Tsch0e

Hello,

since 2 years now i have pain under the inner site of the patella.
It always is good at the beginning, but it gets constantly worse during the tour.

It is more a burning kind of pain and not a pressure inside the knee like when the saddle is in the wrong position.

I already tried to do a bike fit and also an MRI to see if anything is wrong inside the knee but nothibg changed.
Also a physiotherapist could not help me.

Does anyone have that problem too?
I am really hopless now.

Carbonfiberboy 

This is really common among cyclists. Sometimes it's the inner side of the patella, sometimes the outside. It's usually a simple problem of muscular imbalance, something to do with how one pedals. Your VMO is probably pulling your patella to the inside. IF that's the case, you need to strengthen your vastus lateralis. It might also be wise to temporarily raise your saddle to reduce the pressure on the patella and pedal with your toes pointing in. You probably are pedaling with your toes pointing out now. If so, reset your cleats.

I had the VMO type of patella problem years ago. I raised my saddle and pedaled in zone 1 only for 30' a day indoors while also exercising my knee muscles. That worked. It never came back. Took a month or so.

See: https://www.setforset.com/blogs/news...alis-exercises

Velo Mule

This sounds familiar to me @Tsch0e , but, I have to caution, that even though my experience seems similar, it might not be the same root cause. When I started bike racing I did well with almost no training. Once I got off to a good start, training rides started to get more serious. As I trained more, I got slower. I thought the pain in my knees were just because I working so hard. I didn't think it was because of a problem. I finally went to the college clinic as the pain became constant and my knees would either lock up or give out. They diagnosed the problem as chondromalacia patellar. This condition is also known as "runners knees". I did some physical therapy, but things did not get improve.

Next stop, a orthopedic surgeon specializing in knees. They did an X-ray and had a machine to measure my knee muscle strength. This muscle strength machine measured an abnormal application of force that is typically seen when pain is involved. The doctor therefore came to the conclusion that I indeed had chondromalacia patellar. He explained that this condition is a result of a muscle imbalance. Normally they are in balance and the kneecap (patellar) tracks properly in it's groove. But when there is an imbalance the patella doesn't track right, this results the tissue on those rubbing surfaces becoming pilled like a sweater and pain.

He said there are two ways to improve this condition: We do an operation where we guess at how much this imbalance is and cut the stronger muscle just enough to try to achieve a balance or you can quit bike racing for now and do exercises to strengthen the weak muscles. Of course, for me it was the second option. I had already been doing physical therapy, so I continued to do it at home and the last thing is that by being sensitive to condition, I learned what activities helped and what made it worse. For me swimming, particularly breast stroke with frog kicks worked well. I also did resistance exercises that strengthen my inner muscles.

I think the next step is to see a Orthopedic surgeon. If you can find one that specializes in knees, that would be the best. They will probably set you up with physical therapy. You may need to spend some time off the bike. By the way, I tried all the fitting things, changing my petal stroke to pull up and none of these changes worked for me.

Please let us know what you find. This happens to some of us when we get more serious about doing more cycling.

Photokid1970

My knees do not hurt day-to-day standing, sitting, walking etc - but they hurt when pedaling on the bike or walking up steps. It's not major, but it's a consistent presence. It goes away with OTC pain meds, so my doc says that I don't need to worry about it yet. I'm not so sure, since it's been going on for several months now without really changing one way or the other. I haven't thought about whether it's under/near the patella or not - I'll start to pay closer attention so I can give more details that just "My knee hurts". This is good info to read.

GhostRider62

Do you have Gout? (long shot)

Do you eat fruit or fructose drinks when riding? They can exacerbate gout symptoms.

Does the burning feel like a blow torch? That is what gout inflicted my left big toes felt like starting Transam. An electrical japping burn would be more nerve pain but I don't ever remember reading of someone with nerve pain showing in the knee. Hands, elbow, shoulder, neck? yes.

phughes

Pushing to high a gear does that. Is that something you do, or do you spin? Since it happens when you climb stairs, I suspect you are pushing too high of a gear, for you, rather than spinning.

oldbobcat

Pile-driving big gears is the worst enemy of knees. The first step is to learn to stop pushing down when the pedal won't go any further. Then, gearing down, pedaling faster, and pedaling round (where the foot approximately follows the path of the pedal) is so healthful it can be therapy for knees. Plus, it gives the legs a sleek, lithe and flexible look.

BFC

Excessive shear and compressive forces on the patellofemoral head. DO NOT let this go since pain is an indicator that you are damaging your knees. Only a few bike fitters in the US know how to fix this with the right equipment.