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Knee Pain/ Discomfort

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Knee Pain/ Discomfort

Old 11-17-21, 01:20 PM
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Knee Pain/ Discomfort

33 years old, average between 150-250 miles a week.

About 6 days ago while on my wahoo kickr doing zone 2 work I started to feel discomfort in my left knee. At the moment I didn’t think much of it, I initially tried to keep going but the pain started to grow so I abruptly stopped. I had ridden 265 miles that week, so thought maybe the miles had something to do with it.

The next day I got back on, after about 5 miles it started again. I hopped off and adjusted my cleats and again after about 5 miles the discomfort would start. So I stopped.

The next day after reading some articles on line I opted to raise my seat 3mm and push my seat back 1.5 mm. I had also slammed my stem about 1000 miles ago, so I raised it 5 mm.

Again after about 5 miles the discomfort would start.

I talked to my unofficial coach about it and he advised to take a couple of days off, looking at my training load he figured my body was tired. He also thought it might have to do with so much time on the trainer. I’ve only had the trainer for 3 weeks now and before that never used one before. The problem I had with this, I didn’t feel fatigued or tired at all. Most of my work on the trainer was zone 2 base miles. I did not feel like I put any more stress on my body than I usually do, and if anything I put less stress on my body.

The next day the weather was perfect so I opted to ride outside to see if this made a difference. Again at a round mile 5 the discomfort would start. I rode til about mile 10 and then with discomfort there was some mild pain so I opted to turn around.


The pain on a scale of 1-10 is a 3. I could push through it but concerned about long term damage if it’s something serious. The discomfort/ pain is in front of the knee, underneath the knee cap and on the right portion of the knee cap. Discomfort is get during the down stroke I’ve ridden 6500 miles this year, 5000 have been on this bike and I have never had any issues until now.

I’ve spent the last two days icing it as well as taking ibprofen.
The plan now tomorrow is to hop on without cleats to see if that makes a difference.


Any advice would be appreciated. I really am at a loss of why or what to do.
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Old 11-17-21, 08:49 PM
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Originally Posted by cubewheels View Post
Is this the inner side or outer side of the knees? Right portion of the knee cap doesn't really pinpoint the location since we have two knee caps and right to one is left to another.

At first glance, your problem has nothing to do with too low saddle and your recent adjustment might have made it worse, you should take it back to previous adjustment.

rode again tonight to try and pin point the pain. looking down at my leg, its the very top front point of my knee. with pain also slightly right. pain is present in the down stroke.
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Old 11-17-21, 09:07 PM
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My advice, take a few days off the bike and consider seeing an orthopedic doctor.
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Old 11-17-21, 09:33 PM
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So I took two days off. Today I got on the bike with it on the trainer and I didn’t wear cleats. For the first 20 mins or so I was fine, but then the discomfort started. I made minor adjustments to the seat height and it’s basically back now where I’ve had it the whole year and I was able to ride without much discomfort. I was going light, and I was focusing on keeping my leg in the position that was causing any problems.
I had to run some errands and when I got back I wanted to get back on and do some more light miles, but this time instead of discomfort the pain was pretty instant. I tried different foot positions and nothing mattered.

I guess I really want to know what caused this. I wasn’t training harder than usual, I havnt hit my knee that I am aware of, and I didn’t have any discomfort until 5 or 6 days ago. Just seems really strange too me.

Plan is to take some more days off, I found some PT exercises to help strengthen the muscles around the knee. If it still bothers me when I get back home then I’ll go to a sport doctor.

Just wish I could get it to stop now, or atleast figure out why.
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Old 11-17-21, 10:06 PM
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I think PT exercises are good. Also, don’t neglect the core and mix in some Pilates, Lagree, or yoga into the training, there are a lot of small muscles that help stabilize us on the bike but don’t get exercised while cycling. The core can relieve larger muscles of big loads, and once we start losing form on the bike we can add a lot of stress to your knees, back, neck, etc.

You’re in your thirties now and need a whole body approach to cycling and you likely over did it at some point in the recent past and your muscles don’t recover like they did ten years ago. Getting old is kind of a bummer like that.

