# Medial Knee Pain - Can't Shake It



## Dunbar (Aug 8, 2010)

I've been fighting medial knee pain in my left knee since May. Never had an issue on my 7sp Trek Navigator 1.0. Sold that, bought a performance hybrid (Jamis Coda), knee pain started shortly thereafter. I got a road bike in July, rode that exclusively since then, no change in knee pain. Here is what I have done so far (besides lots of little adjustments):

1) Stretching made no difference.

2) Went clipless (SPD) in August, no change in pain compared to platforms.

3) Got professionally fitted by a very well regarded fitter in September. He made small changes to my fore/aft position but raised my saddle 4cm which I know is a lot. No real improvement after 1 1/2 weeks so I stopped riding bikes entirely.

4) Went to a sports medicine clinic in October. My impression was that since my knee wasn't popping, grinding or swelling they had no ideas so the doctor recommended PT.I went to about 8 PT sessions and have been doing the exercises since then. They seemed to think stronger glutes would help so lots of leg exercises and some core work.

5) I've been off the bike since late September other than a few test rides. The pain gradually goes away with rest and seems to come back immediately when I start riding again. It is hilly around here but I have a triple and I keep the cadence up.

I'm looking for suggestions, I would really hate to have to give up biking at the age of 33. The pain is a low level continous pain that I notice off the bike. It does not hurt when walking up stairs and I don't get any inflammation, popping or grinding. Here is a picture of where the pain is.


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## silver7 (Oct 26, 2005)

Your sore knee looks swollen compared to the good knee. Could it possibly be arthritis?


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## bmxhacksaw (Mar 26, 2008)

Shave yer legs and all the pain will go away.


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## ziscwg (Apr 19, 2010)

I'm not expert, but since you have been to them.............
And I have had some pain there......................

I got some Specialized shoes that have this built in wedge to the shoe. That angle can realign you knee in motion.

You can use the shoes you have if you get the Spec footbed thing. $45 and you get the wedges to make that "wedge out" work for any shoe. Worth a shot.............It's better than not riding.


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## ziscwg (Apr 19, 2010)

Also, have someone ride behind you and look at your knee motion. See if they see anything weird. Or, if you have a trainer, video your legs from dead straight on each leg. Have something that is verified vertical behind you to compare the motion too.

Just trying to give my non expert suggestions. I have been there with knee pain. It sucks. 


Also, are you a spinner or a masher?


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## Dunbar (Aug 8, 2010)

Those aren't my legs, I took the image off google. The fitter used a laser to track my knee position and movement on the trainer and didn't notice anything (he was made aware of the pain.) I've been spinning ever since the pain started b/c that's what everybody recommends. But I had no pain on my 7sp comfort bike which required me to mash up hills. Granted I wasn't riding as much when I had that bike.


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## CurrentlyBikeless (Mar 7, 2008)

*Research patellar tendinosis*

I would recommend you do some internet research on patellar tendinosis to see if this might match your situation. 

Here is a very good web blog on one riders experience and recommended solution:
http://eccentric-exercises.blogspot.com/ 

I had a minor pain in the area you indicate and went to the doctor in an attempt to avoid something more complicated. He also was looking for something more readily apparent and told me I was doing no harm. As long as I ride easy I have no problems. When I try to push myself hard over several rides, then I begin to feel the tendon in my left knee. I've recently started the eccentric exercises, but it's too soon to tell if it will solve the problem.


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## stlutz (Jan 6, 2005)

Is it only when cycling that you have knee problems? What about doing other activities?

What do you do with your legs when you sit? What about your regular footwear--did the onset of knee problems coincide with new shoes, for example? Sometimes the real source of the problem can be completely unrelated to the activity where it shows up.

What is the nature of the "test rides" you have done since Sept.? How long/how intense etc.? By "test ride" do you mean that go you go out and try to do a good ride to test your knee out, or does that mean your knee starts hurting before you get to the end of the block? It is *real easy* to overdo it when coming back from a tendonitis problem (if that is your issue). On your first rides, your pace should be embarrassingly slow (i.e. an 80 year-old would pass you) and you build up from there. And *always* ice afterwards.

Injuries are weird things--sometimes you're in major pain, but a little ice and and you're good in the morning. Other times, issues take a while to resolve. It's not unusual for people to end up seeing a couple of different PTs etc.


