Knee Pain Bike Fit Basics -- JH

The Simple Rule for knee pain

The two main areas -- the front and back of the knee -- do have some simple correlations that many have heard about. Namely if the pain is in the front of the knee (quad tendon/patellar tendon/patella) then the saddle is too low, and that if the pain is is at the back of the knee (hamstrings), the saddle is too high.

To a certain extent these generalizations are true.Except when they’re not:What I mean by that is that it’s not that cut and dried because often times knee pain, in the front or back of the knee, isn’t coming from saddle height at all, but rather has a root cause somewhere else.

Which brings me to a cardinal rule of bike fitting that needs to be addressed before we go any further: Because we’re connected to the bike at our feet, hands and rear end there is more push-pull with our mechanics on the bike than just about any other activity we do. In PT we call it regional interdependence and it basically boils down to the idea that a posture or movement change in one area can have a significant impact on another distant area. An aberrant movement at the feet can cause a problem at our hands or shoulders and vice versa. This phenomenon is especially pronounced on the bike.

This is where the true difficulty of bike fitting lies -- being able to ferret out these distant and complex mechanical relationships and then understanding what changes will solve the problem. Of course knowing what the cause of the problem is will be the most important step.In this module we will address some of these complex relationships to increase the likelihood of solving more problems.

Some fundamentals of the process when making bike fit changes

Do not expect the pain to disappear quickly. Most of these injuries take time to develop and so even if we perfectly fix the root cause, it’s likely to take (often significant) time for it to resolve.
Be cognizant of riding on terrain that increases the symptoms -- for instance if hill climbing makes your knee pain worse then you should moderate the amount of time you spend doing this, but you shouldn’t completely avoid it either.
Make changes -- raise the saddle around 5 mm -- and then complete at least a couple rides that include the sort of terrain that tended to exacerbate the symptoms. Don’t make any decisions about whether a change was “good” or “bad” after a single ride.
You can judge the change after a few rides based on a change in one or more of the following parameters: frequency, intensity, or duration.
1. Frequency: Does the pain occur less or more often? It could be that it hurts on every ride still, but it no longer hurts after every ride like it did. This is a positive change in frequency.
2. Intensity: Is the pain less intense? Maybe it hurts the same amount at the beginning and end of the ride but now there’s a period in the middle where it feels better. This is another positive sign.
3. Duration: Does it not hurt for as long?

As we change saddle height we need to carefully track all of these. Any improvement in any of these areas is considered a positive sign that the changes were beneficial.If after 2-4 rides the symptoms are exactly the same, then we can assume the change was either not enough or not the right change to begin with.If the pain increases consistently* then we need to move backwards and undo it.*Consistent pain increase means that it didn’t just hurt more on one ride, but on more than one and then pain never dipped below its baseline level. This is where things can get very messy since there is always a lot of gray area with tissue healing. It is entirely possible that a change might cause a significant increase of pain on one or more rides, but still provide relief on a different ride -- these cases can be difficult to read, but should usually be tested further.Patience is the key here.To start, we need to understand the tissues that can be involved in our discomfort. Location of the pain, nature of the pain, and the sensations associated with it will be important to better understanding what is causing the problem and how we can best fix it.So in the next section we're going to look into the area or location of the pain and how we might use this to narrow down to the involved tissue.

Tissue Injury - Location

Quad and Patellar tendons

How is it irritated

Generally both these tissues are irritated with excessive knee flexion. Maximum knee flexion occurs at the top of the pedal stroke which is also the time when we begin the loading phase, or our power stroke begins which adds to the stress of these tissues. Knee flexion with force production is a recipe for a tear in a tendon.What fixes can help? Raise saddle, move saddle back, shorten cranks

Mechanics of Injury

The patellar and quadriceps tendons are injured in so similar a way that we can essentially take a look at them together since they share the same cause and mostly the same management.The way these tendons are injured is through a stretch under force. Again, as a quick review, the tendon is in the act of being stretched while it is being loaded when the quadriceps activate to exert force down on the pedals. This happens towards the top of the pedal stroke, when the crank is near “12 o’clock” -- the knee is bent the maximum it is going to be during the pedaling cycle and this is also when the large muscles surrounding the thigh begin to become their most active in pushing on the pedals.The more the knee is bent, and the harder the cyclist is pedaling, the more strain is going to occur at the patellar and quadriceps tendons. Increase in strain leads to more disruption of fibers and more potential for inflammation and pain to spiral out of control and a persistent injury is born.Sub-patellar tissues are irritated in a different way, however roughly the same set of bike fit issues can bring it about. Sub-patellar cartilage is irritated when it is compressed against the femur. As the knee flexes more the quad and patellar tendons pull on the kneecap from both ends and press it into the femoral groove. Given time and repetition, this can lead to injury.How do we get increased knee flexion at the top of the pedal stroke? The most common way is to have your saddle too low. This is not new or earth-shattering information.

What you’ll see/measure

As you’ll read in the Bike Fit Fixes section, having too low a saddle height is one of the more common causes of patellar and quadricep tendon irritation, but this is one of the most deceptively difficult things to remedy. When the saddle is too low, not only will the knee be bent or flexed at the bottom of the pedal stroke, but more importantly, it will bend more at the top of the pedal stroke. Typically in a bike fit we're looking to have the rider's knee extension angle at the bottom of the pedal stroke between 35 and 45 from full knee extensionWithout being able to measure, a rider will only experience the fact that their knees are far from straight at the bottom of the pedal stroke.Just determining what “too low” or “too high” is can be incredibly difficult, since some riders will fall outside the range of what is considered a “normal” saddle height for a person their size. It’s also a very fine line between what is mechanically functional for a rider, and what will cause a problem -- usually as little at 0.75” (or 18 mm) in either direction.

Rider Report | What does it feel like?

Of course, the knee discomfort is usually located on the front, but it’s the nature of the pain that can differ. Quad tendon irritation will reside above the knee cap while patellar tendon lives below. The pain is often, but not always, present to start rides. As the rider becomes more fully warmed up, then it can often lessen or disappear, only to return again at the end of the ride as the rider fatigues.Pain off the bike is possible - especially when going up and down stairs, running or squatting down, but often the pain won’t be present during normal daily tasks.

