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18283 Views 16 Replies Latest reply: Sep 10, 2012 5:18 AM by AliciaGriffin 1 2 Previous Next
TriZero43 Amateur 13 posts since
Jul 9, 2007
Currently Being Moderated

Feb 17, 2011 6:39 AM

Pain on Inside Right Knee

Hi Everyone,

 

I posted this to the Triathlon thread, but it's probably more appropriate here:

 

I've been experiencing knee pain, on the inside of my right knee, after cycling.  If you were to look straight down at your right knee, it would be just to the left of the knee cap.  I've taken my bike in and had it refit and sure enough the seat was too low however, I continue to have this pain.  I will say that it is inconsistent, as in it doesn't occur after every ride or trainer workout.  I've tried keeping my legs closer to the top tube but I'm wondering if a cleat adjustment might be in order?  The pain usually subsides after a few days and then I'll stay off the bike for a week or two as a precaution.

 

As always, any suggestions are appreciated!

 

Thanks,

 

Tony

  • GarylDavis Expert 46 posts since
    Aug 6, 2010
    Currently Being Moderated
    1. Feb 17, 2011 8:36 AM (in response to TriZero43)
    Re: Pain on Inside Right Knee

    There's a lot of different variables that might be causing this problem.  Let's start with the saddle since you said the height was off...

    1. Whenever you change something on your bike, expect a few days for your body to adjust.  Now on your saddle, whenever you make a height adjustment you need to check for FORE/AFT since it can throw your knee position off in relationship to the PEDAL SPINDLE.
    2. You know about running a plumbline from just below the kneecap to check that it bisects the pedal spindle?
    3. Now you want to check your handlebar height in relationship to the saddle.  Everybody differs depending on whether you want to be more upright or aero.
    4. Work on those (3) areas then go out for a few rides, but NOT too hard and increase your mileage with each ride IF you are not in pain.  See if the pain remains in the same area or changes.  The most important thing to remember is if you start to feel pain...then you need to STOP.  You can only cause more damage and therefore lengthen the time it takes to set yourself up with a proper fit.
    5. If you still have pain, then let's check the CLEAT ALIGNMENT.  My first question..did you adopt a NEUTRAL POSITION on your cleats? That is generally the best place to start.  From there you make minor adjustments to either TOE IN or TOE OUT.  There might also be some considerations with orthotic positioning which should olnly be approached if none of these other methods work for you.
    6. MOST IMPORTANT NOTE: Make sure that you find a competent bike fitter!
  • GarylDavis Expert 46 posts since
    Aug 6, 2010
    Currently Being Moderated
    3. Feb 17, 2011 2:23 PM (in response to TriZero43)
    Re: Pain on Inside Right Knee

    Sure, you can try that with the cleat.  When you walk naturally, you're not pigeon toed I would think.  I would think your toes would point outward based on what you just said.  So adjust to what's natural to you...NOW..don't over adjust because most pedals (you are using clipless) have a certain amount of "float" that will also compensate for you.  Make "small" adjustments only to that cleat until you feel comfortable and then stick with it for a little.

     

    Your mileage and intensity is important so that you don't place too much stress on bones/muscle.  Are you a "masher" or "spinner" when you ride?  If you like to push the higher gear you have to remember that you are adding a lot of stress.  Try a combination if you have to since "spinning" can actually improve your ability to move not only faster, but as some seem to think it is just more efficient for the entire "machine-your body".

     

    Anyway, I'm glad to see that you have a pretty good understanding of the basic concepts, just remember to make your adjustments in small increments and once you find a "baseline"..ie..cleat position (draw or scribe the position on the bottom of the shoe) so when you have to replace them, they will be exact and write these down for future reference...saddle height, how far your bars are below the saddle, etc.

     

    All of that said, make sure you give yourself a little healing time and don't push too hard.  Increase mileage and intensity once you start to feel comfortable and then you will have nothing more to do than maybe a little fine tuning.

     

    Good luck and happy riding.

