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Knee Pain

Old 06-28-19, 05:09 AM
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BikingViking793
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Knee Pain

I'm in my 3rd year of road cycling and have just started having this weird knee pain. I'm pretty sure it is from changing my seat. Last year I would have this weird soreness in the groin area where the leg meets the groin. I noticed I only seemed to get it from riding outside. I have a different bike for my trainer inside. So I put the same seat on my outdoor bike as I have on my trainer bike and now I haven't had that problem. But as I'm picking up my miles outside my knees are starting to get weird pain. Sometimes it's while I'm riding, sometimes its just randomly through the day. One knee or the other will have a little pain in the front and sort of to the outer side of the knee. So it is always on the outside area but towards the front. It seems to be moving back and forth between both knees. One day it will be the right and the next the left. Pain/discomfort might last for an hour or a few then goes away. It is more noticeable on stairs. Have only experienced it on longer rides, usually I'll just get up to walk and suddenly feel it. I'm pretty sure it has something to do with my fit changing with the new seat as I had no issues last year and had no issues through the winter just using the trainer bike. I put my seat back slightly, but don't think that fixed the issue. Last time I had knee pain it was in the back of the knee and lowering seat fixed that. Any suggestions for how I should move forward? From what I read it sound like moving seat up/back is the thing to do. With the new seat I'm not sure how much room I have to move up as I'm sure it changed my fit. I'm currently taking a couple days rest from riding hoping. Usually I ride 5-6 days a week.
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Old 06-28-19, 05:43 AM
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I have a troublesome right knee but it acts up only infrequently. I do knee exercises with ankle weights to strengthen those muscles just above the knee. Before I got to that point I observed that the right knee would occasionally brush the top tube. Clearly, the right leg was not moving straight up and down. To correct that situation I found it was necessary to locate a 1 1/2 degree shim, (available from a bike shop) between the cleat and shoe. I also built up under the arch of the foot bed to further shift the knee outward. I would suggest you observe, over a few days, whether your knees are working straight up and down or are they sort of waving about. An eccentric movement will cause uneven loading at the knee. In most sports such movement is not a problem but cycling is so repetitious that eccentric movement accumulates damage. This is also true of modern tennis.
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Old 06-28-19, 08:56 AM
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If I'm having knee pain, usually it's because I've been riding in too high a gear ratio. When I was young, I could mash out a high gear and accelerate quick with never a pain. Can't do that after getting old. So learning to keep a high cadence for climbing and accelerating keeps my knees feeling good.

One time I bought a new crank that was only 5 mm longer than what I'd been riding. I quickly developed a weird and very slight pain behind my knee. Didn't seem to affect my strength or performance in any way and I thought it'd work itself out. It was just annoying. But four months later it was still with me. Went back to the size crank I'd been riding all my life and never had that particular pain again.

Seat too high or too low, too far back, too far forward. Maybe, it's something we all play with.
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Old 06-28-19, 09:24 AM
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Regulars here have now seen what I am about to post a few times - the piece I wrote years ago regarding the chronic knee issue, chrondomalcia patella. I was diagnosed 40 years ago by a sports medicine orthopedic surgeon who also raced. It was decades before I saw all of what he told me and rarely have I seen it all in one place.

"Chrondomalacia patella. Yes, I can tell you a little about it. I was diagnosed in ’78 and given very good advice by the doctor (an orthopedic in sports medicine. He was also a novice bike racer, so he had more understanding of the cycling aspects of CP than most). I will do my best to pass on what he told me.

In CP, the kneecap is not aligned with the knee under it, hence there is chafing as the knee is moved. This causes wear, first to the cartilage, then to the bone under it. The wear accumulates with number of repetitions and pressure. At some point, the wear can cause permanent damage.

Some people are more prone to CP than others. It can be triggered by exercising in cold weather, exercising without adequate stretching of the hamstrings, i.e. touching your toes or less extreme stretches of the same tendons. It can be brought on by exercising without adequately strengthening the small quadriceps muscles just above the kneecap.

I brought on my CP by training to return my body to racing form after a very serious accident. (I was weak enough after my hospital stay that I was no match at 24 years old for any 7 yo.) The accident was in November, and I returned to riding miles in March. I did nothing to keep my knees especially warm and did no stretching exercises (rationalizing that since my leg never extended to anywhere near straight, there was no chance of injury, hence no need to stretch). I was wearing just full tights and thermal underwear under them in Boston. The temperature was probably not much above 30. The ride that started it was 100+ miles on my racing bike, my first outdoor ride on that bike. It had 175 cranks. My trainer, with fixed gear and very low BB, had 168’s. After the ride I had a dull pain in my mid to upper knee in front. That Saturday was the first race of the season. I was forced to drop out, my knees hurt so much.

