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I'm a guy with banged up knees. I'm trying to decide if it is worthwhile for me to splurge for a high-end bike fitting or go with a more ordinary fitting or skip getting a fitting altogether.

Background

  • One of my knees is missing a whole lot of articular & meniscal cartilage.
  • I'm experiencing knee pain while going for relatively short distances (at the beginning of the ride & after 10-12 miles).
  • I ride with Speedplay Frog pedals. I'm turning 49.
  • haven't had a fitting since January 2012.
  • I don't race or do group rides.
  • If my knees were solid, I'd like to do social rides or even go touring.
  • I ride a Surly LHT & use it for commuting & shopping.

It is more accurate to say I "used" the bike for those purposes. I'm pretty much not riding now because doctors have told me that knee pain=fresh damage. I have the option to get 1) a run of the mill fitting similar to the 2012 fitting from a well-regarded bike shop or 2) get a fitting from a physical therapist who works with racers, triathletes, etc. I've been to a lot of physical therapists & surgeons without much result at this point. (Most seem have expertise with runners but none have any background with bikes.)

My last fitting was useful but I can't say it was ever quite right. I had joint issues back then which likely made the fitter's job impossible. I went back to the fitter a few times without much success. I mean, there are only so many adjustments you can make to the seat position right?

At this point, I'm looking to avoid throwing more good money & time after bad. Maybe I should just get platform pedals? I keep seeing posts pointing to clipless pedals as causes of knee issues.

Perhaps I should just get a recumbent to limit knee strain?


Hi everybody, Thanks for the rapid & thoughtful responses. I was very interested to read about Power Cranks and Highpath engineering's split cranks. Here is some more background & some responses to the recommendations:

  • I have 150 mm crank arms mounted.
  • I am slow on the cadence. My core is weak so my pelvis wobbles at higher RPMS.
  • I’m sure I need work on my pedaling technique. When I try to pull up on the pedals, I end up with tendonitis behind the knee.
  • I’m happy to warm up with a gentle beginning to a ride but I’m getting pain pretty much pulling out of the driveway, before I have a chance to start the warmup.
  • I don’t really trust the physical therapist/fitter I found. He works with a sports medicine doctor I found & both run a “factory” practice. They move you in & out on the clock. I have some complex medical issues & neither showed any appetite for exploring them during a recent evaluation. My sense is they are there to make money & serve racers. I won't get either of them any publicity & so am not useful. I've run into providers like this before. They have the skill to help but maybe not the will.
  • I’d be happy to see someone other than the PT/fitter but have had little luck in finding someone with expertise in both bikes & rehabilitation.
  • I did find a fitter at the bike shop who worked for a couple years as a physical therapy assistant. I could see him as well. Based on the above do any of you have further thoughts?
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    I think more important that how much you pay is who you pay. Look for a fitter with a background in rehab rather than pro tour fittings. If articulation is the issue, look for option such as Power Cranks and Highpath engineering's split cranks. Short cranks make a world of difference. Consider an EBike. There are many options to allow you to keep riding, BUT you need the right person to advise you. – mattnz Sep 26 '16 at 23:23
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    Would a recumbent actually reduce knee strain? – Nathan Knutson Sep 27 '16 at 3:41
  • I would look into a full approach to the issue. You already say your core is weak, strengthening your whole body may be necessary. Knees do not work in isolation, hip and back and glutes etc may help or hinder your knee work. Even upper body, I dare say. Mobility and flexibility and strength, you must address all and invest time on your body, don't let this send you to the couch. Work on the issue don't expect it be magically gone by paying a sum of money to wizard fitter – gaurwraith Sep 28 '16 at 15:40
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My advice is that you consult a sports medicine specialist, for example a physiotherapist, especially one who specializes in knees.

Once you find such a person, find a second. Sometimes you just don't get along with them. For me, I have to feel I can trust the person, and get honest discussion of the options and the pros and cons.

While bike fit may be an issue, it's only one approach. Other things to be considered are

  • gearing. Perhaps you just need to pedal at a higher cadence.

  • power and speed. Perhaps you're just trying to pedal too hard for that knee.

