8 Months of indoor Cycling and still cannot shake knee pains. Desperate for help!

Hi all,

Looking for some guidance here. I picked up a Peloton stationary back in February of last year as a dual purpose for my wife to get some exercise in (we have 2 young kids now) and for me to do some training on for dinghy sailing and get some good cardio in on a restricted schedule (nice to ride super early in the morning or late at night). Since day 1, I had some knee pains and messed around with shoes and bike fitting for awhile… going from what I read about being optimum, to have a much lower seat with a much wider q-factor, pedal spindles over middle of shoes, even shorter cranks. Sometimes I would get temporary relief but the pain always came back, often in a worse/different way.

I had two online bikefits because there are not good Bikefitters where I live (Puerto Vallarta, Mexico area) to my knowledge. They had some varying opinions based on my videos and I made the recommended changes, still knee pains. By the way, no cycling = no knee pain.

Eventually I spent part of the summer working in Oregon and had a bikefit done in Portland on a Retail, then another done in San Fransisco on a Peloton with P-fts/Pedro. Pedro ripped out all the wedges and other modifications the other guy made to my shoes/cleats and basically put me back to where I initially started when I first got the bike and was reading about optimal positioning.

I returned home to give this new/old setup a try and have the pain creeping in again. It is mostly right side, anterior but also a bit under the knee cap, at the top more. Sometimes it comes on left side in a similar fashion. I have tried a lot of stretching/yoga afterwards and core activation, glute activation and this does help the recovery but it still doesn’t feel right while riding. I can never get to the point of muscle burn because the joint starts nagging early. I started mvssb and didn’t even do an FTP, I just dialed it to where my knees will TOLERATE a 1 - 1.5 hour ride. I dream for the day of just muscle fatigue/soreness! One recent discovery was that I wasn’t feeling much of the pedal to the outside under my foot. I got the urge to undo my shoe and have it much looser and that actually help make the pain subside right away and I had better pedal contact. But then, it only helped so much, and the pain is still there ride after ride as the primary obstruction to progress.

What should I do next? Keep tweaking? Keep trying different exercises? Fly to another bikefitter with a Peloton in house hopefully? Keep riding the mvssb and hope I just adapt? It’s frustrating because I love to work hard, be disciplined and progress… and I really love the programs and even the cycling… but I don’t want to hurt myself permanently or do unnecessary damage.

Thanks for reading. C

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Muscle weakness in other parts of the body are often to blame for knee problems. If you sit a lot at work, you may need to focus on strengthening glutes and posterior chain. One random search result:

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Correct. Knee issues could be coming from other areas such as glutes, hip flexors or even core. I would look at exercises as suggested and stretching those muscles. .

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You may want to see an orthopedic surgeon to rule out anything potentially more severe. For example, missing cartilage under the knee cap between the femur and tibia can cause pain when cycling (bone on bone due to angle of flexion), but not be an issue when doing other activities (e.g. elliptical, swimming, and even possibly running).

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What sort of pedals/shoes are you using?
Have you tried using flats?

My experience has been that flats let your foot find a natural comfy spot, while my SPD’s took months of fine tuning. If you haven’t tried flats, it might be worth a try.
I’m not trying to suggest using flats permanently, but it might help eliminate a problem with cleat position.

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Your knee pain sounds an awful lot like my knee pain. Mostly center but moves around a bit. I do a bit to help strengthen the stabilizer muscles like step downs and clam shells and the like plus stretching but I think the main point of relief came from my shoes. What caused my knee pain in the first place was a saddle position that was too low and too forward so that I had a knee over spindle position that put a lot of strain where it aught not to be. After fixing the position issue it persisted and only when I addressed cleat position did I start feeling relief and heading in the right direction. I agree fully with @Rosscopeco (I did what he suggested and it helped) that if you’re using some sort of clipless system remove it from your bike and go with flat pedals for a little bit for 2 reasons. First so you can take some of the strain of being locked in off your knees and still ride and second so you can find out where and how you like to naturally push the pedals and replicate that with your clipless. When you put your clipless back on you’ll have a better idea of where everything should go and what it should feel like.

And for an extra tidbit I might suggest trying out some more supportive insoles for your shoes. Recently I decided to try out road shoes and shimano road pedals and dialing the position has brought all the knee pain issues I had before. Dialing in the cleat position has been paramount but has been largely unsuccessful. That is until I pulled the specialized body geometry footbeds out of my old MTB shoes and put them into the new. Things improved remarkably at that point. Apparently the arch support though present in my new fiziks was still not enough plus whatever other things the insoles helped support. I’m not quite there yet since I need to get my stance width adjusted to match my old set up but it really put me on the right path. An insole that provides your foot/arch with proper support can help greatly with knee tracking and take some of the strain out of the system. I’m currently going down the rabbit hole on this shopping brands like currex and solestar in addition to the specialized ones to see what else is out there.

I went to a chiropractor and physical therapist (both in one office) who put me on a lot of rolling and stretching work, along with twice weekly torture from the chiropractor. It turned out that most of my pain (feels like it’s below the kneecap) comes from things that start at my ankle and wrap around my leg up to the thigh area. Stretching and rolling the calves, hams, quads, and glutes alleviated 90% of my pain, but it took time and rest.