Finally, Maybe replace your cleats if they look a little worn.
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Old 11-17-21, 10:43 PM
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This sounds like chondromalacia patella, a chafing of the kneecap on the cartilage underneath. I had it come on when I changed bikes in March from my short cranked fix gear and went for a long ride on my long cranked racing bike. Three days later I had to drop out of the season opening race because of the pain. Got introduced to an orthopedic surgeon at the race. He laid it for me what I had, what I had to do to continue racing and the long term. I still have the condition but it doesn't rule my life - as long as I play by the "rules" he spelled out. If I'm negligent the pain comes back. That doc made it very plain that if I break too may rules, it's knee replacement time. Several orthopedics have told me since what that doc told me was correct.

Years ago I wrote a long account of that experience. I'd post it here but for now I"m handicapped by an internet computer I am keeping entirely separate from my other. PM me with your e-mail if you ant to read more. I'll send that to you and if you want, you can paste it here. (I've posted it a few times in the past but my search abilities are limited.)

CP now has a new name but I'm too old to change. If you google chondromalacia patella, you can find the new name.
Edit: I see the file posted, I haven't opened this version for a while so I don't know exactly what's there. (Did I sign my possessions away? Will I be sentenced to life? (Not really worried. )
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Old 11-18-21, 08:25 AM
  #7  
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Originally Posted by 79pmooney View Post
This sounds like chondromalacia patella, a chafing of the kneecap on the cartilage underneath. I had it come on when I changed bikes in March from my short cranked fix gear and went for a long ride on my long cranked racing bike. Three days later I had to drop out of the season opening race because of the pain. Got introduced to an orthopedic surgeon at the race. He laid it for me what I had, what I had to do to continue racing and the long term. I still have the condition but it doesn't rule my life - as long as I play by the "rules" he spelled out. If I'm negligent the pain comes back. That doc made it very plain that if I break too may rules, it's knee replacement time. Several orthopedics have told me since what that doc told me was correct.

Years ago I wrote a long account of that experience. I'd post it here but for now I"m handicapped by an internet computer I am keeping entirely separate from my other. PM me with your e-mail if you ant to read more. I'll send that to you and if you want, you can paste it here. (I've posted it a few times in the past but my search abilities are limited.)

CP now has a new name but I'm too old to change. If you google chondromalacia patella, you can find the new name.
Edit: I see the file posted, I haven't opened this version for a while so I don't know exactly what's there. (Did I sign my possessions away? Will I be sentenced to life? (Not really worried. )


Thanks for the post, sounds very similar. We’re both of your knees affected or just one.

Up to this point I have never stretched before my ride, and I rarely pay attention to the temperature of my knees. However, I’m either wearing tights or leg warmers and tights, in the winter, so this will def make me think more in the future.

This might explain why the pain was worse last night too. I got done do the PT where you sit flat on the ground with your back against the wall and raise your leg with flexing your quads. I did 5 sets each leg 15 sec each. I then iced for about 25 mins. While my leg was still cold I got on the bike……..


Sent the letter to my wife, she’s making a doctors appointment for me when I get home sometime next week. As for now I’ll do what you mentioned.

I know it could be something else, but as you posted this a doctor friend of mine who also cycles came to the exact same conclusion after reading my symptoms.
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Old 11-18-21, 11:02 AM
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Originally Posted by bampilot06 View Post
Plan is to take some more days off, I found some PT exercises to help strengthen the muscles around the knee. If it still bothers me when I get back home then I’ll go to a sport doctor.
Don't wait to see if it still bothers you. Go see an orthopedic doctor that specializes in sports injuries. Putting it off and hoping it will get better can only make things worse.

I was fortunate. When I made an appointment to have a professional bike fit done (something I would highly recommend) I mentioned that I had knee surgery years ago, and was particularly concerned with that. The shop knew a young orthopedic doctor who was opening his own practice in sports medicine, and he asked to attend the fitting. It was great! Rather than guessing about saddle height, setback, angle, and cleat positioning (as well as so many other measurements taken), the measurements were transferred from the fitting jig to my bike (all done with lasers - I was very impressed!) and adjustments made where needed. The doctor checked my knee while I was pedaling and helped them compensate a bit for the wear and tear it had undergone. I haven't had any knee pain while riding since.
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Old 11-18-21, 12:05 PM
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Knee injuries/discomfort is probably the most common complaint we hear on BF. It's endemic to cycling because of the repetitive nature of a very particular movement which becomes trained into our muscles even though it's not optimal.