Let's go over some basic bike fit fixes (but more on this later)

If you believe that, indeed, a low saddle is the cause of your knee pain, the simplest way to start is to raise the saddle in 5 mm increments. This sounds easier than it is because there are a lot of things to keep in mind -- most people fail to heed these which prevents them from fixing the problem:The conventional wisdom is that pain in the front of the knee means your saddle is too low, and in many cases this is true. But while this simple rule is correct often and can solve this problem a lot of the time, it’s a bit too simplistic and there are many exceptions. The main exceptions have to do with the fact that we adjust our saddle height based on the amount of knee extension at the bottom of the pedal stroke, or the 6 o’clock position. This is fine most of the time, but due to individual differences in body measurements and mechanics, you can have your saddle height adjusted perfectly for the amount of knee extension at the bottom of the stroke and still have too much knee flexion at the top of the stroke.How? One way is by having incorrect crank length. Regardless of crank length a rider can always get the proper amount of knee extension at the bottom of the pedal stroke -- this metric, how straight the knee is at the bottom of the pedal stroke, is looked at in bike fits the most. What is often ignored however is how much knee flexion occurs at the top of the pedal stroke. The longer your cranks are, the more your knee will be bent at the top of the pedal stroke. So what’s the right length for you?Crank length is a fractious topic and diving into the research to come up with a cohesive explanation would require an entire book unto itself. If I were to boil it down to three simple ideas, they would be:

Power generation is independent of crank length -- you don’t get more power by simply having longer crankarms
Most research shows that wildly varying crank length (from 140 mm or shorter all the way up to 210 mm and longer!) doesn’t have a dramatic impact on many measurable variables of mechanical efficiency (or power of course) at least in the short term
There’s no evidence that having cranks that are too short make you prone to injury, but having cranks that are too long can certainly create problems for some.

As for determining what your proper crank length should be, there are some formulas where you can plug in different measurements like your inseam, tibial length, overall height etc, and come up with an optimal crank length. But as with most formulas, they have severe shortcomings and fail in exactly the area we’re trying to succeed -- accounting for individual differences and when someone doesn’t “fit the mold”.The best way to determine whether you have the right length cranks is exactly the same as trying to find the right saddle height -- it helps to measure it. Again, you can refer to my past videos on getting the right saddle height, whether they be the simple ones, the heel on pedal test, or advanced, where you can take yourself through a basic video motion capture assessment.After doing any of these tests you make appropriate changes to your seat height and riding for a few weeks proves to be less painful, but the symptoms have not completely resolved after a few weeks you’re still experiencing the same (or worse) knee pain in frequency, intensity, or duration, then it might be time to explore crank length.I'd encourage all riders to take advantage of a free program I have outlining how anyone can measure relevant joint angles while pedaling on digital video. Again, this program is free just by simply signing up on my website. This represents a more advanced method of personal bike fitting that can make help a rider learn a ton about themselves and how they sit on and interact with their bike.Let's assume you perform this advanced method and through the data you accumulate, you decide to raise your saddle up and get your knee extension into a better range especially for the tissue at the front of the knee. Now that you’ve optimized your saddle height for knee extension at the bottom of the pedal stroke you can then check those same videos to see what the maximum knee flexion angle you have towards the top of the pedal stroke. If your knee extension at the bottom of the stroke is good, but flexion at the top is getting pretty close to the limits of where we like to see most people and, most importantly, you still have knee discomfort, then you may be a good candidate for shorter cranks.Another, less common, cause of too much knee flexion is using a shoe/pedal combination that has too much stack height.What is “stack height? It’s the distance between the bottom of your foot and the center of the pedal axle. The thicker the sole of the shoe and the higher the engagement surface of the pedal is from the pedal axle, the more stack height a rider will have. Imagine if you wear running shoes on platform pedals -- the combination of the thick sole of the running shoes with the large platform pedal body could put the bottom of your foot a significant distance from the center of the pedal axle. The same can happen even with clipless pedals which all have varying amounts of stack just as all cycling shoes have different amounts of sole thickness.What about saddle fore/aft?In the debate about front of the knee pain, along with saddle height some will mention that having your saddle too far forward is also a culprit, and this is sometimes a valid point.But this is another area where it’s not that simple.If you take a rider that has a properly adjusted saddle height and you simply slide their saddle forward on the rails of the seatpost, this WILL put more pressure on the front of the knee largely because when sliding the saddle forward you are also lowering the overall height slightly as well because of the 72-80 degree angle of the seat tube.But if you adjust for saddle height when you slide the saddle forward, by raising it a few millimeters, knee extension remains the same at the bottom of the pedal stroke and the knee flexion at the top of the pedal stroke stays the same as well -- the hip and knee are just in different locations but the overall triangle between the Hip → Knee → Pedal remains unchanged because the saddle height remains hasn’t changed nor has the length of the upper and lower leg. In most circumstances this won't cause knee pain by itself.Having the seat too far forward, even with a properly adjusted seat height CAN create extra stress on the patellar and quad tendons.How? When the seat moves farther forward the hips move as well, so they end up being closer to directly over the bottom bracket (and feet) rather than behind them. With the hips further forward, and the upper body in a standard road bike position, it’s more difficult to engage the hip extensors, which are the large gluteal muscles in our rear end. The hip extensors work best when the pelvis is in a stable position. When our hips get too far forward, we lose the stability of the pelvis because we lose some of our stabilization through our feet.

Newton’s Second Law and your bike seat

If we look at a cyclist from the side, their hips sit behind their feet during the power phase of the pedal stroke. And at all times, the hips are above the feet, because our saddle is above the cranks and pedals -- pretty basic, right?When we push on the pedals during the power phase of our stroke the pedals are pushing back. Newton’s Second Law of Motion is the one that has the “equal and opposite reaction” clause in it, so not only are you acting on your pedal, your pedal is acting on you as well.Because the pedal is below your hips/pelvis, when you push down on it, it’s pushing back up on you (and your pelvis). This is great because it provides, among other things, a brief period of unloading of pressure on the saddle -- it literally saves your butt during rides. This is why one of the largest segments of riders plagued with severe saddle issues has partially to do with their lower power output relative to their body weight. If your power to weight ratio is poor you’re not going to be un weighting the saddle much.Because the pedals are in front of your hips/pelvis during the power phase, when you push down on the pedal, the pedal is also pushing you backwards on the bike. This exerts an aft or posterior force on the pelvis which provides stability by keeping it securely in place on the saddle instead of sliding forward. When the hips stay backwards on the saddle, the hip extensors have a solid platform to push from. When the hips slide or roll forward during the pedal stroke (because the seat/pelvis is not far back enough behind the pedals/feet), the fact that the pelvis is moving keeps the hip extensors from working at their full level.When the hip extensors don’t work as much, or perhaps they’re delayed, it requires the quadriceps to work more and this extra work and force is passing through the quad and patellar tendon.

