# Knee pain. Who to see first.



## scribble79 (Aug 29, 2012)

I am having some knee pain in my left leg that has always bothered me but now is getting worse. It only affects me when riding and it starts acting up within the 1st half mile. I have tried adjusting the seat every which way. I even swapped back to normal pedals to rule the clipless pedals out. I have 2 bikes and it is the same on both. 

Should I start at the doctor or look to a fitter ?


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## RServranckx (Apr 19, 2011)

Without a doubt, go see a qualified fitter first.

Rob


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## PJ352 (Dec 5, 2007)

If you haven't had a proper fitting, I'd suggest that first, but would be curious (specifically) where your knee pain is and when it occurs (climbs, cruising,accelerating...)


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## scribble79 (Aug 29, 2012)

The pain is even just from cruising around and not working hard at all. It seams to be on both sides of the cap. 

I am just not sure if a fit is worth it as the fit is more than the bike was.


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## PJ352 (Dec 5, 2007)

scribble79 said:


> The pain is even just from cruising around and not working hard at all. It seams to be on both sides of the cap.
> 
> *I am just not sure if a fit is worth it as the fit is more than the bike was.*


Both sides of the kneecap _may_ indicate more than one fit deficiency (assuming you didn't experience the pain before cycling.

If the pain is fit related, you have the choices of winging it on adjusting fit (quite possibly with erroneous results), continuing to ride, enduring the pain (but I doubt that would last long) or rationalizing that the fitting is an investment towards actually using the bike you already purchased. 

I'd opt for the latter. A standard fitting will do, and that should run you about $50-$75. Just make sure to have it done at a reputable shop by a knowledgeable fitter.


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## ewitz (Sep 11, 2002)

Within the first half mile? From just cruising around.


Sorry but you need to HTFU before you can determine if it is a fit or fitness issue.


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## PJ352 (Dec 5, 2007)

ewitz said:


> Within the first half mile? From just cruising around.
> 
> 
> Sorry but you need to HTFU before you can determine if it is a fit or fitness issue.


Not necessarily. If the OP is 'cruising' at a cadence of 40, there's a fair amount of pressure on his knees.


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## scribble79 (Aug 29, 2012)

I'm not saying I quit riding after a half mile that is just when I start to notice the discomfort. I can get anywhere from 5-10 miles before it is just draining and making the ride not comfortable. If my left knee handled it like my Right knee I would be in the 10-20 range currently based on how the rest of my body feels after a ride. Once I am off the bike or not moving the leg like that the pain subsides.


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## scribble79 (Aug 29, 2012)

PJ352 said:


> Both sides of the kneecap _may_ indicate more than one fit deficiency (assuming you didn't experience the pain before cycling.
> 
> If the pain is fit related, you have the choices of winging it on adjusting fit (quite possibly with erroneous results), continuing to ride, enduring the pain (but I doubt that would last long) or rationalizing that the fitting is an investment towards actually using the bike you already purchased.
> 
> I'd opt for the latter. A standard fitting will do, and that should run you about $50-$75. Just make sure to have it done at a reputable shop by a knowledgeable fitter.


The shop I am looking at has been around for a long time but I can't find anything on there fitter. $100 fit or $150 with cleat adjustments.


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## PJ352 (Dec 5, 2007)

scribble79 said:


> I'm not saying I quit riding after a half mile that is just when I start to notice the discomfort. I can get anywhere from 5-10 miles before it is just draining and making the ride not comfortable. If my left knee handled it like my Right knee I would be in the 10-20 range currently based on how the rest of my body feels after a ride. Once I am off the bike or not moving the leg like that the pain subsides.


Sounds fit related to me. Re: the $100-$150 price range, they'll vary by region and even locales within regions, so consider expanding your search to include some more out of the way LBS's. You may find more reasonably priced fittings. 

Obviously, not knowing your general location or proliferation (or lack thereof) of LBS's, I'm just throwing out suggestions.