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## Hula Hoop (Feb 4, 2009)

Also maybe try Speedplays.Can't rule out a float issue.


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## Dunbar (Aug 8, 2010)

I don't do any other physical activities besides cycling, if it's hurting a lot of walking can aggravate it slightly more. I do cross my legs when I sit, but like I said the pain pretty much goes away on its own by staying off the bike (no changes in footwear.) My test rides are neither easy nor hard, they're about 2/3 more normal distance and medium pace. I live in a hilly area which means there's no way to go super easy. I don't notice the pain on the bike, only afterwards, usually not until the next day. You read about people getting back on their bikes 3-4 weeks after knee surgery and here I am 10 weeks on.


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## AzTallRider (Apr 7, 2010)

My wife is a physical therapist, and I can hear her saying "Ice and Ibuprofen". In my experience (FWIW), it's hard to tell with knees whether you are continually aggravating a problem (like with an existing fit issue), or if the cause of the aggravation is gone, and you are just taking a long time to recover from it. It is -possible- you got the knee problem from having your seat too low, and it is just taking forever to recover. 

Can you convince one of your health providers to order an MRI, or at least Xrays?


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## PoorCyclist (Oct 14, 2010)

I am no expert but have some of the same problem
try this test, it helped me to understand how my 2 knees / foot do not bend the same that's why one was hurting in the medial area.


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## bruce_wayne (Apr 30, 2010)

wait til the pain goes away...

Then get on the 7sp. comfort bike and ride...
Pain now?


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## Dunbar (Aug 8, 2010)

I would try the comfort bike but I sold it to buy the Coda. I can always rent one though to give that a shot. I did have the seat up pretty high on the comfort bike. I "educated" myself when I got the Coda and measured my cycling inseam which turns out was off by about 1.5". All good suggestions, I do go back and forth between thinking its a fit/tracking issue and/or the injury is just slow to recover. I did ride for 4 months that way so it's definitely not out of the question. 

I will try that test tonight, the fitter did watch me walk to determine varus or whatever. He put a wedge under my right cleat but not the left.


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## skygodmatt (May 24, 2005)

*Knee angle*

I had the same EXACT same pain in the exact same location when I rode lots of miles fast. 

What solved it for me were three things: 

1) check your knee angle with a goniometer. The angle should be about 25 to 28 degrees at dead bottom of the stroke ( crank arm aligned with seat tube) . If it is steeper like 35 degrees , that will load the knee. 

2) Check to see where you plumb. Run an plumb bob from just under your knee cap ( the tibial tuberosity ). The plumb line should intersect the pedal axle when the crank arm is horizontal at 3 o'clock. If you plumb in front of the pedal axle, that will place too much stress on the knee. I found it best to fit most riders logging in big miles with a plumb at or slightly behind the axle. 

3)) Cleats. Make sure your foot has a small amount of free play to either side.

I was also going to suggest the varus/valgus knee check but it looks like you've got it covered if you've been checked with a laser. 

You'll find it. Just takes time. Ice when sore and tone it down a bit before you tear it up.


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## stlutz (Jan 6, 2005)

Was just re-reading the thread--did your PT explain to you what he/she thought was hurting (tendon, muscle, bone etc.) was and how the proscribed exercises would help resolve it? For that matter, the sports medicine doc should have at least told you what he thought hurt. (BTW, I would expect the PT to have a better handle on it than the doctor, based on personal experience)

Also, what constitutes "normal" mileage?


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## Dunbar (Aug 8, 2010)

I saw four different PT's at this large facility. They all had different theories but the most confident thought my knee was moving during the stroke. He immediately said "glutes" when I showed him where the pain was. My normal mileage during the week is/was 13 miles and about 600ft of elevation change. I have been doing about 7-8 miles and maybe 200-300ft of unavoidable climbing on my test rides.

skygodmatt, thanks for your experience. I think the fitter did a pretty good job on those points especially the angle and kops measurement but I'll double check. The float actually feels pretty neutral to me, I can rotate the foot slightly left and right from the natural resting position.


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## skygodmatt (May 24, 2005)

Double check the varus/valgus issue. 

I tried some of those S-works shoes with the canted sole 2 years ago. 
In 2 days I developed pain so I went back to my Shimanos. Problem went away. 
Specialized told me that 20% of riders don't benefit from it....but the majority do.