Another pitfall to having the saddle too far forward

Something I’ve noticed in my bike fitting practice is that having the seat too far forward can also lead to a more toe down posture at the ankle. Pointing the toes more causes the leg to act longer which bends the knee more. You can do this on your own bike….with your foot on the pedal lift the heel and point the toes more and watch what happens to your knee -- it bends the knee more, right?The compensation of pointing the toes is the result the body trying to improve stability for the rider. In the standard road position we have good stability when the hips are behind the feet (when the saddle is pushed more aft -- see the paragraph above regarding Newton's Laws).When the saddle is pushed forward, the hips will be closer to being directly over the feet. This creates a scenario where the rider will not be balanced on their seat and a disproportionate amount of weight falls forward onto the hands. Pointing the toes creates some artificial stability through the feet by putting the balance point for the foot on top of or in front of the pedal which exerts a force either up or back respectively on the rider. It’s basically an effort to get the feet more in front of the hips, because pedaling with the heels dropped puts more of the foot behind the pedal and therefore further underneath the hips rather than in front of them more.When I see athletes in this ‘too far forward’ saddle position and I move their saddle back, often they begin to naturally correct their toe-down posture after just a couple rides. This allows the knee to extend normally and takes the strain off the front of the knee structures.Possibly even more important is that being in a toe-down posture also has the effect of preferentially activating the quadriceps over the hip extensors/glutes. When the quads work more, we have more force going through the front of the knee.We can see a great correlation to this in terms of proper squatting technique. Many people squat incorrectly and let their weight move forward onto their forefoot and toes -- this causes the knees to track in front of the knees during the squat. Ideally we want to keep the weight on our heels and midfoot, which will keep the knees predominantly behind the toes, and the hips back. This allows the glutes and hip extensors to get in the game and do their share of the work.On the bike, we can’t exactly push through our heels, but as we minimize the amount that we’re pushing through our toes and forefoot (by not toeing down), and keeping our hips behind our feet, we get more engagement from our hip extensors. The result is better balance between the muscle groups, and less force and compression moving through the kneecap.

Cartilage under the Patella

Mechanics of InjuryCartilage is an interesting tissue. It acts like a slippery surface to ease the motion between two joint surfaces. It often has curves and contours to help guide the motion at the joint by allowing the two ends of the bone to mate perfectly. It’s fed by synovial fluid and at the same time the synovial fluid acts as the lubricant to make the joint motion smooth and resistance-less.The cartilage under the kneecap is no different, in that it fills the gap between the two round surfaces of the femur and facilitates the movement of the kneecap as it moves up and down in this groove in order for the knee to bend and straighten. The kneecap itself acts as a fulcrum point to increase the transfer of force from the quads in the upper leg to move the lower leg and straighten the knee. It’s called a sesamoid bone and we have a number of them throughout the body, although the kneecap is the largest.Since the job of the entire quadricep complex is to straighten the knee, we can assume it does a lot of it’s work with the knee bent. With the knee bent and the quad tightening, the kneecap is pressed into the femur as it glides up with the straightening of the knee. Just as we saw with the patellar tendons, the more the knee flexes during the loading phase when we’re pushing down on the pedals, the greater the amount of force the patella is pressed into the femur which can lead to damage or irritation to the cartilage on the back of the patella. So the cartilage experiences a compression injury.At the top of the pedal stroke if the knee is flexed 120° or more, the kneecap is literally being jammed into the femoral groove.It’s no big secret what the most common way to have increased flexion on the bike -- having the saddle too low. All the same fixes apply -- raising the saddle, moving the saddle aft, and/or shortening the cranks.Pain under the kneecap is one injury that responds especially well to shortening crank length. I’ve found that some cyclists are particularly sensitive to knee flexion under force at the top of the pedal stroke and shortening the crank can almost completely solve the problem on its own.What if none of this works?Sub-patellar pain can be extremely stubborn and in some athletes it can progress to an advanced chronic level where it’s called chondromalacia patellae. It can persist even when saddle height, fore/aft position, and crank length have all been optimized. This program is not meant to be a substitute for medical care, so if you’re in this camp, you can visit your favorite PT and they can get you set up with specific exercises to treat this persistent problem.But we haven’t exhausted the bike fit solutions just yet. The kneecap is often acted on in a non-linear way. It doesn’t move much side to side because of the way it tracks in the groove at the end of the femur and numerous things can exert medial (to the inside) and lateral (to the outside) forces on it and create excessive pressure on different aspects of the sub-patellar surface. For this reason, there are a number of solutions in the coming modules that explore medial and lateral knee pain that can affect the cartilage of the kneecap. These coming modules address medial and lateral knee pain and often these fixes can provide support for sub-patellar issues as well.IT band is often blamed for pain on the outside of the knee, and while I usually don’t ascribe to generalizations in bike fitting, but there’s just not a whole bunch on the outside of the knee.

Medial and Lateral Knee Pain

The outside, or lateral, and the inside, or medial, aspects of the knee are very common areas of trouble for cyclists, second only to front of the knee problems. The lateral side of the knee might be the simplest to understand in terms of the structures involved that can create discomfort, because the truth is, there just isn’t a whole lot on the outside of the knee. The medial side is slightly trickier but we’re going to break things down in a very simple way Lateral Culprits:IT BandLateral joint ligaments of the kneeLateral Meniscus Medial Culprits:Medial Joint LigamentsPes Anserine AreaMedial MeniscusWe’re going to address the knee joint ligaments, medial and lateral, together because these structures are injured by the same movements -- often in the opposite direction, but the same movement nonetheless. We’ll do the same with the medial and lateral meniscus.Ligaments of the knee -- these are the structures that provide more ligamentous support for the knee joint and also hold the kneecap in place.We often think of the major ligaments of the knee, like the anterior cruciate ligament (ACL), medial collateral ligament (MCL), and lateral collateral ligament (LCL) as very defined bands of tissue in and around the knee. And in the case of the ACL, this is true -- it’s a very distinct strand of tissue in the knee joint. But the LCL and MCL are both more vague structures because the are part of the greater joint capsule surrounding the knee. This joint capsule is a patchwork of thin tissue plastered in a ball that completely surrounds the knee joint. The LCL and MCL are just thickenings on either side of the knee joint -- where the ligament ends and the capsular tissue begins is a bit of a gray area.Because of this, defining exactly when the irritation happens on the LCL versus another tissue isn’t usually a useful argument to engage in -- we can just discuss them as a whole by saying there is a problem with the ligamentous structures on the lateral side of the knee. We will treat or manage these issues the same way.Ligaments are irritated in much the same way on either side -- through varus/valgus forces and torsion of the tibia (see below).The IT band and lateral retinacular ligaments often go hand in hand because the IT band actually has a few fingers of tissue that attach to the lateral side of the knee cap, so often symptoms from the IT can also come from lateral retinacular ligaments and vice versa.Lateral Meniscus: The meniscus is cartilage in the knee joint which allows the round end of the femur to mesh with the flat surface of the tibia. Both meniscii (medial and lateral) are adhered to the top of the tibia.The lateral meniscus is injured less often than the medial, but both are irritated mainly through compression. The reason the meniscii are less problematic on the bike is because pedaling a bike creates much lower levels of compression than other activities, like walking, running, or jumping. So generally, if a rider has meniscal damage and irritation, riding the bike is usually much more comfortable than other activities. Essentially, if you have enough meniscal damage to create pain on the bike, you probably have larger problems you need to address and so it may not be useful to search out significant gains through bike fitting.Mechanics of injuryThe mechanism of irritation for medial and lateral problems includes torsion of the tibia on the femur, and varus/valgus stress on the knee joint. Think of torsion as the tibia rotating along its length, like when we pivot too quickly and we twist our knee joint. Some degree of tibial torsion is normal -- the tibia needs to rotate in order to allow the knee to flex and extend fully. On the bike, because we have rapid knee flexion and extension, the amount of this torsion motion needs to be tightly controlled to avoid straining the tissue surrounding the knee and creating irritation. This becomes especially important with our feet clipped into the pedals. A poorly positioned cleat might be able to exert enough force on the tibia to twist the knee as it flexes and extends during pedaling and irritate the surrounding knee tissues.Varus/Valgus: These two forces are often new to people, but they’re really simple to understand. Picture the knee straight and a force pushing on the knee joint from the medial side, pushing it laterally into a bow-legged posture -- this is varus movement. A force pushing from the outside on the knee into a knock-kneed posture is a valgus force. Knees don’t normally bend this way of course, but squatting or pedaling a bike (any activity that involves bending the knee with the feet attached to something be it a pedal or the ground) there is the chance of introducing a varus or valgus force.I want to reinforce that it's not necessary for you to have an anatomical varus or valgus knee deformity -- usually known as being bow-legged and knock-kneed respectively. A force that pushes on our knee laterally to the outside as a varus force, or a force pushing it medially as a valgus force can create problems.Where to look for these forces? What causes torsion and varus/valgus forces? Let's look at the most common ways that these forces are introduced to the legs.

