# Knee pain and muscle imbalances?



## kreuzberg

Hi,

I've never had knee problems before and this summer I started having knee pain all around the knee cap. There were some fit issues in april and may with cleats and seat height, fore and aft, etc, so that's probably what set it off. But now I have had pain in different parts of both knees on every ride since july. 
My knees don't hurt when I touch them, I can't push anywhere on them to produce pain. They do hurt when I sit with my knees bent, or when I'm riding (hi force or low, hi cadence or low, it doesn't matter). They also hurt when I walk around sometimes. Taking time off doesn't seem to help. They hurt in different places all over my knees around and under the kneecap, and very frequently on the outside of my knee, and the center.

Recently, I spoke with a fit guy at LBS and he noticed that I pedaled with my heels waay in (toes pointed out) which he said was causing muscle imbalances, my VMOs were not doing much work, and my outer quads were doing all the work which was creating an imbalance. So I began to pedal focusing on heels out, keeping my knees straight up and down. The pain went away for about three weeks and now it has been back for two or three weeks.

So first off, it isn't agonizing, I can definitely ride through it but I do NOT want to cause any serious damage. Is there a way to reverse this problem and keep riding? I have tried taking a few days off the bike, it didn't do anything. Is this an easy fix?

Also, does anyone know about muscle imbalances and/or have experience with this type of problem? It is an area I don't know much about.

Any other advice really is much appreciated. thank you.


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## Salsa_Lover

have you seen an orthopedist ?

I don't have such a pronounced problem as you, but I do have flat feet and my legs are not straight.

I had different kinds of knee pain in the past until i got orthotics made.


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## dgeesaman

I have experienced this running, but it's fundamental to any activity.

In my case it was a knot in one of my leg muscles that was constantly pulling on the knee joint causing pain. How is your stretching routine? If you're not doing much, I suggest doing much more and doing most of the stretching after your workouts. If you have been stretching consistently, go see the orthopedist so they can find the root cause. In my case it was a knot in a muscle that couldn't be stretched and with 3 sessions of electrical stim the knot released and never returned.

Muscle imbalance is not to be ignored. Running is a great offset to the muscle use in cycling.

David


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## kreuzberg

Salsa_Lover said:


> I had different kinds of knee pain in the past until i got orthotics made.


Well then maybe this thing is the excuse I was looking for to buy some new bont shoes!
:thumbsup: 

Did the orthotics stabilize your foot or something? I have speedplay pedals and I notice that I can rock the shoe from side to side a little, like up and down. I kind of wish this wasn't there, but I haven't heard of anyone else complaining of it.


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## kreuzberg

dgeesaman said:


> I have experienced this running, but it's fundamental to any activity.
> 
> In my case it was a knot in one of my leg muscles that was constantly pulling on the knee joint causing pain. How is your stretching routine? If you're not doing much, I suggest doing much more and doing most of the stretching after your workouts. If you have been stretching consistently, go see the orthopedist so they can find the root cause. In my case it was a knot in a muscle that couldn't be stretched and with 3 sessions of electrical stim the knot released and never returned.
> 
> Muscle imbalance is not to be ignored. Running is a great offset to the muscle use in cycling.
> 
> David


Once you fixed it, did your knee problems just go away? I don't want to cause any long term damage...


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## Bike Poor

My knees start to hurt if I don't stretch consistently. Doesn't take a lot, 5 minuts at the end of the ride makes a big difference.


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## wim

*Odd.*



kreuzberg said:


> I pedaled with my heels waay in (toes pointed out) which he said was causing muscle imbalances, my VMOs were not doing much work, and my outer quads were doing all the work which was creating an imbalance. So I began to pedal focusing on heels out, keeping my knees straight up and down.


Not exactly sure I can follow this clearly. If you have pedals and cleats which allow float, your feet rotate automatically to where they want to be and (more importantly) to where they need to be. Pedaling heels out / toes in may have improved tracking of your knees, but at the cost of generating a counterforce against your natural (usually tibial) rotation. Did the fitter change the rotational angle of your cleats, or are you forcing yourself to pedal heels out on pedals with almost unlimited float?

I also can't see the connection between foot rotation and a "muscle imbalance." Do you have more details on how that can be?


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## RUV

you really should go see your primary care physician or an orthopedist. this sort of ongoing pain needs to be evaluated in person, especially for something like imbalanced quads causing patellar misalignment. you'll need a thorough knee exam. up until you said the pain moved all over the place, I was thinking this was patellofemoral syndrome.

in the meantime, I would consider icing your knee and taking ibuprofen as needed.


