This all sounds very similar to the knee issues I’ve dealt with for the past 20 years. My knee pain is ONLY in my right knee. Although I have creaking, popping, and clicking in both knees, the pain only exists in my right knee. It first showed up in 1999 when I was attempting a cross-country charity ride. Despite logging a few thousand miles in training, I did not have any issues until I started the ride itself. I guess the multiple back-to-back 100+ mile days were the breaking point. Never had any knee pain until then, and I’ve battled with it ever since. Sometimes I think it would have just been easier to hang up cycling and pick up a different sport.
I had an MRI completed on my knee in 2016, and it showed some minor roughening of the articular cartilage behind the patella. It also showed that my patella was tracking too high and too far laterally (which I already suspected). I completed physical therapy that year also, and one of the things that I think was helpful was dry needling of my lateral shin. Interestingly enough, the physical therapist told me that every cyclist she’s ever treated that used a “clip-in” pedal system had overly tight lateral shins. So maybe that is a factor. That spot always feels like a trigger spot on me, and I try to work it out with self massage as often as possible.
Some years are better than others. Last year I didn’t have ANY issues at all. This year it started on January 1st, and has been nagging ever since. I went through physical therapy again (for the 5th or 6th time) back in April-May. That helped some but I was still having numerous issues with that right knee. I had a bike fit at my bike shop completed in mid-June and that resolved probably 85-90% of the knee pain almost immediately. But I still have lingering issues, and Sweet Spot work is especially difficult. I can do workouts like Spanish Needle and Striped without any knee pain, but the longer steady-state stuff is murder.
I’m planning on focusing more on foam rolling, stretching, and working on strengthening my glutes and my core over the next couple of months. I’m also going to try a new pair of shoes soon. Then I’m going to see a bike fitter about 90 minutes away from me that specializes in knee pain (I’d go now, but it’s $400 for the bike fit and I just spent over $10,000 replacing a roof and bathroom floor, and I just don’t have the money).
Sorry I can’t add any concrete answers for you. But I can offer my empathy, because I definitely know what you’re going through and it’s incredibly frustrating. I’m jealous of my teammates and friends who can go out and log 10,000+ a year pain free. And I struggle to get through a 10 mins of a TR workout without any pain.
I’m confident there is an answer out there though, and I’m going to keep working until I find it.
Went and had a fitting done. Hadn’t had one in 5 years. Amazing how the body changes over time. The biggest thing for me was my seat had crept too far forward at some point so 3 mm back and got some new shoes and cleats. Helped a ton.
Is it worth your while exploring the supplements side of things? Glucosamine springs to mind:
And this stuff, which I’d never heard of until recently but which produces some intriguing results in a Google search and has some interesting reviews from users:
Im not sure this has been suggested as yet, but use rollers, exceptionally good, I don’t know the scientific reason behind this, but it works, use them a couple of times a week just spinning and seems to shake knee pain. Was recommended to me by Coach Marcus Arnold one of Australia’s best Track Coaches and has worked.
Thanks Nate for sharing your story and empathy. I hear you!!
I’ll look into some releasing of my lateral shin.
Amazing (in a happy, not surprising way) that the bike fit helped so much. I jumped on the bike the other day and I forgot to move the seat back after my wife had ridden…. Behold - no knee pain!! About 45 minutes into the ride though, my left knee started to hurt, sort of badly. I dropped it back to somewhere in between and finished the ride fairly happily. Then in subsequent rides, I tried messing around with the fore/aft position again, moving it forward when the right one hurt, back when the left one hurt. No dice really. Sometimes I feel like changing my fit just temporarily moves the focal point of the pain laser to a different area.
Could you PM me the bike fitters contact details that you’re going to see? And/or report back on your experience there. I’ve got to the point where I’d take a significant trip to see the right person that might be able to help.
About 5 years ago, I had thoracic back pain so bad that it was something was poking into a nerve on my spine all day every day. Just a constant noise of pain. For years I went through different physics, practitioners, self help treatments etc. trying to find a solution. Eventually, with one simple movement, I rectified it within a couple of weeks. One thing I have noticed with my body, is that when something starts working, I notice it right away… so that’s a good thing.
I have very wide and high arched feet and am considering getting some expensive custom shoes in hoping that may resolve things but will wait until summer while I try other methods before going that route.
Rollers? As in foam rolling?
Does that really work?
To answer your question, yes. It’s absolutely worth a shot. I am taking the glucosamine now and my dad is brining some cissus at the end of the month. If this is the magic pill, I’m all about it. Let’s find out.
Thanks Mike. Do you know what about the shoes/cleats helped the condition?
As in rollers you sit on with your bike like Jetblack rollers inexpensive and fold up and away. There is little to no resistance. And smooth as silk. And because you need to activate your core, glutes and concentrate you can work on pedalling technique
Yes so my cleats were set up neutral. My feet are toes out naturally. So I adjusted my cleats to slight toes out and could feel the difference quickly. I also went back to a KOPS neutral position and it took a lot of stress of my quad and patella tendon. Took about a month for it to clear out but it did. I know people say don’t go only by KOPS but it works for me. I did the retul fit and it put my knee a couple mm forward of the pedal spindle. Just didn’t work for me. Hope any of that helps.
So I have noticed some fore/aft adjustment of my seat position affecting the knee pain. Then during my latest ride, I concentrated (for 75 minutes) on just my sit bones. I noticed that the more weight I put on my right sit bone, the better the knee pain was. Though after the ride it hurt in a somewhat different way (many adjustments needs and adjustment period?) Has anyone with this type of knee pain been down the saddle rabbit hole to see if that could affect things. I am beginning to theorize that my sitting position/hip shift or something along those lines could be a significant factor. That said, every time I find an “adjustment” that helps, eventually it hurts again. But I’ll keep chasing this around for a bit to see if the improvement is lasting. Just wondering if there’s a good strategy for saddle selection - I won’t be able to try a gamut… probably more shot in the dark on amazon and hope for the best. I have the saddle that comes with the Peloton bike… pretty generous padding, I don’t know much about saddles… yet.