Any more suggestions for ongoing knee niggle?

Hi all,

Looking to see if anyone has any suggestions in regards to a left knee issue I’ve had for many years now. It hasn’t stopped me riding, but it is very frustrating none the less!!!
It’s a dull pain in the tendon below the knee cap, and occasionally clicks whilst riding. In the past it has clicked or cracked when I’ve had my leg in a position for a while and moved it resulting in a quick sharp pain. I sometimes have tenderness around the VMO muscle as well.

I’ve had various bike fits over the years, but the problem is this usually starts to happen after a few hours once some fatigue starts to develop. My position has always seen to be within the ideal range, with a few very small adjustments done by some fitters. My saddle is currently on the lower side of the range.

I assume it’s a body issue as opposed to a bike fit issue.

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I’m a religious foam roller and stretcher
I saw an Osteo / strength conditioning coach for a while
I’ve tried every muscle imbalance exercise there is (eg single leg squats, single leg deadlifts)

It’s gotten slightly better of late but it still happens on most long rides. Over the last 12 months I’ve had some foot numbness on the same side as well. It kind of feels like I’m not driving through that foot enough so it starts to go numb…who knows. I’m using G8 footbeds but have tried others with the same results.

I’ve started using a massage gun (theragun) lately, and it has been pretty good for me.
Not sure if it’s just a placebo effect! But I feel like I can get into the tendons / between muscles - which loosens everything up a bit.
(Also realised that a lot of my issues tend to originate from much further up my leg than the symptoms - the knee is from my hips, ankle is my calf, etc)

Try a cho pat knee strap… and see a doctor.

How do you know its the tendon? Is the tendon tender to touch? There is also a bursa below the tendon there, you may have bursitis. I can’t imagine a patellar tendon clicking, are you sure it’s not a meniscus issue?

It sounds like it could be PFPS (patellofemoral pain syndrome), I suffer from it as well. Like you mine tends to locate at the bottom of my patella.

The best guide I’ve found is this:

As they explain;

Patella = kneecap
Femur = thigh
Pain = it hurts
Syndrome = we don’t know why.

Everything else is up for grabs.

Taking a different approach here, I had an ACL on my left knee, but done two decades after the initial injury, at which time their was no cartilage left, so, the knee can hurt simply if the weather turns cold, or, I walk down (hill, stairs, etc.). On the bike, I found that the one thing that caused the most aggravation was the pedal type–some allow movement in certain directions, but not others, while others, such as the old Speedplay, allow freer movement in all directions–these were recommended by a local sports medicine doctor, and other folks with knee problems such as Wiggins used them, so I gave them a try–they work for me, and in fact it’s less painful to ride a bike, than walk. Just another thought to consider–good luck.

This is a guess due to lack of information, but an educated one as a physical therapist. Since it usually happens a few hours into a ride, it’s possibly from form degradation over time. As muscles tire, motor patterns can change to spare them, leading to deviations. In your case, the deviation is likely knee valgus (the knee going a bit out of line to the lateral side). This is changing the knee mechanics and causing the pain. If this is what’s going on, it’s fixable through training the posterolateral hip and internal roatators to control the valgus, and through awareness of knee tracking late in rides. Posterolateral hip exercises include clamshells, abduction straight leg raises, fire hydrants, and many others. For internal rotators, reverse clamshells.

And for patellofemoral pain syndrome from above, we actually do know what causes it in many cases and it’s quite fixable (though the fix can take a fair amount of time). Sometimes it degrades into patellar arthritis and that’s not fixable, just manageable. For both conditions, a physical therapist/physiotherapist (depending on where you are in the world) who understands cycling can definitely help.

Good luck!

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Couples of year ago I had the same issues. Thought to get a speedplay xyzr pedals that time but couldn’t find any shop that carried that item.
After long search and reading, I took a shot to buy rotor qrings. Problem solved and the knee issues never come back again.

What imaging have you had done, and what did it show? If none, that would be the obvious next step.

Thanks for all the suggestions everyone. I’ll look at getting an image taken and seeing a Physio based bike fitter!

You should also check out Socal Bike PT: https://www.socalbikept.com/
He specializes in bike related physio treatment and strengthening/prevention.

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