of things cause knee pain. For example: my most recent knee pain was caused by really poor jumping technique combined with lots and lots of gravity. We can likely rule that one out as your issue.

My experience has been:
- Seat too low causes pain in the front of my knee
- Seat too high causes pain in the back of my knee
- Seated climbing causes pain in the back of my knee if I let myself slide back on the seat (basically the same as having your seat too high).

Clipless pedals can cause all sorts of pain if you do not have them set up correctly. If you have your seat position incorrect and then clip in you will undoubtedly hurt yourself over time as your feet are locked into a limited range so all the compensating for your incorrectly set up bike has to come from your joints. When you ride platform pedals your feet are able to shift around to compensate for other issues.
Have you been cycling with clipless pedals for a long time or is this just a recent thing? If you have been using them for some time, did something recently change. (ie: Started riding further or in hills).
I had a hard time with my first set of clipless pedals as I kept setting both cleats in the same position. I ended up with some pain in my knee after a few weeks (approx 200 miles) and had to go back to flats until my legs felt better. My bike was otherwise properly set up so the clipless system was the culprit. After my leg felt better I was very methodical in my set up, I would ride a bit and if it didn't feel right I would stop and adjust the cleat position on just one shoe a tiny bit and carry on. I always did this close to the beginning of my commute so that my legs were not loosened up, I find when they are loose they can put up with a lot more abuse. It took about 6 rides to get it right, for me my left foot turns in a tiny bit and the cleat is maybe 1 - 2 mm closer to the heel than on the right foot. This makes sense as my left foot is marginally bigger than my right.

Almost reminds me of what I had/maybe still have- a patellar subluxation. Basically- the knee cap doesn't glide in it's groove properly and causes pain. The standard cure is strengthen the hip and leg muscles to help hold the knee cap in place.

Lots of leg exercises and losing 50 lbs has made it pretty much go away, but if I really exercise my leg muscles hard- I can still feel some pain now and then. Giving my legs a chance to recover and return to full strength makes the pain go away.

Maybe you just need some recovery?

Also keep in mind that if you are too rigidly fixed to the pedals, that can cause pain in the knee as well. Some clip systems allow you to set the degrees of lateral motion, and I typically go for the larger choice. It may also be useful to adjust the clip-out tension so that you have more play while you are clipped in. Just keep in mind that if you do so, you will have to try a little harder to clip out at a stop.

I'm taking the next few days off. I tried to work this morning, but after a few hours on my feet, the pain in my knee went from barely noticable to pronounced. I was afraid it was on it's way to dibilitating, so I took the rest of the day off and will probably take tomorrow and the weekend off from work as well.

I'm fairly new to riding, and have only put in about 150 miles. I know that doesn't seem like a lot to some of you, but for a heavy guy just starting out, it's a lot. I had the clipless pedals installed at the LBS last week and have gone about 20 miles in them, was doing fine up until yesterday. Since everything seemed okay until yesterday, I'm putting the blame on the pedals. Nothing else has changed in my setup. I've been fitted at the lbs.

Now it's time to scour the internets and see what I can do about it to help speed recovery.

I'm taking the next few days off. I tried to work this morning, but after a few hours on my feet, the pain in my knee went from barely noticable to pronounced. I was afraid it was on it's way to dibilitating, so I took the rest of the day off and will probably take tomorrow and the weekend off from work as well.

I'm fairly new to riding, and have only put in about 150 miles. I know that doesn't seem like a lot to some of you, but for a heavy guy just starting out, it's a lot. I had the clipless pedals installed at the LBS last week and have gone about 20 miles in them, was doing fine up until yesterday. Since everything seemed okay until yesterday, I'm putting the blame on the pedals. Nothing else has changed in my setup. I've been fitted at the lbs.

Now it's time to scour the internets and see what I can do about it to help speed recovery.
Ice the knee down and place a rolled up pillow under your knee when sitting with the leg up.

Not medical advice, but it works for me and for my wife. Is the pain on the inner, outer front or back of the knee, that'll give us an idea whether it's a float issue or saddle height issue, the clipless may have a marginally different height from the center of the pedal spindle vs the Platforms.

That's the precise reason I use clip and strap, by the way is knee pain when using ANY clipless system, even a major float system like Crank Bros or Speedplay Frogs.

Pain is on the outer knee, front in the kneecap reigion. I usually have muscle pain above the knee in that part of my leg muscle, but that's bareable. This pain is dull, in a different reigion, and i just didn't want it to get worse.

Treat yourself to one of these (http://activeforever.com/p-1066-elasto-gel-multi-purpose-wrap.aspx). The best hot/cold wraps you can find period. Even cold for a full 30 mins. The 6 x 30 should be fine.

Pain is on the outer knee, front in the kneecap reigion. I usually have muscle pain above the knee in that part of my leg muscle, but that's bareable. This pain is dull, in a different reigion, and i just didn't want it to get worse.
OK,that could be low saddle. When you are on the saddle, you should be able to place your heel on the pedal with the leg at full extension. If you have any bend at the knee with your heel on the saddle, it's too low.

Alternatively, if the saddle height is correct, it could be a float issue, but that is low order of probability, because float issues tend toward pain in one side of the knee or other.

Third possibility is tendon inflammation and rest and recovery are needed for that. If the pain is BAD, you need to see a doctor. You can make sports related overuse injuries a lot worse by not attending to them. Given the sudden onset, I would strongly think about seeing that Dr anyway. I'd suggest a Sports medicine Dr rather than a GP.

How long are your cranks.
I find that riding 175's causes more pain then 170.
I'm 3" taller than you.

How long are your cranks.
I find that riding 175's causes more pain then 170.
I'm 3" taller than you.

I'm new enough to not know the answer to this question...

I'm new enough to not know the answer to this question...
Measure from the pivot point on your bottom bracket (Where the cranks join) to the center of the pedal spindle.

Almost reminds me of what I had/maybe still have- a patellar subluxation. Basically- the knee cap doesn't glide in it's groove properly and causes pain. The standard cure is strengthen the hip and leg muscles to help hold the knee cap in place.

Lots of leg exercises and losing 50 lbs has made it pretty much go away, but if I really exercise my leg muscles hard- I can still feel some pain now and then. Giving my legs a chance to recover and return to full strength makes the pain go away.

Maybe you just need some recovery?

I had this too, from playing basketball. Cycling helped correct it.

If refitting your rig doesn't work, I'd go see a doc that specializes in sports med.

I made two changes which collectively ended what was debilitating knee pain. As in wincing in pain, and wondering if it was really necessary that I climb into my van to go somewhere.

First, I switched to using Speedplay pedals, with their "free-floating" design. This ended the potential for applying side loads to my knees. Their unrestricted float has been described by some as "feeling like walking on ice", but I had no problem, and quickly and happily adapted in short order.

Second, I adjusted for my forefoot varus. You can do this by installing the LeMond LeWedge shims between your shoe soles and your cleats. Another alternative is the Specialized Body Geometry footbeds which can be used in any brand of shoe, or just wearing a set of their Body Geometry shoes. Personally, I found the shoes to be the best option, as there's more to benefit from than just the varus wedge adjustment.

Cheers

when icing down you want to make sure you don't ice for too long. usually 15 to 20 mins on one's knees is sufficient. the best way to tell is if the skin turns blue. if you keep ice on for too long your body will think it is heading toward frostbite and will send blood into the area being cooled down. this blood will cause further inflammation and could possibly cause further damage. for your size 30 minutes may be ok, just keep an eye on your skin.

when i ice my knees down i do 15 min on 15 min off to let the tissue warm up then back on. 2X per hour.