Road Cycling - Knee Pain and Pedal Selection

I've developed some major problems with knee pain while riding my trainer. I am sure this is a flare-up of the patello-femoral syndrome that sidelined my running. The pain is on the inside of my knee cap, and below it. I'm doing the RICE routine, but was wondering about pedals.

Right now, I ride LOOK PP247s, and have a pair of PP396s on my commuting bike. I was thinking about a pair of Speedplays, but a friend suggested a pair with a lot of lateral float, like Time ATACs. Can anyone offer some advice about lateral float, especially someone with similar knee problems?


Thanks,
Erin

Knee Pain

Knee and hip pain are the most common cycling injuries. The most common cause of knee (and hip pain) in cyclists is iliotibial band (IT band) syndrome. The IT band is a thick fibrous band of tissue, which runs on the outside of the leg from the hip to the knee. Pain is caused when the band becomes tight and rubs over the bony prominences of the hip (greater trochanter) and/or the knee (lateral epicondyle). Tight inflexible lower extremity muscles may worsen the condition.
As injury is generaly a problem of overuse, it is often seen in the cyclist just beginning a training program or early in the training season when the temptation is to do too much too fast. In order to minimize knee and hip pain in the early season, take it easy for the first few weeks. Pedal with low resistance and a cadence of 80-90rpm allowing your body to adjust again to road riding. (Likewise with any change that leads to a slightly new bike position.) Minimize hard riding or hill work for the first few weeks. Add in a stretching program for your lower extremities, especially for the gluteus and IT band to help transition you into your riding season.

The most common causes are:

Faulty saddle height or position
Pushing excessively high gears (slow cadence in cold weather)
Too much leg work in the gym
Cleat alignment
Individual cyclist anatomy
Pain Location
One way to classify knee pain (and identify possible solutions) is to look at the location of the pain.

Anterior
Reasons
patellar tendonitis
patellofemoral syndrome
Causes
pushing BIG gears - cadence too low
saddle too low or too far forward
foot too far forward on the pedal
crank arms too long
leg length discrepancy with seat set for shorter leg
Possible solutions
ride at 75 rpm or higher
raise seat (in small increments of less than 5mm) or move seat back
move cleat forward 1 to 2 mm
shorten crank arms by 2.5 cm
set seat for longer, not shorter, leg with correction for the shorter leg
Posterior
Reasons
hamstring/gastrocnemius
neurovacular bundle
Causes
saddle too high or too far back
too much pedal float
leg length discrepancy with no correction for shorter leg
Possible solutions
lower seat (in small increments) or move seat forward
limit float to 6 - 8 degrees
set seat for longer, not shorter, leg with correction for the shorter leg
Medial (inner side)
Reasons
medial collateral ligament
pes anserenus
Causes
cleat position too wide - foot held externally rotated (toes point out)
excessive knee frontal plane motion
too little pedal float
Possible solutions
narrow foot position by moving cleat inwards
orthotic or wedge to correct foot alignment
pedal float should be 6 - 8 degrees
Lateral
Reasons
iliotibial band
degenerative lateral meniscus
Causes
cleat position too narrow - foot held internally rotated (toes pointed in)
too little pedal float
excessive knee frontal plane motion
Possible solutions
widen foot position by moving cleat away from the bike
pedal float should be 6 - 8 degrees
orthotic or wedge to correct foot alignment

ewitz, you ROCK!

I too suffer from knee pain every once in a while, but then again, old age might have something to do with it too....hehe :D

ewitz, you pretty much covered every issue related to knee pain that I can think of, I'm sure there must be something else out there, but I can't think of it.

A few years back, after many years of riding I developed pain in the knees. I was quick to set up a fitting at my LBS. I think, they charged me 15 bucks for a full evaluation and my cleats were adjusted. No problems every since. The best 15 bucks I've ever spent!

I do appreciate the post. I am also hoping to hear more about people's pedal choices, and how such choices have affected their knees.

One other cause of knee pain is chondromalacia (which I am all too familiar with). Sometimes cycling up hills causes knee pain for me.

http://healthlink.mcw.edu/article/926052680.html

My switch from speedplay pedals from Ultegra pedals has so far reduced the knee pain. I wasnt fit terribly goog by the lbs when i bought the bike so i think i need a good fitting in the spring.

My switch from speedplay pedals from Ultegra pedals has so far reduced the knee pain. I wasnt fit terribly goog by the lbs when i bought the bike so i think i need a good fitting in the spring.

You mean your switch TO speedplay from Ultegra or do you mean the other way around?

from ultegra to speedplay. Whoops.

