Here’s the story - for many years I’ve had one knee that just gets agitated by riding and ends up being more “clicky” and less “smooth” than the other knee - this is on the inside near the top of the knee cap and feels generally like my knee tracking isn’t perfect, leading to irritation of something - I do a lot of hours a year (750-1000) and go through periods of good or bad, I’ll have a happy week and then a less happy period - I often end up thinking on a ride, if only I didn’t have any knee irritation, it would be the perfect ride!
I don’t seem to be able to correlate with bike fit or equipment, but I’ve found myself trying to occasionally chase a solution with saddle height, cleat fore aft, cleat alignment etc. I move between various bikes (summer, winter, trainer, holiday home, MTB) and I sometimes find relief in the variants of fit (hard to get mm perfect) which generally leads me to thinking the current bike that doesn’t hurt is the “right” setup but over a long enough cycle that ends up moving between bikes, so really I think it’s just something else bio-mechanical.
I ride Speedplays with a lot of float and find them quite forgiving, but I do find that Speedplays can create a lot of lateral play if you don’t stay on top of the cleats and replace them regularly, so I’ve also considered going back to more traditional Shimano SPD-SLs, but again this also just feels like chasing a frog around a field.
I have regular physio to stay on top of general strength and conditioning after a back issue and so I don’t think this is general weakness, but I could try and target knee strength / conditioning more specifically, but I’m not sure where to start, so I’m curious if other people have gone after this sort of issue and how they’ve looked to work through it.
You have done a lot to try and fix it. To me it sounds like it’s more of a repetitive motion issue than a lack of fitness or fit. Could be something internal that you might not be able to change. Have you seen an orthopedic person. X-rays and maybe a MRI. When I experienced this sort of knee pain from running it was discovered I had very little cartilage left in my knees and I was forced to cycle more and give up the running.
This sounds a lot like what I had for years before it blew up somewhat spontaneously on what was a normal duration ride for me. I then rode with it hurting significantly and progressively more for several hours before I could make it home. I tried again a little over a week later and it blew up even worse, to the point where I was in significant discomfort during daily activity for weeks, even without riding, and never really went away.
Long story short, I was diagnosed with medial plica syndrome after a year or frustrated and limited riding. I had surgery just about a year ago, but still deal with the issue to a significant degree.
So, I guess my only advice would be to be careful, especially if it does start to flare up, and probably seek medical help sooner versus later if that’s an option for you.
For whatever it’s worth, my particular flavor of medial plica syndrome does not exacerbate while running (and in fact, sometimes running seems to help it), so I took up ultra running
Thank you @eborn18 and @TrekCentury - I think this feedback is useful - I have been considering how to get some diagnosis while knowing that certain diagnosis like “yes your knee is just worn out” isn’t going to help that much - the thing is, this rarely leads to any pain, just some irritation and an “awareness” of the knee, but as @eborn18 says, I obviously just don’t want it to blow up.
And I think people can have too much float. I rode Speedplays for years, and had knee issues, but after the pandemic and post buyout problems getting parts, switched to Shimano SPD-SL. Not as much float, but I found I really didn’t need all that.
I’ve figured out over the years that, when I’m riding more than usual and my knee gets aggravated, maybe isn’t tracking right, I try to work the muscles off the bike, stretching, doing lateral movement exercises, massage gun/ball, etc. The knee is in the middle of that chain from lower back to your toes, and your knee is getting pulled in all the different directions from above and below, from however many different muscles. It only takes one tight muscle to pull the whole thing out of whack.
@foxyscott - yep, I had a lovely new pair of carbon insoles with a reasonable orthotic wedge made up recently by a real pro podiatrist - he works with lots of road pros and makes custom carbon shoes for national track teams, and I must say the insoles and shoes I moved to (Shimano RC903s) are great, but the knee situation is largely the same as before.
