# Knee pain; do my clipless shoes need adjustment?



## Okie81 (Apr 7, 2010)

I've been riding SPD's for about 6 months now and over long rides (2+ hours) I develop a distinct pain in my right knee, specifically to the left of my kneecap. It's mostly sharp when i'm applying a lot of torque (low cadence hill climbing) to the pedals. I'm wondering if I need to make an adjustment. Float seems good; I can move my foot around freely. The clips are fairly loose as well and I believe my seat is adjusted properly too.
Just to give you an idea, here's how they're currently setup (don't ask me why they're this way, it's been a while since I initially installed them)









I read a lot of posts here and also "the cycling knee pain guide" but haven't gotten any good answers to my problem. I'd love to hear from anyone who has delt with this scenario or anyone who can see any blatant issue with my setup. Thanks in advance.


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## AndrwSwitch (Nov 8, 2007)

If you've been doing your research, you know that there are a million ways that cycling athletically can bother your knee, and finding an answer is difficult.

I'd be a little surprised if it's your cleat setup. Not super surprised, though. I think it's more likely that it's either your climbing technique, your saddle's in the wrong place, or your knee tends to wander all the time, and you just notice it more on long rides when you put pressure on it.

If you're climbing at low cadence, are you in or out of the saddle? If it's in the saddle, IMO you need to either get over yourself and shift down, or man up and get out of the saddle. If you get knee pain standing and climbing, I dunno - that would be a less common problem.

If you can spend some money on this, seeing a coach, fitter, or physical therapist who knows bikes and cycling would be helpful. Otherwise, have a friend ride behind you long enough that you stop thinking about him being there, and pay attention to your motion. Your legs should be moving in a forward/back way only - lateral motion is a big problem. If your hips dip or your back moves around a lot when you're riding, that's a problem too, usually with either pushing too high a gear or having the bike fit wrong.

If you've been trying to increase your ride time lately and this is cropping up, it could be a result of too much additional volume too soon. Give yourself an easy week from time to time, and try not to increase by more than about 10%/week.

Overtraining injuries really suck, so you need to get this sorted out quickly. Be a little more conservative about your rides until you do.


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## LeonD (Dec 26, 2003)

I'd put a set of flats on the bike, adjust the seat (if needed) so it's the same height to the pedals as with your clipless pedals and go ride your loop.

If your knees don't hurt, good chance it's the pedals. If they do hurt, look somewhere else.


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## rmi (Jan 14, 2010)

LeonD said:


> I'd put a set of flats on the bike, adjust the seat (if needed) so it's the same height to the pedals as with your clipless pedals and go ride your loop.
> 
> If your knees don't hurt, good chance it's the pedals. If they do hurt, look somewhere else.


Good advice. All of my knee pain was relieved by switching to flat pedals.

Ryan


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## Okie81 (Apr 7, 2010)

This pain is strictly when i'm in the saddle. I get a little relief when I'm up off the saddle and fully extending my legs though. 
There's so many variables involved when it comes to knee pain and cycling, but it also sounds like there's a lot of trial and error involved to get dialed in correctly. I need to pay more attention to my technique since it's something that I never thought much about (especially watching for lateral movement in my knees).
I like the deductive-reasoning approach of switching out platforms, that'll be my last ditch effort.


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## edubfromktown (Sep 7, 2010)

From the picture it appears as though you have the cleats setup at an extreme- all the way back and all the way inward. It might be worth setting them centered horizontally (on the cleat and two screws holding them in) and vertically on the bottom of the shoe. If that doesn't help, try a slightly different seat height as well (at the bottom of a pedal stroke your knee should be slightly bent). HTH


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## Okie81 (Apr 7, 2010)

How about the angle of the cleat? There's appears to be some slight adjustment available but I always assumed that parallell to the length of my foot was adequate. I'm no kinesologist but I imagine that "ducking" my feet out would put more pedaling pressure on the inside of the knee (where i'm having pain) while a "pigeon" stance would put more pressure towards the outside.