I started road biking last October because of knee problems. About two years ago I started feeling pain on the inside of my right knee while running. This was an old Rugby souvenir from my college years (I am 46). The pain grew more intense so that running is now out of the question, I can hike and play volleyball without pain but running doesn't work. A doctor told me to take pain killer medecine, which I don't want to get used to, and then a friend surgeon told me that some non impact exercise might help. I tried an old rowing machine I had and it worked, I could exercise without pain and no discomfort came afterward. I am an outdoor man and rowing on a machine quickly got boring. Then came the idea of road biking, I got a nice used bike on eBay and started riding it about 2-3 times a week for about 10-15 miles. No knee pain at all using toe clips. As the bike came with Look pedals I gave that a shot 2 weeks ago. I am absolutely thrilled. The Look system (red cleats) offers enough float so that the feet angle can vary as needed thus reducing impact on ankles and knees. Since I use these pedals I am more efficient and my knee seems stronger with the occasional discomfort I used to experience completely gone.
I now average 4 15 miles rides a week each with some climbs, feel healthier, and really enjoy biking.

Knees problems suck, last week we went to the Museum and they had a thermal imaging camera, the knee I have problems with was white, my good knee was red, perhaps a doc can explain the heat difference, my insurance is being switched over and I am going the first week in feb, I have Bebop pedals, very similar to speedplays float wise and my knee has felt fine, until I push it, I did 40 miles with a 20 mph avg. last week, big mistake. Oddly though on my bike is one of the few time my knee does not hurt.

Btw stay away from playing hacky sack, you won't walk for a week.

I've developed some major problems with knee pain while riding my trainer. I am sure this is a flare-up of the patello-femoral syndrome that sidelined my running. The pain is on the inside of my knee cap, and below it. I'm doing the RICE routine, but was wondering about pedals.

Right now, I ride LOOK PP247s, and have a pair of PP396s on my commuting bike. I was thinking about a pair of Speedplays, but a friend suggested a pair with a lot of lateral float, like Time ATACs. Can anyone offer some advice about lateral float, especially someone with similar knee problems?


Thanks,
Erin

Hi Erin I'm new at this message board so bear with me if I do somthing wrong.I've got the same kind of problem with my knee.I was looking at the speed play peddles to.I injured my knee when I was 13.I dislocated it and the muscle tore peaces off the bone.After they took the peices out it would fall out of the socket all the time. Now I've got artheritis in it and I'm only 36. Those peddles look like they might help.

Later,
Robin

With regard to leg length discrepencies and saddle height, it seems there is no easy solution. My left leg is shorter than my right by half an inch. I've found that setting the saddle height primarily for my left leg is most manageable, however, it causes my right hamstring and left quad get the most work and my left hamstring and right quad are less developed. The muscle imbalance can cause me knee pain, especially when running. To fight it I do single leg drills and work with weights focusing on the less used muscles.

As far as float goes, I find that more float allows my knees to find their own path and causes less pain.

-s

With regard to leg length discrepencies and saddle height, it seems there is no easy solution. My left leg is shorter than my right by half an inch. I've found that setting the saddle height primarily for my left leg is most manageable, however, it causes my right hamstring and left quad get the most work and my left hamstring and right quad are less developed. The muscle imbalance can cause me knee pain, especially when running. To fight it I do single leg drills and work with weights focusing on the less used muscles.

As far as float goes, I find that more float allows my knees to find their own path and causes less pain.

-s

While obvious, I thought I would point out that you can buy two sets of cranks of different lenghts to accomodate the difference in leg length.

-mark

i would suggest not changing the look's (i ride the same look's) but look into either raising the saddle a small amount or readjusting the postion of the red cleat on the shoe. mine are differing positions on wither shoe.

also, your riding while on a trainer is different than on the road, so it may also be a function of your harder efforts on your trainer since a trainer doesn't allow for certain handling and pressure characteristics than your legs. adjust the cleats and raise the saddle a small, small amount.

since you mentioned that the one knee just started bothering you on the trainer, i am assuming that it hasn't been a chronic thing with your riding in the recent past. i used to have to ice my knee and it ached till i learned about positioning of the cleat. they don't have to be symmetrical either.

good luck.

Knees problems suck, last week we went to the Museum and they had a thermal imaging camera, the knee I have problems with was white, my good knee was red, perhaps a doc can explain the heat difference, my insurance is being switched over and I am going the first week in feb, I have Bebop pedals, very similar to speedplays float wise and my knee has felt fine, until I push it, I did 40 miles with a 20 mph avg. last week, big mistake. Oddly though on my bike is one of the few time my knee does not hurt.

Btw stay away from playing hacky sack, you won't walk for a week.

Assuming white means a hotter temperature, there is significant friction in your knee joint. As the the parts of the knee slide back and forth, friction is generated. There's always some friction, but a lot of extra friction being generated in your case. Friction causes heat (and trauma and thus pain). My orthopedist recommended icing the knees.

