Developing knee pain

[Ranmandx]

I went on a 45k bike ride on sunday. I was just starting out and i felt really good cardio wise i was able to manage a pretty good pace and didn't feel overly fatigued. I did develop some knee pain the following day though. On my right knee it's more on the outside and affecting the tendon right behind the knee. On the left knee it now clicks a bit and is more on the inside of the knee.

I have had a Specialized BG Fit done at my LBS. I have speedplay zero pedals but they didn't really have that much experience with them since they don't sell them. They did bring the cleats in so that my foot is closer to the crank and i got the specialized s-works shoes which they loaded with 2 varus wedges in each. I am flat footed and generally over pronate, have condromalacia in the left knee. I also have a duck footed gait when i walk. I have the left pedal set up so that the release angle is a little smaller so i can make sure i get out in time i usually unclip with the left first.

I also have a trainer at home so i can try out the different adjustments and see how i feel. Anyone have any suggestions on what i can try to fix this? I already emailed my BG Fit guy but because they dont' have much experience with the speedplays i'm not sure he will know what i can do to the pedals. The shop owner did say he liked how the speedplays have fore aft and side to side adjustments but that was it. He wasn't impressed with the float.

Everything else on the bike feels pretty good it's a BMC Racemaster SLX01 i don't feel strained when riding.

 

[kdelong]

The only suggestion that I can make is to get your doctor involved, at least so that he can verify that the pain is from your cycling and not from some other condition that was previously existing and was exacerbated by your riding. He might also give you some indications of which tendons are causing your pain and have ideas as to how to position your feet to prevent irritating them again. If you are lucky, you might have a doctor who worked his way through medical school by working in a bicycle shop doing fittings, but that just may be too much to hope for.

Normally for knee pain, the first thing to look at is fit, but Specialized's BG is one of the better programs that I know of. Don't hesitate to go to another shop that is more familiar with Speed Plays if your LBS can't seem to correct your problem.

 

[vspa]

sounds like a tendonitis in the making,
+ 1 visit a physician,
sometimes your fit is correct but you can still get tendonitis for various reasons,

 

[Ranmandx]

I have had an MRI done recently just a couple weeks ago on my left knee that confirmed chondromalacia. I'll get another doctor to take a look at it and see if there is anything that I can do. Maybe I'm just not focusing on my pedal stroke and making sure my knee stays stable and doesn't move around side to side. I'm gonna ice it tonight. I have another ride coming up Thursday. I need to work on my flexibility and stretching. I can't even touch my toes I'll warm up tomorrow and do a full stretching routine. My hamstrings are particularly tight.

 

[Jim Moore]

Here is something that has really helped me. I started doing deep lunges after reading about it on the internet. Stand straight, step forward as far as you can, hold it for 10 seconds, stand back up, repeat with the other leg. I started with five lunges on each side and worked my way up to ten. It sounds a little crazy, but it was a miracle cure for me. The effect was immediate and profound. I think the theory is that it quickly exhausts the muscle group that is pulling your kneecap off center.

 

[Yojimbo_]

I had so much knee pain when I started cycling I almost had to give it up.

For me, the problem was mostly my left knee - the tendon that connects on the outside just below the joint. I went to clinics and physios but they did nothing for me - other than to encourage stretching.

It started when I bought my first road bike - I had a fit done because I didn't know anything about it - and apparently neither did the guy doing the fitting because he set my seat way too high. The combination of the high seat and overuse caused this problem and my genetics made it worse.

I eventually fixed the seat height issue but it didn't go away - it was so bad on one ride I had to ride home using only my other leg (which also hurt but not as much) and then I couldn't walk for 5 minutes when I got back to the parking lot. That was the last ride for me that year.

After considerable despair, I thought that it came down to overuse (too much too early) and my genetics. My left foot has a lot of out turn - by that I mean when I stand naturally my toes point to the left - similarly on my right leg but not as much. I also broke my leg some years ago and I think I've now got more out turn than I had originally - but they did a great job of putting it back together so I'm not complaining.