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## scribble79 (Aug 29, 2012)

I'm in the Madison WI area. The other shops seem to be $250 and up.


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## Zeet (Mar 24, 2013)

I say, before you do anything else, just have a doctor take a look at what's going on. It does indeed appear to be fit related. However, we're not experts here on the internet. Don't take any chances of making something that's already bad, just that much worse, by not getting the problem properly evaluated. After all, your knee does not belong to us. What if it's something serious, and here you sit on the internet asking bicycle geeks about your quickly degenerating knee?  Might or might not be just that bad!...Who knows? ...You can always get a fitting, anytime...


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## PJ352 (Dec 5, 2007)

scribble79 said:


> I'm in the Madison WI area. The other shops seem to be $250 and up.


That has to be for a pro fit. Ask these shops for a price on a standard fitting, like they include with bike purchases. They take about 45 minutes to one hour plus.


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## PJ352 (Dec 5, 2007)

Zeet said:


> What if it's something serious, and here you sit on the internet asking bicycle geeks about your quickly degenerating knee?


This bike geek thinks if it were something serious, it wouldn't start when the OP rides his bike and end when he stops, but that's just my logic.

OTOH, riding an ill fitting bike could lead to a serious injury.


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## Zeet (Mar 24, 2013)

PJ352 said:


> This bike geek thinks if it were something serious, it wouldn't start when the OP rides his bike and end when he stops, but that's just my logic.


 We're all bicycle geeks, PJ! That's geeks, in the sense that most of us have an inordinate and abnormal interest in, and enthusiasm for, bikes. Almost to the point of being obsessive (Perhaps I should just speak for myself, eh ) No offense will ever be intended or waged against you from me, PJ! I have entirely too much respect for you... 



> OTOH, riding an ill fitting bike could lead to a serious injury.


I dunno, maybe an injury occurred previously from cycling on an ill fitted bike, or perhaps the knee was injured from something else, not related to cycling. OR- Maybe there's really no injury at all. All that I know for sure, is that, that knee needs to get properly physically assessed first, prior to considering a fit. I say this because, after the fit, what do you do immediately afterwards? Do you wait and say, "Let me give myself time to adjust to the fit."? Alternatively, do you say, "That fit that I had today didn't work, I'm going to the doctor!"?...I dunno, whenever we have pain, I think we should always get it checked out first, if we're uncertain about the source of that pain.


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## PJ352 (Dec 5, 2007)

Zeet said:


> We're all bicycle geeks, PJ! No offense...


Just as a FYI, I wasn't at all offended by your comment. Just decided to use the term in my response. And yes, it fits. :wink5: 



Zeet said:


> I dunno, whenever we have pain, I think we should always get it checked out first, if we're uncertain about the source of that pain.


This is certainly a safe route to take, but I'll admit that I don't always take it. 

I agree that we can't *know* for sure, but (IMO) indications are that riding the bike 'as is' is causing the OP knee pain. Fix or remedy the cause and assuming no major injury, his body will no longer be stressed in that area and the pain will subside. How quickly and to what degree is anyone's guess, but getting a fitting is (again, IMO) the right first step to take.


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## Social Climber (Jan 16, 2013)

No reason not to see a doctor. You should do it anyway. I've had sporadic knee pain in my left knee (when riding) for years, even after a fitting. Earlier this year it started getting worse so I finally decided to see a doctor. Turns out it wasn't my knee at all. It was patellar tendinitis. I was just feeling the pain in my knee. I started wearing a tendinitis strap and since then have had few issues and now am riding longer than ever.


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## PJ352 (Dec 5, 2007)

Social Climber said:


> I've had sporadic knee pain in my left knee (when riding) for years, *even after a fitting*.


Which differs from the OP, who has not yet had a fitting. Comes down to opinion in (as the OP states) who to see first. Mine is that since the pain started on the bike and ends off it, a fitting may well cure his ills.


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## ewitz (Sep 11, 2002)

scribble79 said:


> I am just not sure if a fit is worth it as the fit is more than the bike was.