After that race, the race promoter introduced me to an orthopedic surgeon who diagnosed me in the back of a cold van. He laid out for me then and in later phone calls a plan that I will pass on here.

He first stressed that I had to stretch my hamstrings, touch toes or lean forward against a wall or post with one leg back and straight and stretch that hamstring or sit and touch toes. I now prefer the lean forward method. Very specific and hard to hurt yourself. (I am now a 48 yo, I damage if I am not careful.)

Second, he had me sit on the floor and do leg raises. He had me raise one leg at a time and hold it several inches off the floor for a while (I don’t remember the time, but 15 secs should work. Important – while the leg is raised, tense up your quads big time and tense up those little quads just above and beside the kneecap. Feel for them and get to know them. It is those little guys that keep you kneecap aligned. If you are in riding shape, you can do this with say 5 pounds on your ankles, but the tensing up is much more important than the resistance.

Third, KEEP YOUR KNEES WARM WHEN YOU RIDE!! For me, this is critical. I wear these dumb looking “knee warmers” for most of my rides, always below 70 degrees, often under tights. Since keeping the hamstrings loose is important, I had to stretch the elastic. To keep them from falling down, I sewed on garters that I clip onto my shorts.

Fourth, back off riding until you have been doing these two things long enough to make a difference. Keep up the exercises and especially the stretches after you resume riding. Build up your riding slowly. The doctor stressed this to me and it has been very true. My ability to come into real form and resilience on the bike is limited more by my knees than by my lungs/muscles.

After rides, take aspirin or Ibuprofen to speed recovery. I personally think aspirin is better, that my knees recover more with it. I disagree with the ice. I have always felt that moving my knees when they are cold is causing the damage I am trying to avoid. Perhaps ice speeds recovery, but I feel it also continues the damage (at least in my knees).

Big gears are the enemy of CP knees. I love to climb hills standing. I love to ride hilly country on fix-gears. It is a fact of my life that I can only ride certain not-so-steep hills on my commuter and that I have to have and use a granny ring on my custom. It is a fact that there are days, weeks and months when I have to let whippersnappers blow by me on hills where I know I can humble them.

Lastly, what you did not want to hear, but again what the doctor told me. Get used to the idea of CP. If you are at all like me, it will be a fact of your cycling life for a long time. 23 years later for me and I am feeling my knees now because of a very easy ride I did in street clothes without knee warmers at noon today.

Sorry to be the bearer of bad news, but you can still do a lot of riding. I raced that season (I already knew it was my last) and have done 60,000 (?) miles since. I still commute, but only on alternate days. (But for the first 7 years with CP, I did not own a car and rode everywhere.)

I took the time to spell all this out because in the 23 years I have had CP, I have never seen all of this in one place. In fact, I have only heard about the importance of keeping the knees warm from that one doctor. That is the single most important aspect of the program for me. Thank you Dr. Kish, wherever you are. I will probably ultimately need those carbon fiber knees, but by following the regime, I figure I can wait until a) the product improves, b) the price comes down and c) I’m old enough that my cycling level will be within the abilities of those knees. I hope to delay another 10 years.

Since I wrote this a year plus ago, my physician has recommended that I take glucosamine. He was very specific, that I should take 3000 mg/day in the form of glucosamine sulfate or glucosamine hydroxide, but to avoid chrondroitin. This I did faithfully for 9 months. Between riding steadily starting two years ago and the glucosamine, my knees never felt better than they did last summer. I was passing whippersnappers uphill. Then my riding tapered off, I tapered down on the glucosamine and got sick so my riding and conditioning dropped. Thanksgiving I rode 50 miles with 2500’ of climbing on a cool day. My knees hurt. How many of those rules outlined above did I break?"

Ben
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Old 06-28-19, 08:18 PM
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Originally Posted by Iride01 View Post
If I'm having knee pain, usually it's because I've been riding in too high a gear ratio. When I was young, I could mash out a high gear and accelerate quick with never a pain. Can't do that after getting old. So learning to keep a high cadence for climbing and accelerating keeps my knees feeling good.

One time I bought a new crank that was only 5 mm longer than what I'd been riding. I quickly developed a weird and very slight pain behind my knee. Didn't seem to affect my strength or performance in any way and I thought it'd work itself out. It was just annoying. But four months later it was still with me. Went back to the size crank I'd been riding all my life and never had that particular pain again.

Seat too high or too low, too far back, too far forward. Maybe, it's something we all play with.
Yes I was going to try to keep my cadence up. Right now I don't have anything giving me my cadence so it's hard to say what I have been using. I'll have to get a cadence sensor.
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Old 06-28-19, 08:20 PM
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Anyone have any thoughts on me having this issue after changing my saddle? Last year with the same bike I had no issues, but now with the new saddle it seems to be showing up. I'm pretty sure I need to move the saddle up or back or maybe both. It seems like the most likely issue since the new seat probably changed my fit.
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Old 06-29-19, 07:19 AM
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How does this angle look?

