Pain in right knee, what is going on? Pictures attached 📸

Hi there! :slight_smile:

In July & August of 2023 I did a lot of fast group rides and interval running up/down hills. After one particular trial run I started having pain in my knees when walking down stairs. I could ride but running hurt too much. It stayed like this for months. I saw a physical therapist who told me I need to get stronger so I have been doing full body strength workouts during the winter (and XC skiing as I live in Norway). For a while the pain went away but now it’s back after being back on the bike for 6 weeks.

Right now it’s a bit of a niggle under the knee cap on both sides but it’s getting gradually worse. I worry that if I continue it will mess up my season. I haven’t found any cycling specific physical therapists in Oslo, Norway to go to so I figured I would ask here.

Any ideas as to what it might be and what to do? Thanks so much for any feedback!

Edit: I’m 36. 190 cm, 88 kg with 350 w ftp. Been riding for 10 years (never had problems until last year)

Get stronger is the right advice. I’d add in stretching and a foam roller.

This screams if IT band tightness.

Also. Before someone else suggests it - shave em.

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Agree :point_up:. For me, it was tight IT band and quads. If I foam roll every night, my issues go away. Took about a week or two to finally see some results.

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IT band would be lateral.

If it got worse with running downhill, that strongly suggests a meniscus injury/irritation

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I agree with getting stronger but some things are biomechanical too (for me it was one leg is a few mm longer than the other, solved with a shim) and saddle height can help a lot too. If there’s core issues getting stronger may not solve things, mask them at best or perhaps lead to deterioration but certain things getting stronger can solve them completely too and is the best solution A qualified physio should know what’s best for you.

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Agree with above. Also suggest you check your cleat position and make sure you aren’t up against the float limit when you pedal. Also check anything else that might have changed last August since you seem to have ridden fine for 10 years beforehand.

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See a bike fitter that also has Kinesiology experience.
Also an orthopedic doctor might help with an X-ray/mri.

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Nooooooo

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Thanks for the feedback everyone! :pray:

Will for sure start foam rolling and stretching. Will also check my cleats to make sure I am not at my float limit (I have always used Shimano blue 2-degree cleats but I did get new shoes last year so worth checking out).

How would you think about continued training? I don’t want to lose my fitness but I also don’t want to get seriously injured :upside_down_face:

Knee pain is notoriously tricky to diagnose in person without imaging, much less over the internet with (and I mean this kindly) quite a vague description and hx.

That this is bilateral and seems to have had a relatively insidious onset points to overuse rather than acute injury, but that’s based on a lot of assumptions. PFPS would be my guess, but it’s just that - a guess.

I would strongly advise seeing a physio with experience in dealing with athletes (they don’t have to be a cycling specialist, just someone used to dealing with highly active individuals) and depending on their findings, potentially proceed with imaging.

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FWIW, my chiropractor was the only one who correctly diagnosed my knee pain last year as a bursitis (to his credit, he’s a sports-focused chiropractor). I found that kinesio tape helped relieve the pain a lot. I also used a cane for a couple of weeks while walking. Happily, I had very little to no knee pain on the bike but kept it mostly Z2 while recovering.

Between last year and now, I have focused on “getting stronger” and have a few compression knee sleeves that I use occasionally. Admittedly, using them might be more mental than physical, but whatever.

I received advice from everyone, including some doctors, ranging from IT band issues to “stop running” to “stop cycling.” I spent a lot of time with the crew at SoCal Bike PT for specific exercises.

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Thank you so much! I will try to find another physio :pray:

I think id actually cry, if my FTP was 350 and someone told me I need to get stronger :laughing:

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You can continue any activity that doesn’t cause pain while doing it. Clearly, don’t pedal through pain. Foam rolling and stretching is best immediately following your cycling.

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