Knee Pain

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foxyrider
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Re: Knee Pain

Postby foxyrider » 4 Sep 2020, 10:14pm

PaulS wrote:Thanks Gearoidmuar, I checked that thread - very informative. Looks like flats are a good idea for a few weeks, once I can get back on a bike again. At the moment I'm struggling to stand or walk, never mind ride. 2 weeks ago my knees ached a bit after a 100km ride, so I took a few days rest. Last Saturday they ached again, but instead of taking a rest day on Sunday I did another 100km with a friend. Knees sore a bit to start, but I went anyway. (Isn't hindsight wonderful?!) My left knee hurt a lot, and was worse the next day. I am still struggling a few days later. The pain is on and above the knee cap. The knee cap was quite swollen and hot. It is getting better with rest.

My first thought was that my saddle is too high. But this article suggests my saddle is too low (Area 1: Anterior knee pain) :
https://www.bikeradar.com/advice/fitnes ... lem-areas/

Paul Hewitt did a bike fit for me last year, so saddle height, etc. should be good (he raised the saddle 32mm).

Flats might be the answer for a few weeks, or maybe I should go to flats permanently. Shame, I quite like SPD pedals, used them for about 15 years, used clips & straps before that. I've always ridden about 100m a week. But this year I've been doing 100km (and sometimes 100m) rides a couple of times a week, maybe the longer rides are flushing out the smaller problems.

So, next steps.
- Saddle higher.
- Saddle lower.
- Flats for a while.
- Flats forever.
- Move cleats back.
- Move saddle back.

Haha. Or maybe I'm just getting old - 52. Any other ideas gratefully received. I'm feeling a bit overwhelmed, and don't really know where to start.


i doubt age has anything to do with it, i have 5 years on you, do about 300-400km a week using spds or Look Keo pedals, i've used step in systems almost exclusively since 1989 and TC's with shoe plates for 15 years before that. The knee issues (barring breaking my left patella) i've had over the years have each time been caused by strain on an over enthusiastic ride - either more climbing than i'm used to or much further than my usual ride at the time. The most severe incidence had me hobbling and unable to ride for several weeks, rest was the solution, i certainly didn't start moving things about.

So yes, it probably is the longer rides but rather than 'flushing out the smaller problems', the resultant pain etc is a reminder to not overdo things. If you started labouring for a job after years of sat in an office you'd hurt a fair bit, the extra stress/effort of the longer rides is the same thing. Oh and that bad incident was when i was 25! 300km so far this week with exactly the same cleat/saddle position i've used for 40 years.
Convention? what's that then?
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rfryer
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Re: Knee Pain

Postby rfryer » 5 Sep 2020, 7:25am

From my experience...
  • Clip in pedals with more float improved matters for me - I switched to Speedplay Zeros.
  • If you're having issues in this area, you could do much worse than consult a quality bike fitter who specializes in sorting out these kinds of issue, such as The Bike Whisperer. You've got a much better chance of solving the problem for good, and the solution will probably include subtle tweaks to your cleats or insoles that you'd be highly unlikely to stumble on by yourself.

PaulS
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Re: Knee Pain

Postby PaulS » 5 Sep 2020, 6:10pm

Thanks foxyrider, fair point. I should worry less about the bike set up, and listen more to my body. The warning signs were all there, and I deliberately chose to ignore them. Now to heal and start again. Slowly.

PaulS
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Location: East Yorkshire

Re: Knee Pain

Postby PaulS » 20 Sep 2020, 5:36pm

Knee feels better after a (3 week) lay off. Now to check other things. This is the setup I have, from a professional bike-fit. Today I had a short ride, then put the bike on a turbo and captured this still from a video. Looks a bit high to me. And looks quite a bit higher than the photos in the guide : Bike Set Up 2017a.pdf, I cannot put my heel on the pedal at the bottom of the stroke.
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Jdsk
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Re: Knee Pain

Postby Jdsk » 20 Sep 2020, 5:54pm

I'd do that fitting with the heel on the pedal at full extension as usual, and then flex slightly because of the previous inflammation and set the height from that.

And, as always, start gently and work up gradually.

Jonathan

rob_wales
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Re: Knee Pain

Postby rob_wales » 20 Sep 2020, 6:00pm

I think a trip to the physio might be worthwhile. They charge about £30 a session. I have occasional problems with my IT band (iliotibial) which runs down the leg to the knee. I tend to get tight muscles at the front above the knee which can cause pain at the knee itself. My physio did massage and strongly suggested foam rolling. You might want to try that. There are plenty of videos on Youtube, such as this one https://youtu.be/yipIou85-Q8 But I would urge you to go to a physio because it could be something else entirely. Generally, and I hope you don't mind me mentioning it, but the more weight you lose the less likely you are to get an injury, especially running, but also cycling.

You can get the foam rollers on Amazon. I use a softer on as some of them are quite hard. This is a good one https://www.amazon.co.uk/Maximo-Fitness-Superior-Instructions-Included/dp/B06Y97NVKZ/ref=sr_1_13?dchild=1&keywords=foam+roller+ogiyogi&qid=1600621406&sr=8-13

PaulS
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Re: Knee Pain

Postby PaulS » 20 Sep 2020, 7:36pm

Thanks for the feedback. I'm a bit reluctant to change anything just yet, because it was set up by someone who knows a lot more about seat height and bike setup than I do. I also think the primary cause is me overdoing it. So I need to be more aware of aches & pains. And yes, the physio is a good call. But I do think the seat is a bit high too.