The thing that ultimately worked for me is that I moved the cleat on my shoe as much as I could to the inside - and I put a few washers on the pedal so it would stick out more from the crank. This allowed me to have more of an angle in my foot as the crank turned. I also tried to keep spinning / riding all winter (indoors) so I didn't suffer from over use injuries in the early season.

For me, this (seat height, foot angle, avoiding overuse) worked and I can ride any distance I want now (and as often as I want) with no pain. Although I still get the odd twinge every now and then.

My suggestion for you is to consider the same things I did. Good luck.

 

[An old Guy]

Originally Posted by Ranmandx .

I went on a 45k bike ride on sunday. I was just starting out and i felt really good cardio wise i was able to manage a pretty good pace and didn't feel overly fatigued. I did develop some knee pain the following day though. On my right knee it's more on the outside and affecting the tendon right behind the knee. On the left knee it now clicks a bit and is more on the inside of the knee.


---

Cardio condition has nothing to do with the condition of your knees. The important issue is if you have enough bicycling miles in. It may be that your knee is simply complaining about a new work load.

I would suggest you try an easier ride - higher cadence to reduce the load on your knees and less distance. If easier rides resolve your problem, then you can increase your ride distances and reduce your cadence as your knee fitness improves.

 

[maydog]

There is not a one size fits all solution, I suppose. I have considerable arthritis in my left knee from a grotesque knee injury over 15 years ago. I tore my MCL, ACL and sprained the other ligaments and got a significant bone bruise on the outer tibial condyle. I had the ACL reconstructed, with what I am told now, a less than ideal technique that tightened the joint. Three years ago I underwent a significant arthroscopic procedure. Lots of debridement (worn cartilage, scar tissue and bone spurs removed), partial meniscectomy, a capsular release and joint manipulation to restore some extension and to attempt to get more flexion. It was 3 hours of surgery, 4 days of a hospital stay with an epidural and 3 months of CPM during sleep (or attempts to sleep) a spring loaded brace during the day and physical therapy. It may have helped a bit, but today, starting a ride I can barely flex my leg enough to complete one revolution. Putting socks on in the morning can be a challenge.

The silver lining is that I was instructed to give up impact sports (basketball); I filled the void with getting more serious about bicycling. The condition of my knee actually responds very well to bicycling, my knee feels the best after a ride. I used to try to mash the pedals as hard as I could, but found that higher cadence lower torque pedaling was both faster and more friendly to my knee.

Anyway, tweak your setup as necessary to alleviate the pain. All of the feedback I have heard from physical therapists throughout the years is that cycling is one of the best activities for our knees. I have been told that "Motion is the lotion" and "Use it or lose it", if it is hurting you don't quit - correct what is wrong.

 

[swampy1970]

Originally Posted by Ranmandx .

I went on a 45k bike ride on sunday. I was just starting out and i felt really good cardio wise i was able to manage a pretty good pace and didn't feel overly fatigued. I did develop some knee pain the following day though. On my right knee it's more on the outside and affecting the tendon right behind the knee. On the left knee it now clicks a bit and is more on the inside of the knee.

I have had a Specialized BG Fit done at my LBS. I have speedplay zero pedals but they didn't really have that much experience with them since they don't sell them. They did bring the cleats in so that my foot is closer to the crank and i got the specialized s-works shoes which they loaded with 2 varus wedges in each. I am flat footed and generally over pronate, have condromalacia in the left knee. I also have a duck footed gait when i walk. I have the left pedal set up so that the release angle is a little smaller so i can make sure i get out in time i usually unclip with the left first.

I also have a trainer at home so i can try out the different adjustments and see how i feel. Anyone have any suggestions on what i can try to fix this? I already emailed my BG Fit guy but because they dont' have much experience with the speedplays i'm not sure he will know what i can do to the pedals. The shop owner did say he liked how the speedplays have fore aft and side to side adjustments but that was it. He wasn't impressed with the float.

