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  1. #1
    Going once, going twice..
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    Knee pain, outside and slighlt below.

    I just started getting back into biking a few months ago. I have been experiencing knee pain in my left knee due to the alignment of my feet/hips. My feet point out at about 20 deg for my left and 10 deg for my right during a normal walk and to help with this I changed from eggbeaters to speedplay pedals for the free float. This seems to have helped quite a bit with my left knee, but then my right knee started to hurt, probably just a delayed reaction. I have not cut the relief into my right shoe yet to allow the proper angle for my foot, but I can tell you straight away the pain is drastically increased if I put any twisting force onto my leg.

    The pain centers around the, well lets try to describe this non medically. Extend your leg fully and grab your right kneecap. Move down and right about 2" and there should be a bone there, then a gap with some muscle, and a smaller bone. In that gap, and maybe slightly above is where I feel pain. I believe this describes ITB syndrome but I am not an expert. I am also having some shin pain, but I think thats just shin splints or something like it as I get used to

    Here is the odd thing, on yesterdays ride about 5 miles in, my right knee started to hurt. This time pretty bad, I had to stop pedaling it was so bad. Considering I still had to ride back 5 miles, I wasnt sure what to do so I tried pushing my foot forward, and it seemed to help. Eventually I put my heel on the pedal and started to pump. Absolutely no pain. Pull my foot back and by the time the pedal was in the middle, pain was back. It was completely back if I put locked in with the clipless.

    I am going to cut the relief later today, but wanted to get some opinions on what you think might be wrong. My distance from the pedals seems to be correct. Using one idea I should just barely be able to stretch my leg so my heel rests on the pedal vs the ball of my foot during a normal pedal stroke. My hips do not move while pedalling normally. My back is comfortable and I can sit up without touching the handlebar no problem so there is plenty of balance there. My feet cleats are pretty much as far back as possible on the shoes (or my feet are as far forward as possible depending on how you are looking at it).

    My left knee did not bother my at all during this experience, even doing double duty coming all the way back, so I would say getting that foot pointing outwards really helped. I am considering getting extenders so I can point my foot out another couple degrees as I am able to touch the crank now on my left, and we will see about the right. I will get another 3-4 deg with the relief, along with the crank being a bit more flat against the shoe.

    As soon as I get a chance, I will be going to see a doctor, but I want to have your general feedback/ideas so I can bounce them off of him/her. Doctors are great people but they are not magic workers. More information might allow me to describe the issue better and get results that work for me.

    Thanks all!
    Scot

  2. #2
    Senior Member va_cyclist's Avatar
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    I have pain in the exact same place, same leg even. I tried all the same adjustments, but the pain kept returning. Aleve worked wonders for me on my last ride (got me through a century with little to no pain). Another thing that has worked on and off was consciously pulling my knees in toward the top tube as I pedaled. Based on reading I've done and the fact that it's in one leg only, I think it's a simple overuse injury, just basic inflammation, treatable with rest and NSAI's, but I haven't had a medical opinion. Please let us know how the doctor visit goes.

  3. #3
    Dude wheres my guads? skinnyone's Avatar
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    ITBS... I think... Stretch stretch stretch... pedal the middle ring and hopfully you will recover soon... I have had it recently and resting alone doesnt help much... I have also noticed tendonitis in the shin on the same leg... It goes away with showing restraint from bigger gears... Get well soon...

  4. #4
    Senior Member roadwarrior's Avatar
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    See a fitter...there are a ton of threads on cleat fitting...so the short version is that it is not only the angle, but whether your foot is flat on the pedal and the cleat...in other words, if you pronate when you walk, you pronate when you ride. Since you cannot really pronate, or you try to, you put pressure by trying to flatten your foot as you would when you walk. And a shim (Lemond Lewedge) between the cleat and the pedal is what we use to fix that.
    A bike shop with a fitter (a good one) will be able to fit and adjust your cleats properly (forward/back, side to side, toes in/out for starters). You can't just stick these on your shoes and go ride.
    If you google or aj this topic, you will get a million articles...

    Or, you could have an injury, but my guess is that unless this existed prior to riding, it is due to a bad pedal stroke due to a poor cleat/pedal/shoe fit.

  5. #5
    Senior Member roadwarrior's Avatar
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    Quote Originally Posted by skinnyone
    pedal the middle ring
    What's a middle ring?

  6. #6
    Going once, going twice..
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    Middle ring, its a fear of commitment I think...

    Oh and as for pronation, I am neutral. They stick out, but oddly enough I walk/run perfectly without any hint of leaning even with my feet in their wacky placement. Started out running with shoes designed for pronation because I assumed I must do it. Had issues with my ankles and they videotaped my feet and got me a pair of cheap nike air pegasus. Love them and havent had any issues since from running, save a stiff calf or 45.