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Old 06-29-19, 08:08 AM
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The "saddle height analysis pic" should be with the right pedal at 6 o'clock, and your right HEEL on the pedal (not clipped in), and no leaning of the hips. In this position, your leg should almost be straight. Though looking at the pic, I can kind of make out that the left leg is somewhat in that position and appears to be bent way too much. The saddle may need to go up a bunch, maybe 3-5cm to achieve the straight leg, which will also likely mean you have to then move the saddle forward a little to keep you over the pedals properly, and you can use the standard KOPS method for that (knee over pedal spindle). There's lots of videos on YouTube for setting saddle height, and setting saddle fore/aft position using these methods, though everyone's physiology is a little different.
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Old 06-29-19, 09:25 AM
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Here are a couple more pics. I don't think I can move up too much.

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Old 06-29-19, 12:03 PM
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I'm ( after many decades of cycling ) OK with the heel on the pedal leg straight, so with ball of foot over pedal axis

that much bend..

Don't get too ambitious pushing a big gear , and you may not punish your knees ..


Touring , In comfortable gear ratio ,, pootling along, all day, enjoying the vistas of nature .
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Old 06-29-19, 01:13 PM
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Originally Posted by fietsbob View Post
I'm ( after many decades of cycling )

Don't get too ambitious pushing a big gear, and you may not punish your knees ...
I've had bad knees for forty plus years. I've biked on and off for 35 years including seriously and regularly for the past nine years. My knees handle everything on the bike with one exception: Pushing too big of a gear.
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Old 07-01-19, 08:43 AM
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Don't worry too much about knowing an actual number for your cadence. What's more important is realizing when you are putting too much muscle into your pedals.

If it feels like you are using a lot of muscle to pedal, then shift to a lower gear ratio. If it then feels like you are going nowhere, then speed up your cadence.

Even with a high cadence, you can still be in too high a gear ratio if you have not gotten used to not muscling your cranks to make the bike go. You shouldn't have to use a lot of muscle to pedal. The exceptions are, IMO, when you need to accelerate rapidly or the last little bit of climb after you run out of lower gear ratios.

The bike isn't for strength training your legs, again IMO.
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Old 07-02-19, 04:14 PM
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Have a look here: Stretching and cycling specific exercise for knee health

I think you might have a go at trying to relax your ankle, getting the bottom of your foot more horizontal throughout the pedal stroke. Try to feel the heel cup of your shoe as you pedal. Pull back at the bottom, push forward at the top.
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Old 07-02-19, 04:41 PM
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Originally Posted by BengalCat View Post
I've had bad knees for forty plus years. I've biked on and off for 35 years including seriously and regularly for the past nine years. My knees handle everything on the bike with one exception: Pushing too big of a gear.
Sorry new to bikes and this forum....what is the "Big Gear"?

Is that big sprocket up front and little sprockets on the back, as in the gears where i can go real fast?
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Old 07-02-19, 07:29 PM
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Originally Posted by sirjag View Post
Sorry new to bikes and this forum....what is the "Big Gear"?

Is that big sprocket up front and little sprockets on the back, as in the gears where i can go real fast?
In "bigger gears" you pedal more slowly at the same speed. In smaller gears, you pedal faster. The big sprockets up front are called "chainrings." The little sprockets in back are called "the cassette." As you know, we use combinations of these to pedal more slowly or faster at the same speed. When someone says "change to a bigger gear," they mean pedal more slowly at that speed and vice versa. Yes, you can go faster in a bigger gear, but the real point of changing gears is to change how hard you're pushing on the pedals when you're going at the speed you want to go at. So less force on the pedals is easier on your knees. How fast you turn the pedals is called "cadence" and is measured in rpm. Most cyclists pedal at about 90 rpm on the flat. That seems stupid fast for someone starting out and takes some practice and getting used to.
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Old 07-03-19, 05:59 AM
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Originally Posted by Carbonfiberboy View Post
In "bigger gears" you pedal more slowly at the same speed. In smaller gears, you pedal faster. The big sprockets up front are called "chainrings." The little sprockets in back are called "the cassette." As you know, we use combinations of these to pedal more slowly or faster at the same speed. When someone says "change to a bigger gear," they mean pedal more slowly at that speed and vice versa. Yes, you can go faster in a bigger gear, but the real point of changing gears is to change how hard you're pushing on the pedals when you're going at the speed you want to go at. So less force on the pedals is easier on your knees. How fast you turn the pedals is called "cadence" and is measured in rpm. Most cyclists pedal at about 90 rpm on the flat. That seems stupid fast for someone starting out and takes some practice and getting used to.
Sir. Thank you for that detailed response!
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Old 07-05-19, 05:55 PM
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Originally Posted by BikingViking793 View Post
But as I'm picking up my miles outside my knees are starting to get weird pain...One knee or the other will have a little pain in the front and sort of to the outer side of the knee. So it is always on the outside area but towards the front.
That seems like patellofemoral pain syndrome. It can happen when you increase your riding load, before your muscles have adapted to the new stress. I seem to get it every year, in the early season (I have a little of it right now, in one knee).

