How to fix knee injuries for cyclists

The following helped me with knee pain:

  1. Lowering the saddle (bike fit)
  2. Never locking my knees
  3. Strengthening through deadlifts
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Knee pain has been a massive issue for me, and I went through so many PT’s. Sometimes its better to work the issue out yourself. Things which worked best for me were not being so one dimensional. I used to sit and a desk, and sit on my bike with no much else.

Even simple things like walking to work help a ton, other things i now do regularly are monster walks, glute bridges, foam rolling and even better is a lacrosse ball.

Sports massage is good, but i find doing it yourself with a ball is better as you can feel where is tight.

I would say most knee issues are from some other issue in the posterior chain.

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How do people assess an injury; as in the cause, how much time to take off the bike, how to specifically rehab and prevent?

Last Sunday, I was doing Antelope as part of week two of SSBHV2, after being on my feet for 8+ hours at work. Normally I feel a bit flat after a day like that but usually I can grit through it. But in the last interval I began to feel some anterior knee pain when pedaling

Took a week often, did deadlifts over the weekend and walking around with no pain. Started another Antelope today, and pain began at the first sweet spot interval. Still no pain when walking but some when squatting. No passive pain or any when pressing on any part of the knee.

Other than the first day, workouts had been feeling great, and I’ve never really had any persistent knee pain on the bike.

Planning on taking 4 weeks off with plenty of rehab and starting off with some shorter aerobic rides before trying to begin a new SSB block.

  • Cadence adjustment
    (On dirt I usually average 85-90RPM, on road 95-100RPM, and this hasn’t changed. What has changed is my focus on being proficient outside of those ranges. I do plenty of cadence drills.)

If I’m primarily a XC MTB’r but Im on trainer using TR. what should ones main objective be then? Should one hit those lower cadence zones (85-90) if that’s there goal is to excel in MTB? or just follow the instructions in the prescribed plan and roll with it pushing above a beyond that?

What I have been doing is what is prescribed and intensionally increasing my cadence. When i started 6 months ago my natural cadence was low 75-80 now its 90-93 with short spurts of 100-110. I have no idea if this helps me on my XC rides. However It can’t hurt to have a higher cadence and be able to crank out power, it should make you faster right? I know meeting that goal can bring pain, discomfort or worse injury if done for long periods of time correct? Sorry for all the questions here but I noticed this here and it struck a bell with me. As of today Im not experienceing and pain or discomfort, I think just slowly building up my strength.
Thank you

Earlier this summer I had some intermediate vastus medialus pain but it would usually go away after a warming up.

2 weeks ago I got a bike fit. Since the bike fit my vastus medialus have been really sore AND I have knee pain. mostly on the inside but some pain on the upper part of the knee behind the knee cap.

Could my fit be wrong(fitter is very good and highly recommended)? Could my fit be right and now that I’m using those muscles in the right way things are aggravated?

I’m having to stop in the middle of my workouts. I will stretch for several minutes and then I can get back on the bike and I am usually good to go for another 10 to 15 minutes until I have to get off and stretch again.

I do have an appointment to have my fit checked again.

Side note. I do have some cartilage wear and arthritis in my knees(well, right knee for sure as it has been scoped) I was a marathoner/runner for a lot of years

My knees haven’t had issues on the bike until a couple of weeks ago when I first changed my saddle and seatpost, and then got fit.

I have patella tracking issues with my right knee. The funny thing is, it was really bad when I stopped exercising for a decade (stupidest thing I have ever done). Now it gets bad when I’ve been riding my bike a lot. The only thing that helps is swimming. Last time I had serious problems, I only went swimming 4-5 times before all my knee issues cleared up. I had a recurrence this year and I’m still recovering. Trying to convince myself to swim at least once a week all year.

I had PT for the knee and it was highly unsuccessful. Only made things worse. Fortunately, that’s when I discovered swimming.

In the process of clearing up a right knee niggle, which has been hard to diagnose. It has never reached pain, but a telling tightness that continually draws my attention. Rest doesn’t seem to have an effect, and it doesn’t vary with intensity, nor has stretching made any noticeable difference. It has been highly unpredictable, sometimes suddenly disappearing during long rides, sometimes worsening gradually, sometimes not there at all.

I’d now diagnose, with some confidence, patellar tracking issues due to imbalanced muscles. Thus, things that have made a difference have been exercises to restore a more complete (i.e. not cycling-exclusive) functionality. Movement beyond the small ROM used in cycling. I’m talking squats and walking. And not just occasional, as if they will have a magical effect, but treating these activities with the same dedication that I give to my bike work. 50 bodyweight squats every day. Deep ones, in blocks of 10, 15 or 20. Walking every weekend for two or three hours. My body seems to be really enjoying this regimen. Let’s hope it lasts!

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Anyone…started having medial hamstring tendon pain while riding the TT bike, very acute, very short term (goes away when I stop pushing power) . Restart power and ok for minutes then Bam a little zinger. Stop pedaling and it goes away.

Additional info…switched to a different shoe (same orthotics) and it turns out it is 5mm less stack heigh compared to previous shoe. Also, I changed from a -17 110mm stem to a -17 130. I have lowered the saddle and will go back to original stem but, only want to make one change at a time. Medial and lateral knee pain can be caused from shoulder, hip, knee position so, I’m really just after general observations of those who have experienced something similar.

edit: should add I did an all out 20 min test on the same set up a couple days ago with no issues…???