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## MorganRaider

I have/had a similar issue. Put on 700 miles last fall on hybrid, 300 miles on trainer, no kneecap issues. First time cycling other than childhood. Had a good base with lots of elliptical, treadmill and weights. Some tendonitis femoral tendon due to overuse on trainer in Dec. Did not excersice a whole lot from Jan – April. Started cycling mid April with seat too low, got knee pain, left side only. Raised seat knee pain still there, but less. Saw ortho doc, diagnosis: muscle imbalance. 
May - Aug: did excercises, weight training to strengthen inner quads. 

Aug - got new road bike + speedplay X's + specialized BG shoes (built in varus), no knee pain. (had professional fit for road bike ) Inner quads have some good definition now. Last week took hybrid out with saddle at same height as road bike, result: immediate knee pain. 

Took both road bike and hybrid to my fit guru (was fitted for road bike, not hyrbid). 
Turns out my road bike has more setback of saddle relative to bottom bracket so I can maintain proper torso, thigh angle (90 deg) and not put shear force on the knee cap. The distance from BB to stem is identical for both bikes. I am now in the process of trying a thomson layback seatpost on hybrid to try and match fit on road bike.


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## dgeesaman

That was my last issue with knee pain.

However I could not have found or resolved the issue without help from my doctor (trainer). Just saying that you may find it's as simple as a few treatments.


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## alexp247365

I had the same issue with knee pain for over a year, and was finally able to isolate the problem. Maybe my experience can help you.

I had been trying to get rid of my knee pain for over a year by constantly tweking what seemed to be an incorrect setup in cleat placement. No matter how I set up the cleat, I could not get my left leg to pedal with the no pain, perfect stroke feeling that my right leg was enjoying. I tried a wedge thinking that might help. And it did, but was actually the solution for making my foot feel perfectly connected to the shoe, not the knee problem.

I noticed that at the farthest part of my pedal stroke there was what I can only describe as 'knee suck,' or the pulling of the leg straight because either my ankle wasn't flexible enough, or, the seat height was too high.This pulling of the leg felt like the lower leg was being pulled away from the joint. 

I moved the seat height down a little bit and the knee-suck disappeared, along with the knee pain.

I moved the seat height down a little which eliminated the 'knee suck' and also the knee pain.


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## kreuzberg

wim said:


> Not exactly sure I can follow this clearly. If you have pedals and cleats which allow float, your feet rotate automatically to where they want to be and (more importantly) to where they need to be. Pedaling heels out / toes in may have improved tracking of your knees, but at the cost of generating a counterforce against your natural (usually tibial) rotation. Did the fitter change the rotational angle of your cleats, or are you forcing yourself to pedal heels out on pedals with almost unlimited float?
> 
> I also can't see the connection between foot rotation and a "muscle imbalance." Do you have more details on how that can be?


Yes, I apologize for being unclear. It really wasn't about foot rotation, it was about getting my feet in a way so that when i pedaled my knees would go just straight up and down, with no lateral motion (they used to go slightly out at the top of the pedal stroke). Now, I have fixed the cleats so I can't move my feet from this position, my knees go up and down, and when I ride I am really feeling it in my VMOs, or inner thighs (I think thats the VMO...). Hopefully the issues will subside in a few weeks, I guess I will always need to keep stretching though. 
Now I am having some sharp pain above my right knee in the quadricep tendon, I guess from the new position. My guess (and hope) is that this will go away as I adapt, I am icing it right now...


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## kreuzberg

MorganRaider said:


> I have/had a similar issue. seat too low, got knee pain, left side only. Raised seat knee pain still there, but less. Saw ortho doc, diagnosis: muscle imbalance.
> May - Aug: did excercises, weight training to strengthen inner quads.
> 
> Aug - got new road bike + speedplay X's + specialized BG shoes (built in varus), no knee pain. (had professional fit for road bike ) Inner quads have some good definition now. Last week took hybrid out with saddle at same height as road bike, result: immediate knee pain.


Hopefully this is what I am having. Did it go away? My inner quads have waay less definition than outer quads. Did you do any strengthening stuff off the bike? Stretching? How long did it take for the pain to subside?


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## wim

kreuzberg said:


> Now, I have fixed the cleats so I can't move my feet from this position,


For most riders, fixing the cleats to eliminate lateral knee motion would be an almost sure-fire prescription for serious knee problems down the road. Go see someone competent, please.


