Training & Nutrition - Persistent knee pain - can you help?

For the whole last year I have been riding seriously, I have continued to struggle with pain in my left knee, generally localized in the tendon below the knee cap and a little on the inside of my knee.

At this point, I have had a semi-pro fitting (i.e. came with the bike, not Body Geometry, etc), have Specialized shoes and footbeds, Speedplay frogs with tons of float, have tried to correct a leg imbalance by putting two extra shims under my right foot, and stretch and ice.

The funny thing is that the pain goes away for a few weeks, but then it comes back and sticks around for a few days/weeks. I don't hear any crunching, see serious swelling (just a little around the tendon), or experience any particular pain going up stairs etc, so I don't think its patellar femoral syndrome, chondromalacia, IT band syndrome etc. The pain is not extreme -- maybe 3-4 out of ten on the bike, and 1-3 off the bike -- but it can be uncomfortable.

When I got fit a few weeks ago, the guy said that I should try really dropping my ankle as a way to take pressure off the knee (any of you agree/disagree?). I saw a orthopedic specialist in the fall and even got an MRI done, and they didn't find anything wrong. I am scheduled to see a sports doctor in two weeks because I'm very frustrated that it keeps coming back -- any thoughts??? Thanks!

I get this too. It's frustrating, but I find the longer I ride, the more it goes away (for example, miles 1-5 of my ride are very painful, by mile 7 or so, it decreases significantly.)

The start of my season (after winter's off) is always the worst. I suspect that consistent training would help.

generally localized in the tendon below the knee capGenerally, "localized" makes absolutely no sense. And the region you describe would "generally" be described as a ligament. The area you describe is actually more suspect for bursae inflammation.


I saw a orthopedic specialist in the fall and even got an MRI done, and they didn't find anything wrong.I'm assuming an MRI would rule out bursae inflammation -but if your problem is acute and transient in nature - it would not show up a day later anyway.

I'm going to assume you are rather young, rather lean, and having been using NSAIDs off and on for pain relief. Is any of that true?

If so, then I suggest you forgo the NSaids, and use bike trainer and get a camera to study your leg movements while riding differing gears and rpms. Also, take care to compare the "look" of each knee during spinning and how they are alike and are different at different speeds/resistance. This could take quite some time to gather enough film to spot what might be the problem.

Is there anything off the bike that you do that could be stressing your knees?

I spent the last year working out some persistent knee pains, which were a year ago bad enough that I thought I might just be done riding, without surgery. But I also had a habit of ignoring little things that aggravated my knees.

One was my sleep position, which is usually flat on my back. In my sleep I was in the habit of crossing my right leg over my left leg, which pressed the left knee into a "locked" position. I'd wake up with a sore left knee. It took weeks to break that habit, and I also raised a section of the bed under my knees so they are always have a bit of a bend.

Another was, as a mechanic, I have to get in and out of cars dozens of times a day on my vehicle lift, which is about 2 ft off the ground. I was in the habit of resting my weight on my left leg and bending it fully while easing my other foot to the ground, which repeatedly over-strained the front of my left leg.

In both cased I had to change habits unrelated to cycling that were causing problems, and managed to work through the knee pains, never missing a day of riding. Of course, problems could just as easily have been damage requiring surgery - I think I was lucky, but it is possible to get through.

You probably have already looked into this, but have you experimented with the forward-aft position of the cleat? Your cleat might be too far forward, instead of centered underneath the ball of the foot. It's worth experimenting with.

For the whole last year I have been riding seriously, I have continued to struggle with pain in my left knee, generally localized in the tendon below the knee cap and a little on the inside of my knee.

At this point, I have had a semi-pro fitting (i.e. came with the bike, not Body Geometry, etc), have Specialized shoes and footbeds, Speedplay frogs with tons of float, have tried to correct a leg imbalance by putting two extra shims under my right foot, and stretch and ice.

The funny thing is that the pain goes away for a few weeks, but then it comes back and sticks around for a few days/weeks. I don't hear any crunching, see serious swelling (just a little around the tendon), or experience any particular pain going up stairs etc, so I don't think its patellar femoral syndrome, chondromalacia, IT band syndrome etc. The pain is not extreme -- maybe 3-4 out of ten on the bike, and 1-3 off the bike -- but it can be uncomfortable.

When I got fit a few weeks ago, the guy said that I should try really dropping my ankle as a way to take pressure off the knee (any of you agree/disagree?). I saw a orthopedic specialist in the fall and even got an MRI done, and they didn't find anything wrong. I am scheduled to see a sports doctor in two weeks because I'm very frustrated that it keeps coming back -- any thoughts??? Thanks!

Its possible due to your knee swaying as you ride. I had that issue last year, but was able to correct it over the winter as I improved my ride forum.

How often do you ride per week? Distances? how hard? its possible its due to over training and your knee is just a point were it shows the symptoms. I have heard a lot of individuals that have done this, and I did it last season to towards the end.

Along with that do you stretch after your rides? Adding some flexibility might help if you dont stretch after rides.

Knee pain most times I find has to do with fit. We even find it as an issue at the pro level. Next pushing a big gear for to long or during a climb etc. early on in he season we find this as an issue pro's as well. You need to find out what mech. are causing you the injury or it will just keep comming back. Next a proper exam by a sports doc that will give you some advice based on what he sees. At the Tour of California we had a ton of knee issue's during the tour and I have found that p.t. and kinesio tape (http://www.rosachiropractictemplehills.com/custom_content/126277_Kineso_Tape.html)and graston (http://www.rosachiropractictemplehills.com/custom_content/126276_graston_technique.html) work wounders on these conditions. I did a few artiles one for pezcycling news and one for velonews but I think it was a print you can take a look on my sites for links to the articles and they may help....or not LOL

Good luck

I've decided to check into Prolotherapy for my own knee. After doing some research & having some direct experience with it, it appears to be the best new treatment for injuries involving joints, ligaments--knees, backs, elbows, etc. It's a very simple and elegant solution vs. the standard meatball surgeries of the past.

Have you tried a good massage therapist? When the quads (above the knee) can put a lot of stress on the pattelar tendon below the knee.

This problem also sounds a lot like IT band problems. Have you tried laying on your side on a foam roller and rolling out your IT band? You should be able to pick up a roller for cheap anywhere that sells Yoga supplies

When I got fit a few weeks ago, the guy said that I should try really dropping my ankle as a way to take pressure off the knee (any of you agree/disagree?). I saw a orthopedic specialist in the fall and even got an MRI done, and they didn't find anything wrong. I am scheduled to see a sports doctor in two weeks because I'm very frustrated that it keeps coming back -- any thoughts??? Thanks!

I'd ask around and see if you can find the best fit person around - ideally somebody who is a PT. Somebody who can evaluate both your bike fit and your flexibility and muscle balance.

The knees are the weak link, so problems elsewhere often show up in the the knees.