knee pain

[A___]

One of my biggest fear in life is that something happens to my body that prevents me from biking every day, and thought I've always had knee pain lately it's been getting much worse on rides of any distance. The pain is dull and behind the kneecap, and i'm realizing that it might be caused by cycling. Is there anything about bike fit / style I should look towards to try and fix this? I'm fairly inexperienced with bike sizing and geometry in general.
(for usage reference, I bike for commuting around the city, minimum 6 miles a day, only go on long joy rides maybe once a year)

[LouDeeter]

Lots of little rules of thumb for fitting your body to your bike, most requiring slight adjustments, but good start. Are you wearing cycling shoes? If so, make sure the shoe is fit over the pedal axle properly. You can find all of these "rules" on-line. Then, making sure your saddle fore/aft adjustment puts your knee over the pedal axle when the crank is horizontally forward. Height of the saddle would be the next thing to check. Finally, how you actually pedal and in what gear. Do you spin? Do you like to "push it"? Do you use your quads and think pedaling circles? All those things go into making sure the fit is good. At that point, if you are still having pain, it comes down to where. The old rule of thumb was if you had pain behind the knee, saddle was too high and if pain in front of the knee, it was too low, but again, lots of flexibility in those rules of thumb. Good luck. If you can't find the rules on-line, we can help you with those too.

[sheepbleat]

I share the same fear! In fact… I’m sure many of us do.

Do you live near someone who could watch you sit and pedal your bike? At the expensive end of things, this is someone who is a dedicated bike fitter who could make recommendations based on your riding style, body dimensions and mobility, etc. At the less expensive end of things, this is a trusted friend or shop who might be willing to lend their expertise and make recommendations based on how you sit and pedal a bicycle.

I’m saying this because there’s only so much help that strangers can give on the internet without watching you ride and knowing your history. The discomfort you’re describing is often a result of a less-than-ideal saddle height or turning too tall of a gear, but without knowing more it’s truly a wild guess. It could be a wide variety of things.

As another poster has mentioned, you’ll find plenty of “rules” for bike fit and sizing on the good ol’ information superhighway. Most, or all, of these are controversial. Many of them are dated and have been proved incorrect by modern medicine, while others only apply to the “majority” of riders and we’re all a little bit different.

tl;dr - If you’re hurting, I’d try and find a fitter or an in-person resource you can trust to make recommendations.

[Ewiser]

Knee pain can be easily fixed by changing crank size. Drop down to a shorter crank and pain will go away

[benb]

I'd not go and do a knee jerk thing like changing the cranks.

I'd look at everything and get good in person advice, not from us on the internet.

- Get good bike fit advice, not something over the internet. There are lots of very simple bike fit changes that will help with patellar pain.

- Go see a PT or trainer and get evaluated, you might very well have stiff/poor mobility in your hip flexors and quadriceps, which also has a huge effect on this. Things like foam rolling, correct stretching, working on the ITB, etc.. all have a big effect.

- Evaluate knee tracking with someone good, see if you need insoles/orthotics/PT whatever to make sure your knees are tracking strangely during the pedal stroke.

I had tons of these issues in my 20s.. zero in my mid 40s after going through PT in my early 30s. I need to stay on top of my bike fit but realistically nothing massive changed there, no big saddle changes or crank length or anything. It was seemingly all about muscle imbalances I built up early on from non-cycling sports.

Increasingly the websites that talk about this stuff are the same garbage as every other topic.. just thrown together by someone copying other sites to try and get ad impressions when the page shows up in searches.

Overtraining/Overreaching early in the season can also be part of this stuff, but your knees will be more resistant to injury if you take care of all the other things, even if you overreach in your cycling.

[AndyK]

In general "rules, knee pain behind the knee could me your saddle is too high.

[Pastashop]

… or overuse, or pushing too hard too soon, or muscle imbalance, or too much sitting, or age-related cartilage degradation…

I had something similar crop up and stretching / massage / strength training helped. But there is also actual degradation of tissue confirmed by X-rays, so, only so much that can be done about it. Limiting range of motion (i.e., shorter cranks) could help, but it’s only slightly delaying the inevitable in my case.

