Thank you! I use spd pedals both in the spin studio and on my road and mountain bikes. I hadn’t even thought of adjusting the width of the pedals (or however you say that.) I’ll have my bike fitter check that out for me. Maybe I will try just using flat pedals for a while. I definitely toe out just a bit - so do I try to mimic that position on the bike?
Hey reading through these I have something to add. Fore Foot wedge to in case you pronate or supinate as your feet hit the bottom of your pedal stroke. I was having lateral/anterior pain and went to a good fitter and he found that I had almost 1 degree of probation in my pedal stroke which was causing my knee to fall inward and out of line with my hips and ankle. Check that link to see what I am referring to. Hope that helps some.
I’ve got an email in to the bike fitter I used. I will see what he says. I did the Retul fit and I seemed to be pretty well lined up.
I fell down a rabbit hole of q-angle and stance width info tonight. Help me think through the mechanics of this - I found online that the Keiser M3 bikes we use at my studio have a notoriously wide stance - almost 200 mm. Could that be causing my hip and knee issues? I’m pretty sure that’s fat-bike wide. Perhaps when I quit teaching next week and stick to my own road bike, which I’ve had a proper fit for, this will get better?
1 Like
I should say first and foremost to take my advice with not just a grain of salt but with a 2 lbs bag of it. I’m no expert, I’ve just come across a bunch of stuff over the course of finding remedies for my own knee issues. I’m guessing you’re finding this is a journey of self discovery since you’ll need to find out what works for you which is by no means easy.
That being said, the wide position on your spin bikes could be contributing if it’s not a natural position for you. Especially if you’re really hammering it, puts all sorts of extra strain where it aught not to be. Though in most cases I think having too wide a stance tends to manifest medial or inner knee pain, but hey we’re all different. Definitely try messing around with the flats so you can at least get back on the bike in some fashion and do some fooling around to see what might work (you can also put flats on your spin bike, it’s how my wife uses the peleton she has at work). I was lucky enough to have an “ah-ha!” moment but in your case just doing so may provide some relief and reduce the strain on your ITB since you won’t be locked in to your position. After that start messing with the cleats to recreate what you found with the flats. My feet likewise toe out just a tad but when it comes to my cleat position it’s a bit more subtle, but I had to try it out to find out what the over under was. It was something I did during an easy ride like Pettit -1. Paused it a lot to get off and adjust then try the new/old position to see what worked best. I’m sure since you’ve had a few fits your saddle height and set back to get your knee angle and knee over spindle proper are all in the right places and it’s just a matter of finding that last thing that’ll move the strain out of your knees. Keep up with the rolling/stretching/strengthening/icing while working through figuring out your feet, if that is indeed the issue. As Mike said above using a fore foot wedge could provide relief but from what I’ve read exhaust other options first since varus/valgus issues can be misappropriated and as the article he posted says we don’t all have it. That being said, don’t rule it out. But try out arch support first. Hopefully this helps and doesn’t make anything worse. Good luck!
1 Like
Great topic. This past season I experienced my own knee issue. One thing I didn’t see mentioned in Jonathan’s original post is exactly what kind of knee pain he is having. My status is an older cyclist (51) and a licensed naturopathic physician. I competitively race mountain bikes and cyclocross. Over the past five years I’ve increased my training and riding volume. A couple of seasons ago I began to get knee pain one-sided, often after long distances and after the annual 24-hour race that I compete in with a team. This last 24 hour race, I developed severe left side patellar tendon knee cap pain. In my situation, besides relief treatments I focused on bike fit. An extremely common and overlooked problem by mainstream Medical is leg length discrepancy. Many people have one leg longer than the other (just like your feet aren’t exactly the same size), in fact just about everybody does, to what degree can cause problems for athletes. I’ve known about this in myself for decades, but neglected to put my lifts in my left insoles at the beginning of the season. This discrepancy mind you is only maybe 3mm. By putting the left-sided lift in, my knee pain literally disappeared instantly during the next ride. Note that leg length discrepancy can either be anatomical or functional, the latter being caused by SI and hip joint issues. An astute osteopath or chiropractor who looks for this can help correct hip and low back issues. Obviously there are many types of knee issues, but I wanted to mention this overlooked one. I documented this on my YouTube channel. Patellofemoral pain with cycling - YouTube
See my post below, is this only happening on one side? Have you had your leg lengths checked? Note you need to go to someone familiar with functional musculoskeletal issues like a good osteopathic or chiropractor who focus on extremities. I’ve seen many doctors over the years and none pick up on this. I mainly discovered through my mentor and while at naturopathic medical school.
