Unexplained knee pain on right knee cap

Hello all,

Having a bit of a problem, I have been forced off the bike with a knee pain on my right leg. The pain is on the knee cap and the left of the knee cap. It hurts on the push part of the pedal stroke and going down stairs. I have read john lees post on knee pain but I am looking for if people have experienced this pain and what length of recovery am I looking at it. The pain is about a 3/10 more of a niggle than pain. I have had this a week now.

More background. I’ve had a professional fit about 5 months ago and it changed my comfort on the bike ten fold. Not had a single issue until now. I have no idea what caused this just got on the trainers and BOOM knee pain.

Any help would be great.

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Find a good physical therapist. In my experience a PT will probably find the issue and help you get rid of it as well as prevent it in the future.

Tight muscles can cause pain in the weirdest places, I have had knee pain at the top of the knee cap because of a tight thigh. Since you asked about recovery times…took me 1-2 weeks to loosen the thigh and get clearance for getting back on the bike.

If you are not mobilizing / stretching regularly a muscular problem is even more likely, but you will have to get it checked out.


Hey there,

Did you ever resolve your knee pain? It sounds like I have something similar…


Is it literally on your kneecap? I’d been having a lot of pain underneath my kneecap to the outside of my left knee. Turned out to be a torn meniscus & moderate chondromalatia (which I’m pretty sure is another term for arthritis). I ended up having arthroscopic surgery where they took 25% of my meniscus & cleaned up as much of the shredded cartilage under my kneecap as they could. Surgery was December 22 last year & I’d been been off the bike since October. Finally getting to the point I can push hard again now. It still bothers me a bit but nowhere near the level of pain I had. I’ll have to see how it holds up as my riding time increases throughout the year.

I’m getting somewhere with it now. It’s still not 100% but with the right strength exercises and time off the bike I’m starting to see light at the end of this horrible tunnel. The key is it to really do the strength exercises but also take rest in between sessions. Returning to cycling is strange going form regular 3/4 hour rides to holding myself back to 30minutes/1 hour.

The physio told me it’s an overuse injury (PFPS/Runners knee) you need to see either a physio or Dr as soon as the pain starts, I didn’t do this and I could have been riding again by now. Unfortunately for me the NHS in England are of the stop cycling and rest brigade even if you tell them you’ve not cycled for 2 months. Private physio and after 4 weeks the progress was a relief.

Sounds like an issue I had many years ago when I was much younger. Had a really frustrating time, and no improving with rest. Did some research (much harder in those days with no meaningful internet) came up with a diagnosis and prescribed myself some basic leg extension exercises which fixed it within a few weeks. Never had the same problem since.

Hey, have you had any more joy with your knee? Mine is a nightmare now

I have a similar condition after a relatively long ride I did this weekend. It has been my longest ride this year, 6+ hours with one short break. I think my knee got too much stress, the pain or rather discomfort started about 4 hours into the ride.

On the next day I wanted to go on a small recovery ride and I had to turn around because the discomfort turned progressively into pain. The weird thing is off the bike I have zero complaints, I can’t reproduce the pain at all. But as soon as I get on my bike it starts after a couple of minutes pedaling. I had a couple of days of rest and yesterday I went on a small ride and there is no improvement or worsening. The pain actually comes from the movement and not from the force. If I ride in a very easy gear it hurts just the same. Pedaling while standing actually relieves the pain. When I stretch my leg the pain disappears. My knee is not sore off the bike, no swelling etc. Today I did an easy ride on my indoor trainer and still the same. I actually started pedaling with my upper body upright at some point, not holding the handlebars and could have rather a pain-free ride until the end. Totally strange. It seems to me that my injury may not be just related to my knee but maybe also tight hamstring, lower back etc.

I was just wondering if anyone has experienced something similar before. I read on the typical cyclist‘s knee injuries but what I read doesn’t really fit my symptoms.

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I have a very similar issue as you, and unfortunately haven’t found a real cure for it after going to 2 different physio’s.

My knee ache is on the front of the knee cap and tends to mostly show up after longer rides of 3-4+ hours. Just as you, no pain or discomfort off the bike as it usually disappears within half an hour of cycling. Standing during riding tends to relief it a little bit too.

One of the physio’s i visited suggested i wasn’t engaging my glutes enough, and the other told me it might be caused by tight hip flexors/quads. I now regularly stretch my quads and hips after each ride, do gym work mainly for glute strength and also do a quick glute engagement routine before my ride. It’s a bit of a hassle but it does seem to help at least a little bit. Unfortunately not a complete fix but i’d say its about 50% less painful as before.

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I forget which side of my knee cap I had a pain on but it was all caused by a leg length discrepancy (a left /right story). The left is longer than the right and the right seemed to have bulked up to balance that. Then or at the same time the left ITB got taught (maybe trying to pull back the balance). The tight left ITB pulled the right side patella out of alignment so it was rubbing the bone and causing agony in that knee. Apparently though imbalances/ tight muscles in your back/ buttocks can cause a similar problem.

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So I just had a similar knee pain on my L knee but more superficial medial over the knee cap. The tendon that goes from the vastus medialis oblique over the knee cap was also inflamed and felt “rope-y.” I was trying to sort it out over the last 2 months and I think I finally made some significant progress.

A little background… I noticed that the pain started when doing more mileage on my new gravel bike. Over the last 10 yrs, I’ve only ridden mtb and never had this knee pain. I tried remedying it by massage, stretching, rolling, rehab exercises (more closed loop chain), and taping. Nothing helped. I was at a loss.

While on the trainer and while doing the rehab exercises I noticed that my left leg tended to bow out at the knee. I also saw that my cleat position on my left shoe was all the way in so the foot was as close to the crank as possible. It was also rubbing on the crank it was so close. I haven’t adjusted my cleat position let alone bike fit for over 10 yrs since it’s been so dialed from that fitting.

So my thinking was that the smaller Q-factor on the gravel bike caused this since it wasn’t happening on the mtb. Ultimately, I tried putting the cleat so that the foot was farthest away from crank (therefore increasing the Q-factor). Lo and behold no more pain!

If you have superficial anterior unilateral tendon-like knee pain, give adjusting your cleat a try. I’d assume if the pain is more medial, move the foot out from the crank and vice versa.

kneesovertoesguy. a few simple exercises had my knee cap pain under control. it took about 3 months to build from pain to pain free, as part of a lifting programme.

I have the same issue with the right knee but have had it before. I can feel the Fluid build up in it. Very swollen going to physio this week and will have a week off training.