[FAQ] How to Fix Knee Injuries for Cyclists (Knee Pain)

Thanks so much for summarizing your experiences. Glute activation is SO important! I recently have been making that a major emphasis and it has eliminated my nagging knee pains, taken stress off my hamstrings/quads, and made me feel much more powerful.

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Oof! What sort of knee pain do you have? Medial, lateral, below the kneecap? Would be interesting to see what you learn from the MRI as well.

Yes! What did you do to work on your glute activation?

Bookmarking this. I’ve been introduced to Jay Dicharry’s Running Rewired book and see some familiar exercises from there on your list.

My knee injury was caused by downhill skiing (diagnosed as an MCL sprain) and funnily enough cycling was about the only thing I could do without pain in the immediate aftermath. I wasn’t able to run though, not because I had pain when running but because the night-time pain was crazy. It took 18 months of physio to get back to a point where I could run and even now I tend to be super-aware of my knee.

The physiotherapy also sorted out chronic instability in my non-acutely injured leg. The biggest difference for cycling has been my cleat position is much more neutral now than it used to be!

I have also done lots of glute activation over the last 2.5 years now. Banded monster/prisoner, clamshells, side plank clamshells, fire hydrants, glute bridges of all sorts, banded ladder drills; I have an entire folder full of exercises.

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Several things:

  1. I’m usually a bit wary of chiropractors, but there is one guy I have gone to in the past who is great at releasing tight spots with various massage techniques. He worked on my hamstrings, hip flexors, groin, and low back, and after a few sessions glute activation was much more natural/easy.

  2. I got a bike fit that didn’t move my seat position much, but it flipped my stem making it much less aggressive/aero. I now realize I wasn’t nearly flexible enough to ride that way and will slowly work on improving flexibility.

  3. Got a new saddle, the Specialized Power Expert, which seems to make it easier to tilt my hips underneath me while pedaling.

  4. Have been working on hip bridges and other exercises similar to the ones you posted to further emphasize the action of engaging my glutes.

I’m glad things seem to be going well for you now @Jonathan…I’ve been listening through the old podcasts (5 stars by the way) and while it’s tough to listen to you deal with those setbacks, your journey has helped me analyze my own problems.

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Bookmarked.
Due to my soccer and American football background, I have had the following knee injuries over a period of 15 years (all on the right knee):

  • MCL tear (minor, three times spread apart)
  • Medial meniscus tear (minor, x2)
  • ACL partial tear (loose part removed but only half a ligament left)
  • Patella Femoral pain and tracking issues (x3, recurring, partially caused by ITB)

Cycling keeps everything in shape so long as I ensure I’m using my VMO and stretching my hip flexors, but this summer I tore a ligament in my right foot (soccer with my daughter! :roll_eyes:), and now I’m getting tracking issues again. I think it’s because I lost a fair amount of muscle mass when I wasn’t able to put weight through the foot (it’s 98% healed - I couldn’t play soccer, but I can run), and my VMO gets fatigued about 3/4 of the way through the TR workouts.
I’m foam rollering, stretching and I’m going to do more single leg squats (they are great, especially the tiptoe ones), but I think that focussing on my core is going to be the key to sorting it out as the right side of my back is fragile too (and pre-dates the knee).
@Jonathan - all the above exercises are hips down. I know you have mentioned core work previously on the podcast - do you think that the core also helps with your knees? If so, do you have any specific exercises you do for core, or is it just the ones that are on the TR youtube channel?
Thanks for sharing all your exercises - they are great.:grinning:

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It is Thanksgiving week so it will be a little while till I get my results. Time to take up some swimming! My suspicion is a result of TFL (Tensor Fasciae Latae) tightness. I hiked the Highline Train in the Uinta Mountains (Utah) two years ago and blew my knees along the trail because of all the ankle/hip articulation while walking over the broken stones in the trail.
The TFL connects around the front of the hip to the glutes (which wrap from the back) to form your IT Bands. My doctor thinks my right knee is IT band related. Left, waiting for the MRI results.

BTW, coworkers had been telling me to jump on TR for years, but it wasn’t till I started to listen to your podcasts that I moved over. Also, not sure if your office knows, but Pete was in briefly in DCRainmaker’s videos last month, reviewing the new GoPro7.

