Hunterdog

I was/am having some upper hamstring pain. A had a fitter help me with fit for the issue and he moved my saddle position. I think it did help my hamstring. Here’s the issue. I have two bikes, a newer Roubaix that I use as my road bike and an older Roubaix, they do not have the same saddle, that I use on an indoor trainer. I had the two bikes set-up identical until the saddle position was moved. Now, a couple of months into indoor riding here in Central New York, I have developed a patellar pain. It hurts like hell when I kneel on it. It doesn’t seem to bother when I do deadlifts or back squats but does seem more uncomfortable after riding on trainer bike for about an hour. How do I measure the set back position so that I can adjust the seat and both bikes will be the same. Or should I be looking at another cause. Thanks in advance.

berner

I grew up near New Paltz. If you are near Hunter Mountain then you are getting your share of snow. I no longer ski but do like looking at the stuff.

Since saddles differ in their proportions, l try to establish a point to measure from. I assume the sit bones locate at the widest point of the saddle and mark that position with a dot from a whiteout pen. I have a four foot level but a plumb bob or a string tied to a bolt located so as to bisect the bottom bracket. You then measure from the string to the white dot on the saddle to get setback. An alternative method described by Lenard Zinn is to prop the bike up with the rear wheel against a wall. Then measure from the wall to the bottom bracket and to the saddle and subtract the smaller distance from the longer. Setback is the difference between the two.

Hunterdog

@berner. That was my concern about saddle proportions. I also failed to say that cranks on main bike are 160’s and cranks on trainer bike are 165’s. And yes, we have snow. It really is beautiful. Thanks for the advice.

bpcyclist

I would really suggest you see an orthpaedic surgeon ASAP. Patellar injuries can be very troublesome if they are not managed properly.

canklecat

Longer cranks than you're accustomed to can do that.

Ditto, saddle position -- patella pain often indicates the saddle is too far forward and/or too high.

I've recently experienced patella pain for the first time in 3 years. And I know why -- all of the above.

Last year I mostly rode a bike with 170 cranks and had the saddle dialed in perfectly. No problems all year. In January I had to take that bike out of service to fix the headset.

I switched to my older steel road bike that was slightly different but had always fit me perfectly. It has 172.5 cranks. Everything was fine until I experimented with clip-on aero bars in January, and changed the gearing from 50/38 to 52/39 chainrings. To make the aero bar position work I had to raise the seat post about 1/2" and scoot the saddle as far forward as it would go.

I got tired of the aero bars after a week or so and took 'em off. But I forgot to reset the saddle. After a few rides my knees were aching a bit. I've reset the saddle to the original position, but I'll need to take it easy for a couple of weeks to let the knee heal.

Meanwhile, massage, topical analgesics, range of motion exercises, etc.

Carbonfiberboy 

IME saddle setback and small variations in crank length have nothing to do with it. Saddle height, however can have a lot to do with it. Saddle height BTW cannot be measured accurately with a tape, and if you're doing so, it has to be measured from the CL of pedal axle, not from BB center. The way to measure saddle height is with your leg. Ideally to get saddle height the same on both bikes, you sit in your normal position on the saddle, normal foot angle, and someone measures your knee angle with a giant protractor at bottom dead center. That's actually pretty easy to do at home with help and a couple sticks and a tiny clamp. Another usual way to set initial saddle height is by placing the heel of the shoe on the pedal and aligning the cranks with the seat tube. Usually the heel barely touches the pedal with the knee completely locked out. Whether that's the exact case or not is not that material here, so you observe heel pressure or knee angle or gap between heel and pedal and make sure they're the same on both bikes. Always measure with your leg. Because saddles differ, it's the only accurate way.

Knee pain is from knee angle. Saddle fore and aft position only affects hip angle, not knee angle, if saddle height is changed as the saddle is moved and is measured as above.

So a question. Is the patellar pain in the center or to one side, and if so, which side? And do you have that pain descending stairs after you feel the pain on the bike?

Hunterdog

Thanks for the saddle height advice. I’ll check this week. Pain is only in left knee, midline, just below the kneecap. It has developed some swelling and general discomfort. I am seeing ortho this week hopefully I can get some relief.

spokes5678

Check your cleat bolts, a loose one can cause untold knee pain.It feels like you've
been tap dancing on concrete.
Ask me how I know.

