Knee pain - Alternative endurance training


I have had problems with my knees (mostly the right one) for the last 4-5 months after moving from outdoor to indoor training. (The outdoors season is short because of the long winters where I live). My main events this summer are TT events ranging from 10 Km to 30 Km. Duration: 45 minutes max. I am hoping to compete in the national masters TT championship in late June.

My best guess for the main cause of the pain is numerous hard interval training in the TT-position with my saddle a bit too low and with a low cadence (60-70). I loved those sessions, but my knees apparently did not agree :slight_smile: The location of the pain is usually below the knee cap + a burning sensation/pain shifting daily between the lower left and lower right of the knee cap.

Currently I only use the trainer once a week because of the pain. The rest of the week, I do easy strength training, stability/balance and stretching as prescribed by my PT. Meanwhile my endurance fitness level is getting worse every week. I have had some progress doing the prescribed exercises for 5 weeks: A little less pain, better knee stability and better balance. Cycling still casues mild to moderate pain.

I am considering starting to do elliptical training and/or swimming to get back some level of fitness. Seems like my knees are fine with the elliptical machine - at least for short sessions. Running is out of the question. Any suggestions? What would be the most beneficial alterative endurance training to cycling/time trials while I am trying to get my knees better during the next weeks?

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I have, to a lesser degree the exact same issue. My initial thoughts, outside our your actual question, is can the seat be raised some of will that really throw off your CdA? Also can you train on a non TT bike with a better fit for your knees. Probably the closest to equivalent to fittest on your TT bike?

Also I believe sometimes some of that pain can be caused by quad tightness, do you foam roll?


Seems like a bike fit and PT sessions might be a better use of your time. Nothing will replace time on the bike for your bike fitness.


Agree - check the bike fit. Last year I made some adjustments to my setup and shortly after developed debilitating knee pain on any ride longer than an hour. Bad enough that I’d be limping and unable to take the stairs for a couple days. After that happened for the 3rd time, I scheduled a fit with a reputable fitter and the pain resolved immediately. First 4 hour ride after the fit was completely pain free. Well… in the knees at least.


@dprofis - I am currently using my road bike on the trainer, but it does not seem to help much, yet. I guess I may have ignored the pain for too long. I have tried foam rolling a bit, but will do it more in the coming weeks. I think the saddle hight on the TT bike is OK, but I have not used it since September. I did my initial indoor training with a TT tuck on a spinning bike during October-December. During that period the pain developed. I also did some short 800-1000 watt bursts at the end of the interval sessions. I guess that made it even worse :neutral_face:

@bherbers - Right now a bike fit will not be enough, but I will surely do it before i get back on the TT bike. I totally agree with your point about time on the bike, but if I go ahead and do lots of rides now I will have a hard time sleeping, even with painkillers… :slightly_smiling_face:

@perryj - I will do a bike fit, but I also need some time to recover :slight_smile:

Is this patellar tendonitis? What’s the best way to strengthen the tendon?

@perryj Do you remember the adjustment(s) that the fitter made to resolve?

I believe the main knee issues were caused by saddle being too high, and maybe a bit too far forward. Believe he brought it down 1-1.5cm, and then back a little, but there were also changes to cleat position and cockpit, so think it’s probably just the sum total.

As it turns out, I hurt my knee pretty bad during the Lost & Found 100 last weekend, and almost certain it’s because I made a last minute seatpost swap (due to slipping) and didn’t get the fit dialed correctly. After more carefully measuring after the event, sure enough, looks ilke I was at least 10mm too high and likely over-extending my leg. Lots of pain and swelling today and will be forced off the bike for a couple weeks.

So just finally ordered some fit tools so that I can at least be consistent in replicating fits when I need to. Will always take my bike to my fitter, but that’s not always possible and it hurt me pretty good this time.

Thanks for the reply and sorry to hear of the misfortune over the weekend.

I assume the pain is in the back of your knee? Know that there are lots of variables but generally from what I’ve found, pain in the front is from a saddle that is too low and too far forward. Back of knee, the opposite.

Your post is 2.5mos old now, so perhaps you have addressed the issues, but here’s a few of my suggestions that worked for me:

  1. Make the changes yourself (i.e. not your fitter). [you should keep record of your starting position if you want to go back.] Using your trainer you have the opportunity in real time to make several adjustments, including cleat position, saddle height, saddle forward/back. A few minutes on endurance/sweet spot in each position told me what felt better. After dialing this in well, I have now been able to go from 6 to 3 to 0 degree float and its been great.

  2. Ice and Advil. Per my doctor’s recommendation, I iced after every riding/exercising session to reduce any swelling - whether I felt it or not. And for a period of time when it was at its worse, I used Advil to further reduce swelling.

  3. Elliptical definitely helps. There are, of course, some bicycle specific muscles that it doesn’t work so well (e.g. quads), but it’s great for others like glutes, core and back (presuming you are doing them with arms as well). Also, a great cardio.

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