You never did say where the pain was. One one post you said below the knee, on another you said above. You didn't say which knee, left or right. The inside and outside words are medial and lateral:
A lateral orientation is a position away from the midline of the body. For instance, the arms are lateral to the chest, and the ears are lateral to the head. A medial orientation is a position toward the midline of the body. An example of medial orientation is the eyes, which are medial to the ears on the head.
You almost certainly have a muscular imbalance, which is causing the knee cap to move to a position where it abrades rather than being cushioned by cartilage. That's what CP is. The muscular imbalance is caused by cycling with an unbalanced muscular contraction for some reason. PT can fix it. That said, the rule for pain in front of the knee is to take a couple days off, then raise the saddle say 5-10 mm, then pedal only Z1 for 30' for a week or so and only if there's no pain. I'd say do that after some PT.

Here's an old post on that subject: https://www.bikeforums.net/training-...l#post16081392
But read the whole 73 post thread, worth it.
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Old 11-18-21, 12:11 PM
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Originally Posted by Carbonfiberboy View Post
Knee injuries/discomfort is probably the most common complaint we hear on BF. It's endemic to cycling because of the repetitive nature of a very particular movement which becomes trained into our muscles even though it's not optimal.

You never did say where the pain was. One one post you said below the knee, on another you said above. You didn't say which knee, left or right. The inside and outside words are medial and lateral:
You almost certainly have a muscular imbalance, which is causing the knee cap to move to a position where it abrades rather than being cushioned by cartilage. That's what CP is. The muscular imbalance is caused by cycling with an unbalanced muscular contraction for some reason. PT can fix it. That said, the rule for pain in front of the knee is to take a couple days off, then raise the saddle say 5-10 mm, then pedal only Z1 for 30' for a week or so and only if there's no pain. I'd say do that after some PT.

Here's an old post on that subject: https://www.bikeforums.net/training-...l#post16081392
But read the whole 73 post thread, worth it.

Left Knee.

Looking down at my knee, it the top and front of the knee. But I also feel inflammation to the right where the knee cap dips and the muscle meets. Off the bike that’s where I feel it the most. On the bike I feel it more to the center of the knee.
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Old 11-18-21, 12:29 PM
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Get it checked. And get a professional bike fit while you're at it. You made too many changes from your first post, always just change one thing at a time in the smallest possible increments and then test. I have knee pain if my fit is off by even one cm. there's a sweet spot and everything else is no-go. So get it checked out, heal it up, and then revisit your fit with a pro. sometimes a video as part of the fit can be very helpful to track how you move.
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Old 11-18-21, 12:33 PM
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I’ll add this. Scheduled an appointment with a specialist for the second. While on the phone she mentioned she had x-rays from my crash on Oct 14.

hit a v dot work sign stand going 25 mph ish. Had a really bad hematoma on my lower left leg so my doctor wanted to make sure the leg wasn’t fractured.

This specialist thinks it could be related.
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Old 11-18-21, 08:12 PM
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Originally Posted by bampilot06 View Post
Left Knee.

Looking down at my knee, it the top and front of the knee. But I also feel inflammation to the right where the knee cap dips and the muscle meets. Off the bike that’s where I feel it the most. On the bike I feel it more to the center of the knee.
So like walking down stairs is painful? That would be normal for CP.

This is my standard morning stretch series. Might help, every morning: https://www.bikeforums.net/road-cycl...l#post15372967
Worth starting the whole thread, though it has nothing to do with the IT band..

I'm trying to remember just how, other than what I've written above, I fixed my CP 25 years ago, but nobody home there. More recently, I've had some knee wear-and-tear issues, not bike related. I've been using some exercises from the kneeovertoesguy (YT). I walk up a flight of stairs backwards and back done frontwards for 10'. then do x X 25 toes lifts, then 5 sets 5 split squats with my forward foot on the second stair. Gotta go all the way down, butt on heel on that one. See if you can do any of that without pain, just maybe discomfort.

Other than that, the usual gym work, full barbell squats, leg sled, stiff-legged deadlifts, knee extensions between 150° and 180°. In summer I hike in the mountains one day a week which makes a big difference. Basically, I think it's about trying to get the right muscles to fire at the right time so that your kneecap tracks properly.

