Inertianinja

I have never had a pro fit, but I am going to have one this week. Until then, I'm wondering if anyone can offer any insight.

I'm currently nursing pain in both knees. It's not muscle pain, it's more in-between the leg bones and under the kneecap. I don't believe it's a tear - I think the pain would be more sudden an intense - it's more like inflammation. I have been to a doctor for it, and I've been told to just rest/ice/elevate it.

This is the second time it's happened. Both times were following rides where i did very long hard efforts in the drops. other than that, I can go out and turn myself inside out without pain.

Now, both of my bikes are set up pretty long and low. I'm very comfortable on them, but i suspect that the extreme angle caused by being in the drops + hard effort is putting hard wear on my knees.

Now, I'm obviously going to focus on this when i get fit, but i'd like to open it up:

could it be:
- Saddle Setback?
- Bar Height? (my back and arms are comfortable)
- Could it be that I'm sitting too far back when i'm in the drops?
- Could it be that my pedal stroke is bad (not enough pull) in the drops?
- Is this just a danger of doing 30+ minute pursuit efforts in the drops?

AndyK 

Hard to say, and your pro fitter should be able to tell you what you need to change.

As a guess, I would say saddle is too low.

datlas 

It's probably patello-femoral pain/problem rather than meniscal...but if you are asking us to diagnose and solve your problem on the internet, please refer to my sig.

Mike F

The fitting will hopefully resolve this. Please post what it was. Could be saddle height, saddle setback combined with strenuous work outs. Have you tried the "neutral knee" set up for starters regarding the setback? Its only a guide but it helped me when I went to a smaller stem and started messing with stuff.

Inertianinja

i'll give the Neutral Knee thing a try.

Of course, i'm not looking for internet diagnosis. as with many things in cycling, sometimes really puzzling problems can have a simple fix that everyone knows

Kurogashi

If you're using clipless pedals, do adjust the 'float'. As you can see, when you walk, your feet isn't perfectly straight (pointing forward), it's angled to the sides. So when you are pedaling on a bike and locked in with shoes/pedals, if your toes aren't in the naturally arced position, it'll put a lot of strain on your knees.

You might also be mashing too hard on a gear that you aren't ready for. You should have around a 80-90 RPM when pedaling, any slower and you are putting a lot of strain on your knees. So use those gears that you paid for!

If neither of the two above are your problems, then try KOPS. https://sheldonbrown.com/kops.html

And if all fails, hope to God that your professional fitter knows what he is doing and is able to alleviate the problem. Resting/icing will not help in the long run because you'll just develop the pain again and this might develop to be a huge problem down the road.

Commodus

?

Go to a doctor. A physio sports doctor.

Combined with the fit, should be able to find your problem. You may find this approach more effective than asking a bunch of random dweebs on the internet!

HokuLoa

not sure what "pro" you are considering for your fit but you might consider a medical bike fit. A good good sports medicine staff/bike fit is often better for addressing very specific concerns and physical realities. A 3D fit is great for actually seeing what you are working with physically while riding and then making the necessary adjustments. A bit pricier but well worth it to increase comfort/efficiency and prevent injury.

Take this from someone with knee probs (multiple surgeries and meniscectomy) who benefited greatly from my budgeted 3D med fit. Seriously, first ride after I was cursing myself for not doing it years earlier....

MrTuner1970

Ditto on all counts. And, perhaps the saddle is too far forward.

Buffybike

Moving my cleats back in addition to raising my saddle fixed my knee issues.

thcri

Switching from PD-5700 pedals to Speed Play Zero's got rid of my knee pain. Float is important for me.

oilman_15106

No he is asking for a diagnosis. Did you see the MRI posted last week? Afraid this is the future of government run health care, post on BF and see what happens.

Inertianinja

thank you for the suggestions.

contrary to what oilman said, I'm not asking for a diagnosis. It's helpful to see the list of things that others have done to deal with this type of pain, or the different underlying causes, since that might become useful down the road in chasing the problem. If X doesn't work, I can ask a doctor/etc about Y.

