Neverending knee pain/quitting cycling

Did this resolve knee pain you had? I think I’m going to expand on the exercises my physio has given me, and start again with building up my outdoor rides.
from 45 mins easy to, ideally, 85 miles with 6 hills. That may be some time off yet.

I think I’ll start at 45 mins easy, 1 hour, 1.15, 1.30 etc progressing every Saturday until it’s 4 hours. Then 4 hours +1 hill, 4 hours + 2 hills etc…

In the week I could just do Tue and Thur intervals from whatever plan. I think 3 rides per week will allow me breathing space for progression on the Saturday ride.

The ultimate would be 3 X TR intervals in the week from a plan, chain gang Saturday, hilly ride Sunday. That was pretty much what I would be doing without the injury.

@ErickVH was thus progression similar to yours?

Sounds about right. Don’t go straight to threshold work though. Get to where you can comfortably do tempo for 30ish minutes then start threshold intervals from 5 min or so. Go slow. Make steady progress. Don’t freak your body out.

‘Don’t freak your body out’ seems like very sage advice.

Are you completely fixed now? Could you do a crit or sprint up endless short hills now? Thanks for you advice so far.

As I’ve said I still have to do strength work before and stretching after. I have little to no discomfort on the bike or afterwards at this point. I do everything from 200km/3000m days to 2 hour hammer fests. Racing is right around the corner and will be doing that as my schedule allows.

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Have you tried a mid foot cleat position. a lot of people with knee pain like this position and claim that knee pain is lessened. Another possibility is using Pedaling Innovations Catalyst. This is more for mountain biking, however I have used them on my road bike. It is a flat pedal but I had no trouble spinning with them.

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Could be quad tightness, saddle to high, or too far forward, cranks too long ect. ect. Fitters are great but they arent perfect, as you know.

Ive had good luck with advice given by Neill Stanbury. He seems to follow Steve Hoggs philosophy on fitting. Heres a pretty good video https://youtu.be/vMmbXAWcgh4 Theres more like it on Cams channel if it helps.

Also, you can get some freeware to analyze your fit at home. Helps to get in the ballpark. https://www.kinovea.org/

For me, its millimeters between anterior pain and lateral pain. Ive paid a lot of money over the years for every kind of fitting. In the end I have always had to make the final adjustments myself. Let us know what works. Hope you find a solution I know its frustrating process

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Hey dude, just a shot in a dark but have you tried changing crank arm lengths to something shorter? I know you had two bike fits but you didn’t mention if you changed crank arm lengths. Going to try this on my next fit to fix my current knee problem.

At All Levels and Categories of Cycling: Correct Poor Crank-arm Fit to Relieve Chronic Knee (and Hip) Pain | Lower Extremity Review Magazine.

What are you hoping to get out of this thread?

I had knee pain for well over a year, and mentally it almost crushed me. I also saw a number of physios, doctors etc. Like you, i did glute med exercises endlessly, and it didn’t seem to help. However, knee injuries are all different. Ultimately, the ‘fix’ for me was a cortisone injection. Never needed another one, and have been pain free ever since. I do however keep doing strength exercises. I’m surprised that the orthopedic specialist hasn’t looked at this (or surgery).

I had/have similarly issue. It’s a weird feeling in front of the knee, and was wrongly diagnosed with jumpers knee.

Went to a highly regarded knee orthopaedic doctor who has been working for the national teams in hockey here in Sweden, and pretty much found that I had patella mal-tracking due to weak VMO and too tight tendon “pulling” the patella to the outside…

Apparently they have to manuallly stretch the patella tendon at a physio and then I have to do VMO strengthening at home!

I did everything I could for the jumpers knee and it just didn’t disappear: stretch, glute work, foam rolling, it band rolling…

Good thing that it makes sense why it never went away since I got the wrong diagnosis :man_facepalming:

As other mentioned - mid foot or at least cleats to the rear.

Taking a good break from cycling to see if it resolves.

Shorter cranks?

Trying it now. Can’t say it stopped it hurting riding outside but I did prefer the feel of it regardless.

Cool, thanks. I’m seeing an ortho next week. Hopefully I can see whether it’s not just ‘anterior knee pain’

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@super7 hope, basically! Success stories from people in a similar position. My physio has floated the idea of getting a steroid injection. I think it’s worth a try at this stage, it seems a little bit like it’s not addressing the route cause, but if it’s chronic inflammation, perhaps it just needs knocking fully back. Thanks

I had a look at the doctors note just now to see exactly what he wrote, and he jotted down that it was a pretty clear case of Excessive lateral pressure syndrome ( ELPS ), and that the MRI with some white areas on the patellar tendon is easily misdiagnosed as jumpers knee if you don’t actually assess the knee properly as well, and just look at the MRI.

He also said that a week or so of Diclofenac would probably solve it, but he said that it’s important to adress the issues at its core (of course) and just not rely on NSAIDs.

If you’ve been having issues this long, you’ve definitely ‘outgrown’ physios, and need to be seeing someone more qualified, like a sports doc, OS etc. All a physio is qualified to do in your situation, is give you strength stuff which you’ve said hasn’t worked - they know nothing about steroid injections.

I had severe knee pain (ruptured VMO) in 2017-18 and again 2018-2019. Could not ride at all. The root problem was of postural origin. Cortisone did not help. Eventually strength work prescribed by the last of three different physios helped resolve the issue, but learning to feel and understand how I moved wrong in everyday situations has been just as important. Still need to be mindful.

I too did tons of glute work, which helped, but did not resolve the issue. Eccentric quad excercises (with ‘tirante musculador’ belt, or similar) were the same.

If you dont mind me asking, how is your control of the core and the si joint and have they been addressed by physios? On the bike and off? Probably they have, but i ask anyway because in my experience all the hip work had a limited impact before these parallel problems were also addressed. Key excercises for me involved core control plus hip extension on one side and flexion on the other. I still do them, as they are good beyond the immediate therapeutic use.

These days I ride pain free so there is hope, and it has been like this for more than a year, but damn it was frustrating.

Of course I also changed bike position but I think this was more to utilize better hip mobility and power on the bike after solving the main issues. My pedaling changed quite a bit, more glute these days.

Hope you get the knee sorted!

Do you have any examples of these exercises please? I might make this suggestion to my physio when I see him this week to maybe look again for broader issues. Thank you for your help