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Knee pain on top of kneecap

Old 12-26-16, 10:25 AM
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Knee pain on top of kneecap

Hi guys, I have recently been experiencing some knee pain on my right knee. I have slightly outwardly rotated femurs and I pronate but not much on the right side (the left is more problematic). Anyway, it is the right knee that is bugging me, mostly when I ride hard or climb hard. The pain seems to bee either on top or slightly top-left of the kneecap kinda where I think the quadricep tendon attaches to the knee. So I will back off the intensity, and I am usually taking it easy on winter rides. My saddle heights seems okay but a couple may be a touch low. I am not sure if the fore-aft positioning is correct though.

I did have a bike fit done two years ago but also changed the pedals/cleats since then. Plus, I have three more bikes now. I use 20mm pedal extenders too. Things have been fine till recently though. Maybe I have been pushing too hard on some rides...not sure. Anyway, I think I could be helped with a saddle and cleat/pedal fit. Full fits are expensive at 250-300 here for Retul or GURU fits. I can't do that for four bikes. I have read some articles on saddle/knee/cleat/pedal fit by Keith Bontrager and others, plus the KOPS stuff. Should I try to use a mirror and a line to start tweaking things a few mm? Alternatively, I could get a fit on one bike and "try" (this is not easy) to replicate it on the others? I have tweaked the reach fit to where I like them on the bikes. I can't figure out the saddle/pedal/cleat fit yet.

It is frustrating because I am also trying to get more miles in on the trainer when not riding outside. This was going to be the first winter where I put some real base miles in, to get ready for some big rides next year, that I have never done.

Any advice would be appreciated. I really need to improve things and not injure myself. While I have had ITB issues that have been largely improved by pedal extenders and stretching hip flexors, I have never faces any type of other knee pain like I am now.
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Old 12-26-16, 10:27 AM
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Raise the saddle
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Old 12-26-16, 10:32 AM
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Saddle will be Too High when you get a sharp pain on the underside of the knee.
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Old 12-26-16, 10:56 AM
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That could be part of it. There was also a cold day when I tested my Lake winter boots and I think that made it worse since it effectively raised my pedal contact point. I'll raise my sales a touch and take my little torque wrench along and adjust as needed. I think there should just be a slight bend in the knee at the bottom of the stroke. So I'll try that one adjustment first and make sure I am also dropping my heels slightly. Thanks.
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Old 12-26-16, 11:03 AM
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Raise it till you feel the sharp pain then lower it a tad.
I had a 2 inch range where it was comfortable.
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Old 12-26-16, 11:07 AM
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If this only started after you were using the trainer, I'd look there. Riding a trainer is different than out on the road in a few ways, and that change might be the issue.

First of all, in the real world the bike rocks under you, yet is rigid on the trainer. Also, depending on what's under your front wheel, the bike might be leveled up or downhill. That tips your body also, and may throw off your stroke slightly.

As noted, changing shoes also changes saddle height, but IME, small changes shouldn't be an issue, but go ahead and see if raising the saddle helps.
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Old 12-26-16, 07:20 PM
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Raise saddle a tich. Tweak cleat position on hurting knee slightly outwards. Find your KOPS position. If you're get out of the saddle to jam, keep the saddle between your thighs/under you. Don't keep pushing your hurt knee hard. It needs time to heal, so just spin
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Old 12-27-16, 08:54 AM
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Originally Posted by Gweedo1
Find your KOPS position.
The Myth of K.O.P.S.
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Old 12-27-16, 09:34 AM
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Originally Posted by Moe Zhoost
Maybe for you and others it's a myth, but for me and others, it's in the realm of "sqaure 1" fitting steps, on par with saddle height and reach and drop.

To tell somebody who doesn't feel he has yet found his KOPS position and who still is strugggling with fit issues not to worry about KOPS, that it is a "myth", seems misguided.

