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

Training
84

it sounds stupid, but since i ride with the new PowerMatch my knee pain is gone, totally strange!

before i used the new power match, the TR App controlled my Neo 2 directly and for my feeling it wasn’t fluidy, so more agressive and often in the last intervals i got pain in my right knee.

With the new Powermatch, my Neo 2 will be controlled via Vector 3 and the resistance is more fluidy, more realistic, but hard enough!

You think, it’s possible or coincidence?

Sorry, my english isn’t really good!

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85

This would be interesting to test, if the trainers way of applying load to the whole system varies if the power is more constant or more erratic, like it usually is from power meters compared to the trainers readings…

Anyone else felt a difference in PowerMatch vs trainer power readings and the trainers approach to adjusting/applying power?

I can also attest that once my bike fitter told me that my shoes were very small and borderline problematic for my feet, I have started to think about it all the time and now I always feel pain in my feet… soooo never underestimate the mind playing games haha

86

Suffering from knee injury know. I am wondering that injury comes from my pedaling skill. Do you pedal like walking? Heel drops first then rotate from mid-foot to forefoot? Or fix your feet just like doing seated leg press on the bike? Thanks!

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87

How much and how often do you use your cali lift? I’m getting one. I’m done with the knee pain which I know is caused by glute issues and done with the 27 random exercises. This thing looks legit.

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88

I use the Cali Lift ~3x/week in my normal strength training routine. Enough to stimulate the muscles and maintain what I have – I will sometimes use it 4-5x/week in the off-season to promote strength gains, even if it means creating a bit of on-the-bike soreness.

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89

Hi there,

Bit of a late reply, but did you resolve your knee pain? This sounds a lot like me…nothing deladlifting or walking but squats and pedalling.

Cheers

90

Hi, yes I did eventually resolve the issue but maybe not in the most efficient way. I took about four weeks off of the bike, but maintained a regular gym routine. If I remember correctly I was doing upper body stuff and deadlifts, and began to do leg extensions (which I had never done before). I think I read something about problems caused by a weak vastus medialis (the teardrop muscle above your knee). Then I began adding in squats, and a bit later resuming riding in the endurance zone.

This was not my first knee issue, but it was a new one. I find that my knees feel great if I am regularly foam rolling, stretching, and doing a bit of yoga. If I start to slack on that work then knee problems start to appear.

Rest is the best medicine, but then you need to fix whatever caused the problem.

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92

@Jonathan
There was a podcast where you did a video overlay of some of these so we can see the dynamic movements. Can you link that here or give the podcast #? I cannot find it and have been through my library multiple times.

93

Has anyone had a case of pattellofemoral syndrome where symptoms ONLY show up off the bike? I’ve been having pain in that area for about three weeks, just when climbing and descending stairs or steep hiking terrain. I don’t feel it at all when I ride at any intensity, nor when I run. In fact, after rides and runs the symptoms go away for a few hours but then come back, seemingly a little worse. If riding is completely pain-free, should I proceed normally? I should note that my volume is already drastically reduced anyway, as I recently had a newborn. Oddly enough, the pain started my first week of (much) lower volume.

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94

I have something similar, though mine recently started during running. I don’t feel it during or after being on the bike (I am on a mid-volume plan so doing quite a lot). It isn’t ‘that bad’ during a run, but I feel it much more in the day or two after when going up or down stairs. I actually had significantly reduced running in the past 6-8 months and then got ‘runners knee’ - having never had a problem before. Although I don’t feel it on the bike, I am pretty sure that the bike is a contributor in some way for me. I saw a sports doctor and have done a lot of reading on it since. Ultimately it is some imbalance and/or tightness/weakness of various muscles that are keeping the knee tracking correctly. I started a routine of simple strength and PT a few weeks ago and it is already showing improvement. I am continuing to ride normally and adding in my core and specific exercises and it is helping.

95

This has been my issue for six months now. Feels fine during load weeks, then pain creeps in partway through my recovery week. Glad I’m not the only one. Any luck on your end? Your post was awhile back

96

I’ve been going to Physical Therapy for about three weeks now for my knee pain, which is almost certainly IT Band Syndrome. Still no jogging yet for me but the exercises seem to be helping - all glute work. No treatments directly to the IT Band yet such as scraping. Progress is slow - definitely not a quick fix out there.

97

Me. I had the same problem. No pain on the bike and then slowly amplifying pain during the day afterward. Sometimes affecting my sleep. I’m pretty sure it was my quads tightening over the course of a day. What really helped was regular stretching and rolling of my quads, hamstrings, and glutes. Night and day difference between when I was doing this and when I would stop. Most of my problems went away however after a bike fitting…

98

I had something similar, a three day bikepacking trip brought on some pretty serious pain. Best guess is a combination of 30 hrs riding and no stretching/recovery caused extreme tightness in the quads, and knee tracking wasn’t perfect as I avoided rubbing the frame bag.

It went away very quickly in the week after the trip but would start to flare up again after riding (despite little to no pain during). Ended up taking a few weeks off committing to rolling and stretching those three main muscle groups (quads, hamstring, glutes). Finally back to a normal where I can start seriously training without worrying about flare ups.

Foam roller is the best, keep movements on it slow and work through your range of motion in the knee while on it. With winter arriving I have also found that a heat wrap before exercise has helped it feel good and loose.