Q-factor

Q-factor can be thought of as the stance we have on the bike. Essentially how far apart our feet are when they’re on the pedals. Some bikes place the feet closer together (narrower q-factor) while others will place them further apart (wider q-factor).It’s important to not confuse q-factor with q-angle. We know what q-factor is now -- q-angle has to do with the knees and the angle in the frontal plane that the femur and tibia come together at, and, incidentally can have an effect on what we just talked about in varus and valgus knee deformities. For example, some women have wider hips, which causes the femur to angle down and in (when viewed from the front) and then the tibia angles down and out to the side creating an angle where the knee sits to the inside of the hip and ankle in a knock-kneed posture. If you’ve been paying attention you’ll see that this posture exerts a valgus force on the knee.Even if our q-angle is normal, having a q-factor that’s not appropriately matched to us can create a varus or valgus stress on the knee.In this scenario the feet are out of line with the hips. For instance a very small rider with narrow hips is riding a standard road bike that otherwise fits well. But the bottom bracket width, combined with the stance of the cranks and the length of the pedal spindle, puts her feet outside, or lateral to, her hips. This can create a valgus force (knee is pushed in toward the bike) on the knee and put strain on the structures on the medial side of the knee.The opposite scenario is more common as many riders have a q-factor or stance width that’s too narrow, so the pedals sit too close to the frame given the width of their hips. Lateral knee discomfort is more common in this situation as there is a varus force (knee is pushed out or away from the bike) being applied to the knee. But if the mechanics of the feet are compensating by rolling the ankle (and midfoot) inward, medial knee pain is still possible with too narrow a q-factor or stance width.Measure/Visual: The small rider with the too-wide stance will look like they pedaling with their knees heading in toward the top tube. In fact if we trace the knee path we’ll see the knee drift toward the top tube at the top of the stroke and move down and away from the midline of the bike on the downstroke.The rider with their feet too close together will have their knees moving away from the midline of the bike at the top of the pedal stroke and toward the bike on the down stroke. Knees moving up and out. Again this is the more common situation.Rider Report: The too-wide, “up and in” riders will often complain of medial (inside) or posterior (back) knee pain, but lateral discomfort is possible. Because of the cascading effects of the biomechanical chain, there also might be pain toward the inside of the foot --perhaps around the big toe.The more common scenario of the rider with too narrow a stance on the bike will have lateral knee pain as the varus force is acting on the knee. The rider might also complain of pain on the outside of the foot if their ankle and midfoot flexibility is on the more restricted end of the spectrum. If, however, they’re more flexible through the ankle and midfoot, they too can have pain on the inside of the foot, near the big toe. The lateral knee pain can go along with IT band discomfort so it is possible for them to experience lateral thigh or hip discomfort extending all the way up to the pelvis and SI joint.Bike Fit Fixes (again, more depth on this later, but here's just a taste)Addressing q-factor issues isn’t terribly difficult since many/most cleat and pedal systems allow the for adjustment to widen or narrow the stance of the rider. Usually small adjustment are all that are necessary.It’s important to think in opposites when moving the cleat though as many riders get confused. When looking at the bottom of the shoe at the cleat, you need to think in opposites: If you want to move the feet out to the side to create a wider stance, you need to move the cleats in towards the inside of the feet. Incidentally, same goes for rotation of the cleat -- we still need to think in opposites and if we want our foot to toe out more we need to toe the cleat in, and vice versa.Some pedal systems don’t allow for any medial/lateral adjustment however -- like some versions of the Time ATAC mountain bike cleats. Most pedals do allow for this adjustment -- LOOK Keo, LOOK, Shimano’s SPD-SL, Speedplay, Shimano SPD, TIME road pedals, some versions of Crank Brothers Egg Beaters and some versions of TIME ATACs. If your pedal system doesn’t let you do this, your options are a bit limited:Change pedal/cleat system -- this isn’t terribly economical but not a bad option since there are so many options and finding a reasonably inexpensive version is possible.Find a crankset that has a wider or narrower q-factor spacing -- this is not recommended since finding a crankset with a wider stance can affect the shifting performance of the bike by messing with the chain line. And new cranksets aren’t cheap.Get pedals with a longer or shorter spindle. Some pedal manufacturers offer aftermarket spindles of various lengths, most notably Speedplay. But Speedplay already has medial/lateral adjustment built into the cleat so it may not be necessary. File that under “If you need more medial/lateral adjustability”. New versions of Shimano Ultegra pedals are also available in "+4 mm".There are spacers that can be added between the crank and the pedal to increase the stance width. Bikefit.com offers a 20mm spacer, which is quite a big change, but due to how it is assembled is only compatible with pedals that have wrench flats on them - something that’s becoming increasingly rare these days as most pedal makers use an 8 mm allen key on the end of the spindle for installation/removal.