And oddly enough, for some unknown reason, it's usually only one knee, and IME usually the left.
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Old 11-18-21, 08:25 PM
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Originally Posted by Carbonfiberboy View Post
So like walking down stairs is painful? That would be normal for CP.

This is my standard morning stretch series. Might help, every morning: https://www.bikeforums.net/road-cycl...l#post15372967
Worth starting the whole thread, though it has nothing to do with the IT band..

I'm trying to remember just how, other than what I've written above, I fixed my CP 25 years ago, but nobody home there. More recently, I've had some knee wear-and-tear issues, not bike related. I've been using some exercises from the kneeovertoesguy (YT). I walk up a flight of stairs backwards and back done frontwards for 10'. then do x X 25 toes lifts, then 5 sets 5 split squats with my forward foot on the second stair. Gotta go all the way down, butt on heel on that one. See if you can do any of that without pain, just maybe discomfort.

Other than that, the usual gym work, full barbell squats, leg sled, stiff-legged deadlifts, knee extensions between 150° and 180°. In summer I hike in the mountains one day a week which makes a big difference. Basically, I think it's about trying to get the right muscles to fire at the right time so that your kneecap tracks properly.

And oddly enough, for some unknown reason, it's usually only one knee, and IME usually the left.

Stairs have not bothered it. But certain chair heights when I stand up I feel it.

Currently the biggest agitator is the aircraft I am training on. Coincidentally the pain started on my bike after my first sim session on this aircraft. Each sim session is 4 hours with typically a 15 min break in between. The first day of sim it hurt to straighten my leg when we took a break. I’ve since learned how to position myself so not put strain on my knee. But it does make me wonder.

Ill take a look at those, someone else mentioned knees over toes as well.


Earlier today my knee was feeling pretty inflamed but currently at this moment in time it feels fine. Did some PT and stretching followed by ice.
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Old 11-18-21, 08:41 PM
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Originally Posted by bampilot06 View Post
Stairs have not bothered it. But certain chair heights when I stand up I feel it.

Currently the biggest agitator is the aircraft I am training on. Coincidentally the pain started on my bike after my first sim session on this aircraft. Each sim session is 4 hours with typically a 15 min break in between. The first day of sim it hurt to straighten my leg when we took a break. I’ve since learned how to position myself so not put strain on my knee. But it does make me wonder.

Ill take a look at those, someone else mentioned knees over toes as well.


Earlier today my knee was feeling pretty inflamed but currently at this moment in time it feels fine. Did some PT and stretching followed by ice.
Here's a good primer on recovery.:https://blog.mapmyrun.com/truth-ice-muscle-recovery/
I've also found that taking anti-inflammatories can interfere with recovery in the same manner. I'm really careful about what I take ibuprofen for - only tendon sheath issues.
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Old 11-18-21, 09:32 PM
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Originally Posted by Carbonfiberboy View Post
Here's a good primer on recovery.:https://blog.mapmyrun.com/truth-ice-muscle-recovery/
I've also found that taking anti-inflammatories can interfere with recovery in the same manner. I'm really careful about what I take ibuprofen for - only tendon sheath issues.

interesting. I will take that into consideration.
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Old 11-20-21, 01:34 PM
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Did I understand that you can't get an appointment with a bone & joint doctor until Dec 2?

I'd see if I could hurry that up some if you are experiencing pain on a daily basis and it's interfering with your training or career. Even to the point of using another doctor of the same specialty.

Sometimes your own GP or family doctor can get you in quicker than if you just make an appointment yourself.

On the other side of it, go to a physical therapy facility. Check your health insurance. Some will pay for a visit or two without a doctor sending you to them. I'd think you'd want to make certain the person you talk to is a DPT and has some certifications in orthopaedics and sports.
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Old 11-20-21, 07:32 PM
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Originally Posted by Iride01 View Post
Did I understand that you can't get an appointment with a bone & joint doctor until Dec 2?

I'd see if I could hurry that up some if you are experiencing pain on a daily basis and it's interfering with your training or career. Even to the point of using another doctor of the same specialty.

Sometimes your own GP or family doctor can get you in quicker than if you just make an appointment yourself.