  • technique. Perhaps pulling up more would reduce the load on that knee.

  • crank size and cleat positions. These can both have an effect on knees.

  • warmup and cooldown. Getting symptoms at the start sounds like lack of warmup.

Find such a sports medicine specialist, and work with them as they evaluate your options and manage your progress.

Following your edit here are some additional points

  • wobbling pelvis and pain at the back of the knee are both symptoms that your seat is too high.

  • just as an idea, you could try a topical warming agent (ointment) to help with the warmup.

In an earlier version of this post I suggested Voltaren, recommended for me by my physio. I think that was unwise of me - you should obtain professional medical advice. Voltaren is an anti-inflammatory drug, available under prescription in the US. Some researchers warn against it's use.

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    As an example, I have a century ride coming up in a couple of weeks, but have developed a knee injury. Ideally, this injury should be rested until recovery, but I would miss the ride. My physio is working with me to help me get there. If he told me that he advises against riding, I'd listen. But he also understands my particular attributes, having been my physio since '78, through various broken bones, dislocations, strains and sprains. Get someone you trust, and who understands you. – andy256 Sep 27 '16 at 6:03
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Trialling a recumbent is a great plan - don't just buy one, find the local users group and explore the options and shapes. They're not cheap sadly. Options like handcycles exist too, which free your knees from strain totally.

Also try flat pedals for a bit and see if your feet move around without the clipped bits holding your foot down. Could be your knee needs some freedom?

An electric assist bike might be right up your street - you push a little and the bike helps your effort. Imagine an exoskeleton that looks like a bike!

Based on the medical nature of the cause, you're indeed in need of physiological input - Matt's comment is right in that you want advice from a medical fitter, not a bike shop targetting racers.

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    I agree I need to avoid a racing focused fitter. – CommuterBiker Sep 29 '16 at 0:01
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I have a bad thigh, knee, and shoulder on my left side from an IED blast in Iraq. I have so much metal in my body that my x rays look like the skeleton of wolverine from the x men, so I hear you on the pain when riding; I don't think a fitting is worthwhile for you.

I have a Giant Talon size large hard tail mountain bike with the 27.5 tires that I find to be very stable on and off road and nice front shocks. It cost about 650. Alluxx frame is light but sturdy which helps and the low gearing of a mountain bike is great for when the knee pain is bad.

I'm not sure if clip pedals would help or not. Lots of aspirin, icy and hot, hot baths.

I had to stop the opiates which was hard but good in the end.

Physical therapy I find to be of no help.

Personally I think the fact that you are riding through the pain and have a winning attitude is what's gonna get you back to possibly touring.

Good luck sir.

  • So, what your answer to "is a fitting worthwhile to me?" Please read our Tour which is found in the Help menu, to learn how SE is not a chat forum. – Criggie Sep 28 '16 at 23:49
  • Hi Mr. Durden, Wow, thanks for your service to our country. I'm so sorry thatyou have sustained such injuries but happy to hear you remain able to ride. I haven't had much luck with physical therapists either. I want to caution you on the use of aspirin & NSAIDs for pain & inflammation. They are terrible for your digestive tract. They ruined mine :( – CommuterBiker Sep 29 '16 at 0:00
  • @Criggie If you check the numbers under the post author's signature, you'll see he has a bronze badge. If that's the case, check their profile. In this case you'll see he took the tour before writing the answer. – andy256 Sep 29 '16 at 0:47
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    Welcome to Bicycles @Mr.Durden. Good to see you've taken the tour, and good to hear that you're still riding. Don't worry about the abrupt welcome; this site is moderated by us, with all our human imperfections. I have also at times been less helpful than I could have been. In any case, do have a look at How to Answer. I believe that you are implicitly saying that a fitting is not the way to go. My own answer also does not directly answer the fitting aspect, and it would probably be more helpful if we did. – andy256 Sep 29 '16 at 0:59
  • You are correct about my implication @andy256 and I am certainly imperfect, no hard feelings towards any of you guys. – Mr. Durden Sep 29 '16 at 1:20

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