    Scot

  7. #7
    Feral Member Nicodemus's Avatar
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    I had tendonitis of the outside tendon, just below the knee. Sounds similar to your problem. I left it a few months before seeing a doctor, and had to spend months in physiotherapy as a result.

    stretch stretch stretch. See a physiotherapist or check out other information on the types of stretches to do.

    Don't "bounce" when you stretch.
    Hold your stretches for at *least* 15 seconds.
    Get into a regular routine and it's easier. Every night I watch an episode of Simpsons or South Park while I do my stretching. It helps to pass the time.

    Good luck sorting it out - and make sure you don't let this become a long-term problem.

  8. #8
    Dude wheres my guads? skinnyone's Avatar
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    All you middle ring haters... ... I spin a bit, mash a bit, leave the bigger ring for sprints/TTs or catching someone... I noticed a reduction in soreness if I kept my pedalling smooth and if I spun rather than mash....

  9. #9
    Senior Member biker7's Avatar
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    Quote Originally Posted by roadwarrior
    See a fitter...there are a ton of threads on cleat fitting...so the short version is that it is not only the angle, but whether your foot is flat on the pedal and the cleat...in other words, if you pronate when you walk, you pronate when you ride. Since you cannot really pronate, or you try to, you put pressure by trying to flatten your foot as you would when you walk. And a shim (Lemond Lewedge) between the cleat and the pedal is what we use to fix that.
    A bike shop with a fitter (a good one) will be able to fit and adjust your cleats properly (forward/back, side to side, toes in/out for starters). You can't just stick these on your shoes and go ride.
    If you google or aj this topic, you will get a million articles...

    Or, you could have an injury, but my guess is that unless this existed prior to riding, it is due to a bad pedal stroke due to a poor cleat/pedal/shoe fit.
    Listen to Roadwarrior's advice...he is a professional fitter and knows what he is talking about. Barring any structural issues with your knee...likely the bio-mechanics of your pedal stroke as he suggested which can be resolved with a shim in vertical plane and/or cleat realignment in rotational horizontal plane. What I always suggest to people with any knee issue is to adjust their seat position more aft and try changing seat height as well...raising versus lowering to get the back of the knee more involved. Also try and push less gear as skinnyone correctly suggested...and remove the clipless pedals from your bike and ride in tennis shoes. You can do these all at once or one at a time. You don't want to ride with knee pain because your poor mechanics can cause a long term injury. If your issue goes away by riding in tennis shoes...you can also adjust pronation/supination by a homebrew foam insert on either side of the shoe under the insole...then you know your problem is your cleat adjustment which it likely is.
    George
    Last edited by biker7; 08-04-05 at 10:00 AM.

  10. #10
    Going once, going twice..
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    Biker7: I believe he is right that the adjustment will help, but not with a shim. I had my feet checked out and I do not pronate or suponate. Just a normal stride.

  11. #11
    Unemplawyer
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    One thing to consider -- just a possibility -- since you mentioned that you had no pain pedaling with your heel, and increasing pain as you moved your foot toward the proper position on the pedal. Your saddle may be too far forward/too low. Either one would cause your knees to be more bent than they need to be, as well as out in front of the pedal spindle (I know, KOPS isn't for everyone, but I have bad knees, and I have to have my knee over or behind the pedal spindle or I get wicked pain within 10mi).

    Just a thought from another rider with with bad knees.
    Hope you like reality.
    -racingpain

  12. #12
    Legs of Steel chrisvu05's Avatar
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    You seem to have Illiotibial band syndrome. It is basically tendonitis of the knee. You need to do lots of stretching....especially calves and hamstrings. Don't let this get bad because it can sideline you for a while.

  13. #13
    Senior Member biker7's Avatar
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    Quote Originally Posted by scot
    Biker7: I believe he is right that the adjustment will help, but not with a shim. I had my feet checked out and I do not pronate or suponate. Just a normal stride.
    Just because you are normally slew footed...I hope your cleats are mounted on your shoes accordingly... and you don't pronate or supinate visually doesn't mean you aren't translating stress to the part of the knee where you are experiencing pain. Typical rule of thumb...even if not supinating is...to shim the outboard section of the cleat to rotate your knee more inboard toward the top bar during the pedal stroke to take stress off the outboard side of the knee. Don't be deceived just because you don't have a supinated foot that a more pronated position via an outboard cleat shim won't help eliminate pain.
    In the horizontal plane, your cleats should be rotated if you are slew or pigeon toed accordingly of course.
    Good Luck,
    George

  14. #14
    Going once, going twice..
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    That makes some sense. I do have the shoe pointing outward when locked in place, but like I said my right shoe will be modified tonight to allow me to get it pointing out further.

    If that does not work (along with the stretching and what my dr recommends) I will put in some shims on the outside to see how that goes.


    Chris: yeah I disovered the calf thing. Couldnt figure out for the life of me why my legs were always tight. Stretching ITB while sitting or standing and calf stretching combined with the outward pointing on my left foot really helped. A

    Anyone have any other good ITB Stretches?
    Scot

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