Hi All,

I have cycling-related knee pain. It doesn't hurt at all while I am riding, but manifests itself later as pain in the knee when I squat down. This only happens after I have been cycling, and the pain lasts for a few days. It feels like the inside of the knee is swollen. Otherwise the knee does feel strong and structurally sound, no weakness or wobble. Can anyone identify this? Is it patellofemoral syndrome?

At first I thought I had a poor bike fit, but then I had a pro 3-hour long fit done. The fit accounted for any and all strange foot angles and toe pointing. They did shim my SPD cleats a little. It seemed to make the bike feel more comfortable and gave me a touch more power, but the knee issue did not go away. I can't imagine having to give up cycling, so hopefully a few of you have had a similar experience and have managed to overcome it?

EDIT: Searched the forum and found a lot of good info. Sorry to clog things up with yet another knee pain thread. Still, if any of you have had similar symptoms that you overcame, please do respond!

Details on where the knee hurts would help tremendously.

For instance, "The right side of my left knee, and feels like it is running a couple inches above and below" is way different than "between my kneecap and shin"

It's pain at the very center core of the knee. Like it's swollen.

Do you run, walk, hike, etc., with or without knee pain? Have you had any knee injuries, etc?

I went on a week-long cave exploration trip in 2007 with a lot of crawling and squatting with heavy packs, after which my knees basically hurt all over and did not get back to 100% for two years. I chalked that up to a lack of physical fitness and a bad pair of knee pads. Doctors told me I didn't tear anything and that it was an overuse injury. That's the only injury I can think of. An x-ray was done and I naturally have a two-piece kneecap on the left side. Since then I have had numerous long pain-free periods where I can walk and hike with no pain. I just got back from going 4,500 feet deep in a cave in Croatia, ascending all of that on ropes with a 40 lb pack - no knee pain. But as soon as I add in cycling, the pain comes back. Walking and hiking can be painful then, but again only during periods of cycling. If I stop cycling, I can do just about anything I want with no pain. And through it all, the knee feels very stable and strong. Almost all of the pain feels like a swelling in the very center of the knee, behind the kneecap. However, there are occasional fleeting moments of pain when I step, like the force is passing right through the knee and hurting. And sometimes there are twinges of pain on the surface of the knee on either side of the kneecap. But both of those pains are few and far between and 95% of the pain is that internal swollen feeling that hurts when I squat.

I have no idea, sorry. Nothing in my experience. Only think I can think of right off is that your cadence may be too low. 90-100 seems best for folks with knee problems. Cyclometers with cadence display are inexpensive. Cateye Astrale is a good one.

I'm a little suspicious of doctors who say nothing is wrong. This is not normal, in fact it is extremely unusual. I've had doctors tell me there's nothing wrong when I've had a serious structural defect that needed to be taken care of, only convincing them to try for a diagnosis after months of pain. In the US it's common for doctors now to go to great lengths to avoid spending insurance money.

One knee or both? Is it just the L knee that has the 2-piece kneecap?
Do you always ride seated or do you stand to climb?
How long is a "long ride" (time).

My bad knee (old trauma/surgery) swells when there are climate changes such as approaching weather fronts or even walking from my climate-controlled office to outdoors. An hour of walking makes it ache too.

I never do full squats, orthopedist and physical therapist said just quarter squats. No full weight-bearing activities are allowed for aerobic exercise.

On the bike, I slide back on the saddle and drop my heels if I need to grind low cadence < 55 for hills/headwinds. It is easy on the kneecaps but tires calf muscles.

Spinning is hard to do with a stiff/swollen knee and limited range of motion. Some days I need a long warmup to be able to turn the cranks without pain on the bad knee. My avg cadence is < 70 , can't even turn 90+. Not a spinner.

Maybe a long warmdown & post-ride icing will help. Do you take any kind of anti-inflammatory OTC meds?

Pain is mostly in the left knee, although the right knee occasionally has some pain when I step and/or around the sides of the kneecap. The kneecap is only two-piece in the left knee. I don't really do any "long rides", only 4 miles to work one-way, which only takes 15 minutes or so. I mostly ride seated, and do make a conscious effort to spin, although I couldn't tell you what my cadence is as I don't have a computer. I do have a tendency to ride hard; it's difficult for me to just relax and have a leisurely ride, but I've been trying. I'm sure some of you can relate. I do sometimes ice my knees, maybe once a week. And maybe twice a week I take Aleve, which does help some.

I had similar problems which were cured when I got new shoes. I could ride 75 miles and the next day couldn't go up and down steps. I bought Specialized BG shoes and I'm now pain free. As I understand it, feet are either varus or vulgus with 85% of people being varus. This pertains to the angle of your foot when hanging free. Sit on the end of a table with your feet dangling and you'll see that your big toe is probably higher than your little toe. The BG shoes have a small built in wedge that supports the foot so the knee is properly aligned. Go to Barnes & Noble and browse through Dr. Andy Pritkin's book, Complete Medical Guide for Cyclists. You can also go on the Specialized site or just Google varus foot.

