I got those…worked for about 6 months the first time…second time only about 3 weeks…doc said that is pretty common.
FWIW here is my YouTube playlist with most of the exercise I do: https://www.youtube.com/playlist?list=PLoVY_9j19hdpDmIQzkGGdx77IQd_Fd99c
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The core/glute excercise I started with has a unilateral glute bridge as its basis. I do not know if there is a customary english name for this excercise, but here goes.
So, say you do it with the right foot. Brace your core while squeezing the right glute to make the bridge. Simultaneously flex your left knee towards your torso a bit so that you can place your right hand on it. Now you are in the bridge with a left knee - right hand contact. Keeping the glute squeezed and core braced (avoid trunk rotation!), push the left knee with your right hand and pull the knee into the hand with the hip flexor. The push need not be too hard, just to provide resistance. This will challenge the hip flexor, the glute and the core. The idea was to hold this position and try to keep the hip fully extended the whole time.
The variation I did was one where you hold the end position for 30sec at a time. I did (and do) 5 x 30sec each leg. Progression by adding reps or placing the working foot a bit higher.
The eccentric squat with the belt I did like in the video below (though without the wedge, so on level floor): Quadriceps Eccentric Training with Russian belt on Decline Board - Slow Drop Squat - YouTube
Went down very slowly, maybe in 4-5 sec, semi-paused 1sec at the bottom, then up in 1 sec. So emphasis on the eccentric part. Typically did 3x10 or so, which usually was quite enough. Progressions by adding weight. I still sometimes use the tirante / russian belt when experiencing patellar pain, but this is luckily rare.
And as a disclaimer: remember that I was the patient being instructed, not an expert doing the instructing after making an assesment. The responsible thing to say is that it is probably a good idea to consult an expert before trying these.
I could be wrong - I haven’t read every post carefully- but was there ever a specific diagnosis here? If not, that has to be the starting point. Most of us would not accept persistent headaches and a doc saying ‘try x or y’ without an overarching explanation as to what the problem was and how x or y might help…
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When I began cycling 6 years ago after 25 years totally away sports, I had some pain on knees. My believe was that my cadence were too low on the climbs for these initial years… Finally, my cadence is much lighter, and Trainerroad helped with that too. I’m free of knee pain since then.
Also, imho I’d check cleats, saddle,…
I went through 3 years of constant knee pain. I believe if you have chronic pain over 6 months with no clear physical cause then there is probably a large mental component and you have to address that first before the PT will work. I saw a pain psychologist and did a lot of meditation, along with taking many months off the bike completely to clear my mind of the need to ride. With chronic pain your brain has sensitized that region of your body so that any weird signal from that body part will be interpreted as dangerous; you need to break that pattern before you can heal. The technique that worked most for me is called “somatic tracking”. You can heal from long term pain - don’t give up!
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I was having hamstring/knee pain and hit this dude up: https://www.instagram.com/socalbikept/?hl=en
He got me back on the bike and have been riding/training a bunch since he fixed me up last year. I had gone through a few bike fits and even went to the Dr… none of it helped until I saw him!
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Hey man, just checking in. I’ve been having knee pain myself and wanted to know if something here worked for you.
Logged in for first time just to respond.
I was a junior/Cat 2 back years (decades) ago.
After some bad early season training moves, I developed a persistent diffuse unilateral anterior knee pain. At the time this was devastating, and derailed my plans. Did PT, had a useless surgery, no dice. Bike gathered dust.
Weirdly, it just disappeared years later, for no good reason. Fast-forward to med school, decades hence, where I decided to deep dive this sort of knee pain, and found that the true reason for my pain, the one issue that had to be corrected was… unclear.
Despite hundreds of studies over years, no one seems closer to parsing out patella femoral knee pain. Don’t even know the structures causing the pain.
And ironically, as I ease into my mid 50s, my knees feel better than ever.
It’s a tough situation, I have no advice beyond being flexible in your athletic pursuits. This was unacceptable to me as a junior racer, easier in middle age.
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Current situation, still a bit bad.