Jonathan- From a guy in rehab for Patellar tendinitis- thanks for this!! I’ve been dying to know how it is going for you. Totally agree on all of these lessons you’ve learned, right down to speedplays and hip strengthening.

Question 1: how do you incorporate those strength/stability exercises into your training week? Before a hard ride? After? On easy days?

Question 2: I can see a path back to road racing, but MTB or CX seems like the slightest tweak from a maneuver would set me back months. Have you changed anything around MTB riding other than the routine above? Your stretching routine sounds better than mine

I don’t (normally) believe in “magic” fixes, but the Cali Lift Glute Developer is pretty darn close. Full disclaimer: I am not sponsored by Cali Lift, nor have I ever worked for them. I bought this product with my own money.

The Cali Lift does something special - it activates your glutes in a way that is so instantaneous, simple, and significant, I thought there was no way it would work. But 9 months later, my knee pain has disappeared on the bike, and I have noticed significant improvements in both lower body strength and on-the-bike power.

Instead of doing countless, precarious, and complicated glute-activation exercises, the Cali Lift has been a “one-exercise-does-all” for me.

My background: I had two serious knee injuries & surgeries when I was 14 and 15 while playing soccer. I started cycling at 17, and made it four years before serious knee pain returned. I had a TTO (tibial tubercle osteotomy) at age 21. But the biggest difference has been using the Cali Lift for the past 9 months. My knee pain has gone away, despite my racing and training load being higher than ever. Hope this helps.

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Thanks for all the information, nice to see a mix of some ‘classic’ exercise plus ones that are new to me.

I did have a few questions though, some I am fairly confident of the answer but I just wanted to double check and it may help someone else in the future.

  1. The ankle dorsliflexion, is this a hold the position or are you ‘squating’ while resisting the band, how long/how many reps?
  2. Can you elaborate on the difference between the banded stretch and the couch stretch? What do you consider a ‘significant’ amount of time?
  3. Pigeon pose - when you say lift the back knee off the ground, presumably the toes of the back leg are sitll in contact with the ground?
  4. Making a rainbow - this is a left to right rotation movement, right? Reps?
  5. Banded hip twist, Supine rotations in half bridge, tippy bird banded jacks - Reps? I understand that perhaps ‘more is better’ but as a ballpark, what is a good starting point?
  6. Star squat, do you come back to standing between the 3 points or do you crouch with your free leg forward then remain crouched while you move the free leg from front to side to back? Again, rep recommendations?
  7. As a whole routine, what is an effect dose of this? Every day, 2-3/week? once a week?

Thanks!

If I’m totally out of shape or in really good shape I have knee pain, mostly in my right knee. When I was in grad school, I got really fat and didn’t exercise. I could barely carry my son upstairs when he was an infant. I went to PT, and they mostly got it more inflamed. I started swimming, and that fixed it. I hurt my knee this year and started swimming again, and tried to figure out why. I think it is pushing off from the wall twice a lap. Partial squats are supposed to help knee issues too.

I have a lot of problems with patella tracking in my right knee, so I either use a strap or KT tape. If you search on youtube, “IT band KT tape” that’s what I do. I also use bandage prep so that it lasts longer, usually about 4 days. When I had inflammation in my left knee this year, I used the same scheme but not as tight. The inflammation was keeping the patella from tracking properly, which caused more inflammation. What I found out with that was that if I didn’t stand up on the bike, it didn’t hurt. There was inflammation above the knee because of repeated hyper-extension.

Thanks Jonathan. For me, it has been the incorporation of stretching, yoga and leg days from Beachbody’s 80 day fix program for strength training that has made the difference for my back and my knees.

Btw, I’m a long-time listener to the the podcast and had an image of you, chad, and the other guy :slight_smile: in my head. But based on the pictures in your post here, I was way off on what you look like.