  • GarylDavis Expert 46 posts since
    Aug 6, 2010
    Currently Being Moderated
    5. Feb 20, 2011 5:27 AM (in response to TriZero43)
    Re: Pain on Inside Right Knee

    The screws holding the cleats should never be loose.  They should be tight.  Float is the lateral movement allowed by the cleat/pedal contact.  In other words..once you clip into the pedal you will notice a small degree of movement both inwards and outwards and to better define that don't you have to literally twist your foot to unclip?  Same principle but it's usually only 7-15 degrees in most cases.  The cleat has nothing to do with float BUT when clipped into the pedal you have a small range of movement.  Float is just the natural movement of your foot when you put pressure on the pedals which can vary.

     

    Hope this helps you.

  • GarylDavis Expert 46 posts since
    Aug 6, 2010
    Currently Being Moderated
    6. Feb 23, 2011 11:48 AM (in response to GarylDavis)
    Re: Pain on Inside Right Knee

    I hope you got out and had a chance to ride.  Hoping to hear some promising news soon! 

  • GarylDavis Expert 46 posts since
    Aug 6, 2010
    Currently Being Moderated
    8. Feb 24, 2011 8:01 AM (in response to TriZero43)
    Re: Pain on Inside Right Knee

    Ahhhhh, that's good news.  Hopefully you found the issue(s).  You alternated then between spinning and pushing the big gears?

     

    Sprints, Intervals etc., are great muscle/power/strength builders for those areas like our knees.  Drop a line if things continue to improve.

  • gegejoven Rookie 4 posts since
    Dec 17, 2010
    Currently Being Moderated
    9. Feb 24, 2011 5:36 PM (in response to TriZero43)
    Re: Pain on Inside Right Knee

    We wish that you can fully recover then pursue your career in triathlon. Your the best.

  • GarylDavis Expert 46 posts since
    Aug 6, 2010
    Currently Being Moderated
    11. Apr 26, 2011 3:41 PM (in response to TriZero43)
    Re: Pain on Inside Right Knee

    Ahhh, well we have adjustment issues again.  So, we have a new bike which is great....congratulations!!!!  There are some things now to consider..Seat tube angle and basically the geometric angles of the NEW vs the OLD.  If you have the other bike, you can start with measuring the seat height on the old and set that for the new.  From the center of the spindle to the top of the saddle.  Then look at the height from the center of the front wheel to the top of the handlebars.  You might possibly see a difference here since you are probably lower (more aerodynamic).  When that changes so does everything else.  Weight distribution and so on. So you have to go back to the basic steps that I gave you earlier.  Did you get new pedals/shoes/cleats...anything along those lines???

     

    Your setup will change but you can readjust based on what you had previously and make your minor adjustments from there.  Remeber the plumb line and just because your hips don't rock, doesn't mean the adjustment is correct.  Try to look for the 35 degree angle when the pedal if halfway through the stroke.  Try these first, give a little time and go from there.  If you marked the positon of the cleats on your shoes and you changed shoes or cleats, then try to align them the same way.  Also if you have new shoes, they may be thinner or thicker therefore throwing the height off on the saddle somewhat.

     

    Do you understand where I'm going with all this?  New bike, new geometry, new fit, but not major differences..only minor.

     

    Keep me posted and we'll work through this.

     

    Have a great day man and keep on boogying!!.

     

    NOTE:  Don't stress the knee.  Give it some rest and increase mileage and intensity in increments as you did before.

     

    If you look at those differences and approach this systematically I don't see why you would need to see the fitter again.

  • David51603 Rookie 3 posts since
    Jan 7, 2012
    Currently Being Moderated
    12. Jan 8, 2012 9:16 AM (in response to TriZero43)
    Re: Pain on Inside Right Knee

    Tony,

      How is your knee now? I am a soft-tissue specialist for Cedar Sinai Doctor's, which means I fix muscular/tendon issues daily.

  • MotiveForcer Community Moderator 448 posts since
    Jul 9, 2007
    Currently Being Moderated
    13. Jan 16, 2012 11:43 PM (in response to David51603)
    Re: Pain on Inside Right Knee

    Okay Trizero,

    Here goes.

