I've been plagued with medial (inside) knee pain in both knees since overuse injuries a few years ago. I did the damage on a long ride on a touring bike. Trying to recover I've ridden a few different bikes, including the touring bike, never any one for very long. I've experimented with saddle height and position endlessly, without results. Recently with the touring bike in the shop I used only a road bike for a full week. Pretty quickly noticed knee pain was not coming back. It's now been 10 weeks. The one difference between the bikes I had not looked at before was the TREAD or Q-FACTOR. Wider on the touring bike (not by much!) feet are forced apart just a little more. And that seems to make all the difference. Of course I injured myself originally on the touring bike, so that might well be part of it. BUT riding with a narrower tread had made all the difference, and I'm riding pain free, climbing like a beast and etc. I'm very very happy. Sheldon Brown mentions tread and suggests, basically, the narrower the better. If medial knee pain is a problem for you, tread, or q-factor, might be something to look at. Happy riding!

That's good news. I just want to say that it's probably different strokes for different folks. My medial knee pain seems to have disappeared when I went to flat pedals, which allowed me to increase my Q factor. OTOH, I use a TA Cyclotourist crankset, which I believe is known for low Q factor. I ride a 1973 English road frame, which is longer and les upright than today's roadies.

Same shoes on both bikes?

You may be able to get equivalent results moving your cleats inward.

I hear you! Low Q-factor rules for my knees. My knees are even happiest riding my fix gear with its track crankset because the Q-factor is so low. Positioning cleats will only get you so far. Eventually you hit the adjustment limit or, barring that, your ankle/shoe hits the crank. I set all my shoes at the limit and with quill pedals, worn out many cranks rubbing them with my shoes. (I call them "worn out" when 1/3 of the material is removed. Edit: but love the lessened Q-factor 'till I have to replace them!)

Another place you can work with Q-factor is the bottom bracket. Not much you can do on the right side; chainline rules there, but different bottom bracket manufacturers have different approaches to the left side. Shimano makes BBs that are near symmetrical. The old Sugino BBs were much closer left side than right. That meant the Suginos had substantially less Q-factor but that one's foot placement wasn't symmetrical on the bike. My knees loved that! And as long as I didn't think about it, my body cared not a whit that my feet were cocked about half a cm to the right.

I haven't ridden the Sugino BBs for a few years. Been riding Shimanos for their availability, cost and all weather reliability. But I may go back to Sugino for my knees. I heard at a shop that they still do the asymmetrical BBs.

Ben

If you think about walking it's natural to believe that narrowing the Q factor is a reasonable thing to do when cycling; however, a narrow "Q" seems unnatural in a sitting position. And, I've noticed that the Q factor is comparatively wide on stationary recumbent bikes where you are sitting down and that feels natural to me. I imagine that for a more upright seated position a narrower "Q" to feel more natural as it's more like walking than sitting.

These are just generalities. Even so, I can see where a narrower "Q" might perhaps provide more medial relief for more upright cycling; and, if that is the case then I wonder if the opposite might also be true: that a wider "Q" might be preferred for someone experiencing ITB problems.

Not sure if I mentioned this in another thread, @79pmooney, but it's super-easy to roll your own asymmetrical BBs using Shimano's units, too.

Just use a NDS cup like this, along with some old-style bottom bracket spacers, to scootch the whole thing to the right by a few mm:



For example, if you liked the 3P spindle (32-52-35) with your cranks, you could buy a 118mm UN55 bottom bracket, install a 2mm bottom bracket spacer between the "fixed cup" and frame, complete the job with that lipless NDS cup (Wheel and Sprocket has a couple in stock for $7.50 each), et voila -- you have a 3P bottom bracket.

That particular NDS cup is important to the whole operation to make sure everything still makes contact after adding spacers to the drive side.

- Scott

Technically, you would move the cleats outward, which would result in moving the feet inward.

Good thread here. I'm new to cycling and having some knee pain after long rides. I'll get a proper bike fit in the spring, then look into this q-factor info

My situation was the opposite-- soreness on the outside of the knees, sort of along the edge of the kneecap. Went to +12mm spindles, knee pain completely gone. I had previously mounted the cleats on the shoes as far inward as possible, and it still wasn't enough. Now the cleats are about 1mm outside of center, leaving me ~5mm of adjustment in either direction. I guess it's kinda lucky my knees don't like a narrow Q-factor-- because my EU49 feet wouldn't be very happy banging into the chainstays or pedaling heels out like a pigeon.

This is EXACTLY my situation. I climb steep hills here in the Philippines on my road bike (compact double) - no problem, even grinding up 10+% grades. But I bought a nice hardtail mtn bike to use over here a few months ago, with low mountain gears, thinking it would be easier on my knees.. Oops! Even with the lower gears - the first longer ride (1600' EG) caused problems with my medial meniscus. Ended up getting an MRI, hobbling on crutches, etc.

I kept my rides shorter after that, alternating with the road bike, did PT for the knee, carefully made some seat adjustments, did some shorter rides.. and the next longer ride the other knee was also in pain for 3 days. Fortunately I was being very careful and at the first twinge I headed back down.. I have eliminated the saddle height, fore-aft and other issues. It has to be the extra width between pedals, which is approx 20mm.

It was after it happened the second time that I remembered I had this same problem when I bought a touring bike that had a mountain crank a few years ago. Same medial knee pain after only 15-20 miles. I sold that bike immediately, realizing it had a rather huge Q-factor due to the low end crank, and promptly forgot about it. My prior Cannondale touring bike had used a narrower road crank that never caused a problem.

As someone who's run into this problem, I'm very earnestly happy for you!
Getting an expensive pro-fit helped me cancel my appointment with the knee surgeon.
I then replicated a triple-chainring with identical dimensions for the Mount Laguna Bicycle Classic, and that bought me a month off the bike. Triple chainring = wider pedals = sideways torque on knees.
Nothing makes you appreciate being pain-free like going through a period like this. Gratulations!

I get right knee discomfort also and moving that right side cleat inward has been part of my solution that has helped. For me, knee issues are an intermittant thing so that determining causes conclusively is difficult. What also seems to have helped is either a shim under the cleat or shimming the footbed in the shoe. What also helps is the use of kinetic tape which I'm still experimenting with various configurations.