@MikeMunson - yes I hear you and feel this is some variant of the issue. It’s the sort of thing that can also sometimes “resolve” mid ride, like if I really concentrate on my pedal stroke, activating more core and thinking about my glutes, I can sometimes see things fall away mid ride, but that gets trickier 4-5 hours into those long rides with lots of climbing.
@HLaB@foxyscott - I have at times reduced the float right down on my speedplay cleat, since you can adjust the float down as much as you want, but this often again feels like chasing a frog, it might work for a bit, then it doesn’t and I slacken it off. Maybe I’ll try for longer.
Other notes - I’ve had a bike fitter suggest wider stance and extended pedal axles to improve line based knee tracking but when I rode this over an extended period my feet were very “duck footed” on the bike and it didn’t seem to help anything and generally felt less natural and more forced.
I had a similar issue that didn’t seem to be related to position, effort, timing, strength, nutrition, etc. It would relapse and then take about six months to get back to relative normalcy.
I worked with three different physios over two years, and the third one started exploring intramuscular stimulation (IMS), which is also called dry needling. Over the course of a few sessions and some gentle stretching after workouts, we isolated the problem to tightness in my low back and SI joints, which seems to be pulling on my VMO/sartorius in a way that makes it seem like a knee issue. Three sessions later (six total I think) I am now back to 95% or better on most days. I do a light but specific stretch after each ride, and I periodically loosen my low back throughout the day, but all signs point to success after just two months of recovery since the last relapse.
It goes against the grain definitely, but it worked for him (or at least it was the last time I saw him) I think he said it was a fitter that identified it.
Wedges made a difference to me for the one real knee problem I had. My right leg is shorter than my left and IIRC correctly my physio at the time said the left ITB gets taught trying to correct it and pulls the right patella out of alignment, and instead of running smoothly it rubs the bone and is like a serrated knife. I think that was 2008. Although I never had the fit that shimmed it until 2011. Up until that point Id still get a sore/clicky hip when my bb was failing. Touchwood Ive never had that since the shim or the ITB problem.
When my knee bothers me, I use a lacrosse ball or my hands to massage the muscles above and below the knee. I try to find spots that are tight and work on those, and it usually helps.
I also have one knee which I tore the meniscus on ~14years ago, which can suffer after big days or smashy smashfest group rides.
I find that cleats with less float are better, I use spd-sl blue currently, haven’t tried red, but yellow is much worse for me. I have spd pedals on my gravel bike but much prefer spd-sl and don’t want to do long rides with them.
Probably unrelated, but I’m currently trying out shorter cranks, down to 170 from 175 currently. This doesn’t necessarily help with knees at all, but might for some people.
Sounds like an MRI is in order. There may be something structural going on there, especially if you are already doing physio and keeping things strong and balanced. It may be worn cartilage that sometimes is bothersome and sometimes tracks ok.
My right leg and knee are a bit wonky after a crash and multiple surgeries back in 2006.
I use a few wedges on my right shoe, and I wear cleats with 2 different floats. My right leg/knee need room to move and I use a cleat with the most float on my right shoe. The left shoe gets a minimal float cleat.
Sounds goofy, but the combo makes the right knee happy.
YMMV.
Edit - this was completely anecdotal and a sample size of one. A visit to an ortho and an MRI may be in order.
If you can resolve the pain by focusing on form, that tells me that you need a bike fit (to allow you to keep your posture right while riding), or perhaps you’re piling the miles on too quickly and need to let your supporting muscles adapt before going out for a 4-5 hour ride.
there is more than likely a massive knot somewhere in your muscles on the affected leg. This may or may (k)not be a problem as usually people only go looking for things like this once they are experiencing pain.
Common culprits are in the hamstring close to the medial tendon as it inserts towards the knee , as well as the overlap between the hamstring and the groin muscle.
With this kind of thing it’s possible that it is a functional adaptation that either helped you through a tough block or a rough ride and simply never let go. Once you find the area apply deep pressure for a few minutes and then move the knee very slightly through some range of motion like 5-10degrees and you will know you are in the right area because it will feel very strangely good.
