Knee pain / bike fit

Training
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I have mild knee discomfort presently, basically, my right knee feels like it wants to pop, then after a few miles, it does. When climbing the stairs, my right knee clicks a bit. It doesn’t hurt, but it is a bit unsettling. My right hip also clicks when squatting whereas my left does not, sometimes it seems as if after my 2nd set of squats, it stops even if I go as deep.

I recently (about a month ago), moved my saddle back 1cm and prior to that raised it up about 4mm. The reasoning for that was a few things - I felt like I have been swinging my right knee out when pedaling and originally had my saddle about 2cm higher before seeing a fitter. When my saddle was up 2cm from where it is today, my left leg used to swing out. I still have sit bone discomfort which is part of the reason I hop around in the saddle, the other is that when I am sitting where I think I should, my body feels awkward, like it doesn’t want to be there. My body tends to favor one side. I feel like I tend to experience saddle discomfort for the first 45 minutes of the ride and after that, perhaps my body relaxes and I tend to hop around less.

I have focused on spinning rather than grinding through too hard of a gear and routine stretching after every ride longer than 30 minutes or with a higher intensity.

I do basic strength training off the bike using body weight focusing on the arms and legs with some core:

pushups / bent over row / dips / plank / side plank / russian twist / superman

lunges / split squat / wall sit / ball roll out / bridge / V-up

I also do some mobility exercises to improve mobility in the toes, ankles, knees and hips:

reverse lunges / bear crawl / walk on toes with toes pointed in / monster walk / hip hinge / step down

The mobility exercises were originally for my knee pain when climbing the stairs (my motivator for seeing a PT 6 months ago) and big toe arthritis.

That said, I’ve come across this:

and, that post seems to lead me back to PT. I’ve stopped seeing my PT as it is a huge time commitment (at least 1hr there, plus 30m commute round trip) and I can do most of the exercises at home.

So, it seems from the link above that there are likely other muscles that are tight that I’m not stretching as well as building the proper coordination or strength.

In summary, I will incorporate those PT exercises into my routine, but I appreciate any other feedback regarding bike setup or PT. How often do you incorporate PT into your wellness plan and once it gets better, do you ease out of it or do you continue as preventative medicine?

Thanks,

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I’ve had two very high end fits, previous bike and current. Current bike is titanium custom built to my geometry per a fit.

While I generally like my fit, I do often get a very mild clicking/crunching in my left knee when pedaling. Very little to no discomfort most the time but doesn’t seem right.

I decided to move my cleat in that foot back like 1/16-3/32” and it minimized those symptoms by like 80-90%. I know this doesn’t totally answer your question, but something for people reading this with knee issues to consider. Slightest adjustment made a huge difference.

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Agreed on the slightest adjustment making a huge impact.

What is your opinion then on experimenting with adjustments, do you do small adjustments frequently or try to adjust and then test it out for a length of time?

I think I’m leaning toward being a bit more fluid now since I’m obviously still not ‘locked’ or ‘dialed’ in. I have my cleats quite a ways back near the opposite end of the spectrum to where they were when I first got cycling shoes and had the cleats essentially on my toes. That said, I don’t plan on moving my cleats, but am thinking about moving my handlebars up which will also bring them closer to me. My most recent fit (from last year) dropped both the saddle (2cm) and handlebars (1cm).

But in regards to knee pain, it was my thought up until recently that the knee ought to be over the pedal spindle to minimize the stress on the knee joint. But, I think that is also rather an overly simplistic idea because the knee is more complicated and the strength training I do (yoga ball roll) is essentially like pedaling, but with the pedals far in front of you like having your knee well behind the pedal spindle.

Thanks again for your thoughts.

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The saddle too high is classic to having caused you a problem in the first place. Were you comfortable with your fitters adjustments, if so go back to that, move the saddle forward 1cm and drop it 4mm. If you’re concerned about your leg swinging out consult another fitter, rather than tinkering too much yourself.

Also maybe not the issue in your case but for me about 13 years ago, I had a leg length discrepancy identified by a fit which lowered my saddle too. Touchwood the clickey hip I had beforehand vanished and I’ve not had a knee problem since.

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If I make adjustments it’s one thing at a time and I mark/measure where it was before so I can always go back. Also, small adjustments impact other things, which is why I wouldn’t do too many at a time. There’s pretty much a general “range” for everyone on different fit metrics, but definitely some room to play in those ranges before finding what is just right.