I say this as someone who has made the same mistake plenty of times: when you make a set-up change like your stem (20mm is a big difference!), don’t go in all guns blazing with a test. Give your body chance to register the change, grow comfortable with it, and then increase the load.

It may have felt fine on your test because you were making a maximal effort, the adrenalin was flowing, the muscles were all doing their best, and your body had bigger things to handle than a new movement and position in the hamstring. You got off and the endorphins were flowing, masking all problems.

Don’t think about small changes–should I move my shoes, lower my saddle?–but about the whole system. You’ve created two distinct stresses: a maximal effort and a position change. Your body only has so many resources to adapt. Let it do that.

Have some rest. Ice. Gentles rides. Build up to tempo riding, stay away from threshold.

And don’t panic.

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Appreciate the advise pdf500 and agree with all points. The timeline was test on the 4th. No riding on 5th or 6th (work). The 7th was the incident while doing SST and the front end change.

Went back to original front end set up. Also, despite using an Ergon cleat jig I found the right heel 5mm inside my old shoe (toe pointed out) and as previously stated the stack on the new shoe was 5mm less.

I ended up riding really easy on the 8th for a couple hours. Then against better judgement I did a criterium the following day. Everything felt fine despite being able to “feel” the hamstring tendon all day. Wife was not feeling good and bailed so I rode home (2 hours) after the race Z2. So far so good, but, I have not been on the tt bike.

I have a stage race ITT Friday (VOS) so I’m a bit nervous and undecided how I want to proceed.

Sorry, I misunderstood the sequence. I think it’s more solidarity than expertise that I’m providing! Injury is tough, especially if you’re on form.

I wonder whether you were fatigued from your training load (implied by your testing), then made a change, stressing the tendon in a new way with a position change on top of the regular demands of training? Tendons are so much slower to strengthen and heal than their surrounding musculature that injury can occur while the muscles are seemingly coping with a training load or position change. (I learned this the hard way too: can you spot the pattern?!)

It sounds like things are going in the right direction now? I don’t think the toe out would have made so much difference. Saddle height (which as you say, changes with cleat stack height) and fore-aft would be the things I’d look at. Remember, when you raise your saddle you’re effectively moving yourself backwards from the bottom bracket. And if you push your saddle back, you’re effectively raising your saddle. So some tinkering there might be in order? Hamstrings and glutes are recruited more the further back you’re seated.

I think you’re doing all of the right things. Be conservative: your fitness won’t disappear over the course of a week or two.

Spend some time cycling with your wife. She might provide some useful discipline: not feeling good? Get off.

Best of luck with it.

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Anyone ever have issues with knees related to the saddle being too far back? I had a flare up of what was likely patellar tendonitis a year ago or so and have been battling knee pain on and off since then. One of my main position changes was to move the saddle pretty far back. It’s uncomfortable for my hands but but seems to reduce the strain on the knees and my kneecaps seem to be over the pedal axles with the cranks at 3 o’clock, as most fit guides would recommend. But lately I’ve been having some tightness in the hamstrings and possibly in the hips, coinciding with some possibly different-feeling knee pain, and moving the saddle forward again seems to help with this. Wondering if I should leave the saddle slightly more forward or keep it slammed back to the rear.

Also I’ll throw in another “thank you” to Jonathan, these exercises look promising and I’ve started incorporating some of them into my regular routine.

I’ve had some soreness in the knees that I’ve mostly resolved by moving the seat forward. Pain was usually during hardish efforts in the saddle. I did notice that when I got out of the saddle I ended up having to move back to get back on the saddle so thinking those were related.

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Finally figured out a knee issue that has been plaguing me for the last two months, hopefully this can help somebody in the future.

Oct/Nov 2019: crawled around in the attic running new wiring for thermostat and doorbell. I remember my knees being extremely irritated after kneeling on the joists in the attic for hours on end, but didn’t think much of it.
Dec 2019: fell and bruised my butt (don’t ask, dumb story) and had to take a couple weeks off from biking and running
Late Dec 2019: ramped up my running mileage and then went and did the Festive 500 despite not having much recent mileage going into it.

This is around the time when I remember starting to have noticeable pain right on the top of my patellas after runs, bike rides, and even just normal life. In the back of my mind I was thinking “dang, probably got some tendonitis starting because I ramped up my training too quickly.” Ended up taking several more weeks off due to illness, and figured it would help the knees.

Once getting back on the bike in late January, I found that my knees would just ache off and on, and would get worse with any riding. It did not feel like tendonitis though; the pain seemed localized in little bumps that I could feel gliding around on the tops of my patellas. I finally went to see a sports medicine doctor, and he said that it was prepatellar bursitis likely caused by all the kneeling in the attic, and my training was preventing them from healing. Got cortisone injections in both knees and the pain seems to have subsided.

TL;DR: if you have superficial pain on the patella and there is no tendon pain above/below the patella, think back to see if you kneeled or bumped your knees recently. You may have prepatellar bursitis. These injuries do not seem to heal properly when cycling and running frequently, so you may need to ice it aggressively, get cortisone injections, or even have the inflamed bursa surgically removed.