Knee Pain and Injury

Question

I ride a road bike, mainly on flat terrain. About two years ago following a 100k ride I had major pain in the front of my knees, just above the patella. The pain did not subside, was present during the following rides, and I have not been riding (due to a number of unrelated health issues) at all frequently or for any real distance since.

This is the third road bike I have owned - and I have been cycling seriously for about 10 years and have previously completed a couple of century rides. I do not ride competitively.

I have had two professionals fit and adjust my bike for me - but this was prior to my injury. I now have little faith in their methodology: After all, I wouldn't be injured if the fit was perfect, right?

My preferred course of action, to ensure I don't repeat the injury, is to make small adjustments to my bike to find a pain-free riding position: I am currently feeling tweaks in my knees, in the same location, even though I am starting out slowly by only doing 20 to 30K rides.

Can someone provide me advice on how to move forward with this? Please let me know if you need more information from me. Thanks

Answer 1

The pain at the top of the kneecap is classical patellofemoral pain syndrome -- the most common knee problem. The most direct treatment is simple strengthening exercises for the secondary muscles supporting the knee joint so that the kneecap remains properly positioned -- such exercises can provide relief in 48 hours or less in some cases.

But you should probably consult a sports medicine doc first.

(My personal experience has been that some sort of toe clip or clipless pedal arrangement helps this condition, vs plain pedals, though there are probably arrangements that can make it worse.)

(And probably the easiest way to make the condition worse is to lower your seat too low and pedal too slowly, in too high a gear.)

Answer 2

I think you need to start shorter than 20-30k. That seems pretty far for someone unaccustomed to riding and with health issues.

Fit is important but to assume you will not be injured because your fit is good is wrong. Your body needs to be ready for a 100k ride and still freak injuries could occur. Also they likely fit you for maximum power or speed rather than comfort or to protect your knees. I am not saying that their fitting method was correct either.

Answer 3

The clipless pedals comment needs to be answered. It may be that your feet are at a bad angle compared to your knees.

For example, when my knees are pointing straight ahead, my feet stick out at 5-15 degree angles rather than straight ahead. It caused enough problems that I had to get custom Speedplay pedals in spindle lengths long enough to accommodate that splay, and not lock down the float. One thing you can do to check this is sit on a bench that is high/wide enough that you can have your knees right at the edge of the bench and let your feet dangle. See which way your feet point.

You could also need shims under one of your cleats to adjust for leg length not being the same, your seat may be causing you to rock, or it simply may be that you jump from a 20-30k normal range up to a century, which is quite a difference.