Firstly, his correct KOPS has to be found and evaluated before deviating from the basics. When finding proper fit to enhance riding comfort and efficiancy, a process of elimination starting with the basics doesn't seem a bad idea. If KOPS doesn't work, then try something else, but to call KOPS a myth and suggest not trying it, is to do it a disservice IMO.
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Old 12-27-16, 10:31 AM
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Measure your inseam (put a book between your legs and measure the drop to the floor). Then subtract 10cm. That's a good starting point...see how far off your current seat height is from this measurement. Any adjustments should be very minor, in 1cm increments. Ride a while after each adjustment, don't change it and then move it again 20 minutes later. <<<things I learned in my pro bike fit. Hope this helps.
Oh - and remember - every adjustment to your seat height will change your position on the bars. So they may need to change once your seat is comfortable. My fitter told me the goal is to feel like you are perched like a tripod, weight distributed so you are "floating" on the three touch points of hands, seat, and feet, with no one point bearing more pressure than the others.
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Old 12-27-16, 10:33 AM
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Thanks, I did read the article and a couple of others. I agree it is a starting point, without which I do not have one. I'll get a plumb bob and a string and have the wife help me, possible with a long mirror on the side. I have already planned to raise the saddle height. The wife is not aware of my latest purchase (my BMC that hides in the basement's darkest room) so I'm on my own with that one.
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Old 12-27-16, 11:15 AM
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People insist on making fitting into some kind of measurement science, yet it's not possible because there are too many variables. It's actually very easy to find a decent, close approximation of correct saddle height without using any measurements. Just let your leg tell you.

Adjust the saddle height so your heel rests flat on the pedal with your leg straight. That very close to perfect height, and will allow a slight bend at the knee when you pedal with the ball of your foot centered over the pedal.

It won't be dead on precise, because it doesn't account for things like the foot length, or that you might have leaden slightly when measuring, but it will be right within 1cm or so, usually to the low side. However your body will adapt by adjusting via the ankle angle.

Over time you may feel that you can go higher. Do so in small increments of 5mm or so, but stop short of where your hips rock as you pedal.
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Old 12-27-16, 11:21 AM
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As I raises my saddle, I can (sometimes) go a bit numb after an hour or so. I can either tilt it down a bit or improve my posture maybe. I bet I slouch slightly. Need to also address that. This is helpful information, especially since I wan to do the Triple Bypass ride in 2017...120 miles or so and over 10,000 ft of climbing. I think it ranges from 8,000 ft to 11,000 ft in elevation so the bike fit has to be near perfect.
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Old 12-27-16, 11:48 AM
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Originally Posted by Gweedo1
Maybe for you and others it's a myth, but for me and others, it's in the realm of "sqaure 1" fitting steps, on par with saddle height and reach and drop.

To tell somebody who doesn't feel he has yet found his KOPS position and who still is strugggling with fit issues not to worry about KOPS, that it is a "myth", seems misguided.

Firstly, his correct KOPS has to be found and evaluated before deviating from the basics. When finding proper fit to enhance riding comfort and efficiancy, a process of elimination starting with the basics doesn't seem a bad idea. If KOPS doesn't work, then try something else, but to call KOPS a myth and suggest not trying it, is to do it a disservice IMO.
Linked article provided because I think it is an excellent discussion of the topic as well as the difficulties integrating all of the different factors into a comfortable fit.

Also note that Keith Bontrager provided the "myth" label, not I. I dare say he knows more about adjusting fit than most here, but you may want to contact him to let him know he's doing us a disservice.
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Old 12-27-16, 11:56 AM
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Originally Posted by Moe Zhoost
Linked article provided because I think it is an excellent discussion of the topic as well as the difficulties integrating all of the different factors into a comfortable fit.

Also note that Keith Bontrager provided the "myth" label, not I. I dare say he knows more about adjusting fit than most here, but you may want to contact him to let him know he's doing us a disservice.
The myth isn't that KOPS has some validity, because it does most of the time. The myth is that it's a critical precise system.

Good fit requires a blend of art and science. Science is a good guide, but good fit often call for tweaking the supposedly spot on position to get the right one that works for the rider. So if you consider KOPS as just a useful rule of thumb, then it'll serve a purpose. But if you consider it gospel, you stand a good chance a poor fit.
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Old 12-27-16, 12:07 PM
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Had something similar and tweaking cleat position resolved the pain.
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Old 12-27-16, 12:15 PM
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Are you absolutely certain that this was caused by cycling? Patella-femoral syndrome can be caused by a an abrupt twist. If you tore a collateral ligament, you might be able to still ride if you use a knee brace that allows the surrounding muscles to be employed, instead, giving the ligament needed rest and re-inforcement.
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Old 12-27-16, 12:23 PM
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It's hard to blame position when the OP states --

I did have a bike fit done two years ago but also changed the pedals/cleats since then. Plus, I have three more bikes now. I use 20mm pedal extenders too. Things have been fine till recently though....

Of course, it's entirely possible that things have been off all along and he's now seeing the results of accumulated damage. But I'm a cause and effect person, and look for something that changed between not having a problem and having one.

The OP mentions riding harder before/when the problem started, so it's entirely possible, or even likely that this is the issue. Possibly he's pushing slightly higher gears longer and harder while chasing more speed, and the solution is to simply ease up a bit for a while and allow his knee to recover. Then try to stick with RPM vs long gearing as he goes back on the attack.