Note that for some people, a simple change of equipment eradicated their knee pain.

The hardest part is the psychological toll this is taking on me. I was getting much stronger this season, and riding much more than ever before. Best shape of my life. I want nothing more than to go out and do vicious workouts and race, but I can't. It's become clear that if i want this to heal, i can't even "go easy." i have to stop. As a result i'm feeling frustrated, depressed, and soft like i'm losing fitness every second.

Injuries suck.
I'm going to go back to the doctor to see if there's any serious damage.
And i'm going to speak to my coach about my position & pedal stroke to see if i'm doing something to cause injury.
And i'm going tomorrow for a professional fit to see if changing something about my bike setup will prevent this from happening in the future.

HokuLoa

I hear you about the "psychological toll." This is my first season back after multiple surgeries and a drastic reduction in physical ability. A couple years ago I noticed some functional changes and pain in my knee but nothing too too bad. I pushed from a ridiculously long, intense ski season into bike time and never felt quite "right." Again, nothing too wrong to get me to do anything but take it a little easy and HTFU. In hindsight probably a mistake as I learned the following Fall. Now after surgeries and permanent osteoarthritis a wish so much that I had address the issues earlier and perhaps have prevented some of the damage. It is amazing how tiny changes in fit can with tens of thousands of pedal rotations aggregate into serious potential injury. Very good to address what is going on and minimize problems as early as possible.

Good luck!

Kurogashi

Make do with what you have. If your lower body is shot, work on your upper body. Sure cyclists don't need a lot of mass there, but it still doesn't hurt to build a few lean muscles up there. It'll also keep your metabolism high when you work out, so you don't get fat while you're off the saddle. So just go to the gym, do a few bench press with very low weights but with very high reps (this will get your heart pumping). Go do some serious core (abs) workouts, all cyclists need a strong core, it is your 'core' after all. Work on your flexibility as well, so you can stay in a more aerodynamic position for a longer time without getting back pain. And if you still have time, pick up a book and learn some proper cycling techniques.

See, look at how many other things you can do in the meanwhile. There's really no point in sitting around and moping, so get to it!

AltheCyclist

I'd agree with Andy above ... I've found that, in general: back pain usually means bike it too big, knee pain means too small.

Bacciagalupe

And you aren't doing this because...?

Chances are it's just an overuse injury, potentially aggravated by a poor fit.

For what little another Internet opinion is worth, I'd rest and ice the knee, then get a good fit, and make sure you tell the fitter exactly what the problem is. If they know their stuff, they'll see what (if anything) about your current fit might be causing the problems.

Inertianinja

I had my fit this morning. angles and millimeters were measured, motions were analyzed, etc.

coach recommended that i move my saddle 5mm down and 5mm back, to focus on keeping my knees stable, to move my cleats in slightly. after a while, try 10mm longer stem. nothing clearly wrong with my pedal stroke, but my extended time in the drops may have been the cause of the pain.

i learned a lot. next step is healing and physical exam by an MD.

George

I'm going through the same problem right now. I'm scheduled for a MRI Thursday. I'm curious to what kind of fit you got. Was it the static fit or the dynamic fit? I was thinking about getting the static fit after I see what the MRI results are. Also did the fitter move your cleats all the way back as well?Thanks and good luck.

motobecane69

BTW, I reread the title of your post. I don't think it's your meniscus. Mensicus issues usually manifest themselves as the leg "locking up" . yours sounds like tendinitis. Also doubtful that you would have torn both menisci and you mention the pain is in both knees. If I did an extremely intense leg workout in the gym and really ratched up exercises beyond the norm, I may feel some musclular or even joint soreness for a day or two but it usually would go away. if yours is lingering, go get it checked out again and if you need a recommendation to a good ortho, let me know I'm also in NYC.