Everything else on the bike feels pretty good it's a BMC Racemaster SLX01 i don't feel strained when riding.

First things first - you made a whole heap of changes so troubleshooting this lot is a bit of a nightmare. The only two things we can say with some certainty is (1) if your old position didn't hurt then you could always go back to it and (2) you'll be advised to take things easy for a week or so and ease into riding reasonably hard with so many changes. Just play it by ear. Start off with hour rides at a reasonable pace but nothing hard and take it from there.

Experience with speedplays is not required. A pedal isn't anything special - the foot is still positioned over the pedal spindle in the same way regardless of what type or brand of pedal you have.

I'd remove the shims but note what you had in each shoe. Going from a regular cycling shoe to a Specialized S-Works shoe that has varus built in then adding more varus shims is something that's going to put your foot in a positition it's not used to and will certainly introduce a new "angle of dangle" for your knee. If you also got the Specialized insole kit then that has varus designed into that as well...

Varus on a stick, with added varus with a few tubs of dipping varus to go with it. Would Sir like extra varus sprinkled on top?

The one thing that the BG Fit got completely wrong for me was the varus/valgus wedges. It felt weird after about 20 minutes on the road and I just went back and did the test they show in the insole/shim kit and ended up changing that part myself.

Ultimately the setup the BG Fit guy gave you may be the correct one for you but it's something that you're not used to yet - either remove the shims and add them one at a time every couple of weeks or leave them all in and ride easy for the next week or two until you get used to them. If you do the latter just don't force the pace.

Check your saddle height. If you can feel yourself having to "reach" or pedalling toes down then it may be a tad high.

Checking cleat position with regards to heal placement, if there's no pressure on either side of the heal or you dont feel like you're constantly trying to twist your foot on the pedal then the cleat angle is correct.

 

[Ranmandx]

I had so much knee pain when I started cycling I almost had to give it up.
For me, the problem was mostly my left knee - the tendon that connects on the outside just below the joint. I went to clinics and physios but they did nothing for me - other than to encourage stretching.
It started when I bought my first road bike - I had a fit done because I didn't know anything about it - and apparently neither did the guy doing the fitting because he set my seat way too high. The combination of the high seat and overuse caused this problem and my genetics made it worse.
I eventually fixed the seat height issue but it didn't go away - it was so bad on one ride I had to ride home using only my other leg (which also hurt but not as much) and then I couldn't walk for 5 minutes when I got back to the parking lot. That was the last ride for me that year.
After considerable despair, I thought that it came down to overuse (too much too early) and my genetics. My left foot has a lot of out turn - by that I mean when I stand naturally my toes point to the left - similarly on my right leg but not as much. I also broke my leg some years ago and I think I've now got more out turn than I had originally - but they did a great job of putting it back together so I'm not complaining.
The thing that ultimately worked for me is that I moved the cleat on my shoe as much as I could to the inside - and I put a few washers on the pedal so it would stick out more from the crank. This allowed me to have more of an angle in my foot as the crank turned. I also tried to keep spinning / riding all winter (indoors) so I didn't suffer from over use injuries in the early season.
For me, this (seat height, foot angle, avoiding overuse) worked and I can ride any distance I want now (and as often as I want) with no pain. Although I still get the odd twinge every now and then.
My suggestion for you is to consider the same things I did. Good luck.

Sounds almost exactly like my problem on the right knee. The left knee is just a **** shoot. Crepitus with chondromalacia already. I'm gonna see what I can do.

 

[Ranmandx]

Thanks for the suggestions and the encouragement to not give up. I always feel that with my right leg I am trying to twist my heel all the time. I will also move the cleats away from the crank and loosen the float a bit more. And take out the wedges and see how it goes. I'll also set up a mirror in front of the trainer to see how my knees are tracking. And I'll just state I never really rode before this is my first road bike my first adventure with clipless pedals and the first few times I ride anywhere near this distance. I used to have a mountain bike chromoly frame with front shocks and a hard tail from when I was really young. Other than that all of this is new to me.