I’ve dealt with chronic knee issues and what feels like a torque thru my hips. You will tell from video that my left hips is rotated downward in comparison to the right hip (this is pedaling easy). It is difficult to push hard (muscle recruitment is compromised) since my hips usually start twisting more with increases in wattage. I’ve been to PT’s, chiro’s, massage therapists, bike fitter, etc… but nothing has helped. Does anyone have any helpful insights or thoughts?
@Jagielag first I highly recommend you read the thread on how @Jonathan dealt with his knee issues. Most of what he recommends have been good for me.
Second, I have a similar issue whereby knee instability / pain / weakness manifests in hip asymmetry / imbalance. I’m still battling through it but here’s a bit of my story.
I ride almost exclusively indoors and use a homemade rocker plate. I neglected to change / rotate the springs regularly and didn’t notice that the left side started to compress such that I was riding with the bike at a slight angle (on average). Over time this manifested in pain in the outside of my left knee and right hip / gluteus medius muscle. At its worst I had a noticeable curvature to my spine when standing upright because of the twist in my hips. This also presented while on the bike and was noticed by my bike fitter.
First remedy was to replace the rocker plate springs and rotate / change them regularly. I’ve set a monthly email / calendar reminder, and have become much more conscious of the uprightness while riding indoors. I’m fortunate enough to have power meter pedals and monitor my left / right balance after every ride. I’m usually 52% / 48% split right / left but notice it getting worse when fatigued.
As mentioned above I also got a bike fit. Part of the problem at the time was my bike was one size too big. We did some unnatural acts to get it to work but I eventually got a properly sized bike. Using the previous bike fit as well as an independent assessment using the Retul system, I used MyVeloFit (great thread here) to dial in my fit.
Next (and ongoing) focus was to strengthen my left leg through single leg exercises. This was easier during the offseason when the focus was on lifting and I need to get back to it. I also incorporated hip and glute exercises (e.g. banded monster walks, etc) into my gym routines.
The glute med pain is actually due to fatigue and overuse as it compensates for the left knee pain and weakness. Before each ride I warm up with single leg raises while on my back and side, and use a lacrosse ball to release the glute med - just put it against a wall and really lean into it. It can be painful but feels oh so good when done.
Hope this helps a little. Happy to answer any questions you may have.
My right hip is rotated outwards due to an injury. This caused knee pain and some serious crank arm polishing by my right heel. My fix was to use a longer spindle on the right pedal. This allowed me to angle my foot; toe out, heel in, without hitting the crank arm. Heel lifts were required in the left shoe to compensate for the slight difference in leg to pedal length.
Not sure this will help a dropped hip.
Have you had any sort of imaging completed? As in, do you know what’s truly causing your issues or are you utilizing PTs and fitters to diagnose and treat without confirming the true cause?
If you’ve not done imaging, I’d find a way to get an X-ray for leg length. Then, if they’re fine I’d see if you can obtain an mri which would provide better clarity to see if it’s something functional or anatomical.
Personally, I’ve wasted a good 23 years with an issue that manifests in right IT band tightness on the right side and low back pain and lack of mobility on the left. This got progressively worse. I worked with multiple PTs, massage therapists, chiros, “expert” bike fitters, and coaches. Essentially all it did was ingrain poor movement patterns. Finally, I booked an appt with a neurosurgeon who performed an X-ray noting no leg length imbalance - although I probably made the problem worse over years by shimming as I’ve definitely got a functional issue due to the pelvic torsion.
What did the MRI show? Stenosis at l4/l5 and l5/s1. Since finding that out the rehabilitation has been much more appropriate/specific and i feel quite a bit better on the bike.
Also, it looks like you’re on a TT bike. I came/come from triathlon and used to put in 12-15 hours/wk on the TT bike. Reason for calling this out is TT bikes are known to be more difficult from a comfort standpoint than a road bike, even for folks without pelvic torsion. I do 90% of my time on the road bike now and feel quite a bit better from that too.
Either way, ensure you exhaust all possibilities before doing any shimming or taking generic advice on the internet. You could shim your way to a 50/50 power balance (I sure did), but i shimmed myself to an even bigger twist from it as well.
My three resource recommendations are: Coach Eric Wong at precision movement, Steve Hogg’s website (and if you’re in CO go see Colby or if I’m TX his guy there), lastly google LEeft AF IR and PRI trainer and follow the leads on hip stuff. Coach E’s precision movement Hip module has made me so much more mobile and ended my left adductor cramping
Incorrect saddle height (most likely too high but could be too low too), tilted saddle (place a board and a bubble level app, calibrate on the floor first)
Thanks everyone for the advice and suggested next steps / resources. I really appreciate you all taking the time to reply!! I have actually been to see Jay Dicharry (Same guy @Jonathan went to) in Oregon but without consistent appointments and modifications to the plan (live in MN) it didn’t offer any relief. I’ve had MRI and x-ray images on the hip and knee. Had FAI surgery about 7 yrs ago but doesn’t feel any worse or better after the surgery. Same twisted feel thru hips/lower body. No structural leg discrepancy but could be functional.
I’ve got a very similar issue. My left pelvis is anteriorly rotated on the bike. This year I’ve developed chrondromalacia in both knees, presumably because my knees cannot track properly when my pelvis is shifted.
I’ve done years of bike fits, PT and now have to spend the spring and summer off of the bike due to the knees. Leg length XR, MRIs, etc, etc, etc.
@zakihoover mentioned it above. Google “left AIC pattern,” coined by PRI. That may or may not be you. But I found a local PRI trained physio and he thinks he can straighten me out. I’d recommend the same for you. You want someone trained in this stuff to evaluate you, rather than diagnosing yourself. I’m not a huge fan of the Youtube world or Steve Hogg’s website for that reason. Hogg is obviously a maverick, but his “90% of cyclists drop their right hip” does not apply to me.
I have actually been to see Jay Dicharry (Same guy