Assuming white means a hotter temperature, there is significant friction in your knee joint. As the the parts of the knee slide back and forth, friction is generated. There's always some friction, but a lot of extra friction being generated in your case. Friction causes heat (and trauma and thus pain). My orthopedist recommended icing the knees.


Uhh ... you listed your car in your sig?

<sigh>

-mark

While obvious, I thought I would point out that you can buy two sets of cranks of different lenghts to accomodate the difference in leg length.


I've thought of that. But haven't tried it. I've been riding a long time this way and it would seem a weird to have different length cranks. Know anybody who rides that way?

-s

I also have exterior knee pain. My doctor suggested a knee support. Works wonders.

Uhh ... you listed your car in your sig?

<sigh>

-mark

I sometimes use my car to transport my bike, so it is relevant!

I would be proud if I had an Audi too, even given my personal preference of the 330i.

Guess what, I moved my cleat back a hair and my knee no longer hurts, doh, I can't say enough for proper fit.

i find that a pedal with a significant amount of float (ie, the speedplay x series) greatly reduce any sort of knee problems one might have. i switched from the dura ace pedals to the speedplays and my knee problems are no more.

Man, I had a terrible time on my century this past Sunday. MS Ride in NYC. By mile 20, the outside of my right knee started to bother me. It was very cold and windy, so I just thought it would go away as the day (and I) warmed up a bit. But no, by the middle of the ride, I was none too thrilled with my knee. I tried adjusting my position a bit and tried to use my left leg more than my right, but just the motion hurt.

I did get some slight relief by standing up, but not for long. I also found a bit of relief if I pointed my right toe inwards a bit (but not enough to release the clip). Unfortunately, after a while everything hurt. This was the closest I've ever come to quitting and honestly, if a SAG van came by, I probably would have flagged it down.

I did finish, though. 8 hours. Ugh...

Here's what hurts: It's my right lateral collateral ligament:

http://my.webmd.com/hw/health_guide_atoz/zm2662.asp?

I'm using SPD clips on Specialized Comp shoes (they have a slight angle in the sole that they claim is better). I did notice that if I tried to stretch out further back on the seat, it go worse. I'm wondering why I haven't had any problems with my left knee?

I was reading on all the stuff above, but I'm not sure what my next step should be. I really want to figure this out without causing further injury to my knee. I believe I should take a fairly systematic approach so that I'm not changing too many things at once or spending money without knowing what I'm doing.

Any suggestions are very welcome.

Thanks,

Warren

I do appreciate the post. I am also hoping to hear more about people's pedal choices, and how such choices have affected their knees.
There's only one true answer... find an LBS that'll let you try and return various pedals.

I went thru SPDs, Look-alikes, and Speedplay Xs, before settling on Ultegras. It's what's best for my knee.

sorry, i know you're looking for some definitive answer, but there just isn't one.

I had some mild knee pain when I first began riding longer distances. I figured old age was the primary cause. However, over a couple of years, I made a number of changes in how I ride, and the knee pain has totally gone away.

-I ride with flat, wide platform BMX pedals. That allows me to shift my foot a bit as I ride, left and right, forward and back. The wide flat pedal spreads pressure across a broad area, so foot discomfort is gone. But altering foot postion also means the stress of the knee comes at slightly different angles, and reduces knee stress. Pedals that lock the foot into just one position mean that the same precise part of the knee is stressed, over and over, one pedal stroke after another.

-I use really easy gears. I try to ride up around 90 RPM while riding at moderate (okay, kinda slow) speeds. This provides a good cardio workout, but is very, very easy on my legs and knees.

-I have gradually raised the height of my saddle, for more leg extension

-I have raised my bars higher than my saddle. No effect on my knees, but the pain in my neck, hands, and wrist is gone. If you are going to get rid of pain, might as well get rid of all of it.

Also note if your leg movement has excessive sideways movement, you will get knee pain as well.

I found this out a while ago after i hurt my knee. Turns out the giant belly I still have to work off was bothering me, so i subliminally started to develop a sideward motion with my legs to avoid having to fight my gut on the upstroke. That caused enough rubbing in the knees to cause some serious pain. Since then I fixed my technique as much as possible, and it seems to be better. I've also taken up an obscene amount of sit-ups and leg lifts a day in hopes to downgrade my "keg" into a "six-pack" :D

I just went thru this entire process.

For road riding, I've been a Look user for many years. I've never experienced problems until recently. On climbs, the pain would exhibit itself similar to your description.

In addition to the fitment issues and position adjustments which have already been detailed in this thread, I decided to consider the different pedals.

I considered pedals with rotational float. Here's my experience:

1. Look pedals have a friction centering action that my knees would resist in their natural movement. Even after adjustment, long extended climbs would get sore and stiff.