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## harpon

The general rule, not considering individual problems is that the lower the position, the more stress on the knees- 
of course you don't want to lock up your knees, and it is also dependent on your current level of flexibility,
and how straight your body frame is aligned otherwise-

In other words, if you have already shortened the muscles with a low seat position,
it may take some time to adjust, and you may have other stress problems elsewhere
if your shortened muscles then pull something else, some other muscle group to the side.

I've ALWAYS had muscular imbalance because of several injuries, and from other sports that pre-dated my cycling career-
stretching helps, I only started it late and wished I had sooner
and I really mean Yoga, because the first thing that a stretching program requires is the yoga not to keep overstretching-
I've practiced yoga since '78 and occassionally still overstretch- 
but not nearly as much as when I started. 

overstretching causes pain and just costs you time recovering from the overstretch- 
it can be hard for someone spending a lot of time training otherwise-
so get those "stolen moments" when you can-
the stretching doesn't have to be confined to a strict routine- but it helps to devote some time!

My advice (after having raced 14 seasons)- with little info here and not seeing your position-
raise your position in small increments, but don't get to locked knees...

and stretching, yoga, definetly helps to balance muscles-
the simplest stretches can be the most important- 
1. corpse pose on back- legs out- basically just laying flat, let your head go where it will-
you'll probably find it 'cycles' around
2. corpse pose with knees up and feet flat- just lay there and relax!
3. frontal corpse pose on stomach- really helps balance the backs of those thighs

those three poses alone can do as much as radical and possibly straining bending. 
You should arrive at a regular routine with a number of poses
8, 10 or more, and they don't necessarily have to be all done together, but it helps
Find a good yoga book, take some lessons
Long fluid motions that don't strain or cause pain.
good luck


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## Hula Hoop

My fitter immediately identified a knees out at top of pedal stroke and pushed
with his hand on my IT band, which was excruciating. I have since began
using a foam roller and my knees have come in, aligning with the hips and
feet better. Now I am getting fitted with Speedplay Zeros. I am hoping this,
combined with stretching after riding will alleviate chronic left knee issues.


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## mjengstrom

I have similar knee issues and was diagnosed with IT Band syndrome. Trying to treat it with stretching and strength exercises along with a foam roller and ice. A friend recommended ART Therapy as well. I heard great things about ART and will probably give this a try. Might want to give some of this a try as well.


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## scarab$

mjengstrom said:


> I have similar knee issues and was diagnosed with IT Band syndrome. Trying to treat it with stretching and strength exercises along with a foam roller and ice. A friend recommended ART Therapy as well. I heard great things about ART and will probably give this a try. Might want to give some of this a try as well.


Same thing my trainer said... Stretching, foam roller and alternating strength exercises. 

That foam roller on the quads will bring tears to your eyes. :mad2:


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## SantaCruzn

I realize that I'm late to this party. However, since knee pain is common with cyclists I'll give a general checklist the OP and others like him should review.

In addition to the bike fit, proper shoe/pedal selection, and pedaling style (i.e. not mashing in too large a gear), there are specific things you can AND SHOULD look into off the bike.

1) Self Myofascial Release (SMR for short). Few of us have the luxury to afford a qualified massage therapist on a regular basis. This is where SMR can and will help tremendously.

2) Stretching - especially the overactive muscles. Obviously, you first have to know which set of muscles are overactive and which are underactive. This is where I strongly recommend you have a qualified professional (Trainer, Physical Therapist, etc.) take a look at you.

3) Strengthening of the underactive muscles. For example, most cyclists neglect the posterior chain which is commonly known as the hamstring complex. There are four major muscles that make up the hamstring complex (semimembranosus, semitendinosus, biceps femoris long and short head). All these muscles have two tasks in common: they concentrically flex the knee (which helps tremendously with the back stroke) and isometrically help to stabilize the knee. I realize the biomechanics of cycling is such that the down stroke is the most powerful. However, this does not mean that we should neglect what's going on the back of the legs. In other words, an imbalanced athlete is most likely going to be an injured athlete.

And before some one chimes in with the comment that the hamstring complex also extends the hip, the biceps femoris short head does not because it originates at the femur and inserts in the fibula.

If anyone has further questions, feel free to post on this thread or PM me. And I respectfully ask that this is my first post not negatively color your opinions on my comments. We were all new to this or other forums at one point.

Thanks very much.

Andy


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