I had a bike fit at probably the best fitter in uk/europe last week. They’ve done Fabian Cancellara, Tom Pidcock, Laura Trott/Kenny, Tao ,and many others. So, hopefully that element is now ruled out as a contributing factor. Interestingly, my pedalling technique on the spin scan was ‘too oval’. I was using my hip flexors way too much at the expense of my quads/glutes. (I could invite a wider discussion here if the trainerroad quadrant technique is really appropriate, but thats for another day). My old fit also had me over extending my leg and my insoles were not stabilising my feet. Whether this was the cause of knee pain, I don’t know, but it could have contributed to it. I am certainly (around 15w from a sweet spot session last week) more powerful in my new position, certainly a lot more efficient. Hard to say without doing a ramp, ftp test but its encouraging some of my lost fitness gains through to injury can ‘come back’ this way.
I am continuing physiotherapy. Focus now (the gyms have reopened in UK) is to really strengthen the quads, particularly the VMO. So lots of slow single leg press, focusing on activating vmo. I am also seeing an orthopedic consultant tomorrow, which hopefully armed with this information and previous mri results, we can get on a path to resolve it. The old mri was ‘hoffas pad impingement due to patellar maltracking’, so my understanding is that there is an imbalance in the quad. Hopefully I can address this now.
It’s bloody frustrating. October 2019 was when this has started and I am constantly striving to improve it. I’m trying not to give up. I quite enjoy being in the gym lifting, so hopefully that will help.
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Only tangentially related, but could you tell me which bike fitter is this? I’ve been keen to try one for a while now…
cyclefit, covent garden. I had Julian fit me. It is pricey, but I am a vulnerable and desperate person with regards to my knee so I’m happy to cut back on other luxuries to resolve this!
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I have knee pain above the patella quite regularly, only on the right knee though.
Whenever I take some days off cycling, no cycling at all, only doing my indoor rowing, the pain disappears.
Once I get back on the bike the pain returns.
So it seems to be connected to my bike. Rowing does not provoke this pain.
Will see a bike fitter soon.
Might try looking into the Kneesovertoesguy’s youtube channel.
Update after seeing orthopedic consultant.
Minor hoffa’s pad impingement due to patellar maltracking. He’s seen much worse of this condition, with people unable to stand etc. It is common in cyclists to have this on the medial side of the patellar. No harm/damage is being caused to the knee, so providing I can handle the pain I am ok to push through, however he cautions I might regret it if it hurts afterwards. Continue my physiotherapy as this will bring relief from pain long term. It’s a biomechanical issue.
Let’s see what happens!
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hey man, I feel you, I am at a similiar point. I’ve also must have the strongest glute medius 
what I find interesting and curious, what you said with you don’t feel that stable on one side/hip/leg than the other one. The same applies to me. On my left side, where I have the pain, I am not that stable (even though training glute med like hell) and I have the impression my femur doesnt sit very well in the hip joint.
Thats also the reason my left leg is slightly more internally rotated.
Maybe you have a same condition where the pelvis is twisted/torqued in each other. I am pretty sure thats the issue for me because I also do get saddle sore because I don’t engage 100% synchonosly with my bike.
in your last post you said you have something like hoffa fat pad → I guess each doctor and each person will give a different diagnosis like also Jonathan mentioned in his knee FAQ → so you still focus on finding the root cause and getting a diagnosis? I have the impression most PTs and youtubers will focus on a ballkpark-toolbox to get you there (mostly focusing on ancles, hips, and leg mobility+strength)
Dominique
Hi there,
Finally fixed it after 3 years.
I exhausted every avenue. 6 physios, 2 x mri, ultrasound, 2 injections, podiatry, 2 x orthopaedic consultants, an osteopath and 3 bike fits.
Everyone above scratching their heads.
Turns out it is all to do with hypersensitivity. All the hundreds of hours fretting over it, missing training, being stressed, the time and effort all built it up to a massive thing.
https://thehonestphysio.com/resources-to-download/
My physio pointed me towards this. Download the pdf. Read it. Read it again. I massively over analysed and over thought it. I ride now with no pain.
