Hey Everyone,

My brother and I are in Buckhorn, KY right now taking a day off on our TransAm ride from east to west. My brother's left knee started bothering him two days ago and yesterday we had to walk the up hills of the last eight miles as his knee was killing him. The tendons in the back of both my knees were acting up yesterday, but not too serious like his situation. We've been taking ibuprofen and icing, but is there anything else we should be doing? We can't sit around for a week to heal up if we want to stay on track for Oregon.

Any and all advice is thoroughly appreciated!

Thanks,

Ethan

I am no doctor - but have tens of thousands of miles touring experience.
I suspect that clipless pedals may be part of the problem.
Combined with repetitive motion injury due to "crunching".

I am old enough to have seen clipless take over from clip pedals in touring.
At the same time, I noticed a spike in knee issues as well.
There will be many who say that they tour clipless with zero problems.
They are right - at least for themselves.

But a small, yet significant, percentage DO have serious problems.
Sometimes these problems can be alleviated by adjustments and by spinning.
(But it seems to be rare, especially after injury has already occurred.)

I was riding once with someone who had to quit because of knee issues.
He pooh-poohed my theory - said he would meet up again a week later.
He had to quit again because his knees were killing him.
Two years later he emiled to say that he went to clip pedals and no longer had any problem.

YMMV

Bike adjustments notwithstanding, you should sit around and wait for it to heal no matter what. Some pain is pretty normal, especially if you suddenly ramp up your weekly mileage like at the begging of a tour you didn't properly train for (did you guys train?), but if your brother's situation is what I think it is, you need to wait until he can ride relatively pain-free, even if that means forgoing part of your trip.

If you try to ride through this, one of you might wind up with an injury serious enough to warrant surgical intervention.

I had knee problems on one tour and just toughed it out, other than walking a lot of the harder climbs and taking walking breaks even on the flats when it felt especially bad. I figured that I had a torn meniscus and would probably need surgery when I got home, but didn't want to end the trip. I wound up being fine in a couple weeks. I can't say that I advise that approach, but it worked out well for me in that case. Taking some rest days is probably a smarter approach.

I can advice being sure that bike fit including saddle height and cleat position, especially cleat angle are dialed in. Very small differences in those settings matter. Also I hope you are running sufficiently low gears and not mashing a big gear up the climbs. That also makes a big difference.

Knee pain from clipless pedals presents as lateral (outside) or medial (inside) knee pain. The kind that emaurice24 is describing sounds more like hyperextension caused by having the saddle too high. Considering the area that they are riding through, it may also be caused by trying to push too high a gear up hills.

Try lowering your saddle some, emaurice. And try to either get ride in a lower gear or get out of the saddle on climbs from time to time.

+1

Check the bike fit. It is quick and can solve a lot of problems. Go on line and do a search for "bike fitting"., You can make a reasonable fit while on the road using common fitting practices. Also, search "bike knee pain" for some of the common causes of knee pain.

The suggestion to check cleat position is also a good one. Some physical therapists actually recommend clipless pedals to maintain knee stability. My wife has a badly torn ACL, and her PT made sure she was using clipless pedals. Do the pedals have any float?

Low gearing also helps.

Regardless of how it came about, the human knee is a terrible design and can go wrong in myriad ways. See a sports doctor ffs - the knee has to last you decades yet.

Having said that my right knee objects mightily to two things - firstly it doesn't like too much horsepower, if i spin in one gear lower than I would otherwise like it is a bit happier.

Secondly - a sure way to upset it is for my saddle to be too low, even a little bit. It's a personal thing but I find that I need the saddle set such that with my heel on the pedal my leg is completely straight. This is standard wisdom as you're probably aware.

Some of my quick release seat clamps allow the seat post to slowly sink. I have to watch this carefully - checking before every ride.

Oh - and an expensive suggestion - you might try some pedals with a lot of lateral float. Time ATACs are very floaty and often written up as being good for people with troublesome knees. They do both MTB and single-sided-road versions.

^^^^ Agree....^^^^

You can ride yourself into injury that takes days, weeks or. months to recover from depending on how long you continue accumulating micro injuries.
You might review what you are doing. Are your heart and lungs stronger than your knees? In other words are you climbing hills or pushing against head winds according to what your breathing and lactic acid limits can handle but don't have a similar base fitness in your joints and ligaments to sustain repetive motion.

Icing and ibuprofen don't stop what is causing the problem, they are first aid and recovery treatment, not treatment for injury. If the problem is X hours of constant effort at Y intensity you have to STOP doing that so you can recover. ONCE you recover you carefully resume activity. It may be that what is causing the injury is 3hrs of 75% effort and that you're fine for 6hrs at 60%. It may be that an accumulation of multiple 90% efforts that last for 15minutes is simply too much. My gut sense is that you're simply grinding too hard for too long and you need to break it up with easy, easy spinning, warming up and recovery EVERY DAY. right now you risk not being able to finish if he is driving himself too hard.

Too hard doesn't have to be 150bpm for five minutes. Too hard can simply be a 75% effort for too long. It could be riding non stop for 3hrs when two two hours stretches at a slower speed carries you farther.

i had a ski injury when I was 23, a bashed patellar tendon below the kneecap. Couldn't walk for a week. 6mo later I did a long mileage tour but made SURE I rode at 60% effort or less in the first hour. A year later I joined a racing club and got racing fit but I absolutely had to warm up SLOW in the first 15, 30, 45 minutes or I was screwed for the day.

You guys have to figure out what the threshold for injury is and work under it. Like I said that threshold may not be immediately felt but you could be hitting it right out the door in the first hour of the day or half way through your day.