If the OP does opt to try changes, he needs to make only small ones and do so one at a time, so he can monitor the results and know what's helping and what isn't.
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Old 12-27-16, 12:32 PM
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Originally Posted by Moe Zhoost
Linked article provided because I think it is an excellent discussion of the topic as well as the difficulties integrating all of the different factors into a comfortable fit.

Also note that Keith Bontrager provided the "myth" label, not I. I dare say he knows more about adjusting fit than most here, but you may want to contact him to let him know he's doing us a disservice.
I won't do myself a disservice by deferring to any authority other than myself on the subject of fit and what works for me, Mr Bontrager included so thanks for nothing. You want to supplicate yourself to the "authority" of others then knock yoursef out with links. But for me, I have read and listend to enough new "blow hards" on the subject of fit on the interwebs to pretty much dismiss most of them as espousing nothng very helpful and choose to work with/stick to the basic and classic principles, KOPS being one. IMO, there is little new out there, just a plethora of Johnny come lately vendors vying for a position in the market place, spewing forth anything that will get them noticed. Though I may take some of what some of them might have to say into consideration, the final word for me, lies with me. And KOPS works for me, like it's supposed to. YMMV.

Start with the basics. Give them time to work, as dialing in a riding position comes with time in the sasddle, and if thngs aren't the way you like after some time and adjustments go from there. That's why a fit session is pretty much a waste of time IMO. It just can't replicate real riding.

The "wheel" of "fit" has already been invented and can't be re-invented.

Last edited by Gweedo1; 12-27-16 at 01:48 PM.
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Old 12-27-16, 02:06 PM
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Originally Posted by Gweedo1
That's why a fit session is pretty much a waste of time IMO. It just can't replicate real riding.

The "wheel" of "fit" has already been invented and can't be re-invented.
A fit session, in case you have never had one, can address things that can take months by yourself, during which you can do some body damage. For someone who is riding with no physical discomfort, I agree, there is no point. But for a non-pro rider who is having pain and/or discomfort, a good fitter can identify the cause based on the rider's description of the pain and watching the rider pedal on a roller system. IMO it was totally worth the $125 to eradicate all my pain and the causes along with an increase in speed and climbing ability and some very valuable tips on technique specific to me and the handling of my particular bike. Yes, I could have gotten there myself after making lots of incremental changes, maybe purchasing some incorrect pedals/bars/seatposts, etc. before I hit the holy grail. You can screw around trying to get it right, or you can just enjoy the ride after a good fit. Particularly as you get older, a less than ideal bike fit can have consequences.
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Old 12-27-16, 02:24 PM
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I don't want to be the bearer of bad news, but this symptom showing up at the winter solstice when it is cold, we tend to be at a low conditioning -wise and with all the holiday stuff, probably not as stretched asn loose as we could be. All this is a setup for chrondomalacia patella (CP) to show up IF you are prone. And if that is the case, the post I created years ago could help you a lot. CP is not fun and requires attention or you can do permanent damage, even requiring knee replacement. I lucked out and was diagnosed correctly 4 days later. 1978.


So, below is that old post.


Ben





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 12-27-16, 04:04 PM
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Originally Posted by linberl
A fit session, in case you have never had one, can address things that can take months by yourself, during which you can do some body damage. For someone who is riding with no physical discomfort, I agree, there is no point. But for a non-pro rider who is having pain and/or discomfort, a good fitter can identify the cause based on the rider's description of the pain and watching the rider pedal on a roller system. IMO it was totally worth the $125 to eradicate all my pain and the causes along with an increase in speed and climbing ability and some very valuable tips on technique specific to me and the handling of my particular bike. Yes, I could have gotten there myself after making lots of incremental changes, maybe purchasing some incorrect pedals/bars/seatposts, etc. before I hit the holy grail. You can screw around trying to get it right, or you can just enjoy the ride after a good fit. Particularly as you get older, a less than ideal bike fit can have consequences.
I have never had one because I eschew them. I find them superflous and in all truth, distasteful if not insulting ...for a handful of opportunistic enterpreneurs to muddy the waters on something as simple as getting to find the right position on your bike for your style of riding, and reduce the joy of owning and riding a bicycle down to some tyoe of intellectual and measured pursuit requiring some type of specialised equipment that only a certain few can operate, when it is anything but. I'm not about to let somebody hijack my experience.

What you missed out on, yes...all that nusance dialing in, brings you closer to your ride and the riding. And since when is one position *the* position for life? Maybe a few months, yes, but we change, our riding preferences and our position. Just how many fittings will you need since you haven't learned how to do it youself? Ask your "fitter" and I'm sure he'll want to see you regularly, just to make sure you're not hurting yourself, at 125.00 a pop.