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I had 5 days or so left in my tour and I think the foot pain immediately went away (the outside of my right foot always hurt (where the bony protrusion is), but the saddle discomfort was seemingly still there. It always seemed like it came and went in waves. The fitter showed me my old saddle was worn out (bending with little effort), so I replaced it with a relatively stiff Giant Particle Flow saddle. It seemed better and then once I got back, after 2 weeks, it really felt like my sit bones were bruising. I really struggled to find a place in the saddle and would stand up to take some pressure off. Fast forward a month or so later and I ended up replacing that for an Ergon Road saddle which is better, but still can be uncomfortable.

It felt nice from the standpoint that I was doing much less of a leg press and more driving my legs around in a circular motion.

Yes, I have a dynamic leg length discrepancy too. My left knee is always in front of my right, at least it looks that way visibly when I look down.

I have also made a conscious effort to not let my legs swing too far out as I have a frame bag I ride with all the time and prior to having a gravel bike, I only ever had water bottles in my frame. I always used to pedal with my knees nearly brushing the frame as I pedaled.

I’ll have to ask my local bike shop - I haven’t been 100% happy and was hoping I could educate myself to a better solution.

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I cant help with the solution, but I have a similar set of popping feelings (except mine never pops) and ontop, mild to middling pain in the right knee, central to front, especially at low RPM & high power. Also hurts when you prod it hard with your finger etc

Initial Physio reckoned Meniscus damage but then my bike fitter, who was also a highly rated physio shot that down as bollocks.

Further investigation led me to my workplace physio who suggested it could be Patella Tendinitis and after doing a bit research, it does found familiar.

I have a meeting tonight with a Knee consultant who charges are eye watering £220 for a 10 minute appointment, so I am hoping to get some answers or atleast some scans lol.

If its anything to do with the tendons (me & you) then eccentric exercises are apparently the way to go.

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I experienced something similar, and still do sometimes.

I have found the problem usually lies in my hips. like a hip inpingement.

Work on strengthening your glutes, and opening your hips prior to riding and lifting. Think banded clams, Hip stretches, 90/90s with leg lifts, Hip airplanes. Look at Squat university’s stuff. Work on internal rotation. I would pair this up with working on unilateral stuff in the gym so the dominant side doesn’t do all the work.

regarding bike fit, if it feels like your knees can’t come in to meet the pedal, try pushing your cleats inwards to meet the knee.

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I’d probably suggest trying to get a medical diagnosis of the problem before doing too much to fix it.

Unfortunately there are a few conditions that could cause those symptoms and I’d be dubious of anyone who claimed to make a definitive diagnosis without a scan.

For what its worth my meniscus tear felt like the descriptions in this thread…

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for what its worth, i was diagnosed with a meniscus tear.

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Yes, all good points. Perhaps I should consult a professional and since I’m obviously not happy with my current PT and there are a bunch nearby, I try another one or see a sports doctor.

Addressing the earlier posts - I have my cleats inward as much as possible so that would effectively move my feet further apart.

I think stretching before I ride is worth noting - I have thought I probably should, I’ve done it before other sports AND it seems that after about 45 minutes of riding that something loosens up to where I feel more comfortable in the saddle. I’ve never bothered stretching before riding as I try to ease into it.

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Focus on doing activations before your ride. Wake up your stabilising muscles. it makes the world of difference.

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I have had three professional fits over the years. The last one was the real deal and was a game changer for me. So much so I am contemplating ditching my #1 bike because after two years of FAFO it can’t get the necessary reach set. (15 mm short due to a proprietary seatpost, no zero-set back option available the lowest is, tadah; 15mm) But even he missed a trick on my cleat settings (keo’s usually reds but often greys); He did apply a wedge on the left to correct a lenght issue. He did change the relative fore and aft placement of the two (left is further ahead), but he centered the nose for straight tracking and a medium q-factor. This evetually caused an ache in my left knee. My solution has been to reduce the q-factor and go to a slight nose in on the cleat (toe out on the foot). This sorted it.

+1 on the activation suggestion: ITB stretches and hip flexors.