    You are asking the right questions. Not all the answers you've gotten here are spot on. Generally pretty good but not completely.

    I've addressed this issue several times in the past here on ACTIVE.com.  I'm sorry that I have not been on site for awhile...

     

    Let me start with a question or three.  Where do you interface with the bike?....   Well, for most of us our hands make contact with our gloves which grab onto the handle bars. Our glutes, etc. fit in bike pants, usually with pads in them, interface with with the saddle, and our feet make contact with our socks, then our shoes which have cleats attached to them and those cleat into our "step-in" pedals. 

     

    I belabor this point on purpose.  There is stuff between our bodies and the bike.  Now, the anatomy of the foot is such that for most of us it tends to pronate. There are three aspects to pronation and the most relevant here is an action called "everting." Most people's feet evert.  When the foot is in what is called the adaptive phase of gate the bones of the foot become loose and pliable. This is a good thing when walking and stepping onto stones and twigs and such but in a bike shoe that is not an issue.  So, your foot is inclined to go to a "weak" place when in a cycling shoe and roll or evert inward.  This can cause stress on the knee straight away.  Why Gary suggested that the last resort to consider is an orthotic adjustment is beyond me.  As far as I'm concerned, it was the first thing to consider.  Getting a good footbed in your shoe could be the solution to your problem that just does not seem to go away. The fact that not one person, including your fitter has not suggested this correction does not surprise me. No one seems to get it. Buy an expensive bike. Get great shoes but don't consider the anatomy of the foot.  Go figure.

     

    So, floatation, what is up with that?  It was not built into the first cleats that came onto the market. They came out because people like me and you had knee problems. It takes the foot away from that pain place in the pedaling stroke BUT at the expense of power to the pedal. As your foot rolls inward it puts pressure on the medial aspect, probably a ligament, or some other soft tissue of your knee as David suggests. If you float away from that pain that is good but your alignment (translation "power") is compromised. Floatation dealt with the symptom and not the problem.  No doubt, that is what the advice you've recieved so far has been as you are dealing with the symptom.

     

    May I suggest that you consider purchasing a set of ALINES.  They are built to be anatomically correct, have been on the market for several years now, are customizable, and reasonable in price.  Go to www.aline.com.  I recommend them to darn near everyone. If you like contact me by email and I can help get a set.  Most dealers guarantee them. They work great in hiking boots, skates, ski boots for sure, and do not compress over time as most of the competitive products that are less anatomically correct.  The captain of my race team, (a former teammate of Bob Roll by the way) got a set and it alleviated a specific back problem and he won he Masters Point series that season here in Michigan.

     

    Adjusting equipment in small increments is very good advice but I'd say that your primary interface on the bike is your feet and this has been neglected.  I took out a set of footbeds from my bike shoes which were custom made and put in the Alines (which I took out of my ski boots) and discovered that they elminated a hitch in my cycling stroke I didn't even realize that I had until it went away.  I'm a master bootfitter in the ski industry and while I've built many footbeds, the Alines are better than most footbeds I've seen come my way.  Start from the bottom up.  Most alignment issues start at the feet.

     

    EJ LEVY

    Motive Forcer

  • GarylDavis Expert 46 posts since
    Aug 6, 2010
    Currently Being Moderated
    14. Jan 17, 2012 10:27 AM (in response to MotiveForcer)
    Re: Pain on Inside Right Knee

    EJ,

     

    As always you are a wealth of advice and I hope Trizero that this is the avenue that will fix your problem(s).  I just wanted to point out that I am/was not against the use of orthotics to correct the knee problem.  It's just that we made some adjustments and we seemed to be on the right track until we changed bikes.  Generally orthotics are or can be expensive especially if you want to have something that is made especially for your foot.

     

    It seems that we've tried just about everything so hopefully this will do that.

     

    Nice to see you back EJ and good luck Trizero.

     

    As always, keep us posted.

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