PJ352 said:


> Which differs from the OP, who has not yet had a fitting. Comes down to opinion in (as the OP states) who to see first. Mine is that since the pain started on the bike and ends off it, a fitting may well cure his ills.


The OP has already stated that he is riding a POS. Why throw good money after bad?


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## PJ352 (Dec 5, 2007)

ewitz said:


> The OP has already stated that he is riding a POS. Why throw good money after bad?


Because even when riding a POS a cyclist has to take steps to ensure a decent fit to avoid injuries. I think this thread illustrates that fact pretty well. 

Assuming the knee discomfort is fit related (which I am), I'd never view a fitting as a waste of money. Odds are the OP won't ride much if this isn't remedied.


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## ewitz (Sep 11, 2002)

PJ352 said:


> Assuming the knee discomfort is fitnes related (which I am), I'd view a fitting as a waste of money. Odds are the OP won't ride much ever.


Fixed it for you.


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## scribble79 (Aug 29, 2012)

So you are saying that because I can't stand the pain past 10 miles I will never get the level of being fit enough for a full or half century ride. 

I admit I am not in great shape but want to ride to get into better shape. Since I started riding last September I have noticed my cardio is better and want to keep improving.


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## Randy99CL (Mar 27, 2013)

The problem with questions like this is that we have no idea of what level of knowledge the OP has accumulated.

Scribble, you've said that your bike cost less than a fitting and that you've "adjusted the seat every which way."
Do you know how to adjust your saddle according to your leg length? Have you checked the KOPS to at least get a starting point for where it should be?
Those two settings put the saddle close to where it needs to be for your body and you can tweak it from there.

If you don't want to spend the money for a fitting do spend the time to read everything you can on adjusting the bike to you. Lots of books in the library, or websites, or ask questions here or at your LBS.


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## scribble79 (Aug 29, 2012)

I have decided that the problem is not only bike related. It seems to be anytime the leg is used in a manor similar to pedaling is when the pain arises.

I am going to see the doc on Friday and have it evaluated. Once I know what is up I will get it corrected then purchase my new bike with a proper fit.


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## Zeet (Mar 24, 2013)

scribble79 said:


> I have decided that the problem is not only bike related. It seems to be anytime the leg is used in a manor similar to pedaling is when the pain arises.
> 
> I am going to see the doc on Friday and have it evaluated. Once I know what is up I will get it corrected then purchase my new bike with a proper fit.


Now that's what I'm talking about, Scribble! Only Scribble can look out for Scribble...Smart decision! :thumbsup:


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## scribble79 (Aug 29, 2012)

Well saw the general doc today and he had no idea as to the cause. I did learn that our University hospital has a specialized cycling clinic. Got an appointment for a bike specialist to check me out and it sounds like a fitting is part of check up so off to the LBS to pick up a new ride.


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## PJ352 (Dec 5, 2007)

scribble79 said:


> Well saw the general doc today and he had no idea as to the cause. I did learn that our University hospital has a specialized cycling clinic. Got an appointment for a bike specialist to check me out and it sounds like a fitting is part of check up so off to the LBS to pick up a new ride.


When this thread started, I was pretty sure your knee pain was precipitated by cycling, but in your last post (2 days ago) you indicated otherwise. 

I think your current plan to see a bike specialist is a good one, but sometimes with this type of injury, a sports Ortho doc is better (I should say, more knowledgeable) than many GP's. 

All that said, I'm back to form and/ or fit being the source of your knee issue.


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## scribble79 (Aug 29, 2012)

Well hopefully this person can figure it out and also is an excuse for me to get into road cleats.


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## PJ352 (Dec 5, 2007)

scribble79 said:


> Well hopefully this person can figure it out and also is an excuse for me to get into road cleats.


I obviously don't know the credentials of the person you're going to see, but if they're well versed in bike fit/ physiotherapy, I think your odds of success are good.