I went to my shop and they checked my pedal stroke with a laser level shining a red beam up my leg while I pedaled. They said the stroke looked perfect with my Shimano shoes. However, they told me most riders have a goofy knee S curve stroke and fit many riders with shims and wedges and that jazz. Their problems get solved. 
I was just one of the lucky ones with a good stroke they said. 

Check that out.


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## bigskychuck (Jul 14, 2008)

Maybe you have anserine bursitis. 

http://www.sports-injury-info.com/pes-anserine-bursitis.html


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## porksoda87 (Jan 22, 2009)

Muscle Activation Therapy. http://www.muscleactivation.com


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## Dunbar (Aug 8, 2010)

Updating this thread. I bought some Speedplays about a week ago and noticed an immediate difference. I'm hoping this solves my issue!


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## durielk (Jan 8, 2011)

You probably made some major changes to your angles while on the bike, with the new bike & fit. It is going to take a while for your body to adapt to the new situation, you probably went out to hard to fast and you pay the price. Just ride & pedal soft if possible or spin more in a lower gear, eventially everything will get adjusted. Pulled tendons/ligaments take a long, I mean long time to recover.


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## Dunbar (Aug 8, 2010)

durielk, my bike fit hasn't changed since last September. I stayed off the bike a total of 6 months. I went to the same bike fitter in April to have the fit re-checked and he didn't change a thing. He advised me I could gradually start riding again. Even taking it easy (lots of trainer, no hills) and icing it after every ride I could feel the pain coming back. I've done a total of 3 rides on the Speedplays and there has been no pain.


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## durielk (Jan 8, 2011)

Dunbar, I dont' think you can have the same fit from a Navigator-Hybrid-Road Bike, but anyway. I think moving your seat 4cm would be a big fit change, if the seat was too low your front/top of your knees take a lot of load.
To me you have injured a tendon or ligament. It is going to take time. 
My suggestion is rest, aspricreme and/or/alternate capzasin, ice after easy rides, & get a percussion/massage unit & work it over a little every day. The idea is to get blood to the area & get rid of the inflammation.


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## Paradox_Q (Aug 1, 2009)

bigskychuck said:


> Maybe you have anserine bursitis.
> 
> http://www.sports-injury-info.com/pes-anserine-bursitis.html


Thanks for the link. I think that this identifies my knee pain and I can take this info with me when I see the PT. This pain came on quick, but I could not identify the source :mad2:, although, I have increased my running distance (and speed), as well as, bicycling mileage.


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## Nyggen (Jun 14, 2011)

*My story...*

Hi

I also had the similar problem as you Dunbar.

I never had it before, but i started to do a lot of training for a big race and then the knee pain started.

I have read a LOT on the internet and tested things like specialized s-work shoes, pedalspacers to get distance between leg 40mm wider, i started to use higher cadense (80 or more) and i also tried a lot of different settings on the bike.

Most of the things didnt do ANY diffference at all, but here is what i did and what i think did the results for me, today everything seems very good and im ready to do the 22hour race next thusrday.

1.Look at the angulation of your feets while walking, you should adjust cleats so you will have almost the same angulations while riding, use also cleats with floating (e.g. shimano yellow) (I was able to move the pain from innerside of knee to outerside if i took the heel to far away from the bike)
2.Toeball should be right over the axle or slightly behind it.
3.Adjust you seat higher. You should just raise it 0,5cm at the time untill you have to strech to reach the pedals, then you take it a little lower. (I think this was my main problem, people often keep their seet too low)

After some testing with these tree points my pain just disaper, remember that 2mm can make a huge differense!

BTW - Im still using pedalspacers, high cadense and s-work shoes.....


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## Paradox_Q (Aug 1, 2009)

I have ended up with similar pain right below my left knee (medial)  In addition to cycling I run, hike, and lift weights. This is a new pain that I have never experienced before, so I finally went in to see the Doc.

Doc (PT) said I have Pes Anserine Bursitis. Good news is that he said I can keep up all my activities :thumbsup: but that I need to ice massage it after exercise (Dixie cup), take my anti-inflammatory meds, and show up for my every other day treatments of a topical anti-inflammatory that is applied through electrical stimulation.

So far, the injury feels better after treatment, but not so good after heavy activity. I have another running race this Saturday which will irritate it. Cycling on the other hand, usually makes it feel better for a little while, although I can sometimes tweek it when I get up out of the saddle.


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