I’d recommend getting a quick fit by someone knowledgeable, but also getting some diagnosis by a healthcare / sports physio for potential structural issues.

[Turkle]

I am not a doctor. Caveat emptor.

I have a friend who gets knee pain from riding his bike. He consistently rides in WAY too high a gear, which makes his cadence much lower than anyone else's around him. It's visible and noticeable. It puts tons of stress on his knees and causes him pain.

Of course, he's a stubborn doofus, so he refuses to change his ways...

Now, I'm not saying this is your problem whatsoever. Haven't seen you bike. But one of the best ways to relieve pressure on your knees is to put the bike in a lower gear, increase your cadence, and spin away!

(I notice you're in NYC... I had to stop riding a single-speed bike because of knee pain, so if you're still riding a fixie maybe it's time to admit those days are over.... )

[htwoopup]

I am not a doctor either. And I recognize that everyBODY is very different.

But my experience was somewhat like yours in where the pain was that developed after many decades of cycling (and running in much younger days).

My main bike is a Spectrum that TK did after fitting me at The Barn so I know I was fit properly.

After developing the pain (which also got worse when I would be sitting and cross my leg), I went to a noted ortho who specializes in lower extremities and is also a cyclist at NYU Langone. She found nothing remarkable in my knees or legs etc.

I went for a new fit at another noted fitter thinking maybe over the last 4 years my fit needed to change. He changed nothing.

It got unbearable. Plus I all of a sudden had other issues like total leg pain and back pain on standing. I went to the HSS almost walk-in clinic (you make an appt online) at Lex and 60th-ish. They did XRays and tests there and sent me for an MRI on 75th St.

Said I had a pretty messed up vertebrae situation. Probably from the running in my youth which was excessive.

Gave me meds, PT, an epidural shot (which was a couple of weeks after first appointment). Said hope this works because if not we have to do surgery.

The thing that amazed me is that the first thing that cleared up was the knee pain.

I hope your situation is not the same. But I will point out I am lightly cycling about 20 miles a day during my recovery period and I have no pain.

Just telling this story because sometimes we get too “inside baseball” as cyclists and even the right kind of doc if they are “inside baseball” might miss the forest for the trees.

What I am trying to say is absolutely get a fit from someone good but if that doesn’t work, that may mean it is something else and so don’t give up and think that you will have to give up cycling because there probably is a fixable reason somewhere. It is just a matter of finding it and that may be in an unexpected place.

[giordana93]

another thread where op's first and last post was months ago. no need for a bump to top

[Ntxsage]

The responses can help other silent observers though. I’ve gotten something from it and am relatively new to the forum. I picked up cycling this year precisely after a knee issue shut down my running. So thanks and keep them coming!

[HowardCosellsPR]

My 2c, based only on my experience... Long time long-distance rider, former mtb pro-level racer... never had knee pain from years of dumb bike stuff, until last year when some dull behind the knee pain turned into sharp pain, and then devolved into 6 months of on the couch, pain just walking or descending stairs and serious nerve issues.

Things I've learned in since taking my first extended brake from being a 'fit' human, who was fast on a bike:
1. Cycling is actually terrible for your muscle health. It trains only portions of movement
2. Fit (WITHIN like 1cm) can not make up for muscle imballance/core instabilities.
3. Surgery (in many cases) has almost no improved outcomes over long-term, committed pt.

All that is to say... my life was 'saved' by 1.5hrs x 3week of dedicated strength work on my quads, glutes, hamstrings and tibialus'es. I started with isometrics (Spanish squats) and moved into body weight and mobility... and then on to full squat matrices, deadlifting and 'all the things'. 6 months (yeah... that much) of dedicated work and I can now ride again. I've just started introducing real efforts and it's all moving in the right direction.

So... all that to say. Fit is often a band-aid, making up for muscle imbalances and weaknesses... figure out if you have real weaknesses (bike related overtraining or just normal adult human stuff) and address that. And then get fit. OR do both simultaneously.