You don't have to buy new shoes. You can get varus inserts that do the same thing. It really worked for me.

I don't know if this is what you have https://www.webmd.com/pain-management...topic-overview but I am plagued by knee pain if I don't keep my hamstrings and my quadriceps stretched daily. If I understand it correctly the kneecap will often move incorrectly through it's track if your muscles surrounding it are insufficiently limber.

see a sports med knee specialist. get an MRI. don't expect commentary from lay people in a bike forum to be in the least bit applicable to your own medical reality.

Look, I'm not trying to be a jerk but trying to play internet doc or expecting others to convey their own internet doc "wisdom" to any positive effect is just foolish. You MAY stumble onto a "truth" but you are FAR more likely to a) waste your time and/or b) misdiagnose and further exacerbate your problem. The only really effective solution is to bite the bullet and get an exam and an MRI to see exactly what is going on inside. If you are serious about cycling (and about your knee health in general) you shouldn't put the slightest faith in what anyone here has to say diagnostically (me included) and you should be making an appointment w/ a qualified specialist.

BTW - I work in the Orthopedic industry and even w/ all the experience I have I could theorize all day long but it is ultimately meaningless w/o actually examining you....

Thanks for the advice everyone. I have made an appointment with a doctor and am also in touch with a physical therapist who can do a medical bike fit.

Hopefully its just a minor fit tweak... best of luck! ;-)

So when I say, "Your knee pain is caused by excessive nose-picking," you know I'm right.

yup, especially when the habit is picking one's nose with the big toe. Tough to do and the repetitive use injures are a real bear...

Are you the same HokuLoa on the www.nosepickinggymnastbearsforums.net?

Just wanted to follow up on this thread and let you know what the outcome was. So I went and saw a physical therapist who evaluated me and also gave me a medical bike fit. She was a pro rider at one time, so I felt pretty confident in her abilities.

I had two visits with her. At the first one she looked at my body mechanics while standing and walking, and did some range of motion stuff to see how my joints were moving. There was no damage to my joints but there were a few issues: I always knew I had flat feet, but apparently I have one naturally flat foot and one fallen arch, so she made me aware of how that was making my knee turn in while walking and standing. It's something I can apparently compensate for without orthotics just by staying aware of it. I also bounce a lot when I walk, and don't fully extend my leg straight with each step. She told me to change how I walk to a straighter step so I don't stress the knees as much. And last she told me that the muscles on the outside of my legs dominated the inside, and that I could bring the inside muscles back into play by doing some glute exercises. I've been practicing everything she told me and my knees are feeling great, however I have not been riding at all so I can't say where the improvement has come from.

The second visit was the medical bike fit. Turns out I had my seat a bit too far forward and a little high, one of my SPD cleats was in the wrong spot and turned a little. I also ride with a rounded back, didn't lead with my heel on the downstroke, and was not keeping my thigh bone parallel to the top tube. So we corrected all the stuff we could and now it's a matter of me being very conscious of my riding technique.

I'll update this thread again in a couple of months and let you know how I'm doing. Thanks again for all the inputs.

OP, good news! Always nice when it is just a relatively minor fit issue and not an actually injury. Certainly best to find that out with a little added expense before the discomfort turns into a full blown, expensive condition...

Bah, my secret is out! To be fair, my actual handle there is "ursus hokuloas."

It's not commonly known, but resveratrol is turning out in a lot of very recent research to be a miracle substance for joints. Including the spine. I could post the references if people want. This requires larger doses than a lot of supplements that are sold as resveratrol can deliver. The best way to take it is to buy the 50% trans-resveratrol powder that is made from Japanese knotweed, from a reliable source, and take it buccally, in your cheek. Then it absorbs into your bloodstream. It doesn't taste bad, its a little gritty.

It really works, not just for joint pain, it helps a great many medical conditions and may even extend life span. There is solid science behind it. Right now its perhaps the most studied natural substance.

I don't know why the medical profession doesn't read more about this stuff. What the hell are they thinking, ya know?

Also, DLPA "DL-phenylalanine" an amino acid, (taken in the morning/afternoon, not in the evening, or it could interfere with tryptophan transport) is not analgesic, but it potentiates your body's own analgesic, endorphins, by slowing its rate of metabolism. It also - because its half L-PA, is energizing. Yes, a paradox.

A lot of the time I suspect in bikers joint pain may be an garden variety infection that has never been treated adequately. Thats just a hunch.

Actually, reading backwards, HokuLoa is right, you should get an MRI. Not an x-ray which the doctor knows often shows nothing. Resveratrol might make the pain go away, but if you have something serious, it will also make the symptoms improve, preventing your problem from becoming the priority in your doctor's eyes that it should be.

MRIs only cost $99 in Japan. I don't know why they are so expensive in the US, probably to discourage people from getting accurate diagnoses/maximize the income stream.