I hope you get this sorted out. Riding in pain/ discomfort is not fun.


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## Zeet (Mar 24, 2013)

scribble79 said:


> Well saw the general doc today and he had no idea as to the cause. I did learn that our University hospital has a specialized cycling clinic. Got an appointment for a bike specialist to check me out and it sounds like a fitting is part of check up so off to the LBS to pick up a new ride.


Were you given an X-ray?


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## scribble79 (Aug 29, 2012)

No x-ray was done at the General docs location.

Here is a little run down of the clinic that I am scheduled for.

Cyclists Clinic: Injury Evaluations 
Biomechanical assessments are used in combination with a thorough musculoskeletal evaluation to address your injury. During the initial evaluation, patients receive:

Cycling history review
Physical examination (i.e., flexibility, strength, skeletal alignment, foot structure)
Biomechanical analysis of cycling technique
Bike measurements and biomechanical fit assessment
Treatment plan and bike fit adjustments, as appropriate
Injury treatment and prevention education
Follow-up visits scheduled as needed

The person I am seeing practices physical therapy at the UW Health Sports Rehabilitation Clinic. He specializes in treating athletes with an emphasis on the effect of sport biomechanics on injury and return to sport. He has a special interest in swimming- and cycling-related injuries and is the co-coordinator of the UW Sports Rehabilitation swimming and cycling clinics.


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## Zeet (Mar 24, 2013)

scribble79 said:


> No x-ray was done at the General docs location.
> 
> Here is a little run down of the clinic that I am scheduled for.
> 
> ...


This sounds great, but without an initial X-ray, it seems as though, they've left one large stone unturned. Something tells me that you're going to end up eventually getting an X-ray, after the physical examination. Perhaps, this is their attempt at being a more thorough and efficient health facility, by not over prescribing X-rays. Sounds like a top notch organization. I'm most certain that you'll be well real soon. At any rate, good luck with your health and future cycling quests! :thumbsup:


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## PJ352 (Dec 5, 2007)

scribble79 said:


> Here is a little run down of the clinic that I am scheduled for.
> 
> Cyclists Clinic: Injury Evaluations...
> 
> ...


Very promising. You should do well under this persons advisement.

I think your thread points up the importance of good fit/ injury avoidance, so please update and let us now how it goes.


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## scribble79 (Aug 29, 2012)

Well finally has my appointment with the pt/fitter. Found my saddle to be about an inch too low and about 1/2" to far forward. The big thing is that I need to put on 1" pedal spacers to get my foot position correct due to my skeletal make up. Spacers should be here tomorrow and then get some miles on them.


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## SauronHimself (Nov 21, 2012)

I don't think an initial x-ray would be appropriate since that will only show bones. An MRI would reveal much more.


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## PJ352 (Dec 5, 2007)

scribble79 said:


> Well finally has my appointment with the pt/fitter. Found my saddle to be about an inch too low and about 1/2" to far forward. The big thing is that I need to put on 1" pedal spacers to get my foot position correct due to my skeletal make up. Spacers should be here tomorrow and then get some miles on them.


Given your (somewhat) unique circumstances, I think you took exactly the right course of action. 

Also (IMO) this points up just one reason why DIY fittings won't work for some (I actually think, many) individuals. Unique anatomical issues are near impossible to first identify, and second, employ the appropriate fix.


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## c_h_i_n_a_m_a_n (Mar 3, 2012)

PJ352 said:


> ... Also (IMO) this points up just one reason why DIY fittings won't work for some (I actually think, many) individuals. Unique anatomical issues are near impossible to first identify, and second, employ the appropriate fix.


But would you agree that most of us will get use to their bike? I am sure we can 'fit' quite a range of bikes. Assuming that we are in the casual weekend rider category. For those who race, maybe they should get a fit, but then again, it looks to me that most pro peloton riders use a variety of bikes based on the conditions and most of them look to be smaller than if they had gone for a fitting. I could be wrong ...

