Knee pain from too much hill work?

phreak

On longer rides I've been getting some knee pain towards the outside of my left knee around the two hour mark. I'm trying to diagnose what is wrong by process of elimination.

I'm fairly certain my bike setup is fine as that has been professionally fitted and has been perfect in the 18 months since (until recently).

I bought some new shoes in autumn last year so I've been wondering about cleat positioning. I'm not convinced it's this though as the problem has only been recent + I've done the dangle legs off the table thing and both left/right are hanging the same, and as both shoes are setup identically it doesn't seem like that could be it.

So I'm wondering if it's the amount of hill work I'm doing. For the last month or so I've been doing 3 60 minute tempo sessions with two bricks under the front wheel, plus a longish ride at the weekend.

Could it just be a case of over-use? What is most likely to be causing this? I'm riding the Mortirolo in July so need healthy knees

seanoconn

Are you stretching? If not, stretch your hamstrings, glues and quads. Take the pressure off the kness a bit.

phreak

No, I don't tend to stretch much. I've seen a few sites suggesting strengthening exercises for the knee as well but not sure what exercises do that. Any suggestions would be great.

irezumi

Could be anything from ITB, patella shifting, to something minor.

It's going to be related to pedal/cleat/shoe setup or muscle imabalance. Could simply be a case of too low cadence/lack of strength causing problems.

This however is all pi**ing into the wind as will any reply on here. Go get professional advice (ie sports physio).

phreak

I'm just trying to think of what has changed recently to contribute to this. I've had the shoes with cleat setup since late August last year so they have been used for a few long rides before with no resulting knee pain, so I'm not really sure it's that.

I was thinking of trying a longish ride with my old shoes to see if they caused pain, then at least I can rule out the cleats, but I don't know if the cause of the pain is there now so will flare up anyway.

turnerjohn

I had the same problem (well sounds like it) was so painful I almost couldn't pedal at all !
My physio said cleat position (which I didn't totally believe) but turns out it was. Cleats can "creep" so maybe they have slowly moved. Its a funny one to sort tho. I ended up working out at what angle my knee started hurting then gradually turned the cleat in the opposite direction...can't go to far as could make things worse the other side...but I sorted a happy medium. Bit of rest as didn't want to damage anything and so far so good...no problems with knees since (over year ago!)
You may also find your new shoes angle your foot differently. I had a new pair of Sidi 6.5's which played hell with my soles...Shimano R300s sorted that out though

sfichele

Get advice from a physio and dont ignore the importance of stretching, especially the hamstrings

twotyred

By putting two bricks under the front wheel you've buggered up a perfectly good riding position. It doesn't mimic climbing on the road. My coach stopped me raising the front wheel on the turbo for climbing repeats for that reason. I suggest removing the bricks. Depending on what you consider tempo then 3 60 min sessions a week may be too much. Try mixing it up a bit with some other shorter turbo sessions.

ut_och_cykla

Cleat position and tiredness in the muscles stabilising your foot would be my guess. It is possible your foot is 'rolling' over the outside edge of the pedal and tired from hill sessions which seek out all irregularities in body symmetry and bike set up. Try moving the cleat so that your foot comes slightly closer to the bike - we're talking 2-5 mm at most. Stretch carefully - thewhole leg chain, glutes to calf muscles. And if it doesn't clear up soon see a physio!!

phreak

ut_och_cykla wrote:

Cleat position and tiredness in the muscles stabilising your foot would be my guess. It is possible your foot is 'rolling' over the outside edge of the pedal and tired from hill sessions which seek out all irregularities in body symmetry and bike set up. Try moving the cleat so that your foot comes slightly closer to the bike - we're talking 2-5 mm at most. Stretch carefully - thewhole leg chain, glutes to calf muscles. And if it doesn't clear up soon see a physio!!

I thought about my cleat position. Did the whole dangle feet from a table thing and they seem to be identical to each other. The left cleat is setup the same as the right one, yet my left knee gets sore whilst my right doesn't.