Carbonfiberboy 

That's a bit weird. Just below the knee is the tendon attachment. Not a usual cycling issue. Usually a tendon has gotten tight for some reason. So I'd guess the pain happens on a saddle which is too low. Try raising it a cm. But that's treating the symptom rather than the cause. Can you perform a full bodyweight squat ATG until your hams hit your calves? Without pain there? Swelling there and discomfort is probably from tendinitis. Try 600 mg. ibuprofen every 6 hours, 3 times. Let us know if that makes it go away. That's diagnostic for tendinitis. If that's it, then the question becomes - Why? Usual answer is lack of full range of motion stretching and/or weight work, but there are also other possibilities..

79pmooney

I just had a thought. Wearing cycling shorts, place a small piece of tape over your hip bone. Then mount each of our bike in an inside hall where you can near balance and use the wall for support. Go to your usual riding position. Have someone else hang a plumb bob from your piece of tape and measure the distance back from the center of the BB spindle. Then do the same with the other bike. (Have him/her do the same with the height or use any of the many ways to compare your hip vertical heights between different bikes. Knee bend, heel on pedal, etc.)

You might also want to do a forum search for one of my posts where I posted my experience with chrondomalacia patellae. I posted the same piece multiple times, including in the past month or so. Tight hamstrings are a real no-no if you are prone to CP.

Ben

Hunterdog

I tried the ATG squat test. It didn’t go well with severe pain below and to the outside of the patellar. Called in a favor and saw ortho with x-rays. Nothing on images but ortho believes that I have patellar tendinitis, told me to use Volteren and Rx PT, no squats, of any kind, until pain and swelling dissipates, and a few days of no cycling, gym, etc. He’s not sure of probable cause. So it may be next weekend when I can look a saddle position. Thanks everyone for your help.

jppe

Knee pain can be troublesome to figure out sometimes so here are some random thoughts from my experience.

I think that as a general rule, patella pain comes from saddle height. From personal experience if the saddle is too low knee pain is in the front of the knee. If the saddle is too high knee pain is in the back of the knee. Since your cranks are of different length on the two bikes, I'd suggest measuring from the pedal bolt to the sit bone area of the saddle and adjust the saddle height as needed to get the height correct. If the pain is just in one knee, you might move the cleat in the shoe on that side closer to the arch or away from the toe. That should make the length of the pedal to the saddle a touch longer or simulate the saddle being a little taller. Pushing harder gears than you normally do can contribute to knee pain as well. Higher cadence using easier gears can help with that.

It might be smart to check your pedaling motion as well. If your foot is "swiveling" (moving in and out away from the bike or moving in a direction not parallel to the top tube) then the lower leg might be twisting the knee. It's easier to spot if you tape a small rod to your shoe pointing frontwards. I have friends with shims added to their shoes to correct that.

Do you have "float" in your cleats to allow for the shoe to move around? Cleats that don't have float can be tough on knees as well due to the twisting motion.

I've always had to let my knee pain calm down before doing a lot of pedaling. Good luck with figuring it out!

Carbonfiberboy 

OK, that's exactly what I thought. It probably has nothing to do with saddle position, height, etc. The ortho is wrong. Back at the beginning of time, docs recommended rest for injuries. That has changed for the most part, but obviously not entirely. Two things make tendinitis go away: increasing range of motion, and stress. What makes it worse is high repetitions at low stress, i.e. cycling. So give the cycling a rest for a week. The idea of stress is that stress is the only way to signal your body that something needs repair. Some posters have found that only max weight at low reps fixed their tendinosis. Here's a good article on the subject: https://www.physio-pedia.com/Tendino...Rehabilitation I've seen similar programs work very well. Main thing is to go heavy, use slow movements, focus on the eccentric (lengthening) movement. So in a squat, that's the down movement. Don't go down beyond the onset of mild pain. Don't do leg extensions. Beyond that, I'd warn that there's a lot of BS about this on the web.

Start doing these stretches: https://www.bikeforums.net/road-cycl...l#post15372967
every day. 3 times a day wouldn't be a bad idea. Only stretch to the point if mild discomfort, never pain. Be gentle.