Inertianinja

it was on a trainer, i'm not sure if that's static or dynamic.

the cleats were kind of interesting.
i end up putting pressure on the outside of my foot when i get tired and therefore sloppy. he took my shoes off and looked at my arches/gait, and saw how much i of a vagus (rotated out) i had. recommended some shoe inserts by Specialized, which were counterintuitive to me but i'm excited to try them.
We talked about cleat position relative to my big toe joint, and how that can change depending on whether i drop my ankle or point my toe. i don't really do either. he ultimately recommended trying the inserts first, then moving the cleats inward (to widen my stance) slightly.
we also talked a lot about watching the knee's position in relation to the foot as i pedal. my knees tend to move towards the top tube as i get tired. i have to work on that.

metalheart44

Here is my meniscus story for you to consider as you wish. Last year I experienced some acute right knee pain: I had trouble placing weight on it immediately, walking down stairs or slopes was painful, and at night I had to use a pillow between my knees to prevent pain. It was about two weeks before I could see the orthopod and during that time I did ice and rest and the knee pain improved substantially but did not go away. Saw the doc and he did the MRI thing and it showed a meniscus tear. He gave me some options: do nothing and see how it would progress; try cortisone shot and see if that relieved the pain; or, scope it. I chose the cortisone shot. It took a a couple of weeks for full effect, but I cycled pain free for the rest of the season. A week ago, I was working outside and to make a long story short experienced similar pain in my left knee: I could not walk on it immediately, pain at night, etc.... It was a week before I got to see the doc and the pain improved with ice and rest. The doc manipulated my leg and knee and said that it was highly likely that it was a meniscus tear. Since the pain and other symptoms were nearly identical to last year, I believed him. He suggested a cortisone shot to see if that improves functioning and pain and I agreed. I am waiting to get back on the bike until the weekend, but I am hoping this is the answer. Good luck with yours

HokuLoa

A word on cortisone and orthopods:

Cortisone is like a bandaid. It can be put to "good" use getting you past the pain "hump" of a minor, self repairing injury (like a bandaid on a minor laceration). It can also be used very poorly to coverup an injury that REALLY deserves to be addressed in a more comprehensive fashion (like a bandaid placed over a 4" deep puncture wound). A lot of docs are unfortunately needle happy and rely far to heavily on cortisone. My point being, cortisone is OK for pain but it fixes/addresses NONE of the underlying issue(s) and is rarely if ever the comprehensive "answer."

So using metalheart as an example (hope that is OK) if one develops a meniscal tear in one knee that is "solved" by a cortisone injection and then later develops the same symptoms in the other knee then chances are VERY good that one should look to the root cause of the injuries. A non-sports med orthopod may be a great surgeon but that doesn't mean he/she know jack about your sport specific issues.

If you are cycling a lot then get the opinion of a good sports med doc who knows knees and cycling really well. Maybe better, get the once over from a sports med specialist who does medical bike fits. The root of the injuries may very well be linked to a minor fit issue causing undue stress over the 1000s of pedal strokes each ride and aggregated throughout a season. The cortisone may make you "feel OK" but if internally you continue to exacerbate the damage then you are really doing yourself a disservice....

just 2 cents from someone who works (and suffers) in the orthopedic/sports med world....

Inertianinja

interesting stuff also. i never had sharp/sudden pain - it was more like a radiating pain that just kind of spread. it has been intense, but not something that prevented me from walking.

motobecane69

This description is so inline with Patella Femoral syndrome. The knee moving towards the top tube creates a large angle. Females have this problem on a greater basis than men because the structure of their hips are different, they have wider hips and then angle sharply down towards the knee so the tendency is to pull that kneecap to the outside. so if you start moving your knees towards the top tube when you get tired you are creating the same effect. Attention to technique, foam rolling your it band, and isolated quadriceps work will help repair the problem long term while ice and anti-inflammatory meds will relieve your short term pain.