Brad Smith

I've been cycling seriously since about May of 2006. I've lost a lot of weight (from 225 lbs. two years ago down to 175 lbs.) and am now in really good shape. Before that I managed to somehow irritate and injure the outside front portion of my right knee. Everytime I tried to get back on the elliptical machine, the problem would flare up after a predictable number of minutes. I took a lot of time off from exercise, lifting, etc., instead opting to just walk a lot more. After it didn't improve, I went to the orthopedic doctor and got an x-ray and a MRI. Neither revealed anything, although he thought there *might* be some fluid. Surgery to figure out what was wrong was next up, and I didn't like that option.

After taking some time off, I started cycling in May (initially on a hybrid, finally on a road bike in October). Long rides often caused the flare up in the right knee, and occasionally a very similar flare up on the outside front part of the left knee. I have not had the road bike professionally fit due to the lack of a LBS in town that does fittings. The most I have tried to combat it is seat adjustments and blind cleat adjustments. I currently ride Shimano SPD pedals (A520s) with Adidas MTB shoes that are a size too big (due to the loss in fat and thus foot size).

I've notice the condition with my knees seems to be really bad when getting in and out of my car and walking up stairs (on the days it's flared up, usually after a longer ride). It feels awkward and occasionally has brief moments of pain when walking or doing other stuff, usually in combination with a weird step or two or lateral movement of the knee.

This weekend I went shopping for several things... new running shoes, new cycling shoes, new pedals, and a professional bike fit. I found new running shoes. I have new cycling shoes on order. I went with the Shimano M225SE shoes because their line was more comfortable on my feet than the Sidi and the Specialized. Had to go with the more expensive shoes because I needed the wider toe box. They should be here yet this week.

I looked for Bebop pedals and no one carries them. I really think they may be best for me due to the float, but I wanted to find them locally (since the M225 shoes have a carbon sole, shaving the treads/soles down may be an issue in order to fit the cleat).

I also (finally) found a bike shop in a nearby city that does a $125 professional bike fit and cleat adjustment.

So, several questions... any thoughts on my condition? any equipment recommendations? am I taking the right steps or should I just have surgery?

Mo'Phat

You're kidding about surgery, right? Knee pain is all about fit, and (IMO) you don't really need a pro fit to help with knee pain. With SPD's (minimal float that's spring-loaded and self-centering) cleat position on your shoes is vitally important. You might not think that those little brass cleats can have much effect, but a degree or two off-center will have a major impact over a long ride.

Something to consider trying: remove your SPD cleats and ride around with your MTB shoes, looking closely at how your feet sit naturally on the pedals. I, myself, am a little duck-footed...maybe 3 degrees away from straight. So I tried mounting my cleats skewed inward just a hair. When engaged, my toes were sticking outwards like my natural (un-clipped-in) position. This helped considerably.

Also, cleat fore-aft positioning is important, too. Too far forward, and you're using your toes too much and putting strain on your arches and calves. Too far back, and you're not being as efficient as possible. There's a sweetspot; normally with the pedal spindle directly in line with the widest part of your foot.


Finally; float isn't 100% necessary to relieve knee pain. Many people (me included) have tried free-floating pedals like Speedplays, and have gone back to pedal systems with minimal float (SPD-SL, Look, etc.) because they were able to align themselves correctly and didn't need float.

Mo'Phat

ps. Major kudos on your weight loss!!! A huge accomplishment. Congrats!

idcruiserman

Illiotibial band

aikigreg

bebops can pretty much only be had online, but they're worth it!

Brad Smith

Well, I definitely don't want surgery. When the doctor told me he had no idea what it was, but wanted to do surgery to find out, I decided to try other factors to change.
I'll definitely give this a shot, though I'll probably still get the pro fit. I don't trust myself all that much and I really want to get it right. I'm hoping the pro fit will at least get me close to a well-fit bike(s).

Thanks for the advice!

Brad Smith

My only concern with buying online is that they may not fit my shoes and that my shoes can't easily be adjusted to fit (carbon soles).

aikigreg

are they road soles, 2 bolt hole shoes? If they're mountain bike shoes, you'd have to trim the lugs probably, but it fits any road shoe without shaving anything.

OCRider2000

I'm guessing he just wanted to scope you so that he could properly diagnose exact what is going on. They give you a general, insert an arthoscope (probe with a camera on it) and look around. Having you been cycling in pain this whole time? or is this something new?

Brad Smith

aikigreg: It's a MTB shoe that accepts the SPD bolt style (not SPD-SL).

OCRider2000: It has been happening more recently on my road bike, which was purchased in October (and only got a few short rides before winter). My other bike (a hybrid with fenders, suspension, etc.) gave me the issues as well, but on really long distances. I may have had the hybrid dialed in better than the road bike. But in general, this is not something new. It just crops up on long distance or on some of the tougher rides (hillier routes, etc.).