Forefoot Wedging/Posting

Besides addressing the stance of the pedals another common bike fit adjustment that needs to be made in conjunction with it is posting the forefoot for varus/valgus. There are those words again -- varus and valgus. Think of this as tipping the foot so that it's either oriented with the inner edge of the foot (and big toe) lifted up (forefoot varus) or with the outer edge (little toe) lifted up (forefoot valgus). For the rider that has their feet set too narrowly, along with moving the cleat position to increase the stance width (or longer pedal spindles if you want a more aggressive fix), often a bit of varus posting of the forefoot can help. Especially if the rider has normal to flexible foot and ankle mobility, this can help to stabilize the foot so that the knee can track more vertically and relieve movement through the hip.We can add varus forefoot support by placing wedges under each cleat or under the foot itself inside the shoe. They are also sold by bikefit.com, but there are other options available from Specialized and Shimano. These wedges are pretty simple, and in order to get varus support, place the fat side of the wedge to the inside of the foot. I should note that in my bike fitting practice, I don’t use these shims very often -- perhaps in 20% of bike fittings. When they’re necessary, they can be very helpful and a little goes a long way. In most cases, just two wedges are often enough to have an impact. I do use more on occasion but it’s very rare -- I’ve seen many riders come through my door with some very tortured cleat wedge and shim combinations that often end up being entirely unnecessary.Most people respond to varus support -- about 75% of the population exhibits natural forefoot varus (although they likely won't have symptomatic clinical forefoot varus deformity), and this seems to correspond well with those responding to forefoot varus support on the bike. Symptomatic forefoot varus is reasonably rare, but cyclists tend to respond well to mild varus support likely due to the low weight-bearing environment that cycling presents.With so much of the population having natural forefoot varus, many bike fitters want to post almost everyone that comes through their doors. But the truth is that most people are asymptomatic -- they may have forefoot varus posturing but it's either not severely postured, it doesn't move dynamically enough to create a problem, or, as is often the case, the cycling shoe itself already has varus posting built into it. In these situations, mild posting of the forefoot with wedges, perhaps just two, often doesn't create a problem, but it's also not performing any real function. I see this scenario often -- it's hallmarked by seeing no change in pedaling mechanics when we remove them.

Insoles

There will be cases where a custom or semi-custom insole will be the best solution for the rider. Because of the extra space that the insole requires, a new pair of shoes may be necessary, so this isn’t a cheap solution, but it may be the best solution especially in very stubborn cases of a forefoot varus that is creating problems. Having the ability to control the posture of the heel and the midfoot, which you don’t get with the cleat wedges, can be critical to establishing a solid base for the leg to work from.

The overly flexible cyclist and medial/lateral knee pain

Flexibility is often seen as this overwhelmingly positive trait, and in many respects it is a very good thing. But there is a misconception that cyclists (or runners or triathletes) always need to be more flexible. The truth is that in order to be a healthy, uninjured cyclist only a small amount of flexibility is fundamentally required. Having a little more than that is good. Having a lot more than that isn’t better -- and it can often lead to trouble.I have many clients, often women, who are already very flexible and yet they still focus on their yoga or flexibility training on a daily basis. (Many athletes gravitate toward what they’re already good at, so those already with above average mobility default to yoga or stretching since it comes so easily to them).The other side to the “too flexible” coin is that the athlete doesn’t have enough strength or stability. This lack of stability can lead to aberrant motion at the spine, hip or knee during the pedal stroke.A very common presentation has the knee drifting medially or laterally because of poor stability through the hips which can lead to knee pain on either side. This is a situation where the rider would benefit from being less flexible as a bit less freedom of movement through the spine, pelvis, and hips can provide some passive control for the lower extremity, and especially the knee, as it goes through the pedal stroke.Another factor to consider is the type of pedal system the cyclist is using. Most pedals have very similar amounts of freedom of movement, called “float” -- TIME, LOOK, SPD-SL, SPD all live in the 3-9 degree range which is in line with what most athletes require. During my bike fittings many athletes are surprised to learn that more often than not we use somewhere between one and four degrees of float.Speedplay pedals, however, can have nearly 30 degrees of float available to the rider. For some cyclists this can be a good thing -- these are generally cyclists with poor overall flexibility and the added float allows the hips to move through their limited available range without restriction (the feet “floating” are allowed to move to relieve this movement). Interestingly many of these riders also don't use excessive amounts of float which begs the question of the whether it's the float that relieves their problems or some other characteristic of the pedal.In my experience, the way Speedplay pedals affect riders breaks down like this:~15% really benefit from the significant float since the freedom of movement works well with their sometimes less flexible frames~15% the extra float actually causes them problems. Often these riders have above average flexibility and mobility and perhaps lack some stability through their body.~60% of riders, they make no difference positive or negative.For athletes with average mobility these pedals don’t create too many problems, but the extra motion isn’t necessary or used in any functional way.Cyclists already too flexible can have big issues with them because the “too flexible” cyclist also has limited stability so they are unable to control all the freedom of motion that the Speedplay pedals leave them with. There are variations of Speedplays that allow you to limit the amount of float, but usually any of the other pedal choices that have more standard amounts of float will work well. The lack of float creates some stability for the rider since their muscular stability is limitedMeasure/Visual:Overly-flexible cyclists will display knee medial and lateral motion as seen in other situations -- the clues to the real problem will be discovered during the off-the-bike physical assessment of the rider. They will score well above average in testing for hamstring length, and especially hip internal and external rotation. When I have a cyclist with 20-45 degrees of hip rotation in both directions I begin to think that they might run into problems with stability or control of hip motion. Having this flexibility certainly doesn’t guarantee there will be a problem -- excellent athletes are hallmarked by exceptional flexibility that is controlled well by adequate muscular stability -- but if issues do arise then stability needs to be addressed.Rider Report:Complaints aren’t terribly unique. Often the rider looks at their flexibility as a good thing (and they double down on it and work on it further as mentioned before) and so they won’t recognize it as the source of their problem.It is possible, due to all the uncontrolled movement, for the knee pain to occur on both sides and pain in other areas, especially the hip and low back is common, since the aberrant motion is transferred.Aside from that there is nothing very unique in the subjective complaints of the rider.Bike Fit Fixes:If an overly flexible rider is using Speedplay pedals, then either limiting their float or changing to another pedal system can create some stability to control hip and knee movement. Many times this is enough, but my recommendation for most athletes, even if this is successful is to not stop there.Stability training and exercises are the best way to permanently solve the problem. There will be more on this in future installments.