I also switched to Speedplay to give my knees much more float.

Good luck!

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Thank you! Interestingly today, I tried putting in a medium arch support insert in my right side and the pain was reduced markedly. Can you tell me more about your rabbit hole? I have a very wide foot (6E) and a very high arch so I’m about to order a higher arch insert to see if that helps more. Given I had a pain reduction from loosening the BOA on the shoe, and further reduction putting this insert in (ok, I also dropped the seat 1cm), I am hoping that focusing more on the foot will get me most of the way there as a focus for now.

I did try pedaling for awhile without the bike shoes and it was somewhat improved from the original but sort of reached a point where nothing was improving further. Then going back to the bike shoes was unchanged. I might try that again. Thanks @Rosscopeco.

Thanks - are you riding painfree now in your knees with that maintenance program?

Ok very good. MRI’s are cheap here in Mexico and can walk in same day without an RX and get it done. I’ll get after it.

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I am on a core program and I have noticed the more I “flex” my core, the less knee pain there is. So I think it helps but the root cause maybe somewhere else. I’ll put some dedication in to these areas and see if there’s an improvement.

I’d say 90% good.

I’m in my 50s though, so a few achy joints are expected. I just need to pay attention to the warning signs so i know when to back off.

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I’ll admit that my looking into insoles has just scratched the surface. I’m trying to find out what spending the bigs bucks will get versus spending a moderate amount but still seeing good results. Either way I think it’ll be money well spent since I’ve had my mid-arch specialized body geometry foot beds (the blue ones) for about 4 years now and feel like they’re still doing the job. Check out this website where this guy has reviewed a whole bunch of insoles both cycling specific and not but still used for cycling- https://biketestreviews.com/the-best-cycling-specific-insole-part-ii/ . He mentions that he has rather high arches as well so what he says may be more applicable to your situation than to mine. It’s saved me a lot of googling at the very least.

Just wanted to update here in case others may be able to benefit.

  • After months of bike fitters suggesting my q-factor go wider and wider, I took out a couple of washers and brought it as narrow as possible. Some improvement in knee pain.

  • I read about the foot/ankle tip above and started thinking about it. Then I listened to the K-Star podcast episode and did the knee-gapping mobility which seemed to loosen up my calf a bit at the knee joint. Then in one of the trainer road rides, coach suggested I loosen my lower legs. I started to notice that I was holding my right foot (same side as the pain) really tight and not letting the ankle bend freely.

  • I’m not sure if this is correct or might lead to further issues down the road, but I started to press down a little more on my heel during the down phase and this flexed the ankle more giving more motion. If I concentrated on doing this more often through the ride, the pain is markedly reduced. So with the undoing of the BOA and also consciously keeping the ankle flexing and extending a bit, I have made some significant progress.

  • I have been doing the mid-volume base build which is actually quite a lot of work to step into off the couch but have been loving it. It’s just enough intensity and plenty of duration to “figure things out” like bike fit/mechanics issues. I made it through to the 4th week, 2 more heavier weeks to go, but I’m feeling much better in the knee and this is GREAT! Thanks for all the insights here.

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This! I was having quite a lot of discomfort with my knees last winter (first indoor training season). I noticed that it was probably caused by too much plantar flexion of the feet. Once I concentrated on the heel down (more like neutral but feels like down) it disappeared.

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I solved a lot of issues by doing mobility exercises on my ankles using Kelly Starretts tips. Keep at it

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I didn’t see it mentioned yet, so I’ll bring up float. How much float do you have with your cleats? Couple years ago I tried out 0 degree float and had knee pain. Took me a couple weeks to figure out that was the cause. Then I went back to 6 degree float. It wasn’t an instant pain relief as my knee was still inflamed. It took another 1-2 weeks after the fix for the pain to subside and no knee issues for years.

Just this past weekend I bought fancy new shoes (S-Works Recon). First MTB ride with the new shoes felt ok, but a little tight and not super comfortable. I thought maybe the BOA’s were tightened too much. The next day I wore the shoes much looser, but 1.5 hours into z2 gravel ride I had intense pain below the knee cap (lateral, posterior). I haven’t had knee pain in years, and all of a sudden I do. The only change in my setup was my shoes and possibly cleat position going from one shoe to another. I moved my cleat up a bit (was slammed back as far as possible) to see if that helps. Will ride today and see if cleat position helps.

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I hope it works out with the cleat adjustment for you. I have The red Xpedo cleats, which I believe are 6 degrees. I feel like I have the range I need there - almost all the way duck to a little bit pigeon (I still don’t know exactly where my foot wants to be so I tend to play with the angle a bit when there’s pain to try and get relief.)

i battled knee issues but mostly from bad position. Once i corrected my position i got back to a strength program which i neglected for over a year. I have increased range of motion and strength in my knees,hips, and ankles. This has helped me tremendously in so many ways. If your not strength training look at adding that into your week. I kicked my 5th ride for the week to get 2 days a week of strength training. Feel better and am still seeing improvements. Dead lifts, Squats, bent over barbell rows, and push-ups are all i do. Oh and my knees feel better than ever. Hope you can use some of that to improve your issues.

Mike

Thanks Mike. How did you figure out what “bad position” was?