If you are into the first week of riding you have to figure this out, icing and ibuprofen isn't the solution, changing how you are riding is. Whether it's seat height, technique or time at a particular effort can't be diagnosed over a forum.

I agree that they are likely not the whole answer, but on the other had they still are helpful and important, IMO.

Pace may be too ambitious , slow down and smell the Roses, maybe walk hills

rather than overstress trying to go up them pedaling too hard.

Certainly, but if they have't figured out the cause and he thinks " they" (his brother) can't afford the time to heal up the icing and ibuprofen are simply for getting him to the bus station.

how much/what kind of training did you do before the trip?

what kind of bikes do you have?

what is the gearing?

how much weight are you carrying (body weight and bags)?

what is your average daily mileage?

what kind of pedals ya got? (can you switch to platforms?)

how long into the ride does the knee pain begin?

is the pain only on hills?


rest for a few days. take a greyhound part-way.
you won't miss much in kansas......

Yeah, except for all the headwind

I had the knee issue - 2 things I did that helped
1. if you are riding clipless pedals move the cleats all the back as far as they will go
2. KT Tape -https://www.kttape.com, you can get it at dicks sporting goods and the webiste has youtube videos to apply it.
I've had tendentious in knees and elbow as well as shin splints and neck muscle pain the KT tape helped. It is imperative you shave the area and use alcohol to clean prior to application.
3. shorter days and more rest days

Much better idea than pushing into injury if there's a time issue. If one brother is truly hurting he can go a day or two ahead to set up camp and take recovery rides. Easy spinning rides to recover. Muscle soreness can recover fairly quickly but ligament and joint injury can take weeks or more.

Agree, if pain is in back of knee, the saddle may be too high.

I keep a bit of electrical tape on my seatpost, about 5m above the top of frame or seatpost clamp so that I can keep track of exactly where I want my seatpost. The tape is above instead of right on the line because I want to be able to see if there is any slippage.

You might want to mark the seatpost with a bit of tape, maybe an inch above the top of frame or seatpost clamp as a marker and then start lowering the seat by quarter inch increments. If you keep the tape in one spot, that gives you a reference point.

Avoid high torque, keep cadence up but use lower gears and just plan on riding at a speed that is 15 or 20 percent slower for a few days. After a few days, reassess.

I never stand on the pedals to accelerate or power up a hill. I did that a few too many times and my knees suffered for it, instead I always just gear down and stay in the saddle.

If you had to walk up hills, does that mean that your lowest gear is too tall? If so, you really need to stop at a bike shop and get a smaller chainring for your granny gear. If you are riding a double instead of a triple, you might need a new triple crank which might mean new front derailleur and maybe new shifter. My smallest chainring is a 24t, what is yours?

Since we're all just guessing, my guess is with jamawani / clipless pedals.

Most people set saddle too low - having saddle too high is less likely.

OP appears to use clips, brother uses clipless:

https://www.crazyguyonabike.com/doc/p...740&size=large

I don't suggest standing to accelerate or power up hills. I suggest because it alleviates the constant grind that you can get into on long uphills. It's much harder to do on a loaded touring bike but, thankfully, I have a stiff framed Cannondale that lets me throw the bike from side to side better than the noodly steel frame I used to ride.

My lowest gear on my touring bike, by the way, is a 20 tooth with a 34 in the rear.

I referenced your post because I agreed with your statement about saddle height. My other comments were intended for the original poster. If you thought that I was somehow making negative comments on you or your riding style, I assure you that I was not.

I've had this happen a few times for whatever reason.It went away after a couple of easy days.I've actually had to lower my seat a tiny bit at times to help it along.

My pain is mostly all over,old man pushing too hard for too long.

Normally pain in the back of the knee means the seat is too high...pain in the front means the seat is too low...pain all over your knee,the gearing is too high or pushing too hard in a high gear

Pain in the sides of your knees is from clipless pedals.

I would take it easy for a couple days(rest or low miles),lower the seat 1/4-1/2 inch and see what happens.If it's something simple,it should feel better in a day or so.Don't keep riding if the pain doesn't get better.

+1

It takes quality time to find a correct setup with clipless pedals. The second pain starts, you know the setup is wrong right away! At that point, you have to begin making adjustments to cleat position, saddle height, etc, etc. One reason I stopped using clipless and went straight to platforms is that my feet no matter how much I tested, revolted against SPD pedals.

I will say that it's going to take weeks or months before you're 100% pain free.

I transitioned from tennis shoes on rubber pedals to tennis shoes in toe clips on serrated road pedals to leather racing shoes with metal cleats on road pedals in toe clips to racing shoes with plastic cleats in toe clips to SPD pedals with little float to SPD with more float.

The fine tuning I saw necessary with clip less was pronation/supination adjustment. But the slight discomfort and adjustment came in the context of high horsepower output in race training not touring efforts. There were MANY other adjustments of much greater significance in race training than getting the foot position right since that was so fundamental.

The folks I knew who got knee problems did it to themselves by pushing past the warning signs, repeatedly.

Maybe the brothers could benefit from a different shoe pedal fit, or a lower hp effort.

It also takes quality time to develop good pedaling technique on your own.

When I was part of a racing club in the 80's we were lucky enough to get a fellow who was a cycling coach who had trained an Olympic cycling team in Eastern Europe. First thing he did was check seat height. Out of about eight guys four had their saddles too low by about 1/2-3/4". He was with us for only a month and it drove us crazy because he had us pedal so slow but he wanted to make sure we could ride a clean rotating pace line before we got into speed work and strength conditioning. It also gave him the chance to see how people pedaled.