Pes Anserine Bursitis
 

From what I have read online and been told by other cyclists is that a general rule of thumb regarding knee pain is - pain in the front of the knee from too low a saddle and pain in the back of the knee from too high a saddle. Ok, so from some pinpointing around, I am experiencing what looks like Pes Anserine Bursitis. The pain is in the front of the knee, just below the knee and slightly to the inside. The pics I have seen online of this looks exactly like where I am feeling it. Now, I read that a major cause of this is from the hamstrings beeing to tight and overused. If the hamstrings are the cause, and I admit that mine always seem tight no matter how much I stretch them, wouldn't this contradict the theory of pain in the front from too low a saddle if the source of the pain is coming from the back hamstrings? Thanks.

I have it too, only one knee, and it won't go away. Stretching seems to help general knee comfort, i.e. the ability of the joint to put up with the bursitis without it causing ITBS or other pain, but doesn't make the bursitis go away. My hams are more flexible that most folks my age, i.e. I just now stood up from the computer and put my knuckles on the floor while wearing thick soled shoes.

OTOH, it only starts to affect my cycling when I go over 70 miles of hard riding and I seem to be able to hike for however long. So I guess it's under control, sort of. Bummer that it hurts, though. My guess is that I injured a tendon attachment somehow and the resultant swelling is causing the bursitis. In which case it should go away after about 6 months.

Messing with saddle height didn't help. Messing with pedal stroke mechanics didn't help. NSAIDs help a little, but less than I expected.

So I'd say stretch for general comfort because that helped my problem and it probably won't hurt you.

Thanks for the info, CFB. I do find stretching helps quite a bit, but knowing it's still there is frustrating at times. Though it seems to be Pes Anserine, I still haven't ruled out Sartorius Tendonitis. The two seem very close to each other when they attach to the side of the knee, however the sartorius runs over the thigh, not behind - which doesn't make sense why hamstring streches would make it feel better if it is the sartorius. I'm leaning more towards PAB.

It reads that PAB is likely caused from overused and over tight hamstrings. How can I be sure that I am not cycling more with my hamstrings and not my quads? Is there a fore / aft saddle position in which one uses the quads more and the other the hamstrings more?

I don't know. But I have noticed that when I stand and ride that my quads get tired very quickly. This indicates to me that I am using my quads pretty hard. So based on this it would seem that the more forward the seat the more the quads would come into play and the hamstrings would be used less.

Just a guess.

Makes sense to me, thanks.