# Outer Knee Pain



## UltralightHiker (Jun 9, 2011)

I have been riding for 1 month as of today. I went on my longest ride to date this morning. Around mile 15, I started having pain in my left knee, on the outside of the knee. Not in the front, or back, but the outside. As soon as I got off the bike at the end of the ride it felt better. I am assuming it is a minor adjustment that needs to be made, but I am not sure what to do. I did not want to go messing with anything, because I have everything else pretty close I think.

I got fitted initially, and was having pain in the top of my hamstrings. I dropped the seat a few mm, and moved it forward a few mm, and those pains went away. I then started having pain in my hands, so I pointed the nose of my saddle up a bit and that helped. Now the outside knee pain. Any suggestions?

Here was the ride:

Time: 01hr 17min 53sec 
Distance: 23.46 mi 
Elevation Gain: 771 ft 
Avg Speed: 18.5 mph 
Max Speed: 26.8 mph 
Avg HR: 161 bpm 
Max HR: 175 bpm 
Avg Bike Cadence: 91 rpm 
Max Bike Cadence: 119 rpm


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## Mcdougal (Jul 30, 2011)

Sounds like the IT band, which is a devil if an injury if it gets bad. Do you use a foam roller? That is a very good IT band injury prevention tool.


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## Mcdougal (Jul 30, 2011)

There are lots of things that can hurt the knees, so who knows if the IT band is what caused the irritation. However, injuring the IT band can be pretty debilitating if it gets bad enough. Most people dont know anything about this injury until it happens (happened to me in both knees). The foam roller is a good tool, but doing IT band specific stretches is also important.


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## UltralightHiker (Jun 9, 2011)

I run, and do a lot of long distance backpacking and have never had any problems, so I immediately turned toward fit. Could it be a seat or cleat adjustment causing the IT band problem? As the pain started flairing up, I noted I had a twisting motion in that knee as I was pedaling (heal wanted to turn out on the down stroke) which I assume was a cleat setting. I did not want to go making any changes until I knew what I was doing.


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## steelbikerider (Feb 7, 2005)

Try a cleat adjustment. With me pain on the outside of the knee meant that I needed to point my toes out more and pain on the inside meant toes need to go in if I remember correctly. Be sure to mark where your cleats were before moving and make a small change on one shoe at a time.


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## Mcdougal (Jul 30, 2011)

In running a change in form or heel strike can lead to IT problems. While I'm no cycling expert, it doesn't seem crazy to think that a change in form (tweaking your foot with each pedal stroke) could irritate your IT band.


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## webmstrk9 (Aug 12, 2007)

A friend posted this on his facebook a couple of hours ago....there's a stretch which is mentioned in this article as well as this thread.

http://fitbie.msn.com/get-fitter/tips/11-quick-solutions-cycling-problems/tip/8


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## FTR (Sep 20, 2006)

I will suggest that you have your cleats set up so that you are too toe in.
I have had this problem myself and a slight adjustment to the cleat position sorts it out.


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## bradXism (May 10, 2011)

Can't really tell unless I were there to you poke at it. Sounds from your description as ITB . Iliotibial Band. the ITB is a long tendon that runs down the outside of entire length of your thigh. It is attached to a fairly small muscle on what most would refer to as their 'hip'. (Its actually your Illium). Its a fairly useless muscle for human anatomy and has more importance in four legged animals...but thats a tangent. The band inflames a 'Bursa' lateral to your knee. Bursa are sack filled with the same fluid that are in your joints. The sacs are between tendons,ligaments and the bones as a lubricant of sorts. I have many anecdotal accounts of this type of pain diminishing after a few minutes of riding, this may be because it moves the bursa around until the fluid is on both sides of the tendon (I am sure this can be debated). Usually if its runners, it will be worse right after running. If your shoes get really worn and you have another irritant, it may get very painful running.
The above suggestions of the cause are probably both correct. 
Cleat rotation with the heel rotated too far out. Seat height, even your saddle being too wide can all contribute to it. Stomping too big of a gear doesn't help. Running in shoes where the heel is worn to the outside. If your feet are thin and slopping to the outside of the shoe in the front, would irritate it too. The most common cause is overuse and/or over-development of you lateral thigh muscle, Vastus Lateralis, gets more use and causes an inbalance of the stresses on the knee. Often there is a noticeable strength difference between the muscle on the inside, the Vastus Medialis, the little bulge on the inside you knee.

Again it would help to see these things first hand and I heavily suggest you to a Sports Med oriented physical therapist. ITB syndrome is common and the sooner you get there the easier it is to fix. You can mess it up and have a real hard time. The suggestions of massage, you might get some for anti-inflammatories, might give some relief but unless the causes are fixed to stop the continual irritation, you are shoveling Doo-Doo against the tide.
Leg extensions from the knee with the last little bit towards full extension and the foot rotated out is the usual long term therapy. I am suggesting too much based on a small written paragraph and can't really commit to it unless I saw exactly what you are talking about. There is a small chance it could be other things and I very strongly suggest you find a Sports-med Physical Therapist. They certainly have seen this before where an orthopedic surgeon would send, or should, send you to a PT anyways.

It has been my experience that once you have this, you probably will be prone to it unless you continue the leg exercises. Vastus Medialis, (And abdominal core strength) is one of the muscles people should work on keeping as they age. Muscle strength imbalances can lead to long term damage of your knee joint. 

I need to put some type of disclaimer of responsibility here but I am just an imaginary name entering on a forum question. There is no way anyone who familiar with this treatment wise would give you a solid answer just from your description and it could be something else. I don't suggest you take any of my lecture/advise as anything but a suggestion to the diagnosis or the cause and get to the above mentioned PT or sports med facility otherwise this will become harder to fix.

Good luck


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## PJ352 (Dec 5, 2007)

FTR said:


> I will suggest that you have your cleats set up so that you are too toe in.
> I have had this problem myself and a slight adjustment to the cleat position sorts it out.


In lieu of a proper fitting, I agree with the above. 

Here's some info I think you'll find useful, specifically under Knee Pain (lateral):
http://www.cptips.com/knee.htm


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## longbeachbiker (Apr 29, 2011)

Sounds like ITB. I've had success dealing with IT pain by adjusting the cleats to toe outward a little bit. Also, foam rolling and stretching help. Check out athletestrainingathletes website (can't post link due to low post count) for a great resource for self dealing with ITB and other injuries.


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## Peanya (Jun 12, 2008)

For me, my fitting put my Q factor too wide. I moved my cleats outward (so my feet went inward) and the pain disappeared. If you've recently got a fitting, you should go back to the place you got it done at and express your concerns. Hopefully, they guarantee the fit and won't charge extra.


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## Dajianshan (Jul 15, 2007)

I had IT band pain for 4 months. I stopped riding and iced the knee. The key was when I started stretching the hip. Hurdler stretches worked wonders.


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## cyclequip (Oct 20, 2004)

ITB is pretty common and not too difficult to sort out:
1. Lower your saddle height.
2. Lower your saddle height.
3. Increase your stance width - either by moving your cleats medially on the bottom of your shoes or by inserting spacers between the pedal and crank. 
4. Stretch both quads and hammies - but not too diligently - just keep them loose aftyer a ride.
5. Local massage helps.


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## UltralightHiker (Jun 9, 2011)

I eneded up adjusting the cleats this weekend based on this website: http://www.pccglobal.com/outdoors/cycling/PedalCleatInstall/index.php

I went for a 30 mi ride this morning with no issues. I assumed it was a fit issue since I have never had any problems.

Thanks for all the suggestions and help.


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