Physios of TR, Can't ride for more than 30 mins. Pain behind the knee/upper calf

Having some really annoying pain behind one knee/top of calf.

came back off a long off season, various illnesses and injuries extended it.

came back reasonably hard? not too bad, but like 8hrs a week. Pain started after a faster group ride, almost felt like my bibs had bunched up behind my knee. pain has been consistent since, about 30mins into the ride the pain comes, can sometimes avoid it hurting by consciously not using trhe muscles in the back of my leg, but its not ideal. pain definitely more noticable up climbs.

had pretty much the same bikefit for 2 yrs, although having a new bike this season. have tried lowering the seat, and checking it against my measurements, but theyre consistent. feels like it could be a calf strain or something. ranges from right behind the knee in the soft centre to about 2 inches lower.

have rested and taken a week or so off, but 30 mins into the ride, the pain came back.

will book to see a physio, but thats not for at least a week or 2, and its already been going on couple weeks.

I have had a similar issue for a couple of years now. I haven’t been cycling consistently during that time, but every time I do it comes back just as you described - often after around 30 mins, usually when climbing. I too have played with with focusing on different muscles during the pedal stroke, sometimes I think that helps, but it doesn’t make the issue disappear.

I did go to a physio when the issue first arose. After some prodding around we seemed to think it was not so much the knee but the very top of the one of the calf muscles. I had the usual prescription of stretching and strengthening, but as I wasn’t consistent with my cycling I also wasn’t consistent with possible treatment.

Since initially getting that pain I have been doing a lot of running, very consistently. Weirdly (or maybe not?) I have never felt this pain while running - so it is something specific to cycling, and in just one leg (my right, dominant one).

Just this week I decided to start back with TR, and was thinking about this problem, and I did come up with a possible cause… I cross my legs when sitting very often… and I just noticed that the top of my right (problem) calf sits and compresses on the hard outside part of my left knee. I have no idea if this was the cause, or an aggravating factor, but I decided to try and stop crossing my legs and see. It is not exactly the best thing for your legs anyway, and if it clears up the problem then fantastic. It was crazy I never noticed my leg crossing at that particular point! So we will see, and I would be interested to read anyone else’s input on this.

Could be trigger points in the lateral head of the gastrocnemius which ae very common about 2 inches below the knee - although they are often running related. Or of course the muscle behind the knee is the popliteus muscle which is small - usually hurts if your hamstrings are tight - if its the former area try foam rolling or massage balls - if the latter er…don’t it’s v sensitive there - hamstring stretches could help and lots of them as the muscle itself is virtually impossible to stretch.

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I had this problem for years. For me, the problem was a tilted pelvis. Because my pelvis was higher on one side, the distance to the pedal was farther, and I had effectively too high of a saddle. This resulted in the classic saddle too high, pain behind the knee symptom. It seems straightforward when you type it out, but it wasn’t obvious to me at the time because I had already lowered the saddle and it was already too low for my other leg.

In my particular case, the cause of the tilted pelvis was a functional imbalance in my muscles due to leaning on my left elbow when I sit and work at a computer. The result is:

  • tight left hip flexors + quads => anterior pelvic tilt on the left side.
  • tight right QL => Pelvis pulled up on the right side.
  • tight left traps and rhomboid => upper body rotated while sitting on bike.

No amount of stretching or exercise helped without first releasing said muscles with trigger point massage or foam rolling. In fact, without releasing the muscles, many of the stretches and exercises exacerbated the problem. I recommend finding a professional with an expertise in cycling for help. It took me close to ten years, over half a dozen doctors and countless physios before I found someone who was actually able to help.