R1lee

This, speedplay zero's will probably solve your pain. Undo the screw and go skating on your bike.

ericcc65

You described my experience almost exactly. Except as it got worse it started hurting off the bike too, a half mile uphill hike had me nearly on the ground. After arthroscopic surgery the doctors still aren't 100% sure what is going on. Luckily I had a world renowned expert in the area of the knee (the posterior lateral corner) nearby me. This was serious crap, no amount of fitting or cleats would help (I did a Retul fit with Todd Carver). So far there are a few potential culprits that come to mind.

The expert out here suggested a rare condition, fabella syndrome. If the pain is on the side but towards the back look at that. The other issue it could have been for me is iliotibial band syndrome, but I've had that severely in the other knee while hiking (not biking) and this feels different. Beyond that maybe some type of popliteus injury. Of course, I had clean MRI's and that's the first thing for you to do, go to a doctor and check out your tendons and ligaments. My arthroscopic surgery revealed nothing really wrong, but the original doc did a lateral release (did not make me happy). I'm not sure if that helped or the specific PT for fabella syndrome (I'd been through tons of PT before, this was more targeted). But I'm biking again and doing climbs. Still hurts but it's "good enough."

If it is fabella syndrome the thing that helped me was a crazy amount of calf stretching and also calf raises. Just on flat ground, lowering the heel hurt too much.

If it's a serious repetitive stress injury like I had I've found all the suggestions to change your pedals and tweak your fit by half a centimeter is about equivalent of telling someone who just got a compound fracture to start eating calcium pills. This can be crappy, serious, long term stuff. But maybe it's not for you and some of these suggestions will work, at least a place to start.

Camilo

Like people have said, quit messing around and have it looked at by a professional - either a sports-oriented orthopedist or a physical therapist who is familiar with bicycling.

Quit trying to solve the problem by yourself or with bike fitters.

In the mean time, ice your knee when you cause it pain, and if it were me (because I've had good luck with my injured elbows and knees) do a several day course of proper dosing of ibuprophen, naproxen or such. I mean, take the med on a schedule, maximizing (read the label!) per dose and per day doses. Do it for several days in conjunciton with the ice.

This stuff is just basic treatment for joint pain, and is best done as soon as you notice it. (for future reference).

fuji_owner

Aww... that is so sweet. I can save the rest of my cheese cake for tomorrow.

roccobike

OP, I had a similar problem. Got rid of the SPDs and went to LOOK pedals because they have a larger degree of float. The pain gradually subsided, but it took a month before the knee was completely healed. Don't expect to get on the bike and in one ride all is corrected because I doubt that will happen. Because your pain is so severe, I'd keep that doctor appointment. I would recommend an Orthopedic doctor.

jcg878

I had knee issues last year after I self-poor-fit my pedals and went out for a ride. Messed up the knee pretty good and had pain for months. I saw medical personnel in this order: 1) PCP - no help, but referred to PT. 2) PT - no help, tried but had no diagnosis to work from. 3) back to PCP for MRI. 4) Sports medicine - no help, looked at MRI, said 'try a different exercise' and gave me a steroid injection in the knee 5) orthopedic surgeon - said "go ahead and ride after strengthening your muscles again".

By the time I saw the two specialists, the pain was mild so the main solution was time. I'm sharing this experience because 2 of the 3 people who IMO should have known better weren't useful - the PT and the sports med guy. The latter was a huge disappointment, and when I asked about his specialization he said he did a residency in "family medicine with a focus in sports medicine". I'm in the medical field too and I know that's a euphemism for "family medicine + a few months of sports med" which in itself doesn't mean he isn't any good, but I was pissed off by what he told me and his lack of effort. The orthopedic surgeon was much more useful and basically said "ride away, you won't make it any worse" and gave me tips. BTW, the diagnosis was chondromalacia with an earlier tendonosis. I am 36.

So from all of this probably-not-useful tale I'd take away: see the right person and have it worked up correctly. Don't dick around and don't accept poor medical advice.