Thanks for sharing @Jonathan! Out of curiosity, did your PT have you working on both legs or just the trouble maker? If only one, did they have you switch to start working on both at some point? If so when?
Tim

Hey Jonathan … I’m currently recovering, on the build back from petella tendonitis and pre petella burstitis. Its been awful, but since having it all surgically drained and cleaned up its been getting better.
Why did this happen ? I do not know … perhaps over training as I had ramped up my training for a full ironman distance triathlon - which I’ve since deferred to 2019.
BUT - one suspicion I have is poor gut health. Whilst recovering I have been exporing poor gut health and yes I have some food intolerances and confirmed ‘leaky gut’ - both of which can lead to auto-immune issues. I’m still exploring, not trying to resolve why I have these issues as Ive never had anything like this for the previous 45 years … I’m now looking at what’s the root cause of all this - next I’ll be looking into gut bacteria
So - I’m sharing all these details because i also believe that all the good stuff and correct fit and good training etc etc. can still go bad and you can still get injured if something else is not right - for example your gut health.
( I also have some tendonitis going on in right shoulder and left elbow from swimming - so I have issues not just in the knee - all of which I’ve never experienced before - hence my holistic approach to examining why may be causing them all to blow up )
Michael

I have bad knees, trust me they are bad!! Walking any distance I get impact pain but cycling is great and can manage distance and hills, my consultant give me credit for getting where I am by keeping going and cycling and if I don’t I get more pain (the arthritis sticks!!) Anyway after a knee replacement I had a revision of my bike fit and shorter cranks were recommended. I know loads of people who have had reputable bike fits but cranks aren’t usually mentioned.

I’m 5`4’’ so why would I have cranks the same length as someone 6’4" even on a smaller framed woman bike?! The difference has been good to great. The theory is that I don’t have to crunch up my knee when flexing on the up… it generally stops me twisting - it was marginal but my hip would twist to make a bit more room as I flexed - plus I used to get groin/hip flexor pain but don’t get that any more.

While the physic theory is longer crank more power I don’t feel I have lost any and am way more comfortable on the bike and knees are good (or as good as they will be)!!! Might be worth thinking about particularly those with shorter height/legs/possibly the ladies out there if they have a problem in this area. There was an article this year in one of the cycling mags this summer about this and the argument was good towards considering this, after all we fit most of what else is on our bikes saddle up/back/handlebars tilted, we buy a bike for our size but the cranks are generally one size fits all.

So it appears that 2 weeks in to HV SSB2 I’ve developed a patella-femoral issue, basically runners knee. Not awful but a dull ache that got worse as Sundays session went on, right behind the kneecap. I’ve tried cycling a few times this week but can’t put any power down. Trying to get a physio appointment and foam rolling twice a day on quads, ITB, glutes etc. Aside from that does anyone have any advice on how I can recover well, and crucially how long before I’m back on the bike? No pain walking or on stairs, only if I sit and push my foot against the floor hard.

Hmm -
Knee injuries are so individual, it is difficult to discuss.

In the summer of 2017, I was experiencing knee pain while riding (Right Knee), and it only got worse as the summer went on. The pain got to a point where I stopped riding for two months, and was looking for answers on how to fix. Rest, and PT did not solve the issues, and I got an MRI during that time also. I finally found a surgeon that was confident about my knee pain that it was “Plica Syndrome”, and that an arthroscopic surgery would fix the pain.

Plica Syndrome: https://en.wikipedia.org/wiki/Plica_syndrome
Basically - some tissue in the medial part of my knee got inflamed from overusing it (cycling!). Surgeon goes in and removes the inflamed tissue, and resolves the issue.

Flash forward to fall of 2018, and my right knee is perfect. No issues, not a bit of pain. Unfortunate thing is, that my LEFT KNEE is having the same issue! I was quicker to the gun with getting surgery, and it will be 3 weeks post operation tomorrow. I’m still in the recovery phase, and am able to ride, but its about every other day to keep the inflammation down.

Anyways, I wanted to share my experience. I could be a minority, but it seems like the more cycling friends I meet, the more I hear about Plica syndrome. Hope this helps. :slight_smile:

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I’ve had to take some 3 months off bike due to patella tendonitis and work travel and among physical therapy exercises purchased a powerdot and run the knee programs and quad massage and have started seeing some promising results.

:joy::rofl::joy::rofl::joy::rofl::joy::smiley:

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An alternative short Rectus stretch that I find much easier to spend significant amount of time in.

images

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