This is the image I mean, which looks quite a bit lower than mine.
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PaulS
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Re: Knee Pain

Postby PaulS » 21 Sep 2020, 9:24am

Jdsk wrote:I'd do that fitting with the heel on the pedal at full extension as usual, and then flex slightly because of the previous inflammation and set the height from that.


Done. I've dropped the seat so my heel touches the pedal. It feels low, but looks better. This is a photo of my heel deliberately dropped, and a photo with my foot pedalling normally. (It is pretty much the height I had before the fitting. Ho hum.) I'll try that for a while. Gently, and build up slowly.
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531colin
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Re: Knee Pain

Postby 531colin » 21 Sep 2020, 9:39am

Edit...I typed this then found Paul's latest post....I'll post anyway. Paul I suggest you read the bit on my DIY bike fit about how it feels when I am riding, dropping the heel when forcing the gear, and so forth. Are your photos pedalling the turbo at a normal cadence?

Paul, in your photo your toe is very obviously pointing down.."toe dipping"
Steve Hogg here https://www.stevehoggbikefitting.com/bikefit/2011/05/addendum-to-seat-height-how-hard-can-it-be-2/ talks about 2 sorts of "toe dippers". There are those whose natural pedalling style is toe down, and those who only ride toe down to compensate for too high a saddle, they have to point their toes to reach the pedal at the bottom (and maybe drop the hip also), and if you lower their saddle they revert to a less toe down pedalling style.
I have put these pictures up before. This is somebody who came to me rocking her hips and pointing her toes just to reach the bottom pedal...
Image003 by 531colin, on Flickr
This is the same rider after I lowered her saddle as much as she would let me. Note that there is no difference in the degree of bend in the knee, but the foot is almost level, although still a touch toe down.
Image012 by 531colin, on Flickr
I suggest you proceed as follows;
Put a bit of tape round your seatpost 50mm above the top of the frame. You now have somewhere to measure from, and you can get straight back to where you are now if you want to. Then repeat the photo you posted, but with the saddle say 10, 20 and 30mm lower.

PaulS
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Re: Knee Pain

Postby PaulS » 21 Sep 2020, 11:01am

The previous photo is at 26.5mm lower (where my heel just touches the pedal). These ones are at 10mm, 20mm, 30mm, 40mm lower (labelled on the top tube). I have tried to keep to a normal cadence on the turbo (although using a turbo is a bit new for me.) Thanks.
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531colin
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Re: Knee Pain

Postby 531colin » 21 Sep 2020, 6:42pm

OK, after the odd false start I found I can click on the photo and read the top tube labels!
So at the maximum (40mm) saddle drop you are pointing your toes at least as much as at the 10mm saddle drop.
I think that makes you a natural toe dipper, rather than somebody who is toe-dipping to compensate for too high a saddle.
I am a heel-dropper, which makes it a bit difficult for me to advise you.
However, I think the general principles are the same;
You are more likely to get injured with too high a saddle than too low. (stretching for the bottom pedal)
Set your saddle low enough so that you can pedal smoothly "through the bottom" at high cadence on your worst day, when you are tired and your legs are stiff. If you want more knee extension you can slide back in the saddle**, for example to get maximum force for minimum muscle effort at low cadence, ie forcing the gear. I think I would go for 30mm lower than current for a first stab.
I am unable to super-impose photographs, although I know that there are people who can do this; I would be interested in comparing the bend in Paul's knee at the various saddle heights, if there is anybody out there who would superimpose the pictures for us? I think there is noticeably more bend in the knee at 40mm than elsewhere?
**I also drop my heel; this may not be a natural thing for you to do?

PaulS
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Re: Knee Pain

Postby PaulS » 21 Sep 2020, 8:00pm

That's great, thanks Colin, much appreciated. Apologies, I should have used bigger labels. I've dropped the seat down 30mm, and will try that. Top of my list now is injury prevention and rehabilitation.

I don't really know the natural angle of my foot, I've never paid that any attention. Maybe I dip my toe as a result of the seat height over the last year, and it has stuck. I was a bit surprised to see the toe-dipping in the photo, but it feels natural and ok. I tend not to push big gears sitting down. I try to keep a fast cadence, and then I stand up if I'm pushing too hard and too slow. I noticed that by dropping the seat my knees have moved about 20-30mm forward of KOPS (it was bang on with the higher seat). I cannot move the seat further back, and already have a layback seat-post. Maybe that makes my toes dip - or maybe not.

Anyway, thanks again for your help, and I will give that a go.

Cowsham
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Re: Knee Pain

Postby Cowsham » 21 Sep 2020, 8:48pm

Maybe most know this already but it was a good starting point for me --- with ball of the foot on pedal axle and the crank horizontal, with a plumb line pressed on the front of the forward knee the plumb Bob should be over the pedal axle.

Also second ditching any kind of clip or toe strap. Use a good quality nylon /composite pedal with good bearings, just makes things more comfy and they're lighter.

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Paulatic
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Re: Knee Pain

Postby Paulatic » 21 Sep 2020, 9:13pm

Yes we’ve all heard of KOPS and most of us discover it’s of very little use in finding your position on a bike. If it works for you then it’s a coincidence.
https://www.stevehoggbikefitting.com/bi ... oad-bikes/
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foxyrider
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Re: Knee Pain

Postby foxyrider » 21 Sep 2020, 10:28pm

Looking at the pictures i agree with Colin, the 30mm looks about right, the 'bike fit' is clearly far too high. Look forward to your feedback when you've done a few miles.
Convention? what's that then?
Airnimal Chameleon touring, Orbit Pro hack, Orbit Photon audax, Focus Mares AX tour, Peugeot Carbon sportive, Owen Blower vintage race - all running Tulio's finest!