Too Much Toeing Down

Too much toeing down or pointing the toes is another common driver of knee pain. It has the distinction, however, of being able to cause knee pain through the anterior structures, like the patellar and quadricep tendons, but also through medial/lateral structures as well.Cyclists often toe-down, or point their toes, during their pedal stroke when their saddle height is placed too high. In an effort to reach the pedals easier, the toes are pointed to make up some distance. Usually the knee is already extending, or straightening, further than it should be from a functional movement standpoint and the effectiveness of the pedal stroke is diminished.Certain aspects of a poor bike fit, like cleats being too far forward or the hips being too far forward relative to the rider's feet can facilitate a toe down posture. A major struggle with any sort of ankle or foot mal-alignment is that even when the bike fit is fixed, the ankle and foot are very slow to change. I call them slow adapters. I believe the ankle and foot are slow to adapt because a lot of their influence is in the area of proprioception and balance which are very primitive and basic body functions that are managed in lower brain centers of the brainstem. These primitive tasks can get quite hardwired into us and it makes sense that they might take time to change.An ankle/foot toeing down more will create more knee flexion throughout the pedal stroke. The more we plantarflex the more our knee will be bent. THis increase in knee flexion can lead to more force being placed through the front of the knee as described numerous times above.Something else can happen though to create lateral knee pain. Especially when the saddle is a little too high and the ankle is/foot is pointing to reach the pedals easier, as the foot points down, there can be a tendency to invert the foot as well as an enhanced torsion (twist) of the tibia. When the tibia rotates excessively it can pull on the IT band that inserts on the lateral side of the knee and create knee or hip pain. This is one very common way riders experience IT Band discomfort on the bike I recommend that either before or after this section you begin to take a, look at and measure your bike fit. I have a free program on my website. If you're already a member you can simply go to the Member's Area (or register here for free) and start the "Not So Basic Bike Fit" Series. It will walk you through everything you'd need to know to get some accurate and important measurements to properly get a handle on how you interact with your bike.

Potential Bike Fit Fixes for knee pain

It would be impossible to cover every scenario of what might solve a rider’s knee pain, but this doesn’t stop many people from trying to find that one specific cause for their own knee problem. The reason this isn’t more successful is that most bike fit issues aren’t from one single large factor, they’re a handful of factors, some big some very small, but no less important to full resolution of symptoms.It’s for this reason that we’re going to cover many possible remedies and do it in such a way that we address the most common and larger causes but still work our way through the more obscure ones as well. Because in all likelihood, your knee pain will resolve not after we correct one thing, but more than likely two or three changes. If this seems confusing at this point, don’t worry, it will becomes more clear as we go.So here are the changes that most often provide resolution to cycling knee pain:

Raise or lower your saddle

Of course this idea was mentioned in an earlier section, and it bears repeating because most knee issues will need a change of saddle height. Having the wrong saddle height is the easiest way to create an issue for your knees (and certainly other areas, which we’ll get into). Again, it often isn’t the only factor, but it is the most common.Let’s dig deeper into why having your saddle too low or too high can cause trouble.

When the Saddle is Too Low

We’re used to hearing about proper saddle height referenced by the measure of the knee angle at the bottom of the pedal stroke. Determining how straight the knee gets at the bottom of the stroke (6 o’clock position) can go a long way toward determining if saddle height is correct.But tissue on the front of the knee, where most knee discomfort originates, is stressed not at the bottom of the pedal stroke, but at the top. At the top of the stroke, the knee is flexed maximally in the pedal cycle, which stretches the quadricep muscle, quadricep tendon, patellar tendon and increases compressive forces on the patella and sub-patellar cartilage. Because this is where we begin to put real force through the pedals, these tissues are being asked to contract and produce force while being flexed maximally as well. This is a perfect scenario for tearing of tissues to occur as well as compression of the patella into the femur.The lower saddle height is, the more knee flexion occurs at the top of the pedal stroke. Going even a few millimeters below optimal saddle height can strain these tissues and create knee pain.Most cyclists have a narrow range, perhaps 1-3 cm, where saddle height is agreeable to their overall mechanics and problems don’t surface. Go below, or above, this and aches, pains, numbness and other problems will present themselves.

When the Saddle is Too High

Having the saddle too high is certainly less common a problem than too low a saddle, primarily because when a saddle is too high by even a moderate amount it can be difficult to reach the pedals and complete a normal pedal stroke, so riders self-correct rather quickly.But just as having the saddle a few millimeters too low creates issues so too does having the saddle a couple millimeters too high.The most common presentation of this is pain behind the knee, and for the most part this can be true a lot of the time. With the saddle too high our knee “reaches” for the pedal and is asked to straighten too much which strains the hamstrings and causes pain behind the knee where the hamstrings attach.But in most cases the knee isn’t straightening to its maximal limit - even when a saddle is very high the knee might still be bent 15 or 20 degrees, so why should this cause knee pain when the rider can clearly straighten their knee fully (to zero degrees) when off the bike?In much the same way that too much knee flexion at the top of the pedal stroke can cause front of the knee pain, even when the rider can clearly bend the knee further than this off the bike.The measurement we’re concerned with this time is the traditional knee extension at the bottom of the pedal stroke measurement. If the saddle is too high, the knee will have to straighten beyond the range that is comfortable/powerful for it and the hamstring will be forced to lengthen or stretch further, under load, which will cause tears in the tissue.The most common tissues involved are the medial, or inside, hamstrings (nominally the semitendinosis, semimembranosis) and often the tendon of these tissues or at least the musculotendinis junction (where the muscle and the tendon meet) are most likely to carry the brunt of the problem.Why does the bike cause knee pain when we’re not even close to the end range of our motion - at the top and the bottom of our pedal stroke? Because of mechanical factors that go into riding a bike: force production and cadence.As discussed earlier, force production is a major factor at the top of the pedal stroke, and with the front of the knee tissues stretched across the flexed knee this creates the main problem with anterior knee pain.At the bottom of the pedal stroke it’s cadence, and the speed at which our legs are turning, that creates the problem, because at this point we’re asking the hamstrings to lengthen very quickly, and while they’re not a tremendous force production muscle at this point, we are asking them to coordinate the pedal stroke and to do so at a very fast rate. At the bottom of the stroke the hamstrings are playing a large role in the transition of the pedal/foot from moving downward to translating backward. They do this best when the knee is still bent roughly 35 or 40 degrees or more.

How do I know I need to change saddle height?