The doc recommended an NSAID, Volteren. You can take that instead of the ibuprofen I recommended. I don't know if there's any difference in effect, but of course the doc wanted to give a prescription. Here's guide to both: https://www.rxlist.com/ibuprofen_vs_...-condition.htm, That link gives a limit of 3200 mg/day for ibuprofen. I think a better limit is 1800. The pain-relief aspect of an NSAID is the minor thing. The major thing is that it reduces swelling. The pain you feel in your tendon is due to swelling of the tendon sheath. That rubbing is destructive of the tendon, hence the recommendations in that physio link. Ibuprofen or other NSAID is not a bad thing if used when necessary for inflammation. I know a female runner who took ibuprofen for 6 months during her rehab, no problem. I know a lot of cyclists take it before or after every ride. Not a good idea at all. Not a toy.,

Carbonfiberboy 

And since you have pain on the outside of the patella, it's not only tendinitis, but also mal-tracking of the patella, and in your case it's the VMO which needs strengthening, the most common thing.. So take a look at this post: https://www.bikeforums.net/training-...l#post16081392

Hunterdog

Update: I finished a course of PT which helped some. Now doing home exercise program (should be gym based but you know). I have ridden a couple of times now that weather has started to turn. Not going hard but the hills didn’t flatten much over the winter. No pain while cycling but I don’t think I’ll cycle as often and as far as I did the last few years. Thanks for all the suggestions.

Carbonfiberboy 

Take for what? Read the thread. "Painkillers" aren't what you want. What painkillers do is allow you to do more damage. Pain is good, it's information. It's telling you to stop doing whatever it is you're doing to damage your tissues. OTOH there are medications one can take to help one to heal, and healing decreases pain, so they are sort of a painkiller, but it's not the same thing.

79pmooney

For my chrondomalaia patellae, aspirin and Motrin are godsend. Have been for 40 years. I don't ride on aspirin but will take it if my CP is up after the the ride. Helps a lot with the pain and allows me to sleep, but far better, my knees don't hurt when I get up. My theory is that aspirin encourages blood flow, hence faster healing. I don't know that and don't really care. What is obvious is that my knees love it and recover far better.

When I was diagnosed, the doctor prescribed Motrin (or recommended it; I don't recall if it was prescription in 1978) and mentioned that aspirin also worked. Aspirin is far cheaper and easier to get and gives me no other (apparent) issues if I use it only as needed and seems to work just as well for me. (I take one to two 325 mg standard pills. Actually, my GP told me to stop taking mini aspirins right after I Costco'd a pile so now I take however many minis seem to be required.

Another common practice for knee and other sport injuries that I absolutely stay away from is ice/cooling for my knees. The usual word is that ice is good and prevents or reduces inflammation. But ice also means that every time I move my knee, my patellae are riding over my knee like there is sand in there, directly furthering the injury mechanically.. Now I could put on two full length splints and stay in a wheelchair for the next several hours but I'll pass on both that and the ice. Instead I wear really warm pants and keep my knees toasty. All "wrong" but my knees like!

Best advice from that doc, Gary Kiss of Portsmouth, NH, probably long retired - listen to my knees! Next, all the stretches, the need to keep them warm, etc (my ling post mentioned above) and aspirin. Thank you Dr Kish.

Ben

Carbonfiberboy 

To make my post maybe a little clearer, doctors have long since stopped prescribing "painkillers" for back pain. Instead, they diagnose the source of the pain and look to PT, lifestyle changes, and possibly surgery to ameliorate the pain. Same thing with knees: diagnose and prescribe. Unfortunately, there don't seem to be a heckuva lot of doctors who know anything about cycling knee problems. That may be the most frequent request for help that we get here. But what to do depends on exactly what the problem is. It's frustrating to have people ask for painkillers when what they need is a diagnosis. I bet doctors feel something like that, but without the frustration since they have the complainer trapped in their office.

Many different things cause knee pain. There's not one solution.

Hunterdog

Follow-up: After a lot of work, stretching (abductor).and band work, the patellar pain has really diminished. I still can’t put full weight on knee but it is much better. No pain when climbing. Thanks everyone for your input.

Carbonfiberboy 

But still pain when descending stairs? That's the usual diagnostic symptom. So keep doing what you're doing as long as it keeps getting better.

Hunterdog

I don’t recall pain walking downstairs, thankfully. My office is on the fourth floor and I haven’t been in an elevator since March 1; never a crowd on the stairs.