2. TIme pedals have a spring centering action. This would make situations worse as my knees would stress as the springs would always tension towards center.

3. Speedplays - I tried X2s which have 25 degrees of free float. The difference was dramatic. My first ride was 35 miles on flat roadway and I did not experience any of the soreness or pain that I've become to associate with spinning. I selected this route so I could maintain a 90-100rpm cadence without the stress of a long climb. It was a dramatic improvement over the other pedals. So my next ride was a 33 mile climb with two 1800' elevation gains. Again there was no pain or stress on the knees. The Speedplays were dramatically better on my knees than any of the other pedals I tried.

Hope that helps

Check that your bottom bracket is square with the frame. Find a straight edge at least 24 inches long have someone hold it against your chainwheel; then looking from above close one eye and see if the straight edge is parallel with the top tube.

If a frame is built with the bottom bracket out of square you will not notice it as you pedal but your knees are constantly twisting. Just a simple thing to check and eliminate.

Yes, the speedplays do have more float than the time atacs. I switched to time atacs when I had PF syndrome on the advice of a cycling coach I consulted. Also he recomended high, forward saddle position. I got mostly better, a little twinge still after hard days. The time pedals do have a recentering force which I don't like. My new pair seems less floaty than the old ones. I saw in a catalog that they have 5 degrees of float. I thought they used to be 11 degrees?

I just went thru this entire process.

3. Speedplays - I tried X2s which have 25 degrees of free float.



Man, 25 degrees of float? That sounds like an awful lot. Does that make it more difficult to unclip from the pedals at stops?

Hey everyone! a most sad but common problem for many it seems, im 20 and sadly i hurt my knee in high school playing lacrosse, we had a coach (from the very oldest of old school) who thought tough strong lacrosse players should run the preseason in full gear, sweat suit....and WINTER BOOTS! doh! well one season of this and my knee was toast anyway i use cheep Richey’s on the mtn bike and my knee goes through some complaints about 2+ hours into riding....but wait there’s hope, on the road i use speedplays..(cant remember the model) but i love them, the float took a little to get used to but there things are butter! i have sidi g4's and feel like I put on fine leather footies every time i suit up, however i have noticed if i dont tighten them correctly i get some "roll" or odd angle on the foot, but my knees are ok. My knee problem was explained by my doc as you have a muscle that holds the knee cap in place, yours slipped off and over and rubs oddly (from the hard hitting running drills on an unfit knee, it was my first lax season after NOT playing soccer in the fall and being out of shape to start running with improper shoes) I would like to note as many have said FIT FIT FIT, dont be afraid to ask the LBS to explain and tyr different setups, if they make a rider happy, they will probably get return business and as most know, we seem to spend a good amount of money at the "right" shop.

peace all, im back to work!

edit: i have speedplay x2's, they are super floaty, but not in a bad way, also exit and entry is ooh so smooth and easy

Man, 25 degrees of float? That sounds like an awful lot. Does that make it more difficult to unclip from the pedals at stops?

It's not difficult at all. Speedplays have a reputation for requiring little training. Beginners have no problems learning entry/exit techiniques.

As TSPINNING said:
Exit and Entry is oh soo smooth.

I curious too now. You must rotate your foot more than 25 degrees to get out? I believe you that it is easy but seems like a much larger movement than needed w other pedals. I would probably prefer speedplay, but the times are working out well for me.

"With regard to leg length discrepancies and saddle height, it seems there is no easy solution. My left leg is shorter than my right by half an inch. I've found that setting the saddle height primarily for my left leg is most manageable, however, it causes my right hamstring and left quad get the most work and my left hamstring and right quad are less developed. The muscle imbalance can cause me knee pain, especially when running. To fight it I do single leg drills and work with weights focusing on the less used muscles.

As far as float goes, I find that more float allows my knees to find their own path and causes less pain."

Slider, I have a 15mm leg length inequality, 7mm in the right tib-fib and 8mm in the right femur, and a twisted/bent right hip. I eventually got CT'ed to get the best possible assessment.

It took 7/8" of shoe sole buildup and to correct for the total leg length inequality on my cycling shoes (I use 3/4" on my walking shoes), plus pushing the saddle forward to get the right knee closer to the pedal spindle. I use equal-length crankarms. The forward position is not as efficient for the longer left leg, but if I don't push the saddle forward, I risk damaging the right knee.

I get by with SPDs, but my friends with various leg handicaps often swear by their Speedplays.

With regard to leg length discrepencies and saddle height, it seems there is no easy solution. My left leg is shorter than my right by half an inch...Actually, I think there is an easy answer these days...you might want to do some surfing, a number of pedal systems, Speedplay included, offer shims to equalize leg length differences. Having different crank lengths IMO create more problems than it resolves, as you would have to adjust to different pedaling circumference - strange concept... :)