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Author Topic: Cyclist with mild (but debilitating) Medial Knee Pain.. experiences, advice?  (Read 47341 times)

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Offline jvanv

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The Background
After 15 years or so of knee-pain-free cycling I came down with a case of medial knee pain just 2 weeks before my only long event of the year (240km, 5500 meters of altitude gain, 9-10 hours I hope).
I ride long distances, generally 4-5 hours several times per week. 
I am 30 years young.
I have raced at the highest level for may years with several friends who are world/national champions.
Riding 4-6 hours is not overly taxing on my body as I normally can do it several days in a row.

The Pain
The pain is on the inside of my left knee near where the quad meets the knee. The pain is at the 4:30 position from the kneecap (perhaps 15-20mm from kneecap) (with 12 oclock being towards your foot, 6 oclock towards your head). It is just above the widest point of the knee (when leg is straight, at the widest point when knee is flexed)  where the inside quad muscles join the knee.  There is a dull pain when I apply pressure with my finger but it isn't terrible.  The "size" of the painful area is about the same size as my finger pad when I press it.

- Can ride for 30 minutes to 1.5 hours without much pain.
- When pain starts, it feels as though someone is grabbing my leg just above the knee (laterally) with their hand and starts to increase the pressure on the inside.
- After 1.5 to 2.5 hours the pain is unavoidable and fairly consistent. Ironically, downhills where I pedal easily (or after I stop pedaling and start again) are the worst.
- The pain occurs mostly at the downstroke.  Increasing power increases the pain. When coasting, having the pedal at the 12 oclock position (maximum knee bend) is pain-free.
- The other leg feels great
- off the bike immediately after the ride, walking is not painful. Only really noticeable when climbing stairs (and mildly painful descending) - not as painful as cycling but I notice it.

What happened
I did a hard ride last week (my last pain free ride) but the next day the pain was noticeable early in the ride. Took 2 days off. Today's ride was just as bad.

My Questions
So what is this injury? A ligament thing? Meniscus thing? MCL? Overuse? Quad muscle thing (where it joins the knee)?
What do I need to do to "heal" for my event in 2 weeks?
How can I prevent this?

My setup
- Speedplay X1's - recently switch from X2's that have a slightly longer (by 3mm) spindle
- Sidi Genius 5.5 (Specialized BG footbeds - the one's with the raised area above the ball of the foot)
- LeMond Wedges that adjust your connection to pedal to accommodate for valgus / varus (have 2 wedges on the foot that feels good due to a foot/ankle pain that has since been cured with the wedges) On the painful side, no wedges currently.
- VumaQuad crank 146mm q-factor (width between pedals) (recently switched from an Ultegra (150 q-factor), and also an Easton EC90 (147.1 q-factor)
- saddle position: zero-setback post with rails in the "middle" position (recently switched from setback Ritchey where the seat was slammed all the way forward
- pedaling style: toe down
- foot position: generally straight but speedplay's free float allows for toe-in, or toe-out as needed
- Cleat position: spindle over ball of foot, laterally in the "middle" position. Tried moving the painful leg's cleat to the inside (foot moved further away from crank) but it didn't seem to help.
- other things:
-- I have flat feet
-- I have long legs (34" inseam (86cm), but I'm only 5'11 (181cm))

Thanks for any advice!

Offline mollyc

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HI there: I don't know much at all about cycling, but do know that the pain you describe is exactly where I felt pain from my torn MCL..except, I felt it at both ends of the MCL above and below the knee.  I felt it when I put direct pressure there with my finger as you describe, but also when I did any weight bearing with my knee bent (squats, stairs, lunges, bike with resistance). Resting, elevating, and icing were the thing to do to allow the MCL to heal. It took mine a long time to heal, even though it was only a grade 1 tear...but, I had a lot of other things going on with my knee as well, so that might have complicated the healing process (ruptured ACL, bone bruise, soft tissue damage, swelling). 

