Hi All,

Thanks for all the responses.  Just to bring everyone up to speed from my last post in April of last year - I saw a sports medicine doctor last April.  He performed some physical tests and took x-rays but couldn't conclude on a diagnosis.  He thought maybe a strained VMO. He prescribed a knee brace for stability which I wore for the rest of the year on training rides (not during races).  I had no issues for the rest of the year and competed in several races.  Took some time off (October, November) and just trained light.  Started to pick it back up in December and yes, the pain came back.  I've noticed the trend that the inception of the pain is always after a session on the bike trainer.  Which doesn't make any sense unless I'm somehow putting my body in a different biomechanical position once on the trainer.  Anyways, did the usual and scaled back on bike riding (there is no pain while running).  The pain went away until this last weekend when I decided mileage wasn't going to be an issue.  My bad.

The pain is too localized (if that is the correct term) to be simply the cartilage under my knee getting inflamed (IMO).  I can point to the spot but the pain is too deep to be sensitive to the touch.  From what I've read online (google university), it sounds similar to plica sydrome as it doesn't hurt during knee extension but more with flexion.  And the area of pain looks accurate.  Still not sure.  I'm also doing strengthing exercises with the bands for the glutes, hips and quads.  Trying to strengthen all the areas around the knee.

EJ, your insight into orthotics to say the least is a beacon of light.  My background is running so I've always associated orthotics with running shoes and never thought of the implications of pronation during cycling.  But it makes sense.  Let me check out the link to Aline and see what they're about.  With regards to float, I changed to Speedplay X series (unlimited float) last year as I was thowing everything at this issue.

David, I am interested in your thoughts as well on the muscular/tendon impact.  I foam roll daily and strongly believe in myofascial release.  Can you recommend any good rolling techniques or preventative exercises based on what you've heard?

Gary, good to hear from you, my man!  Hope you are doing well and thanks for keeping up with me.

Thanks again for everyone's insights.