Hey fit gurus, M.D.s and other knowledgeable sorts, let me pick your brains. Don't worry, I'm not asking for medical advice per se. I'll consult my doctor further about this, in all probability.

Recently, I've been dealing with a strain in the medial hamstring group of my right leg, where it attaches to my knee. My doctor has given me a treatment plan, so I've got that well in hand, but now I'm starting to think about the cause. Here are the facts:

1. This injury first cropped up a few weeks ago on the rollers. I've never experienced a knee injury of this kind before, and I've had a few. Thanks to previous experience, I've avoided making this one worse by pushing too hard, so it's been irritated rather than painful. The damage isn't too serious yet. I have already raised my saddle a bit (I stupidly dropped it when the injury first appeared).

2. In January, I moved my saddle forward by several mm. I had been well behind KOPS - as in, close to two cm behind KOPS - and wanted to see if I could get more comfort by being more directly over the BB.

3. I've had a long-standing sensation on my right foot of not being able to get my cleat back far enough, even though my feet are the same size. Obviously, the problem is not that the left shoe has greater adjustability for cleat position than the right. Yet, this sensation persists.

4. I noticed on my ride home today that, while my left ankle remains relatively stable and my foot angle relatively consistent throughout the pedal stroke without effort, I have a distinct tendency to drop my right heel on the down stroke of that pedal. It takes some focus to maintain a relatively stiff ankle and avoid dropping my heel - that is, I must activate the muscles of my lower leg to do this. On the left, no such effort is required. This makes pedaling feel better.

5. I have flat feet, and my right foot appears to have great pronation than my left. I am using OTC orthotics, which has essentially erased previous knee pain associated with over-pronation.

So, here's my hypothesis: my injury is the result of this tendency to drop my right heel under power, which of course puts more strain on my hamstrings. My over-pronation might explain why the injured part is my medial hamstring group, rather than the strain being more evenly distributed. My saddle being so much further back would explain this not being a problem in the past, since this would effectively change the vector of the pedaling force through my leg and require me to pull my heel up as I pushed the pedal over the top and through the downstroke, making both for a reduced "cantilever effect" on the end of my foot (so less force for my ankle to resist) and causing me to keep my toes pointed enough to avoid straining my hamstring. The tendency of my ankle to "give way" when balancing on the ball of my foot or just behind it, as you effectively must do when putting the power down on the pedal, would explain the unbalanced feeling of my right foot, even with the cleat rammed all the way back on the shoe. If this is correct, sensible treatments would include raising the saddle even a bit more to encourage me to keep my heel higher than my toes, and more importantly, strengthening whatever it is that is deficient in my right ankle, be it muscles/tendons or just the neural pathway involved in keeping that ankle immobile. Continuing to improve hamstring flexibility would also be a smart preventative measure.

So, here are my questions for you:

1. Could this be correct? Is my understanding of the physiological and fit issues going on here sensible, and does this explanation account for the symptoms I've been experiencing?

2. Is this something you've heard of before, and are there effective exercises to strengthen my ankle and prevent further injury?

3. Do you have any other thoughts, questions or suggestions?

Thanks everyone!