What metric or test can we use to determine if a saddle height change is in order? There’s more than one way to go about this.You could use a calculator, like the LeMond method where you take your true inseam and multiply it by .883. The usefulness and accuracy of these formulaic methods is often inversely related to how easy they are to use. They might get some people relatively close to their proper saddle height but because they lack sensitivity in regards to individual differences in strength and flexibility among other things, they just don’t cut it most of the time.The simplest way to get proper saddle height and include some aspect of personal mobility is to measure using an old trick of pedaling backwards with your heel on the pedal. I have an article I wrote on this subject -- namely what the easiest method to determine proper saddle height is. Put your heel on the pedal and pedal slowly backwards -- your knee should straighten fully (or nearly so) when doing this but not at the expense of your hips. Your hips shouldn’t rock back and forth over the saddle and your heel should remain in contact with the pedal the whole time. Move slowly and have a friend check your movement if you’re not sure. Sometimes it’s hard to tell how much your hips are rocking. You could also video yourself doing this in order to check your hip motion.Is this the most accurate method of determining saddle height? No, absolutely not, but among the very simple methods, I find this one to be the best.There are definitely more complex ways -- as I mentioned above, I have a free program that teaches anyone how to use basic video motion capture technology that we all have through our phones, tablets, GoPros and other devices how to do a basic bike fit assessment of proper saddle height. Even in the hands of someone who has never done it before, this can yield good results and shed a lot of light on how a rider moves over their bike. It takes more time and a little planning, but the results are significantly better -- additionally we can use the video to investigate other aspects of the bike fit and potentially solve more problems.Either of these methods can go a long way toward showing you how low (or high) your saddle is. For instance, if you use the heel on the pedal method and you can easily pedal backwards keeping your heel in contact with the pedal and at the bottom of the pedal stroke your knee is still bent a lot, you know that you have a long way to go and should raise your saddle a bit more. If your knee is only bent slightly then perhaps you just raise a small amount at a time.How much is “a small amount”? And what constitutes a large adjustment? When I’m performing a bike fit, and I believe my client is pretty close to their ideal saddle height I may raise it only 3-4 millimeters, but if they’re further off I might adjust about 4-5 times that -- perhaps 20-30 millimeters (or right around an inch). On occasion I do get someone in that’s a huge amount off -- the equivalent of doing the heel-on-the-pedal test where the knee remains bent 20° or more at the bottom of the stroke -- and I have to raise their saddle 75-100 mm (3-4 inches).A good rule of thumb is to start smaller than you think -- err on the side of caution. You can always raise the saddle more later and in my experience it’s easier to undershoot the mark and slowly work your way up (or down) to the proper height than it is to bounce drastically back and forth between too high and too low.

Get your hips back

As with so much on the bike, balance is important. I don’t mean in the “making sure you don’t fall over” or training wheels idea of balance strictly, although this is important. I mean making sure we have the right amount of weight on our hands, our butt, and our feet. Also, we need to consider muscular balance so that the muscles are working together in the right proportions to most effectively support and propel us.No other place is so important for this as in the hips. Making sure the hips are positioned properly will ensure both of these things happen. We need to have the hips a safe amount behind the feet so that we have good balance of weight distribution between the butt and the hands as well as making sure that the large muscles on the back side of the hips and butt, called the gluteals, are put in a position to do their share of the work. Of course their are many muscles that do work to turn our pedals but the lion’s share of our power is driven by the gluteals and the quadriceps. Having the proper balance between these two muscle groups is key. If the hips are too far forward, often this fosters dominance of the quadriceps over the gluteals because with the hips further over the feet, it can make it difficult to activate the large muscles of the glutes.Take as an example performing a squat two different ways:First standing upright squat down allowing your knees to move in front of your feet as you descend versus performing a squat where you keep the knees even with or slightly behind your toes.When you allow your knees to track in front of your feet the quads will predominantly activate whereas if you keep your weight back more, the hip and glute muscles are noticeably more engaged.How far back the hips need to be is determined by more than just leg or femur length. Trunk and hip stability, pelvic angle, flexibility, saddle type, and bar position are just a few of the factors involved and so each individual will truly be different where their hips will be balanced.How does this cause knee trouble? When the hips are misplaced, and the glute/quad balance is upset it is more often the case that the quads are doing more and the glutes are doing less than they should. This over-activity in the quads simply leads to more strain being placed through the quad muscle, quad tendon, patellar tendon and the sub-patellar cartilage.When the quads are over-used, then all of the problems associated with the too high/too low saddle height issue are magnified.Quads dominant and the saddle too low is a recipe for disaster of course.Quads dominant and the saddle a little too high can still create front of the knee problems -- however other problems like calf, achilles and toes/foot problems become even more common since the rider is more likely to “reach” for the pedals with the ankle, feet, and toes and strain these tissues on the lower half of the posterior (backside) chain. We’ll dig into this further as we discuss more of the secondary effects in a section coming up.How do I know I need to get my hips back?So how can we figure out if our hips are misplaced? There are a few ways to look at this, and I prefer the more functional on the bike test that we’ll go over second. But first, many bike fitters use the Knee Over Pedals Spindle (KOPS) rule.KOPS is the idea of lining your knee up directly over the pedal spindle while the pedal is the forward (or 3 o’clock) position. The problem is that this just doesn’t hold biomechanical water. In many circumstances the knee will fall somewhere generally over the pedal in this position but this isn’t strictly a requirement for good power output or healthy knees. There is a false idea that if your knee falls in front of the pedal spindle then this will place extra strain through the extensor tendons of the knee and create front of the knee pain. While it is possible for this to happen, it depends on a few other things happening -- the knee being in front by itself won’t cause knee trouble. Just ask any triathlete who rides on a steep seat angled bike. Triathletes knees often fall many centimeters in front of the pedal spindle and few experience knee pain as a result.The KOPS test is done by dropping a plumb line from the front of the knee and adjusting the saddle fore/aft until the plumb line bisects the pedal spindle. There are many problems with this test: First, there is little agreement about what part of the knee should fall directly over the spindle. Should we be dropping the plumb line from the front of the kneecap? The tibial tuberosity? Center of rotation for the knee? These are just three of the ways that are out there as a “rule” and they all produce significantly different positions on the bike.So if the KOPS method isn’t the way to go, how should we figure out saddle position? I prefer the functional balance test I went into detail in a previous YouTube video. This test can help you figure out where you are the best balanced and generating power equally through the large leg muscles. One individual might have their knees a couple centimeters further back or forward relative to another cyclist.An extremely important thing to keep in mind for this test is that your saddle’s fore/aft and tilt may be perfect but you still might fail this test. How? You may not be sitting on the correct part of the saddle. The most common cause of this is when the handlebars are set too long and/or low which will tend to draw the pelvis forward on the saddle. This usually results in saddle discomfort too because the pelvis is resting on a narrower portion of the seat putting pressure on the soft tissue of the perineum. So if you have knee pain, and you’re considering whether you need to get your hips back, if you also have saddle discomfort then you’ll want to look at handlebar reach and drop (in the next section) as a potential piece of the puzzle.