Carbonfiberboy 

Yeah, if you can tell the difference between good and poor. In working my various physical problems over the past 40 years, I have had very little good medical advice from anyone. I have had the very stupidest advice one can imagine from a variety of MDs. The first thing they don't want to do is make a diagnosis. Why? Because a diagnosis puts their word and work on the line and it also costs money. They don't want to spend money on their watch, and they don't want for their word to ever be questioned, like they make, uh, a misdiagnosis. Doctors have egos so huge they fill an entire room, leaving little room for useful thought.

So every single problem I have ever had and fixed, I have diagnosed myself and then forced a doctor to validate my diagnosis, sometimes with great difficulty. ("No, you do not have a torn meniscus. No one could do what you do and have a torn meniscus. Take ibuprofen." I knew I had a torn meniscus and had to dance on the guy's desk before he'd order an MRI.) My wife has much worse horror stories. One doctor almost killed her. Another ordered an xray of her arm when she had 6 broken ribs and a pneumothorax. When we finally got a diagnosis from another doctor 3 days later, I had the pleasure of holding her down when the chest surgeon arrived with a chest tube to put in and no anesthetic. Hey, chest surgeons are Important Busy People and aren't going to wait for anesthetic. And plenty more similar.

Orthopods and similar doctors are good at fixing stuff once there's a diagnosis - think very good finish carpenters. Nimble fingers and great tools. There are a very few good PTs out there, but they're hard to find, and then harder to get a prescription for that works with your insurance. Never assume that your doctor knows anything about PT or PT personnel. The field is crammed with people transitioning from college to some hopefully useful job. Very few stick with it long enough to learn anything from experience. You want a PT with a few gray hairs who's been at the same location for 20 years or so.

atallen223

Okay so here is an update. Went to a sports medicine doctor here in Geneva, and they took some xrays and they couldn't find anything. Which is good... and bad. Since I don't have pain just walking around then he thinks it isn't a torn meniscus or ligament or anything. So I'm going to get some new shoes/cleats and go for ANOTHER fitting....

ericcc65

It's a good step, but I'd push for an MRI next. x-rays are mostly useless in this case, just tell you if a bone is cracked but I would estimate a large majority of knee problems don't show up on x-rays. MRI's show soft tissue stuff like ligaments, tendons, meniscus, and cartilage.

Campag4life

https://www.cptips.com/knee.htm

OP...read the study above. You have medial aka inside knee pain. Cyclists generally learn lessons by injuring themselves sadly. The knee has to track straight. Speedplay pedals...help...maximize float Wedges to align foot vertically and even Q factor aka distance outboard the foot is positioned changes knee tracking.
Tell us when you ride, how far your knees are on each side from the outside of the top tube.

Lastly, until you resolve this, change how you ride the bike. Spin a light gear. Focus cadence in the 90-100 RPM range.
Other influences are seat position...height is key and also fore/aft position. Knee pain or health aside from what God gave you to work with is largely influenced by your mechanics and riding ability. People ruin knees all the time with poor technique.
Good luck.

ericcc65

Unless you're like me, and have a repetitive stress injury. In which case the more revolutions you have the worse off you are. I wish it were always as easy as more float or different pedals or higher cadence but I don't think the advice applies in all situations.

atallen223

Yeah when I was riding it seemed like the higher cadence hurt worse.

atallen223

To answer those questions do you think I should try another fitter armed with this new knowledge?

Camilo

Still recommend ice and non steroidal/ over the counter anti inflammatories as well as trying to figure out and mitigate the cause. Dose according to guidelines, but don't pussey foot around.

jcg878

This could mask a bigger problem though. I agree with Eric - I'd push for the MRI. Continued pain after a "clean" X-ray may be enough for your insurance company to approve it. And it is just an n=2, but based on my own experience I'd see an orthopedic surgeon.

Camilo

Oh, I don't disagree at all. My original post mentioned this in addition to getting it properly seen to and figured out. I just thought that the OP was ignoring doing something about the symptoms in the mean time - and in many cases, this stuff is the definitive treatment. But again, not disagreeing about getting it figured out, whatever it takes.

clausen

Try a sport massage therapist. Doctors gave up on my knees years ago having no cartilage and where no help last year after twisting my knee getting out of the car. Pain cam after 1.5 hours on the bike every ride for a month even took a week off. 1 massage, a day off and has never acted up since.