If I get a niggle, no big deal. No damage being done. It soon goes away.
If your knee pain is lingering, I massively suggest this.
Good luck!
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Hey
This document/paper is quite long but I will read it. My friend who is a shrink also suggested it one time to me that pain is very complex and you have this chronic pain cycle where it always comes back.
I will read it, thanks.
Thanks for sharing the PDF… I found the relapse section helpful.
Several years ago I was dealing with neverending knee pain - I tried everything - doctors, PT, MRI, tons of stretching/foam rolling/glute exercises etc etc. The one day I realized I couldn’t remember the last time I felt the pain! It was just gone. I think I had been training with less intensity although still doing 12-15 hour weeks - sometimes more, not often less, and still doing some very hard rides. But I was busy getting surgery (unrelated), recovering from a broken wrist, traveling, then having a baby, and wasn’t racing much so training was less intense overall. I was still riding a lot though and very competitive. I’m a cat 1-2 female racer.
Then suddenly in the past couple of weeks I’ve noticed the twinge. Yesterday I had to cut my ride short. I was devastated about it until I read the part in the PDF about the relapse strategy.
FWIW I think my relapse is due to following the trainerroad high volume sweet spot base plan. While the hours and mileage are easily within my normal volume, I think the prolonged threshold efforts were too much. That’s the only thing I’ve changed in the past few weeks - my bike fits are EXACTLY the same (I’m a stickler for this after years of knee pain), equipment the same, volume is slightly less than what I was doing over the summer. So following the relapse advice, I’m just going to take a step back and do short endurance (30 min and going up from there as long as I dont feel pain) for a few days with lots of ice, stretch, strengthen, and then try to work up to longer threshold efforts gradually.
Posting an update for anyone referencing this in the future…
Upon noticing the recurrence of my knee pain (diagnosed PFPS/chondromalacia by a sports orthopedic years ago) I immediately cut back on the volume and intensity - was doing sweet spot high volume base. Did 30 min of easy endurance, then 45 the next day, then a few days of an hour… then added a little tempo, then a short sweet spot ride etc. Have not returned to the 2 hour sweet spot rides in SSHVB yet. During these rides I stopped and foam rolled if I felt twinges.
I generally adhered to the PT principle of stretching what hurts and strengthening everything else around it, especially strengthing the opposing muscles like the hamstrings and glutes.
I did the following:
- Foam roll before and after riding and sometimes during. Progressed to flexing my knee as I foam rolled, sort of pinning the muscle on the roller and then flexing so it really stretches - lots of youtube videos on this.
- Clamshells, hip flexion while laying on back with one leg straight and the other leg bent and the straight leg rotated just lightly outward, hip abduction while laying on side, RDLs without weight, and good mornings without weight. Did good mornings and RDLs before riding to get some activation. Added resistance to these after I was able to do the movements controlled and easily. Was surprised at how terrible my clamshells and hip flexion was. Strengthening Exercises To Help Stop Kneecap Pain (Patellofemoral Pain Syndrome) - YouTube
- TAPING - this was the single biggest thing i did this time that i think made a huge difference. I did not tape during rides but sometimes had it on all day and night (eventually irritated my skin so wouldn’t do at night). This gave me a break from the pain cycle which in the past is what really did me in. I personally believe that the more you feel pain from PFPS, the worse your pain will get. The tape gives you a break from that so your nerves can stop escalating the pain response. How To Tape & Stop Kneecap Pain (Patellofemoral Pain Syndrome) - YouTube I didn’t do the first layer of tape, just a couple pieces of leukotape giong from the outside of the patella to the inside of the knee so that the tape pulls the patella inward.
- ICE after every ride and sometimes throughout the day if pain is persisting. Used it at night too the first couple of days. I did not use any medication.
I worked for a few years in a PT sports medicine clinic and also went to a PT multiple times for knee pain in the past so I know I’m doing stretches, exercises, and taping correctly. Of course would recommend going to PT if you are unfamiliar with how to do these things the right way.
I hope to do more of the longer sweet spot rides again soon but will not push through any pain.
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