Ibuprofen and ice after a ride, avoid mashing in the hills, ramp up efforts gradually. Here's a little guide: Patellofemoral pain syndrome
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Old 07-18-19, 11:06 AM
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Have someone follow you from behind while you ride. If it switches from one knee to the other, it very well could be you have a dominant side causing minor leg length variations. This is very common. It becomes a matter of using your core and working on proper posture to ride without favoring one side. Also make sure your saddle is not off center at all. https://www.stevehoggbikefitting.com...ght-side-bias/
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Old 07-18-19, 11:09 AM
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Originally Posted by terrymorse View Post
That seems like patellofemoral pain syndrome. It can happen when you increase your riding load, before your muscles have adapted to the new stress. I seem to get it every year, in the early season (I have a little of it right now, in one knee).

Ibuprofen and ice after a ride, avoid mashing in the hills, ramp up efforts gradually. Here's a little guide: Patellofemoral pain syndrome
I will agree with this. I began a tour in June, with my right knee already hurting. I was careful the first two or three days, making sure I didn't mash, but still did 50 miles the first day, and the pain was gone by the third day.
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Old 07-20-19, 11:04 AM
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Very helpful topic! I have been riding for years and never had knee pain until last week!!

The pain started on my (somewhat) new gravel bike. The frame is a little bigger than my other bikes, so I thought I could compensate by adjusting the seat position. However, I was only able to improve the problem slightly.

I am 100% certain it is this bike because I have no knee pain while riding any of my other bikes.

I am debating whether to pay for a professional fitting or just sell it and get something closer to my size for gravel.
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Old 07-20-19, 11:51 AM
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Originally Posted by Nikon Fan View Post
Very helpful topic! I have been riding for years and never had knee pain until last week!!

The pain started on my (somewhat) new gravel bike. The frame is a little bigger than my other bikes, so I thought I could compensate by adjusting the seat position. However, I was only able to improve the problem slightly.

I am 100% certain it is this bike because I have no knee pain while riding any of my other bikes.

I am debating whether to pay for a professional fitting or just sell it and get something closer to my size for gravel.
Riding gravel has nothing to do with it? Shouldn't be hard to duplicate the position you have on your other bikes.
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Old 07-20-19, 01:55 PM
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Originally Posted by Carbonfiberboy View Post
Riding gravel has nothing to do with it? Shouldn't be hard to duplicate the position you have on your other bikes.

I haven't had a chance to ride it on gravel yet, so yes, it the bike.

I tried duplicating the same position as my other bikes, but it didn't work. Crank set seems too long, position of seat has me riding a bit farther back than I want; seat is adjusted as far forward as possible. Overall design of this bike simply does not fit me.
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Old 07-20-19, 03:47 PM
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Originally Posted by Nikon Fan View Post
I haven't had a chance to ride it on gravel yet, so yes, it the bike.

I tried duplicating the same position as my other bikes, but it didn't work. Crank set seems too long, position of seat has me riding a bit farther back than I want; seat is adjusted as far forward as possible. Overall design of this bike simply does not fit me.
You saddle is adjusted fore-and-aft so that you have KOPS? That's the first thing one does.
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Old 07-22-19, 04:28 PM
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Originally Posted by Carbonfiberboy View Post
You saddle is adjusted fore-and-aft so that you have KOPS? That's the first thing one does.
It looks like his knee position is far in front of KOPS. While KOPS is not the be-all and end-all of bike fitting, a knee position far in front of KOPS will put more stress on the front of the knee. Didn't the OP say he was experiencing knee pain? Hmm.

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Old 07-22-19, 05:57 PM
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Nice work, terrymorse. To measure KOPS, knee over pedal spindle, one drops a plumb bob from the bony protrusion on the front of the knee, just below the knee cap. The plumb bob should intersect the center of the pedal axle. Yes, being this far forward could definitely contribute to knee pain.

IOW, your saddle needs to go back a long way. It also seems likely that you saddle is much too low, which is also pushing your knee too far forward. The rule of thumb is, "Pain in front of knee, raise saddle. Pain in back of knee, lower saddle."
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