I have some devoted cyclists in my family (one of whom reads this board..hi Cara!), so I know how hard it is to not be able to cycle at the level to which you are accustomed. I wish you luck figuring out what is going on with your knee and moving towards recovery! Molly
Ski accident 2/14/09
Ruptured ACL, MCL sprain, bone bruise
ACLr allograft 5/27/09
Knee now 100% fine...skiing and playing tennis regularly

Offline NadiaMac

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I have no idea what is causing your pain, but you describe several recent changes to your equipment (crank, pedal spindle length and saddle position), as well as assymetric foot beds in your shoes. My hunch is that you have an overuse injury related to position change from the new equipment.  Can you get yourself to an experienced fitter, preferably someone with PT experience?  Or return to the old configuration?

My BF is an avid cyclist and he's had pain relief from very subtle changes in his fit (eg, adding shims to one shoe, changing saddle setback by a couple of mm).  My point being that small changes in position can lead to pain, especially when you are riding long and hard.

What's the event?
4/09 MTB crash, severe patellar impact. MRI cleanish, but lots of pain
6/09 start PT, cortisone, synvist
10/23/09 scope: medial plica excision, lateral meniscectomy, chondroplasty

Offline sailchic

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Wow... I'm in awe of your training schedule.  I'm training for my first century (100 miles/161km) at the end of September and barely have enough time to put in enough in the saddle to get ready for that!   

No good ideas on the injury, but have you thought about getting your setup checked at your LBS, particulary since you've been changing out components?  I know some of the ones around where I live have some really sophisticated equipment that can determine your optimal setup... they adjust your bike from there.  I figure they're experts at dealing with this kind of thing. 

Good Luck!


11/02 L LR, Medial Reefing,
9/05 L TTT, Medial Reefing
9/06 L unscrewed, LR repair
12/07 L TTT revision
12/08 L unscrewed
12/09 R TTT
5/10 R unscrewed

9/11 L MPFL & LPFL repair, VMO adv. -- "global tightening"

EDS Classical Type

Offline Nubes

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Im an avid cyclist as well, and the pain your describing could be several things..I suggest you go see an orthopedic Dr because it could be torn cartalige? might even be as simple as having too much float in your pedals(I ride DuraAce) but I always thought Speedplay pedals offer more lateral float? maybe your over training alittle and are getting some tendonitus issues in your knee? you know in cycling, the littlest change can cause the biggest problems sometimes? maybe go back to your original set up and see if the pain is still there? I ride competively but not at your level, one of our teams sponsors is an Orthopedic doctors office so I can usually get in pretty quick!

Offline nanoblade

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Sorry for draging up an old thread, but I was wondering if you managed to rectify this pain for the race or in the longer run?

I've been searching everywhere for someone having similar problems to me, but not found anything till now, your problems are identical to mine.

- First half an hour or so is pain free, and it then comes on slowly or fairly suddenly on hills. Again, I ride 4-5 hours at a time, or used to anyway and this is crippling me from training.
- The pain is in the exact same location, except on my right knee, where the quads join the knee at around 8:00 on a clock face.
- The pain is dull mostly, but very very sharp at the top of the pedal stroke when attempting to put down any decent power.
- I have zero problems doing anything else, and can even go running straight off the bike for 30mins+
- I took 2 weeks off cycling, and everything felt fine then within 30mins of my first light ride I had exactly the same pain again.

I would really appreciate if you saw someone about this and discovered the reason?


Offline mkkl

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Any further luck with your knee pain? I recently started experiencing exactly the same thing.  No swelling or no warmth and the pain disappears almost immediately once I stop riding. 

In my case, I'm thinking the root of the problem might be up in my in hip. 

Anyway, I'd appreciate any input...

