Horrible knee pain! Please help

cyclingkate

Hi guys.

I am a female rider. I was new to cycling about 6 weeks ago.
For the past few weeks, I have suffered with terrible knee pain, only in my left knee.
It is a little sore for the first 5 mile but then becomes very painful.
It feels painful within the knee joint, as well as just below and just above my knee cap. It is also sore on the medial side of my knee. No lateral pain.

I have tried raising my saddle, altering fore/aft position, although im far from an expert on cycling position. I have been trying to just spin, but as I live in a moderately hilly area, it's unavoidable my knees have had to put up with a little bit of load at some points during a ride.

I have been saving up for clipless pedals, so have been using toe clips. Could these be the problem?

I can't continue with this knee pain and, as a medical student, I know it is not wise to continue abusing my knees!! Can anybody share some experiences or offer some advice please?

Thanks!

MikeBrew

Are you using clip in pedals ? If so, you could be down to fore and aft position of these as well as their alignment. For instance if you are naturally pigeon toed or even Chaplin-esque, yet have the cleats holding your feet perfectly in-line, your natural unconscious tendency to try to return your feet to their usual orientation/angle will put a twisting tension through your knees. Pedals that allow a certain amount of rotation or "float" help.
The best advice though is to invest in a professional bike fit.

cyclingkate

MikeBrew wrote:

Are you using clip in pedals ?

I am using toe clips. I am currently trying to save for clipless.

frisbee

6 weeks isn't a huge length of time, it takes the body a while to adapt to cycling and sometimes you just need to take a break for niggles to recover.

Its worth checking how your feet and legs are aligned when pedalling. Are your left toes sticking out more than your right? Is your knee tracing a good circle or sticking out at the top?

MikeBrew

Toe clips could affect how you hold your feet you in a similar way. They say that if you sit on a table and let you legs dangle your can observe your natural foot angle. Gears that are too big also put extra stress through the knees.
A bike fit really is the best way forward though. Not cheap but the investment will repay you tenfold in the long run.

cyclingkate

MikeBrew wrote:

Are you using clip in pedals ? If so, you could be down to fore and aft position of these as well as their alignment. For instance if you are naturally pigeon toed or even Chaplin-esque, yet have the cleats holding your feet perfectly in-line, your natural unconscious tendency to try to return your feet to their usual orientation/angle will put a twisting tension through your knees. Pedals that allow a certain amount of rotation or "float" help.
The best advice though is to invest in a professional bike fit.

Thanks for your advice, it is appreciated. I am using toe clips. They are tight though so my feet don't wobble.
I have a feeling a fit is inevitable. As a student however, it is a very expensive outlay. Although it would be worth it in the long term I'm sure.

cyclingkate

MikeBrew wrote:

Toe clips could affect how you hold your feet you in a similar way. They say that if you sit on a table and let you legs dangle your can observe your natural foot angle. Gears that are too big also put extra stress through the knees.
A bike fit really is the best way forward though. Not cheap but the investment will repay you tenfold in the long run.

Am I ok to post a photo of my cycling position please? Just to give me a rough idea if it looks about right?

MikeBrew

Thing about your knees is that, short of getting into the realm of things like autologous chondrocyte implantation, once your cartilage has gone, it's gone for ever. Look after them

cyclingkate

frisbee wrote:

6 weeks isn't a huge length of time, it takes the body a while to adapt to cycling and sometimes you just need to take a break for niggles to recover.

Its worth checking how your feet and legs are aligned when pedalling. Are your left toes sticking out more than your right? Is your knee tracing a good circle or sticking out at the top?

Thank you for the advice. I havent noticed one sticking out more than the other, but I will look next time I am on my bike.
is it possible to post photos on here for comments on cycling position please?

kajjal

Knee pain on a road bike is not unusual until you get your bike setup correct. It normally happens after longer distances or if you ride hard as this shows up setup issues more.

Using toe clips can be uncomfortable and give an unnatural foot position. If you can cycle without them your feet find a more natural position by themselves. Light weight mountain bike flat pedals can help as they grip well and are quite wide.

Also check your saddle is not too high as this will cause various pain as you over stretch down to the pedals. Symptoms of this are feet pointing down when the pedals are at the bottom, rocking on the saddle and generally over reaching to the pedals.

Look up KOPS as this helps get the saddle fore / aft roughly in the right position and you can adjust from there.