Change handlebar position

Now that we’ve covered the importance of hip position, the issue of handlebar placement will make more sense. A rider could have their saddle height set perfectly and also placed exactly in the correct spot behind their feet but still have poor quad/glute balance and it usually happens due to the wrong bar position.When our handlebar is placed too long/low or too short/high it creates the wrong posture for our upper body. The shoulder and trunk’s flexibility and stability will be compromised and the pelvis will be pulled out of position. The most common scenario for this is when the handlebar is placed too far away and/or is too low for the mechanics of the individual. The upper body and trunk will compensate as much as they can, to reach the bar but inevitably some of the compensation will occur in the pelvis - usually in the form of it tilting forward or sliding forward more than it ought to. This misplaces the hips and we get all the problems discussed above.It should be noted that while less common it is quite possible that having a too short or high a reach to the bar will create the same problem. With the bar placed too high or short, the upper body and torso will be “cramped” or restricted in its ability to assume its most powerful length which will also affect pelvic posture and hip position.It’s significantly more common to have athletes need to be shortened or raised in their bar position though so we’ll focus predominantly on that.

Wedge the Cleats

So far we’ve discussed mostly fore/aft or what I call X-Y changes. When viewing riders from the side, moving the seat or bars up or down (Y-axis) or shorter/longer (X-axis) but now we’re going to address our first medial-lateral or Z-axis movement. We’re all familiar with seeing the knees of some riders move in and out towards or away the bike frame. This side to side movement is common and not always a result of anything happening at the knee. In fact it’s much more common for it to be driven by the hip or the foot/ankle.The knee is what we call a “slave” joint because it’s trapped between the hip and feet and its motion is largely driven by these joints above and below it. We’ve addressed some of the bike fit changes that address some issues at the hip (above) and we’ll get into more exercise-based interventions for the hips that can also help to correct aberrant hip motor patterns that may be causing trouble for the knees in a later section, but this next fix of using cleat wedges is meant to mainly make up for issues arising through the feet and ankles.How our feet line up - what their static posture is - as well as how they move are important drivers of knee movement. Much of the population has some degree of forefoot varus - meaning the forefoot (the toes and the bones behind them, the metatarsals) will rest in an unweighted position such that if you were sitting on a table with your feet dangling in the air, the bottom of your feet in the fore region would be angled slightly towards each other. On the bike, visualize this as our feet resting in the shoes with the big toe and the inside of the forefoot sitting slightly raised up relative to the little toe and the outside of the foot.For most riders, the amount of forefoot varus they have isn’t a problem and doesn’t need extra correcting. In fact many cycling shoes are built with a small amount of forefoot varus in the sole already which is a testament to how common this posture is.The movement of the foot and ankle are also important. In cycling, because the front half of the foot is where most of the action is happening, the mobility of the toes, the metatarsals and the arch or mid-foot are the primary drivers of problems. The more movement we have through the foot, the more likely it is to cause a problem that needs to be addressed. A cyclist could have a very neutral forefoot, as far as varus positioning goes, but with extra forefoot and arch mobility, this can grow into a problem that needs to be corrected.So what happens? How does this forefoot varus position lead to problems at the knees? The forefoot begins in varus during the recovery portion of the pedal stroke when there is less weight placed through it. The inside of the foot (the big toe and its metatarsal) will lift up or unweight slightly from the bottom of the shoe. Then when the power phase begins that big toe and inside portion of the foot has to regain solid contact with the bottom of the shoe because in order to effectively complete the power portion of the pedal stroke the force should finish through the big toe. To make contact the foot and ankle will compensate by rolling inward - this causes the tibia to rotate inward as well which will then drive the knee in toward the top tube of the bike.To control this motion, we have a choice of putting a wedge under the cleat or under the foot itself. The wedge will be oriented such that the fat part of it is to the inside of the foot. The wedge tilts the cleat down on the inside, but since it still has to make contact with the pedal in a flat orientation, this has the opposite effect on the foot -- it lifts the inside (medial side) of the shoe up, which is exactly how the forefoot is aligned in a varus posture. The forefoot gets to stay in its desired position throughout the pedal stroke and so the forefoot, midfoot and ankle joints don’t need to roll inward to compensate and the knee then tracks in a more vertical path with less side-to-side motion.

Move Cleats Back

This isn’t a widely considered solution to knee pain, but one I find often ends up being part of the equation. To understand why, we need to understand what happens to our mechanics as the cleats are moved fore or aft.Cleats more forward:

More toe-down posture through the pedal stroke
Greater ankle range of motion
Increased foot and calf muscle involvement
More likely to inhibit the glute muscles

Cleats further back:

Flatter foot posture (less toe-down)
Less ankle motion
Less foot and calf muscle involvement
More facilitative to glute muscle involvement

It’s this final point of glute activation of course that is the primary issue. The two different methods of squatting we discussed above apply in the exact same way here. The more we allow our knees to drift in front of our feet as we squat, the more weight we’ll be bearing on our toes and forefoot which correlate with increased quadricep dominance. When we squat keeping our knees equal to or behind our toes, more pressure is borne through the back of the foot and less through the toes/forefoot, correlating with increased gluteal involvement.While the cleats don’t need to be all the way back on the shoe, there is significantly lower overall risk when erring on the side of further back than further forward.

Shorten Cranks

This is a knee pain solution whose time has come due. For years the component manufacturers have limited our crank selection to mostly to the 170-175 mm range with a few exceptions slightly more or less than this. This “nearly one size fits all” method is severely problematic though as many athletes are finding their mechanics are much better with much shorter cranks, especially when knee pain is involved.What do shorter cranks do? It’s important to first understand that no matter what length crank you have, your saddle height can be properly set to have the right amount of knee extension for you as an individual, at the bottom of the pedal stroke. If you have 175 mm cranks your saddle height would be set one place, and then if you changed to 200 mm cranks we would simply lower your seat height to get the same amount of knee extension at the bottom of the stroke. Easy.The problem arises with crank length at the top of the pedal stroke. While your knee extension may be perfect at the bottom of the stroke, the longer your crank is the more your knee is bent, or flexed, at the top of the pedal stroke. That longer crank just lifts your foot higher and requires more hip and knee flexion in the 12 o’clock position. This increased knee flexion can have all the detrimental effects that we saw from simply having your saddle too low -- increased stretching of the quads, quad tendon, patellar tendon, an increase in sub-patellar cartilage compression, etc -- and resultant knee pain.For many athletes who struggle with knee pain, moving from a 172.5 mm crank to a 155 mm or 160 mm crank decreases the amount of knee flexion they experience at the top of the pedal stroke enough to relieve these tissues and their knee pain.

Uncategorizedbikefitadviser@gmail.comSeptember 25, 2017Comment