Offline xcrubow

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this is an old topic, but for anyone looking online for a solution, this sounds like something due to fit. i have this pain too when on a non-fitted bike for over 20 minutes. its probably due to external rotation of the foot while cycling. it can be controlled with an orthotic or cleat adjustment (usually). the cleat has to be brought towards the outside of the shoe to cause the foot to rotate internally.

i'm not entirely sure of the treatment outside of fitting adjustments, but you can consult the orthopaedic literature on google/google scholar for that, or ask a doctor.
« Last Edit: July 14, 2011, 02:20:33 AM by xcrubow »

Offline kristine24

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Hi jvanv,

I've been having the same exact issues that you described in your post. I've been biking to work every day for 3 years and doing longer rides during the summer with no issues. One day after a long ride my left knee hurt and it hasn't gone away since and this was about a month and a half ago. I've been stretching and seeing a chrio but we haven't been able to fix it yet...I'm wondering if you found a solution to your knee pain from cycling. I would greatly appreciate any help with this!!

Offline jtrue

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Hi jvanv,

I've been having the same exact issues that you described in your post. I've been biking to work every day for 3 years and doing longer rides during the summer with no issues. One day after a long ride my left knee hurt and it hasn't gone away since and this was about a month and a half ago. I've been stretching and seeing a chrio but we haven't been able to fix it yet...I'm wondering if you found a solution to your knee pain from cycling. I would greatly appreciate any help with this!!

Hey Kristine,

I had a similar issue and for me it had to do with q-factor.  Riding my mtn bike I was fine, but switching to a road bike with a narrower q would "flare" up my medial knee.  No noticeable swelling, just a weird irritation that I couldn't get to go away. Since that time I've started using Speedplay pedals with longer custom spindles.  Not saying this is going to cure your issue, but one more thing to play with.  If I get on a bike with a narrower q-factor it takes a very short time to flare it up.  I've been to numerous ortho guys and had a couple PTs look at it.  They haven't been able to tell me anything.  I haven't had any imaging done yet, and don't think I will need to if I continue to pay close attention and make sure my q-factor is consistent across all of my bikes.

Offline heners

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Hello all,

Old thread I can see and several cases but no feedback with a cause.

I myself have exactly the same issue as the first post except its LATERAL not MEDIAL. I must admit I am not a pro racer but would consider myself a good amateur, 200k weeks were standard, until March that was. Then this pain developed during a 130k ride, happened at around 80k. As stated above its the same location, intensity etc.
This has been on going for 4 months now, I cannot ride more than 80k without it starting, recently it has now reduced to 30k.
Initially i thought it was ITBS, but doesn't hurt to run, isnt sore etc, I've tried various things over the last 4 months, deep tissue massages, foam roller, taken a 4 week rest period, been to see a physio or 2 months, strengthening exercises, stretching, bike fit, nothing seems to work.

I've recently been referred to a knee specialist for a CT but waiting for an appointment.

Reason for bring this thread back is there is a lot of coverage about knee pain and cycling, but not the same location or circumstances as stated above, this is the only forum

Thoughts would be great


« Last Edit: July 13, 2014, 06:15:14 PM by heners »

Offline turbostar

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Time to do Hip excercise's, recon that's where the problem is. All the best

Offline heners

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Thoughts behind that would be ace

Tried lots of exercises

Offline heners

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So just for anyone's future reference if they are unlucky enough to come across this forum searching for an answer many of us have...................

I went to a knee specialist via my heath insurance 

Explained the issue

He did a test caused Stienman 1 on my knee, along with Mc Murray's

Sent me for Ultrasound and an MRI

Ultrasound showed that I have a grade 2 out of 3 tear to both my lateral collateral ligament, and ITB

MRI results not in yet, but this is to show a lateral Meniscus tear.

Thought being if I have had enough trama to damage the ITB and Ligament to a grade 2 out of 3, the likely hood is that the meniscus is damaged too

What does this mean...........
Basically 2 options
If its only the ITB and Ligament, no surgery, deep needle therapy, along with blood injections taken from my arm to promote healing in the tissue (generally poor blood supply), with a 12-15 week recovery period off the bike.
If the meniscus is torn then key hole surgery with around 8-10 weeks off the bike, then see if the DN therapy is required