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## LeonD (Dec 26, 2003)

Okie81 said:


> This pain is strictly when i'm in the saddle. I get a little relief when I'm up off the saddle and fully extending my legs though.


Is your seat too low? You can get knee pain from either a seat too high or too low.


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## jeffscott (May 10, 2006)

Okie81 said:


> How about the angle of the cleat? There's appears to be some slight adjustment available but I always assumed that parallell to the length of my foot was adequate. I'm no kinesologist but I imagine that "ducking" my feet out would put more pedaling pressure on the inside of the knee (where i'm having pain) while a "pigeon" stance would put more pressure towards the outside.


Move the cleats as far back as they will go....set them up straight.

Get on the bike swivel your feet....if a cleat stop interferes with where you like your foot then adjust that cleat...

Basically you want the your normal foot position to be in the "middle" of the float.

It is possible that a non-shimano shoe might interfer with the cleat and reduce the float....

Again if the float seems to interfere with you natural movements then you have some sort of problem.

Secondly seat position is normally the cause of knee pain, but you think that is good..

Thirdly cycling can cause the a muscle imbalance..

The inner thighs and quads become very strong...and the outer thighs not so much.

This results in a knock kneed riding position, and often the knee will move outwards at the top of the stroke....

If you have this...(really in any case) you should start execising the outer thighs..think clams, or side leg raises...with a resistance band. Lunges can help as well make sure you hold the knee out (you should be able to see your inner calf at all times).


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## b-kul (Sep 20, 2009)

as a starting place your cleats should be about under the ball of your foot. id try that.


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## xx Hedgehog xx (May 7, 2010)

I've had the same problem. The reason was the angle of the cleats which made me pedal with the heel slightly more outward than the toe when in the middle of the float. Adjusted the angle and the problem went away.

As for the cleats being too far back or forward I've found that this usually manifests as ankle pain and not knee pain. Not sure if this is the same for everyone but from my experience this is how it goes.


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## ja001son (Feb 27, 2011)

I just started riding clipless today, put about 7 miles on. after about 10 min I had to stop and adjust the toes out some, apparently I'm more comfortable riding "duck footed" trying to ride with my feet perfectly straight was not comfortable at all. It seemed to stress the inside of my knees riding perfectly straight.


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## AndrwSwitch (Nov 8, 2007)

Okie81 said:


> This pain is strictly when i'm in the saddle. I get a little relief when I'm up off the saddle and fully extending my legs though.


Do you sometimes stand up on the pedals to give yourself a break when you're just riding around?

Article from the Late, Great Sheldon Brown on pain...

http://www.sheldonbrown.com/pain.html

Scroll down for stuff on knees.


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## Maadjurguer (Mar 22, 2008)

If you just started riding....this is most likely an overuse injury, caused by just getting into the sport. If you feel you want to keep going, and are passionate about it...then go get a professional fit with a Physical Therapist....not just a fit by any bike shop. Knees are tricky things...I continue to work through my knee issues and only found a solution by going to a PT who specialized in fitting folks on bikes. YMMV is an understatement here. Since the OP can only say that the pain is on the inside of the knee and has not gotten more specific than that....any advice offered here is just a shotgun approach. For instance...is the OP refering to pain at the quad/patella boundary, or is it more on the medial side....does it feel like it's on the inside, or surface....can the pain be recreated doing other activities....does the pain interfere in normal activities such as walking, climbing stairs, etc.

To get good advice, you need to be very, VERY specific....and possibly choose to post on the injury forum...but only after closely thinking about how and when this pain presents itself. It took several years before I finally got my pain dialed with respect to cause and effect....even after seeing several doctors and PT's.......


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## tshulthise (Apr 23, 2010)

If you are duckfoot (as I am) and you find that your heels consistently hit the frame then these pedal extensions might help take some stress off your knees and hips...

http://www.amazon.com/16-Pedal-Exte...GJVU/ref=sr_1_1?ie=UTF8&qid=1300457779&sr=8-1


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## AndrwSwitch (Nov 8, 2007)

I considered a pair of those things at one point. I got a fit done several years ago, and the fitter sold me some of Specialized's fancy insoles, with the shims that go under the forefoot. Now my feet don't duck as much when I'm on my bike, my alignment is better, and I get less pain. Never got around to getting extenders.