StanSeven

A Brooks saddle or a recumbent fixes everything

Carbonfiberboy 

Yup. OP already knows it's a knee tracking problem, so it's probably also a patella tracking problem. Review https://www.bikeforums.net/showthread...1#post15814211

I have good multi-use strength in my legs from hiking, skiing, weights, stairs, and stretching. I can ride anything that I can reach the pedals on if I can use my own saddle.

atallen223

Do you think it could be a saddle problem?

Overall I think because of the fact that my knee does not hurt off the bike, it isn't a problem with my knee (yet), and it must be a mechanical fit issue.

Carbonfiberboy 

Nope. Saddle problems aren't mechanical in this way, IME. Saddle problems first manifest as numbness either in the genital area or one or both legs, or as friction problems, or occasionally as unusual soreness on the ichial tuberosities. Some people like a slightly different shaped saddle to move around on or to push against, but that's not what's going on here.

Not a fit issue IMO, but it wouldn't be a bad idea to get the wedges checked. Much more likely to be a mechanical problem with the nerves and muscles in that leg, a neuromuscular coordination issue or a simple unbalanced strength issue. Very simple to see if different exercise fixes it. Since different exercise is always a good idea anyway, certainly nothing lost by trying it. You've already lost the better part of a week.

atallen223

I've lost a lot more than a week, basically I have lost the whole season so far. Sooooo I'm in it for the long haul anyway.

So today I noticed that when I'm standing my feet naturally point outwards (like \ / ) so is there a way to have a fit that would fit that sort of problem?

Campag4life

You solve it with pedal float. Why Speedplays are suggested. Adjust for max float. I too am naturally slew footed. If myself or others are to ride with little float who are naturally duck footed or pigeon toed (the opposite) then we will hurt our knees. So you need more float or better cleat alignment aka rotation. You never answered my question about how far your knees track from the top tube. Wedges under either side of the cleat changes knee alighnment vertically. You may need some help there as well. Also Q factor. I posted a link that underscores cause and effect.
OP...if you have no knee pain in general endeavors including running or playing tennis etc, then likely its your bike set up in addition to pushing too much gear...a common mistake. First you have to understand the pedal stroke and why alignment of everything matters. Once you learn cause and effect you can diagnose. That is why most learn about mechanics through injury...they pretty much have to...to reverse the chronic pattern of pain.

Carbonfiberboy 

Of course. That should be a part of any fit that you pay for. They attach a little pointer to your foot when you're standing naturally, then adjust your shoe cleats so that pointer still points in the same direction when you are clipped in and in the center of your float. Which is another thing the fitter can do: set your float limits so that your knee is prevented from moving in a "bad" motion. I'm assuming that your pedals have some float. Most have 5°-7° of float. I'm not sure that the average fitter can work to that standard. I wouldn't do as well with the pointer float fit method. I also walk slightly toes-out, but pedal with feet aligned with the centerline of the bike and set my cleats so that's the center of my float. When I pedal knees in, I go slightly pigeon-toed.

If your pedals don't have float, you could try pedals which do have float. Some people's knees need pedals without float, but that's not the norm. Of course you can adjust your neutral float position, just like I do.

ericcc65

After struggling with IT band syndrome I can say taking a week off is nothing. Sometimes it takes 3 months or more of rest to heal from that.

My affected leg also points out. Not sure why as the doctors weren't totally sure of the cause of my problems, but I know I have tight ITBS and maybe some problem with the popliteus tendon/muscle. Float can help with that, also to keep your heel from hitting the chain stays you might need a pedal extender. Or maybe it makes no difference, I'm not sure. Definitely try a good fit, it might solve your problems. I'm not saying otherwise. It's just as someone who struggled with significant issues I get upset when people say a fit will cure all your problems or speedplay pedals will make you feel perfect. Some issues are more complicated than that, hopefully yours isn't!

If it is ITBS it will hurt on the outside of the knee, sometimes lowering the saddle can help. But there are differing opinions on that too.