The main thing is take your time making adjustments and it may take a few test rides to get it right.

cyclingkate

Here are two (rubbish quality) photos of me on my bike, one at the bottom of the pedal stroke and one at horizontal. What are your thoughts please?

sungod

i'd recommend backing right off until you're recovered, it may simply be overuse when you're not used to it, but tbh what you describe sounds like there is some other cause

as mentioned above, be aware of how your feet/knees are moving, having them move in a plane parallel to the long axis of the bike is typically what you want, but not everyone is the same, nor even symmetrical, so beware of following dogmatic prescriptions about what is 'right'

for instance are you flat footed? this can cause knee pain, you can check for pronation walking barefoot, if your ankle 'rolls' inwards as your weight goes on, then that's a sign that arch supports might help

this gives a straightforward explanation of different pain/likely causes, maybe it'll give some clues...

http://www.cptips.com/knee.htm

you don't need to spend on a bikefit, unless you've some unusual problem you can diy perfectly well - though you'll need basic tools to adjust things, worth having a friend to help while you do it

steve hogg's site has some good advice, two key articles are...

https://www.stevehoggbikefitting.com/bi ... can-it-be/
https://www.stevehoggbikefitting.com/bi ... oad-bikes/

maryka

Post a pic if you want (upload to somewhere and link to them), but better is to find some experienced cyclists to ride with and have them watch you. A surprising number of people bow their knee on one side (or both) outwards, or point their toe in or out and don't even notice in when they're riding. Or have a wrong saddle height. If you have a leg length discrepancy you could be struggling with that, given that your pain is on one side only?

I'd also remove the straps from your pedals for now and ride without them and let your feet go where they want to, see if that helps. Give yourself a few days off the bike then see.

Have you got enough gearing to get up and over hills? What's your cadence generally, on the flat or going uphill?

Edit: just saw your pics. Saddle is too high.

imposter2.0

maryka wrote:

Edit: just saw your pics. Saddle is too high.

Gotta love the internet. I would have said the exact opposite.

cyclingkate

Imposter wrote:

maryka wrote:

Edit: just saw your pics. Saddle is too high.

Gotta love the internet. I would have said the exact opposite.

Oh no :roll:

cyclingkate

maryka wrote:

Post a pic if you want (upload to somewhere and link to them), but better is to find some experienced cyclists to ride with and have them watch you. A surprising number of people bow their knee on one side (or both) outwards, or point their toe in or out and don't even notice in when they're riding. Or have a wrong saddle height. If you have a leg length discrepancy you could be struggling with that, given that your pain is on one side only?

I'd also remove the straps from your pedals for now and ride without them and let your feet go where they want to, see if that helps. Give yourself a few days off the bike then see.

Have you got enough gearing to get up and over hills? What's your cadence generally, on the flat or going uphill?

Edit: just saw your pics. Saddle is too high.

Thank you for your advice it is appreciated. I will swap over the pedals to some flats tomorrow. My cadence is usually about 70-90.
I have no issues with actually riding up hills with the gears I have, and could probs ride twice the distance I have been doing, if it weren't for my knee pain!

MikeBrew

Going to back to what Sungod said Ref pronation, your soft soled trainers in the picture wouldn't help in that respect. If I was you though, I'd try a ride with the toe straps loose enough to let you feet swivel to where they naturally fall.
And without wanting to sound too much like long John Silver's feathered mate, I'll say it one more time - bike fit

Lookyhere

i think your saddle is way too low and i reckon you should raise it 5mm and then try another 5mm.
for most people, inseam (bare foot, crotch to floor) minus 10cm gives a reasonable starting point, measured from centre of crank to top of saddle, tape measure to follow mid line of seat post.
you are wearing trainers which as well as being very thick soled (so you might want to try minus 9cm) offer zero support, so this might be causing you issues too.

What size feet have you? i ve my daughters old Mavic and Sidi shoes 39/40 plus some LOOK keo's that i d sell for a very reasonable price, they d just need cleats.

maryka

Apparently I'm outnumbered in the saddle too high category, but I'm going off photo #1 where her right crank is vertical but the knee angle looks pretty open and the heel is fairly raised. Again, hard to tell from one pic so it would be useful to ride in front of someone who could watch your legs/hip movement from behind. Or a bike fit as others have said.

Sleeper Service

Saddle looks too low to me, as your leg is still pretty bent at maximum extension in the first picture.

My wife had this problem with her hybrid. Two minutes with a hex key and the world was a much happier place for her.

kajjal

maryka wrote:

Apparently I'm outnumbered in the saddle too high category, but I'm going off photo #1 where her right crank is vertical but the knee angle looks pretty open and the heel is fairly raised. Again, hard to tell from one pic so it would be useful to ride in front of someone who could watch your legs/hip movement from behind. Or a bike fit as others have said.