99

I’ve had bad knees on and off for years and have been able to overcome very easily on the mtb but do struggle on the road bike. This is mainly down to such a rigid position, having the flexibility of an ironing board and a slight leg length discrepancy resulting in a slight rotation on the saddle. I also have a weak shoulder which also rotates my upper body when leant over on the road bike.
At worst my knee developed bursitis which several physios and doctors couldn’t resolve. Ultimately it was a tight IT band that was being pulled all sorts of ways. The IT band wasn’t the root cause but my piriformis. 1 physio out of about 10 found the cause within 20minutes. I then had acupuncture which alleviated the bursitis within days together with a stretching regime.
I’m now with a soft tissue therapist who occasionally goes to town on any muscle connected to my hips. All other times I’m meant to do strength / stretching routines which then alleviate it. If I have any issues I can generally pin point to my psoas or piriformis

100

Thanks for that good bit of information. How were you treating the piriformis? Through soft tissue work or stretching? I have a chronically tight piriformis and can’t get it to relax even after about a year of glute medius work as well as stretching/rolling. I’ve also started releasing the psoas as well so I think that is beginning to help. Thanks!

101

I’m currently 4 weeks post-injury and 3 weeks into my PT program. I’m working with a local clinic who works with triathletes, and some national team athletes of various disciplines. I think it’s a good clinic.

I had soreness along the inner or medial edge of my left patella, but it was almost indistinguishable. I found it by accident after I was doing some mobilization work on that knee. Never had any issues with strength training or riding and made it through a season of CX with no problems. Then one day in early December I was doing a round of reverse lunges with a barbell and after my last rep I went to do my next exercise and an extremely sharp pain originated right from the patella. Going up a 5" stair hurt.

Now I’m 3 weeks into my PT program and am doing a lot of glute, hamstring, and hip strengthening to shore up the weak/injured side. There was noticeable tightness in my medial quad and it also had two really bad trigger points (which have since been resolved) and also had noticeable lateral weakness.

After 3 weeks I’ve gotten noticeably stronger, but still experience moderate discomfort when cycling, even at ~100-150w, morning walks can trigger discomfort, and doing any loaded exercises that involve knee flexion beyond 25-30º bring about pain.

I would say that in 3 weeks I’ve only gotten like 5% better. I still cannot ride my bike, run, ice skate or run pain free, and simple things like going down the stairs cannot be accomplish w/o soreness.

I’m trying to exercise a level of patience with my PT team and while I do trust them, I’m confused about what’s going on as I’m much more mobile and stronger than I was 3 weeks ago, yet the same symptoms are occurring, and simple tasks like walking can trigger discomfort.

They are confident it’s nothing more than a Patellafemoral Pain Syndrome, and not meniscus or arthritis.

102

Sounds exactly the same as me. I was exactly the same as you at 4 weeks.

2 years, 3 months later. 6 different physios, 3 orthopaedic specialists, 2 x mri, 1 x ultrasound, 3 x bike fits, 1 x hyaluronic acid injection. Hundreds of hours of all manner of exercises. Still not right.

The best guess is low level chondromalacia in my instance, hence the injection. The underlying mechanism/cause, has still not been attributed to anything. I’ve done all the quad/vmo exercises going.

I was 7 hours a week, 4.4w/kg. I recon I’ve lost around 40w due to patchy training. Crit racing career over, no longer a fast guy in my club ( I barely ride with those guys at all now).

So, not a success story by any means. If I could offer any advice (although perhaps I’m the worst person to offer it), it would be to perhaps not expect a quick fix, keep a bit of 1hr z2 consistency so you have some sort of base to bounce back from when things improve. Icing the knee has helped me.

I’m currently investigating with my physio/fitter if cleats positioned further back (not true ‘midfoot’, but with speedplay extender plate pushed back 5-10mm further back than typically furthest back position). This was after riding in trainers on £5 flat pedals from amazon, and realising the pain is massively reduced, and observing where my foot is happiest/natural. This aligns with the fact I cant leg press at the gym deeper than 90 degrees (more knee over toe) without pain.
This is almost certainly addressing a symptom, not the cause, but I don’t really care anymore. I’m also considering giving acupuncture a whirl, because, why not!

Every knee is individual. I would suggest asking for a referral from you PT to an ortho if things aren’t improving after 8-12 weeks.

Good luck, I genuinely hope you improve.

103

My clinic was founded by a Dr of Sport Medicine who was the team physician at the Olympic Training Center for the ski and snowboard teams and the team USA tri-team. He also specializes in Prolotherapy–something I’m starting to read about. I feel as though I’m at the right place, but I wanted to share my rehab process to see if anyone else would chime in.

Thanks a lot for your in depth reply. I’m trying hard to be patient with this, but as you can tell, soreness even when walking wasn’t something I thought I’d still be dealing with. I hope that you can find some help, that journey sounds really frustrating and I’m sure you’ve had to really re-calibrate your expectations.

I just did 30 min @ 0.50 IF without any pain (unless I stood up or sat up, weirdly) so that’s good. Just a hardly noticeable dull ache, so nothing major pain wise. I could have ridden for an hour.

When I connect the dots it seems like my first “symptom” was a very very slight “ache” that started about 3 weeks into my cyclocross season. This would have been back in early August. This was my first year riding single speed, and I’m wondering if the low cadences and mashing likely contributed in some improper quad engagement that kickstarted this injury. Oddly, it never progressed until after the season was finished and I started strength training. That’s all I can think of as I had 20,000 pain free miles prior to this.

104

Hi. I’ve had 13 knee surgeries including fractured tibia plateau, alc reconstruction, fractured femur (into the knee joint), total knee replacement and fabella removal. I’m 40 and have only been able to bend my knee to 85 degree since my femur fracture so I ride with custom 130mm cranks or I can’t get over the top of the pedal stroke. My situation is a bit unique due to all my surgeries but I have constant knee pain (and ankle) while riding but there isn’t much I can do about it now I just do what I can. I do find riding more regularly helps - every second day is better than twice a week. I’ve been to multiple physios but nothing helps. I take Anti inflammatories and wear a support bandage when I sleep to help reduce swelling. I hope you find something that works for you.