On the other side of it, go to a physical therapy facility. Check your health insurance. Some will pay for a visit or two without a doctor sending you to them. I'd think you'd want to make certain the person you talk to is a DPT and has some certifications in orthopaedics and sports.

The issue is I am currently in Dallas for training. I am going home for Thanksgiving, but the doctor was unavailable on the 26th. The 2nd was the first opening where I will be back in my hometown.


I rode this morning on the trainer for 30 mins. I walked on a treadmill first to get warmed up. I made sure to stretch and I even turned the heat on in my room to help the knee.

I didn’t clip in but I was able to ride without any pain or discomfort. I kept it mostly in power zone 1 but I did take it up to zone 3 for a short period. Again no discomfort or pain. I didn’t feel 100 percent but I was happy with the result.

Tonight I got on and clipped in. I had to adjust my cleat so that my toe was pointing in. I only rode for about 10 mins, didn’t want to over do it. No pain, or discomfort.
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Old 11-20-21, 08:02 PM
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Supra Petelar pain is a bugger as with all knee pain. Don't delay, go see an Ortho Doc. X-Ray, CT, MRI may be needed to rule out injury... Let me rephrase that... X-Ray, CT, MRI may be needed to rule out fixable injury. As for ridding... If it hurts more when you ride then don't till ya get it addressed. It looks like you have already hit all the common bases...
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Old 11-22-21, 09:22 AM
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Originally Posted by bampilot06 View Post
The issue is I am currently in Dallas for training. I am going home for Thanksgiving, but the doctor was unavailable on the 26th. The 2nd was the first opening where I will be back in my hometown.


I rode this morning on the trainer for 30 mins. I walked on a treadmill first to get warmed up. I made sure to stretch and I even turned the heat on in my room to help the knee.

I didn’t clip in but I was able to ride without any pain or discomfort. I kept it mostly in power zone 1 but I did take it up to zone 3 for a short period. Again no discomfort or pain. I didn’t feel 100 percent but I was happy with the result.

Tonight I got on and clipped in. I had to adjust my cleat so that my toe was pointing in. I only rode for about 10 mins, didn’t want to over do it. No pain, or discomfort.
Probably not your issue, but since you brought it up.

When you are clipped in, do you feel any twisting of your knee when you go from the bottom stroke to the top of the stroke? If so, then you need to turn your cleat or add more float if you can. If you don't recognize that your foot position is putting your knee in a twisted position then you'll probably have a lot of pain at the end of a ride.

The angle of your foot on the pedal is determined by your body. Not some idea that the centerline of your foot should point straight ahead. My heel on my right foot is more inboard and almost hits the crankarm than my left foot.
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Old 11-22-21, 11:46 AM
  #21  
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if you've been dropping 600+ miles a month for any amount of time with no pain, it's not the bike fit. somehow you injured that part of the knee and that spot needs recovery.
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Old 11-22-21, 06:12 PM
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Originally Posted by bampilot06 View Post
The issue is I am currently in Dallas for training. I am going home for Thanksgiving, but the doctor was unavailable on the 26th. The 2nd was the first opening where I will be back in my hometown.


I rode this morning on the trainer for 30 mins. I walked on a treadmill first to get warmed up. I made sure to stretch and I even turned the heat on in my room to help the knee.

I didn’t clip in but I was able to ride without any pain or discomfort. I kept it mostly in power zone 1 but I did take it up to zone 3 for a short period. Again no discomfort or pain. I didn’t feel 100 percent but I was happy with the result.

Tonight I got on and clipped in. I had to adjust my cleat so that my toe was pointing in. I only rode for about 10 mins, didn’t want to over do it. No pain, or discomfort.
That's right. Since you had pain on the medial side, you need to use your vastus lateralis to pull the kneecap laterally, to the outside. Turning your toe in while pedaling would do that. Perhaps you've always pedaled toes out, which over-strengthened your vastus medialis (VMO). That would have pulled your kneecap inward and caused the pain. You might think about changing your cleats or moving them so that you have to pedal toes in.

With your mileage, any tiny thing which isn't perfect can create a problem. I pedal toes in sometimes, just for a change-up. Normally, my toes point pretty much forward, centerline of feet aligned with centerline of bike..
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