You are looking for the right signs, normally a foot pointing down means the saddle is too high. In this case the uncomfortable position the clips are making the leg go into make it hard to tell either way.

maryka

My other half also thinks your bike is too small on you....

cyclingkate

maryka wrote:

My other half also thinks your bike is too small on you....

Thank you for your feedback. It's funny he says that. At the Specialized store I measured smack bang in between size 51cm and 54cm top tube size. I went for the 54cm.
Was he referring to my reach or general position?

imposter2.0

The bike is not too small - it's fine. And even if it was slightly too big or too small (which it isn't), it should not prevent you from achieving a viable position on it. Either way, the saddle needs to go up, not down. Lift it by at least 10-15mm to start with - personally I'd look at shifting it forward by 5mm as well.

DeVlaeminck

Hard to tell just from a photo but I'd lean more towards Maryka that the saddle is if anything too high and I'd be tempted to say maybe too far forwards.

That said there's a good chance this is just overuse / adaptation unless you feel lateral or medial pressure/movement on the knee joint as you pedal in which case it could be the trainers or a biomechanical issue.

gazrichards

As a sports therapist and owner/operator of a sports injuries clinic and bike fit studio I would say that your saddle is a tad too low.
Do not pay for a bike fit as you are so new to cycling that your body will adjust to positions as you ride more and you are probably still riding relatively short distances etc. Get the shoes and pedals first (but when you fit the new pedals your saddle will have yo come down as the stack on your cycling shoes will be lesser than on your trainers)
You probably have some tendinitis brought on by over use or over keenness to ride as much as possible. Rest will not necessarily make it go away alone and as a medical student you probably understand that treatment is required as well as a bit of rest.
The most likely thing is tight quads causing some issues with knee tracking. The poor position of your bike fit will have accelerated this too.
Loads of quad stretches and glute stretches (glute strength is a factor in knee stability and women are more susceptible to knee problems than fellas I think due to the wider hips)
Some foam roller work will help stretch and repair your muscles too but there's no need to go over board with any of it just yet.
Feel free to pm me and I'll sort some links out to self treatments you can do but there should be no need to pay out for anything but shoes and pedals yet.

cyclingkate

DeVlaeminck wrote:

Hard to tell just from a photo but I'd lean more towards Maryka that the saddle is if anything too high and I'd be tempted to say maybe too far forwards.

That said there's a good chance this is just overuse / adaptation unless you feel lateral or medial pressure/movement on the knee joint as you pedal in which case it could be the trainers or a biomechanical issue.

Thanks for your advice

cyclingkate

gazrichards wrote:

As a sports therapist and owner/operator of a sports injuries clinic and bike fit studio I would say that your saddle is a tad too low.
Do not pay for a bike fit as you are so new to cycling that your body will adjust to positions as you ride more and you are probably still riding relatively short distances etc. Get the shoes and pedals first (but when you fit the new pedals your saddle will have yo come down as the stack on your cycling shoes will be lesser than on your trainers)
You probably have some tendinitis brought on by over use or over keenness to ride as much as possible. Rest will not necessarily make it go away alone and as a medical student you probably understand that treatment is required as well as a bit of rest.
The most likely thing is tight quads causing some issues with knee tracking. The poor position of your bike fit will have accelerated this too.
Loads of quad stretches and glute stretches (glute strength is a factor in knee stability and women are more susceptible to knee problems than fellas I think due to the wider hips)
Some foam roller work will help stretch and repair your muscles too but there's no need to go over board with any of it just yet.
Feel free to pm me and I'll sort some links out to self treatments you can do but there should be no need to pay out for anything but shoes and pedals yet.

Thank you so much for taking the time to offer me some advice.
I think the general consensus is that my saddle is slightly low, so hopefully if i raise it by 5-10mm, it might help.

If you could offer some advice on some stretches I would appreciate it very much.
Thanks again.

cyclingkate

Imposter wrote:

The bike is not too small - it's fine. And even if it was slightly too big or too small (which it isn't), it should not prevent you from achieving a viable position on it. Either way, the saddle needs to go up, not down. Lift it by at least 10-15mm to start with - personally I'd look at shifting it forward by 5mm as well.

Thank you for your advice. I think I will go with majority and raise my saddle by small increments. Hopefully it will help

MikeBrew

http://www.fix-knee-pain.com/cycling-knee-pain/

darkhairedlord

You can't fix your knees on the internet!
All that self-help, self diagnosis and treatment is likely to do is prolong your injury.
Go and see your doctor, they will then send you to a physiotherapist.