Definite YMMV situation, though.


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## Okie81 (Apr 7, 2010)

To elaborate more specially on my pain; it's my right knee, medial-patellar region, anterior to the MCL and fairly superficial.

UPDATE: I went out yesterday and did another long run with a couple adjustments: 
1) cleats facing forward parallel to the length of the shoe
2) Set all the way back towards the heel
3) Seat raised up higher to the point where my knees are barely bent at full stroke.
4) Worked on getting my butt out of the saddle on climbs and keeping a higher cadance.

After 2 hours of riding, I noticed a signifigant decrease in pain (compared to normal). I still felt the sensitive area, but nothing compared the previous runs of this duration.

The caveat of making numerous adjustments is that you can't pinpoint the casuative agent. So unfortunately, I can't tell you what helped. My hips and ankles feel fine, although my back is a little sore (probably the raised seat right?).

Thanks for all your help folks.


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## ja001son (Feb 27, 2011)

Okie81 said:


> To elaborate more specially on my pain; it's my right knee, medial-patellar region, anterior to the MCL and fairly superficial.
> 
> UPDATE: I went out yesterday and did another long run with a couple adjustments:
> 1) cleats facing forward parallel to the length of the shoe
> ...


I noticed I had to make a seat adjustment too after going clipless, It doesn't make sense as to why, but I had to raise my seat about an inch.


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## AndrwSwitch (Nov 8, 2007)

OP, if you raised your saddle you now have to lean forward more to get to your handlebars. So that could be the back pain. It doesn't take much - I notice if I move a 5mm spacer from below to above my stem.

001, there are a couple of reasons you might have to move your saddle up after switching to clipless pedals. The first is that different pedal systems have different stack heights - the distance from the axis of the pedal spindle to where your actual foot starts. So you could have increased that. The second is that a lot of people put their feet further forward on flat pedals than on a typical clipless setup. If that was true of you, you gave yourself a little more leg length by using a different part of your foot when you switched.


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## catfishWRC (Apr 8, 2010)

Too high of a saddle causes you to move your hips left to right slightly with each pedal stroke so you can reach bottom of the pedal stroke, which causes back pain. Almost everyone is most comfortable with cleats under the ball of their foot - why did you move them all the way back? Most also have them pretty centered left to right on the shoe. A good supportive insole can help as well - do you pronate while running? Is your saddle lined up correctly (not angled slightly to the left of the bike)?


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## trailville (Jul 24, 2006)

I went years with knee pain on long rides before realizing it was (at least partially) related to my clipless setup. I figured this out by accident when I started riding platform pedals occasionally, and noticed I wasn't getting the same level of knee pain. I then watched my foot position on the platforms, and noticed I rode with my heels slightly inward. I then adjusted my cleats to give me a similar position, and my knees have been better (though I now split my time between clipless and platforms). Unfortunately a side effect of that new cleat position is that I occasionally accidentally clip out when jumping and bunnyhopping (I'm assuming I move my heels out a little when jumping and now with the new cleat position, that means I'm unclipping).


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## Okie81 (Apr 7, 2010)

If I had to take a guess, my back pain stems more from the extra lean over the bars than from excessive hip movement. Not much movement in the saddle though, and my hips don't lie.  Hopefully it'll get better, if not, maybe I'll try a spacer too.

Riding platforms at my current seat height would make it very difficult to keep my feet planted on the pedals (especially at the lowest point of the stroke). There has to be some amount of downward pressure at all times; you don't necessairly have to worry about that with clipless.


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## ja001son (Feb 27, 2011)

AndrwSwitch said:


> The second is that a lot of people put their feet further forward on flat pedals than on a typical clipless setup. If that was true of you, you gave yourself a little more leg length by using a different part of your foot when you switched.


bingo, noticed it today when riding, good call!


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