I'm 48, in decent shape (6'3", 195 lbs), and just started road biking about 2.5 months ago. I've been building up my distance, starting with 12-mile rides and now I'm up to 45-50 mile rides.

I want to do the MS150 in two weeks, which is what I've been working up to, but it looks like I've hit a problem: my left knee is starting to hurt like h*ll, about 25 miles into my rides. I can push through it for a while, but I suspect it's not something that I should just ignore and tough out - it's getting bad enough that I'm losing all the power in my left leg.

It started when I was out with the wife on the new tandem - I was pushing pretty hard to get us both up a hill. It wasn't a sudden collapse or anything, but I could feel the ache starting then.

I normally keep a fairly high cadence (70-75) and don't try to grind up hills. Except when I was on the tandem!

The pain is on the outside of my left knee, outside and around my kneecap. I've been fitted on my bike, and am reasonably confident that the geometry of my fit is ok. However, I'm thinking it may have something to do with the angle of my foot (in relation to my knee) as I'm clipped in. I've ruled out about everything else...

Not coincidentally, on the tandem I was wearing my secondary biking shoes, and discovered that the cleat in my left shoe was way off, forcing my foot in too close to the crank. This would explain the strain on the left side of my knee.

I did reposition the cleat, but by then there was so much pain that it didn't really help, now I'm limping up and down stairs, etc, waiting for things to get back to normal.

What do y'all think? Probably the cleat and wait for it to straighten itself out? Or could it be something else?

Very depressing... Hope I don't have to bag out on the MS150. Any thoughts on helping the recovery along?

Put some Ice on the knee.

You need to fix the problem causing the pain, PLUS get fully recovered, before doing the big ride. That seems tough to accomplish in two weeks. I think fixing the problem is done by going back to the shop that fitted you.

Ignoring knee pain can be expensive, not to mention put you out of comission for weeks or months.

I also suggest put ice on your knee you can also consult any physiotherapist they will give you best advice and also give you the best therapy for your knee problem I think this knee problem is the common in humn body you can also do some exercise which are related to knee.

Thanks, I'm hoping it was the cleat. I did a ride two days ago with my primary shoes (with properly adjusted cleats), and the knee pain did not occur. Hopefully it's healing up.

RICE - that might get you fixed before the ride, though you'll lose a bit of fitness by being off the bike. If it happened on the new tandem when you were pushing too hard, and you have spotted that you were out of position, you may already know what the problem is and therefore it won't recur if you're careful. Double-check your saddle height and position on the tandem, though.

Work on using even lower gears. Go for 95-105rpm cadence on the flats, 75-85rpms up hills. There may be some issues with form that will be more apparent with lower gears. One common problem is pushing down on the pedal when the crank's at the bottom of the rotation. All that force is doing is trying to bend the pedal axle and stretch the crankarms. No human is strong enough to do that, but all that force isn't resulting in motion and is placing A LOT of stress on the knees. Be sure that your foot's motion is always at a tangent to the crank (90-degrees to crankarm). At the bottom of the stroke, the foot should be pulling backwards.

How were you fitted? There's no one "correct" fit; it depends upon the type of rider and the riding that you're doing. You may have been fitted as a recreational rider, but doing the MS150 is an event for a fit racer. You may be getting in too deep too quickly. The symptoms (outside kneecap) is typically a sign of a saddle that's too low and too far back. Being too high typically causes much fewer issues and much, much less pain.


I recommend going back to your fitter and having them re-position the left cleat to the original position and lock it in place. I find marking the bottom of the show around the cleat with a permanent marker also helps if something loosens out on the road.

At this point, you really need to fix the cause of the problem and then recover fully. I raced for 10-years and know quite a few guys that have permanent knee problems that required surgery; sometimes multiple surgeries over the years. It simply will not "go away" and you cannot "push through it". It's OK to train hard and suffer, but pain is a completely different signal that something's wrong. Don't ignore it.

Another thing to consider is wearing knickers or knee warmers when the temp is below 60. After seeing talk online about the limited amount of blood flow around the knee caps I decided to give knickers a try. I was pleased to find covering my knees solved some knee pain issues I had been having.