The joys of my knee pain

Knee pain, the gift that keeps on giving. I’m a 46-year-old type one diabetic and I have been riding bicycles for approximately 20 years now. Approximately a year ago early on a September morning in my pain cave my quads started throbbing in the middle of a trainer road workout. My throbbing quads shined a very bright light on the knee pain that I have been fighting off and on for the past year. In all honesty I probably had knee pain creeping into my life before that specific event but my aching VMO’s which radiated down into my medial knee was the issue that told me to step off the bike for a while.
I gave up riding for a few months and sought assistance and from medical professionals and anyone else who would give me the time. I have since collected quite the arsenal of stretches, strength exercises, mobility practices…… I have diligently worked on my knee issue the entire time. I have had a brief periods where I felt 100% and then periods when I have considered just giving up cycling.
So here we are, my knees still hurt on occasion. I have seen physical therapist, chiropractors, and physical trainers and so on. I am now concerned that I might be slowly inflicting long term knee damage. I’m not sure if anticipating the end of knee pain is a valid expectation. I often wonder if I have done too much stretching and strength training, have I ever truly let it heal and recover? I’m am thinking about taking a break from all of it until the new year. No more bike riding and a lot less stretching and mobility work. Any input would be greatly appreciated.

Here is the super thread on the topic:

And here is a search on “knee pain” in our main Training category:

How much hamstring strengthening work do you do? Have you ever had an MRI scan?

I can’t say my experience can inform what you have going on, but here it is.

Long history of iliotibial band (ITB) irritation in left leg. Same in right leg except not nearly as severe. Worked with physical therapists, learned and did all recommended stretch routines, etc. I could get by but would ice both knees post ride. As age advanced (now in my 79th year) there was gradual onset of severe knee pain outside of left kneecap. Finally got the point where it just wasn’t worth it any longer.

I got a bike fit from a fitter respected by local racers, triathlon competitors. He made one change. He added 40mm pedal extenders to widen my Q factor. Upon testing that change, I knew immediately he had hit on something. I’m in a medical system that gives me access to Dr. Max Testa. He told me my issue was unrelated to knees, but rather was a shutdown of the VMO (vastus medialus) muscle on both legs, with left leg being the most advanced. That muscle imbalance resulted in misalignment of the kneecap on both legs, again with the left side being worse. A PT regimen woke the VMO’s again and the newly widened Q factor also woke up some muscles in the medial aspect of the quad that had never been employed. It took a week or so to get used to the wider Q factor, especially when under load, but the pain has never resurfaced. All ITB symptoms have disappeared as well.

I know nothing of anatomy, pedaling mechanics, etc., but I believe the issue would never have come up if I’d had the wider Q factor from the beginning. It’s very cool to end a ride based on expenditure of energy rather than ending it due to pain. Live and learn.


A lot of my strength work is focused on glutes, abductors, adductors, and hips. I also do a lot of squats and lunges with very little weight. No I don’t think I really focus on hamstrings specifically.

Nordics help a lot of people with knee pain.

This guy My Story: From Knee Surgeries to Bulletproof Knees - YouTube is also worth checking out. Yes, he’s selling paid programs, but they are worth it IMO. I followed one for about 10 weeks after having about a year of intermittent knee pain and it improved it by c.90%. That improvement has lasted.

I do have a fit scheduled with a highly recommended fitter next week. I am truly surprised by the fact that my knee pain basically just showed up one day and now it’s really hard to put a finger on how to fix the issue. I know the many medical professionals that I have seen know what they are talking about but I am not finding consistent relief. I finally was able to purchase a really nice bike and I don’t want to give up cycling so hopefully I’ll be riding well into my 60s or even 70s.

Get bike fit.
Had knee pain–adjusted seat and pain disappeared.
Have IT band pain–worked on leg form–one side less stable weaker due to previous injury that gets worse on longer rides–got blue cleats and help stablize weaker leg enough to keep IT band pain at bay.
Unless you have bone on bone knee damage, muscle balance correction/stengthening, bike fit can go a long way.

My story is pretty much what @classof42 posted. Wish I knew back about 25 years ago what I know now. I’m 63 and (supposedly) long overdue for knee replacement on my left knee and maybe even my right knee. I’ve had lateral release arthroscopic surgery on both knees to help with the IT band tightness and get the patella tracking correctly. That was also about 25 years ago. I’ve done a lot of work over the years to get and keep the VMO strong.

I don’t ice anymore - it just aggravated my knees more than helped. I still foam roll and stretch every part of my body 5-6 days a week. When the pain is too much, I pop a couple of Aleve pills and that helps a lot. Since I’ve added a collagen supplement to my morning coffee, I’ve noticed that I don’t need the pain pills as much. Took a couple of months, but seems to have helped these days.

I should have clarified in my account that I didn’t start riding with any sort of demand on my body until 2014. If I had ridden as much as you, I likely wouldn’t have made it that far. The ITB demons rose up almost right away. There’s lots of advice around regarding what to do about ITB syndrome, but ultimately I think there will be a slightly unique solution to each unique case. It took me about three years to run down my solution. I’ll never forget the day my fitter asked me to climb on the bike to test the pedal extenders. It was a whole new lease on life.

Thank you everyone for all the stories and advice. I am definitely getting a high quality Bike Fit next week. One thing that I am going to have to accept is the fact that relief is a very long-term investment. Knee pain completely disappearing forever from my life is not probable. It takes work to maintain being pain-free. I don’t really know how to carve out the time to do PT and a training program on the bike. I guess the first step is getting my knee issues figured out. I may use a paid program on the Internet instead of going to a local physical therapist, again. It’s really hard to find a practitioner that is willing to dig into the cycling side of things.

Definitely have a look at collagen supplementation. I had knee myositis and collagen was my saviour. I use this collagen Glow Marine Collagen - Glow Proteins that is proven to help with joint pain. They also have some kind of hot chocolate for pain management but ive never tried it.

Agree with collagen. I twsited me knee in Feb and couldn’t make 1 pedal stroke, or even walk, without knee pain.

6 weeks of stretching, taking collegen and very slowly increasing time first and then inestify and I’m fully recovered. In total it took 8 weeks (I’m 50yrs old)

Not sure it was just the collegen, but I reocvered much quicker than epxected.

ryanbrannon, while noone can diagnose your knee pain over the internet, have you looked into whether or not you need shims under your cleats? If your knee does not move vertically during the stroke, you are bound to load it asymmetrically on the inside or on the outside. I experienced knee pain during skiing (and I went and learned how to make footbeds and got training in ski alignment) - and it was gone forever. I had knee pain while biking, I already knew from skiing what is the likely cause, so I got online certification from BikeFit, learned how to do cycling alignment, installed shims, and pain is gone. If this whole thing is new to you, perhaps it is something for you to consider? Bike Fitters usually do these cleats adjustments, or at least, are supposed to.