OCRider2000

Hmmm, I've had lots of knee issues too so I 've been down this road before as well. The first thing you really need is a proper diagnosis then you can determine how to best handle it. Not all knee conditions are the same. You may need to do more than just tweak your fit. Figure out what the heck is wrong and then go from there. My salvation was learning how to train in such a way that my knees never get stressed and adhering to a rigid stretching routine that I do before and after every ride. And lastly I don't do crazy hills anymore. The first thing though, is to get a definitive diagnosis. I didn't start trying different things on my own until after I had seen lots of docs and was pretty sure that was wrong with my knees. Good luck.

Brad Smith

OCRider2000: The orthopedic surgeon I saw was unable to diagnose it without suggesting surgery. He said he didn't have any ideas (which is strange because the IT Band syndrome I've read about seems to fit). I don't know whether or not there is a good doctor in town. Should I just keep on trying blindly? Or is there a better way?

OCRider2000

There are a few things you gotta keep in mind. One, when it comes to knee conditions (or any orthopedic issue) the last thing you want to do is make it worse. Until you know what's wrong you're not going to know how to deal with it. I'm pretty big on getting second and third opinions especially when it comes to funky orthopedic issues. I would hope that a decent orthopedist after taking your history and examining you would be able to determine what the issue is without having to scope you. My recommendation would be to pay the money and see a few more orthopedists. Once you are confident you know what the issue is you can move forward with a treatment\training regime that keeps you riding pain free. Educate yourself about knees. The more you educate yourself the better able you will be able to evaluate what the doctors are telling you. Through super careful training\stretching I've been able to successfully manage knees issues and ride pain free for many years now. Listen to your body. When it says "stop" STOP....

FIVE ONE SIX

your cleat should be under the ball of your foot, which is the widest part of your foot. so, if you want to try to align the cleats yourself, you should mark the inside of your shoe where that is (you can feel it on the inside of your foot, there's a bone there) while you're wearing the shoes without the cleats.

then, with the cleats lines up under the ball of your foot, pedal for a minute or so and stop your left foot at the 3:00 position and check the left to right float. then do the same and stop your foot at the 6:00 position and check the left to right float. then, do the same and stop your foot at the 9:00 position and check the left to right float. now make any adjustment needed, which at this point should only be a toe in or toe out, so you have enough left to right float with your foot stopped in those positions. then, repeat the process with the other foot...

that's basically what a knowledgeable fitter is going to do, as far as the cleat fitting goes, especially if you tell them you're currently experiencing pain while pedaling. check your current shoes, with the method above, and i bet you have too much outside float and not enough inside float...

also, considering your knee problems, you should consider some type of cycling insoles or orthotics! it's the one thing that almost every rider overlooks, but it's one of the most important. almost every pair of bike shoes, even the most expensive ones, come with generic insoles that do absolutely nothing for your pedal stroke. there's a reason that runners use them, and while biking doesn't look like as hard on your joints, people that had to stop riding because of pains like the ones that you're experiencing will tell you differently...

https://www.specialized.com/bc/SBCEqP...jsp?spid=26339

or

https://www.excelsports.com/new.asp?p...ajor=5&minor=6

and honestly, i'm surprised your doctor didn't recommend either insoles or orthodics...

good luck...

Junkdad

Are your hammies tight? Do you stretch a lot? stretching helped me a LOT for I.T. band. Also, if you are going too low cadence, you may be stressing the knee more than necessary. Think spin,,,

Brad Smith

Thanks for all the advice everyone. I'm doing several things to help combat this now:

1) Working on perfecting some of the typical ITB stretches and, more generally, all stretches. I'll work on doing them several times per day.

2) I'm going to ice my knees briefly after any workouts or rides.

3) I will follow the steps outlined in several posts above to try and adjust cleat positioning, etc. before my short rides on Thursday and this weekend. If things don't improve, I will follow through with the professional fitting next week.

4) I will take it easy on hills and try to improve my pedaling (and spin at a higher RPM than before).

5) I will attempt to find another orthopedic doctor/surgeon, especially one with an emphasis in sports-related injuries. A second opinion is definitely a must.

6) I will continue with my purchase of the new, better fit cycling shoes and potentially explore insoles/orthotics.

7) I will hold off on the Bebop pedal purchase until I have a better idea of what's going on and how my current fitting is affecting things (and because I'm still leery of buying from a no-return-once-opened online store when I'm not sure I can shave my shoes down to fit the cleats).

I think that generally sounds like a good plan. I hope things get figured out. I really don't want to miss out on the cycling season. Thanks again, everyone!

Mo'Phat

Good luck! Keep us all informed of how it works out.

ridethecliche

I thought the cleats were supposed to be the next position down from right under the balls of your feet.
As in, just a little below?

Flywolf

Great thread guys, learned a lot

Mo'Phat

There's always going to be a sweet spot...but if you have pain, you're obviously not in the sweet spot.

Maghreb Biker

Regarding cleat adjustment, for pain on outside of knee can be from toes pointing in too much or from feet too close together. So you should be looking at adjusting toes out a little and/or moving your feet farther out. There is a good section on knees in "Bicycling Medicine" by Arnie Baker. Good luck!