YMMV

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Agree on the activations. The OP could be my long-lost twin, in many respects from their story (masher, foot pains, have to keep my knee in to avoid knee pain, same seat issues, etc.), except I lowered the seat on my mtb in the spring, to see if that would help me to comfortably increase my cadence (I’ve been a toe pointing masher forever, and I am comfortable in low/mid 80s rpms on my recumbent/upright stationary bike, but sustaining over mid 70s on my mtb outside just doesn’t happen…I always migrate back to higher gear and lower cadence, so thought maybe it’s that extra bit of stretch). So, as to the knee issue, I lowered my mtb seat .5 cm, and did a VO2 intervals session (pretty much only do z2 and VO2 inside), and the next week lowered it another .5 cm and did another VO2 session, and at the end of that week, at the end of a regular 2hr outside ride, I smashed a previous PR on a 3 mile segment by 1 mph. Then, the knee pain started, feels like tendonitis on kneecap and just below/inside and outside from kneecap. Of course, I immediately moved my seat back, and most of the pain is on the stationary bike in z2 (that I never moved the seat), but get twinges of the pain when putting down lots of power on the mtb (it’s weird, and doesn’t make any sense to me).

So, after 4 or 5 months of this (I know, it takes a long time with tendon issues), I figured out that doing wall sits, and particularly right before getting on the bike, has made a huge amount of difference. Also, before I started the wall sits, I figured out, when the knee pain would start after warmup, I could stop pedaling and massage the muscle attached to the specific tendon for a minute, and that would temporarily stop the burning, and further trials have shown that using my massage gun makes a huge difference after rides and any time I’m feeling that tightness and the burn around my knee.

For my low back and hip flexor issues (that whole chain from knees to low back), activating the glutes before riding has made a huge difference. Maybe this will help in some way. I’ve been doing some threshold work lately, and am about to try to start some VO2 work again, so hopefully I can be ready for my Thanksgiving mountain trip.

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Cool, this sounds good.

I will incorporate this before I get on the bike:

banded glute bridge

monster walks / lateral band walks

low lunge with twist / runners lunge and reaching toward sky

supine heel tap

dynamic leg swings

As with doctors, I will target the low-hanging fruit first. This is something I’ve heard many times before, there doesn’t seem to be any harm in stretching or activating muscles prior to a ride other than it will delay me 10 minutes, but I am investing in my future self and that person will surely thank me many times over.

Regarding the q-factor, good points, when I first got my clipless shoes, I had them adjusted for as narrow as possible thinking I would minimize the ‘torque’ on the pedals themselves and thus save a little bit in terms of efficiency. I moved them further in to give myself more spacing about 5 years back when I got a gravel bike …

My previous bikes were endurance bikes and while I never felt perfect there, I didn’t have the painful bruising feeling in the saddle. Interestingly enough though, those bikes then were setup slightly differently and I almost wonder if that may have helped somewhat in putting me in a different enough position to minimize repetitive strain in a single area.

That sounds good, enjoy the trip. For me, it took 2 weeks of various PT exercises to stop the initial knee pain when climbing the stairs. I will try these activations and see how that goes.

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pics?

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not sure this is gonna help you or not but I had very bad knee pain. got a few good fits.

i did every exercise under the sun for knees…targeted different muscles. tbh I am not even really sure which one helped the most. I just did them all.

I used a knee sleeve (not brace) to keep my knee warm and i just kept trying to move in pain free ranges. just keep teaching your body “this doesn’t hurt…this doesn’t hurt”. I was eventually able to do the exercises without a sleeve.

i think pushing through knee pain is a mistake because you just keep firing up the pain signal and then your body remembers it more. so just regress exercises until there is zero pain and slowly ramp up. you got a good list above…just keep targeting different muscles in different angles: walk sideways, walk uphill backwards, tibialis raises.

good luck!

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feel free to Pm any ?’s so the thread isn’t derailed too far off the tracks

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BEAUTIFUL!!! i feel like every thread has room for custom bike pics.

to OP: I forgot to mention another thing that I think helped me a lot was hamstring flexibility and hip mobility (especially internal and external rotation)

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I restored my saddle to the position of my last bike fit. I have only gone on a short ride since then, about 3 mi round trip. The only thing I can say is that I’m not stretched or pushed, I feel like the bike is surrounding me if that makes sense.

Hmm, I suppose my body just wants to be in a different position.

I still have the knee discomfort when climbing the stairs (not painful, but also not ideal), but otherwise, the knees feel fine biking thus far.

I see a PT to get some ideas as to what is going on.

In the meantime, I will keep the saddle where it is.