How did it go, did you overcome the issue? I bet the squats and slowly getting back into lifting weights helped.
Thanks for your reply! Yes, I have a leg length discrepancy and I wear a lift. Chiropractor and PT both noticed it. Still battling with the same injury. 
Nope, still dealing with the same injury. I have tried everything with no response. Surgery is scheduled for Dec 9. I may change my mind, but that’s the plan for now. The surgery doesn’t have great outcomes. But I have nothing left to try.
Deadlifts and posterior chain helped the most. Squats are slowly progressing, I’ve also been doing a lot of weighted step-ups
2 Likes
Glutamine or Glucosamine? They’re not the same. Glutamine is usually taken for matters relating to the gastrointestinal tract and the cells in the linings of your small intestines.
Sorry to here that but glad at least the leg discrepancy was addressed. A few other thoughts: often the chronic cycle of pain, especially of a joint or joints in general reflects a cycle of inflammation. Without knowing your medical history some general things I look at with patients include: hormone testing, testing for systemic inflammatory markers, and supporting healing with appropriate measures. Some common things I see include adrenal insufficiency indicated by low DHEA and cortisol. Cortisol is the body’s most potent anti-inflammatory hormone, and the most common hormone deficiency I see. Women and men also often have a decline in their primary anabolic hormones: estrogens and testosterone. The body won’t heal well with these common hormone deficiencies. Also, the nutrients required for joint healing must also be available. I highly recommend a specific collagen with growth factors, anti-inflammatories like curcumin, boswellia, and ginger… and a high grade triglyceride form DHA/EPA omega-3. Lastly, I have seen an old-school naturopathic therapy to be very effective, contrast hydrotherapy. One alternates damp application to the affected joint, 3 minutes hot, 30 seconds cold, repeat 3x, always end with the cold application. I have seen all of these keep patients out of surgery. There are other lifestyle factors that may be impeding healing, … diet, alcohol, sugar…etc. btw, despite the criticisms of the ketogenic diet for performance, the therapeutic and healing effects when done correctly are beyond any other one thing I’ve seen. Excess carbs feed inflammation.
1 Like
Interesting… I am willing to chase any lead to figure this thing out and avoid surgery. How would I go about finding a reputable naturopath? I’m in Colorado Springs, if that helps. I have suspected that something systemic is going on, and other than a positive ANA, I’ve had no luck pinning anything down.
The positive ANA, even if you’re told isn’t “yet” meaningful definitely is a sign of imbalance. Autoimmunity is a clear warning sign of imbalance and a contributor to chronic inflammation. There is nearly always a problem in the digestive tract and its association with microbes and the immune system. I see food sensitivities often with this as well. Here is a link to the Colorado Association of Naturopathic Doctors and those in the Colorado Springs area. I don’t know any of them specifically, but your can chat with a few and find out who appears to have experience with your concerns. https://coloradond.org/members-by-city/category/colorado-springs
Thank you! I’ll do some research!
I just noticed this part of your posts, you are hopefully already addressing this but this would be “low hanging fruit!” Definitely using a generic spin bike and having a wide Q-factor is likely to cause problems, especially given the volume you do. Can you use your road bike and trainer in place of the Keiser? Your training (or teaching) bike should be fit to you, just like your outdoor bike. You may be able to use a shorter spindle pedal and move the cleat on your shoes as far outward to help a little.
1 Like
I quit teaching back in July and was hoping the break would help. It hasn’t. Pretty much zero biking since July.
1 Like
That’s so frustrating, I hope you get it figured out. I spent months off the bike after kneecap tracking issues and tendonitis. Doing SO much better one year later. Probably didn’t need to take so much time off, but I didn’t understand what was going on at the time. Wish the human body came with a guide book, but without pro level help all you have is study and experimentation…
1 Like
@bbarrera It has been much the same for me. Squats really helped for a while, but I think I’m learning that the biggest improvements are from single leg exercises like split squats, pistols, or step ups where you improve stabilization and get the glute medius working as well. I’m strong again (for me), but I can’t handle volume like before the injury (not yet at least). Thanks for the response
1 Like