Look, you can make babies in a laboratory, or the old fashioned way in a bedroom, or anywhere really.

I'm sure using a lab will save you a lot of time and effort and pain, but you miss out on a (much) better expereince.

Look, I understand many people need somebody else to tell them what's right or wrong, I see endless threads, this one included, asking for direction. Not that that's a bad thing, but I try to find my own way whenever I can, and when it comes down to finding the right position for me, I think I'm the best judge of that, using actual riding experiences.

My guess would be, talk to 5 different "experts", oh wait, wrong terminology, I'm in bicycle forum, let me rephrase that, "gurus", and you'll get 5 different opinions.

Best to be your own guru.
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Old 12-27-16, 04:18 PM
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Originally Posted by Gweedo1

My guess would be, talk to 5 different "experts", oh wait, wrong terminology, I'm in bicycle forum, let me rephrase that, "gurus", and you'll get 5 different opinions.
This is pure nonsense. We all know that if you ask 5 self-proclaimed experts you'll get 6 opinions.

Actually I have nothing to say against professional fittings for those who can't seem to dial in a good (comfortable) fit, or who have persistent problems they can't figure out on their own. However, bring more than a few grains of salt with you, and be ready to tweak the expert fit according to what your body tells you.
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Old 12-27-16, 05:19 PM
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Originally Posted by Gweedo1
I have never had one because I eschew them. I find them superflous and in all truth, distasteful if not insulting ...for a handful of opportunistic enterpreneurs to muddy the waters on something as simple as getting to find the right position on your bike for your style of riding, and reduce the joy of owning and riding a bicycle down to some tyoe of intellectual and measured pursuit requiring some type of specialised equipment that only a certain few can operate, when it is anything but. I'm not about to let somebody hijack my experience.

What you missed out on, yes...all that nusance dialing in, brings you closer to your ride and the riding. And since when is one position *the* position for life? Maybe a few months, yes, but we change, our riding preferences and our position. Just how many fittings will you need since you haven't learned how to do it youself? Ask your "fitter" and I'm sure he'll want to see you regularly, just to make sure you're not hurting yourself, at 125.00 a pop.

Look, you can make babies in a laboratory, or the old fashioned way in a bedroom, or anywhere really.

I'm sure using a lab will save you a lot of time and effort and pain, but you miss out on a (much) better expereince.

Look, I understand many people need somebody else to tell them what's right or wrong, I see endless threads, this one included, asking for direction. Not that that's a bad thing, but I try to find my own way whenever I can, and when it comes down to finding the right position for me, I think I'm the best judge of that, using actual riding experiences.

My guess would be, talk to 5 different "experts", oh wait, wrong terminology, I'm in bicycle forum, let me rephrase that, "gurus", and you'll get 5 different opinions.

Best to be your own guru.
Having an opinion on the value of something you've never experienced...interesting. Now, my fitter taught me how to make adjustments and the reasons for them as time changes, shoes change, physical condition changes. And gave me lifetime email support should I have questions. He said unless I get a new bike which is radically different from what I own, I don't need to see him again. As for specialized equipment....he put my bike on a roller so he could see me pedal. And he used a protractor to set angles as starting points. Period. What he used was his many years of experience, which far exceeds my own, as a cyclist and working with cyclists and bikes. And he listened to what I said. A good bike fit is not a static exercise (no pun intended); a good fitter spends more time learning about your preferences, needs, and style than actually dialing in the bike. And a good fitter has to be a good teacher.
It's quite different from a pro fit where it is mostly about the numbers.
Good luck to you with your attitude, though.

Last edited by linberl; 12-27-16 at 05:22 PM.
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Old 12-27-16, 06:18 PM
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Originally Posted by linberl
....A good bike fit is not a static exercise (no pun intended); a good fitter spends more time learning about your preferences, needs, and style than actually dialing in the bike. And a good fitter has to be a good teacher.
It's quite different from a pro fit where it is mostly about the numbers.
...
Thank you foe an interesting post, which seems to bolster both sides of the fit debate.

As your experience shows, a good fit can be a benefit. However, you also support the argument that it's about old fashioned judgement based on experience, and not based on rigid adherence to formulas.

Unfortunately, much of the marketing for fits is premised on the scientific validity of those rigid formulas. IMO arguing that the science trumps experience, then saying that once you get close then you need to tweak based on judgement and experience is circular. Any experienced fitter, especially one who's judgement is being trusted to overrule the hard numbers, is certainly qualified to find the starting place in the first place.
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