I guess on the flip side I could say some of us are unable to fit their bike and hence will benefit from a fitting.



I get knee pain as well but only on my left knee. On both sides on my knee cap. Curious thing is it only happens after about 3 hrs into the ride. Came about on my second ride on a challenge of 4 long rides with climbs with 1 day rest in between.

It is painful even after a ride. More so, if I lift my knee, which suspends the weight of my lower leg and feet on my knee. I think it might be chondromalacia patellae, self assessed, :wink: and rest is all I need. Pain goes away after 2 days.


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## PJ352 (Dec 5, 2007)

c_h_i_n_a_m_a_n said:


> But would you agree that most of us will get use to their bike? I am sure we can 'fit' quite a range of bikes. Assuming that we are in the casual weekend rider category. For those who race, maybe they should get a fit, but then again, it looks to me that most pro peloton riders use a variety of bikes based on the conditions and most of them look to be smaller than if they had gone for a fitting. I could be wrong ...


I don't think I'd say "get use to". Rather, I'd say "make do with a less than optimal fitting". And this would only apply if all fit parameters were 'within reason' of being close to a riders requirements. Stray further and pain/ discomfort will likely result.

Not sure exactly what you mean by "we can fit a range of bikes". If you mean I can fit comfortably on a Trek Madone 52, Specialized Tarmac 52, Rocky mountain 47... then yes, because manufacturers have no standard of measuring for frame sizes, I can ride all of those bikes comfortably (assuming a proper fitting).

Conversely, if you mean I can ride 52 or 54 Tarmac (as one example), then I go back to my previous response. I _could_, but one of those sizes doesn't offer an optimal fitting. I know this to be true, because I ride a 52cm Tarmac.

Of course, one could argue that (with some tweaks to stem length/ angle/ spacer set-up) reach and drop on a 54cm Tarmac could be equalized, but in my case they'd represent unnecessary compromises. And also change my f/r weight distribution. Very important on road bikes. 

Re: the pro versus casual rider scenario, I don't think many of us are pro caliber athletes, so IMO what they do and why they do it (while interesting at some level) is pretty irrelevant to us mere mortals. That said, casual or avid rider alike need to be able to ride a bike comfortably, so IMO a proper fitting is universally required. 



c_h_i_n_a_m_a_n said:


> I guess on the flip side I could say *most* of us are unable to fit their bike *properly* and hence will benefit from a fitting.


Tweaked it a little so that I could agree. :wink5: 



c_h_i_n_a_m_a_n said:


> I get knee pain as well but only on my left knee. On both sides on my knee cap. Curious thing is it only happens after about 3 hrs into the ride. Came about on my second ride on a challenge of 4 long rides with climbs with 1 day rest in between.
> 
> It is painful even after a ride. More so, if I lift my knee, which suspends the weight of my lower leg and feet on my knee. I think it might be chondromalacia patellae, self assessed, :wink: and rest is all I need. Pain goes away after 2 days.


I'm ortho doc so I'm not gonna pin a name on this ailment, but my guess is overuse/ fit related (cleat position/ float/ orthotic or wedge needed). The delay in the onset of pain may may be because the longer and harder we ride, the more likely that loose link in fit will surface.

Here's a link I've posted previously. There's likely related/ relevant info in the text, but scroll to Kee Pain - Lateral for possible causes/ remedies.
CYCLING PERFORMANCE TIPS -


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## c_h_i_n_a_m_a_n (Mar 3, 2012)

PJ352 said:


> ... Here's a link I've posted previously. There's likely related/ relevant info in the text, but scroll to Kee Pain - Lateral for possible causes/ remedies.
> CYCLING PERFORMANCE TIPS -


Cheers for the link. A couple of things that I can do. Will start with cleat positioning first ... quite a bit I can do there. :thumbsup:

Am currently away and so will not be on the bike for 1mth and so resting the knee. But I did go out for a 5km jog yesterday and the same pain still surfaced, but only after the run. Gone in 1 day this time.


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