Knee pain outdoors, but fine on trainer

Hi all,

I’ve had niggling knee pain for about 18 months, seen various physios with varying degrees of success after following different exercise regimes.

I’m at the stage where I am generally ok on the trainer, with little limit to my training. However, evn short, 1hr z2 rides outside cause pain (flat or hilly). This usually requires a couple of days off to recover/ice etc.

Physiotherapy has alluded to a weak right glute being the cause, however I have now done countless clamshells, deadlifts, split squats, bridges etc to address this. This has led me to be ok on trainer now, whereas it hurt both inside and outside previously.

I do feel like I have less power/drive/stability on the right leg. This correlates with the weaker glute I beleive.

Any experience or advice with this would be well received, thank you all in advance!!

Any trigger points in the glutes? Whenever I had knee/TFL/Adductor/ pain I can always trace it back to a tightness in the glute medius/ minimus at the top of my left hip. Roll around on a hard ball for a few days and it goes…then I forget and it returns. I am amazed how much difference this makes to my cycling now but also was the case when I ran marathons. Get a hard ball or tennis ball and just roll around on your glutes looking for sore spots then sit on it for a minute or two…does wonders. In addition knee pain is often due to quad imbalance …either the VMO the inner quad is weak and the knee does not track …in which case lots of single leg squats helps - but only body weight and often with the heel raised on a book. Or the outer vastus lateralis is tight and pulling the knee out…there are often trigger points about 2 inches above the knee …for this you need to foam roll the outer quad and ITB to loosen it so it lets the knee track straight…may work …worth a try :grinning:

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Obvious omission from your post but are you using the same setup indoors and out. The same bike? Etc? I presume you are or you would have mentioned it. I found that an issue I had causing knee pain was due to the saddle misalignment. The nose was ever so slightly out of true causing my hips to swing a bit differently on each side. One knee doing a lot of compensation. Other thing is the as @jdman mentioned the good old ITB. The source of many woes. Do the ITB stretch once in a while if the foam rollering requires too much coordination to get right:

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As above ^^^ but also if the bike set up is identical are you riding the same indoors and out? Do you tend to stand up more or pedal in a higher cadence outdoors. There’s slightly more movement in all planes created outside too than a stationary trainer.

Have you had any x-rays or MRI to assess bone or soft tissue issues?

This probably isn’t the case for you, but I once had stabbing pain in my left knee when riding outside but fine inside (same bike.). Ended up going to a sports doctor and got an x-ray that showed nothing. Had an MRI that showed some fluid buildup in my knee. Then a blood test showed I had contracted Lyme Disease. I can only guess I picked up a tick during a bio stop during the winter. 2 weeks into a 4 week round of antibiotics I was back to riding like normal. Totally not what I expected the problem to be.