By putting two bricks under the front wheel you've buggered up a perfectly good riding position. It doesn't mimic climbing on the road. My coach stopped me raising the front wheel on the turbo for climbing repeats for that reason.

That is interesting. I got it from the Carmichael training video. On the hill one he recommends raising the front wheel to replicate riding up hill.

rick_chasey

Are you mashing much?

phreak

Nope. Cadence is seldom lower than 80 on the road. On the turbo it is mainly 85-90.

ballspondroad

Are you using cleats with float ? If you are, don't forget to use it, turning the heel of the foot slightly outwards or inwards when climbing.

ut_och_cykla

SNIP

I thought about my cleat position. Did the whole dangle feet from a table thing and they seem to be identical to each other. The left cleat is setup the same as the right one, yet my left knee gets sore whilst my right doesn't.

SNIP

Bodies are not usually symetrical. If your cleats are identically placed on your shoes - it doesn't mean that both are 'right' for each leg. I'm not talking about the angle your feet want to be at (toes in/out) - more their position on the pedal right/left....if you understand what I'm trying to say....

SBezza

I had a similar problem with my left knee hurting, well I still do sometimes, and mine is linked to a tight ITB.

If I forget about stretching this after every ride, eventually I start getting pain, but if I do regular stretching I don't suffer any pain. When the knee is sore you can actually see it tracking whilst pedalling, and it does it more on the left than the right.

I would try and see a physio however, as there can be a multitude of reason why it is hurting, and not always easy to diagnose over a website.

phreak

Been in touch with a local physio this morning, shall see what they say. I'm guessing though that one with a decent knowledge of cycling would be considerably better than a bog standard physio?

Headhuunter

Knee pain is cycling's most common affliction and I've heard, one of the hardest to diagnose. I would have thought that if the pain is on the outer side of the knee it is more likely to be ITB tightness pulling on the knee cap. I would seriously consider doing regular stretches, both before and after rides and on a daily basis. A foam roller is useful in stretching the ITB.

I heard from a physio that of all athletes, cyclists are possibly the worst at actually warming up/down, stretching and generally looking after their bodies. They tend to be much more focused on what could be wrong with the bike or upgrading some component than actual bio-mechanics. I've had various aches and pains over the years, wll of which seem to have been settled with some regular stretching and since I've started stretching on a daily basis I've barely had any recurring problems.

As you say, you may also want to consider strengthening exercises. I've heard that it's fairly common in cyclists (and runners as well as other athletes) that the outer muscles which make up the quads often get much stronger than the vastus medalis (the teardrop shaped muscle on the inner, lower, upper leg). Strengthening the vastus medalis can help....

Anyway, best thing to do is speak to a physio and not focus purely on the bike....

tjhooker

I had some knee pain like you describe at the beginning of the year. For me it was definitely ITB. Strengthening my hip flexors and raising my saddle a touch were what sorted me out.

phreak

I'll give stretching a go. What are some good ones for ITB related stuff?

Headhuunter

phreak wrote:

I'll give stretching a go. What are some good ones for ITB related stuff?

I find the ITB quite hard to stretch without a roller. I bought a foam roller and I rest the side of my leg (the ITB) on the roller and roll up and down. It's pretty damn painful to do to begin with, especially if your ITB is tight but if you do it daily, it starts to loosen up and is easier to do.

To start with I supported the side of my leg with my other foot so that not all my weight was pressed onto the roller. I started to notice that my knee felt smoother and more flexible after a while of doing this. You have to stretch regularly though. Before and after rides and ideally take a bit of time each day to do some stretches. You can't do it a couple of times over a week, give up and then expect the problem to be sorted. You muscles will take a while to become more flexible but it's worth it...

phreak

Seen this video on YouTube. It's cycling specific so might be worth a go.

http://www.youtube.com/watch?v=IzUZ36qv ... re=related

phreak

Went to the physio last night and she said it was caused by weak(er) hamstrings in my left leg, so I have some stretches and exercises to do to build that up.