Knee, Achilles Tendon, back...what doesn't hurt?

[Owlie]

Did a long ride yesterday. My back still hurts. This isn't what concerns me, though, because I think it's due to a lack of core strength.

What does concern me is the following:

1) Knee pain. I've had a fitting done (and the guy spent a long time fiddling with my cleats). We never completely eliminated it, but it hasn't been this bad. It's better if I scoot back on the saddle, but that sets my left knee off, not to mention the extra chafing. (I must remember to buy chamois cream...) Left knee is primarily the outside back on the knee. On the right, it's the front inside and the bottom of the kneecap. I should note that my knees tend to turn toward the top tube, in case that helps.

2) Achilles tendon pain, especially right leg near the ankle. Could it be caused by shoes that are too wide in the heel? Or something else?

3) Asymmetrical sitbone pain and chafing. My left sitbone, on every ride, hurts more than my right. And I get more left-sided chafing than right. It almost feels like I'm not sitting squarely on the saddle...like my right sitbone isn't even on the saddle, though I start off that way, and I somehow even stay that way on the trainer. Is this an issue of core strength? I am extremely right-sided...

[indysteel]

Given where it hurts, your right knee sounds like some IT band irritation. The fact that you ride kneed in is further suggestive of that. Do you ride a triple? It could be a q factor issue. I had that in my right knee, too, when I rode a triple. Now I ride a compact for that very reason.

As for you left knee and left sitbone, did your fitter suggest that your left leg is shorter than your right? The pain you're experiencing on your left side suggests to me that your saddle is too high for your left leg. If your fitter concurs, then you might try a shim in your shoe or under your left cleat. Otherwise, drop the saddle down a smidge, depending on the leg length discrepancy. You set saddle height for your shorter leg.

I know little about achilles issues so I have no suggestions there.

If your fitting covered future adjustments, I'd go back and talk to your fitter about these issues.

[Catrin]

(((Owlie))) I hope you are feeling better soon. Is there any chance at all that the saddle might not be entirely straight? I know with my own saddle, because of quite uneven stitching, it can be a bear to get it to line up properly because the eyes wants to use those stitched lines as a guide. I know that wouldn't explain everything but it was the first thing that sprang to my mind.

What kind of pedals do you have? One of the reasons I changed to Speedplay Frogs was the SPD pedals hurt my knees, in the inside if I remember correctly.

[withm]

Achilles tendonitis - rest, ice, massage, stretching will help. Often caused by bicycle seat too high, and "ankling" or pointing toes downward while riding.

[Owlie]

Food for thought...
Indy, I do ride a triple, and the fitter did mention that I should get a compact double on my next bike, but agreed that it wasn't worth switching the crankset out on this bike. The next bike will have a compact double anyway. He did mention a leg-length discrepancy (probably my left, but I don't remember), and did put a shim in.

Catrin, I'll double-check the saddle when I get home. I try to align it with the "point" in the paint on my top tube, but I'm not exactly good at that sort of thing. And I'm using SPDs. My fitter suggested that I get road shoes and pedals (Speedplays or SPD-SLs, and I assume by extension Look Keos) to help with the hot spots from the pedals/shoes (they're too flexible for my liking, and too wide in the heel except as a winter shoe with a thicker sock). It's also possible that my cleats have wiggled out of position a little.

Withm, I don't think I ankle (and have made an effort not to), but I will double check the saddle height, if I can find my sharpie line. It has certainly been worse since I started working in retail, but I can feel my right heel slipping in my shoe a bit. I wonder if that might mimic ankling.

I should also mention that at least some of those issues (knee, Achilles tendon) are much improved if I actually focus on a proper, round pedal stroke. I wonder if it's less an issue of bike fit and more me not actually working some muscle groups appropriately.

[OakLeaf]

At the risk of beating the same drum yet again... How long are your crankarms? +1 on ankling, IT band, seat height ... But when a saddle is simultaneously too high and too low, that means your cranks are too long.

[Owlie]

At the risk of beating the same drum yet again... How long are your crankarms? +1 on ankling, IT band, seat height ... But when a saddle is simultaneously too high and too low, that means your cranks are too long.

172.5.

[OakLeaf]

Don't know how long your legs are, but at 5'3" I can't ride anything longer than 165 without irritating my kneecaps and Achilles.

[indysteel]

I can use 170s at 5'4. 172.5's would be pushing it. Did your fitter talk to you about that? Still, the fact that only your right ITB seems irritated is still consistent with a q factor issue. The right pedal is further offset than the left because of the chainrings. So, sometimes only the right ITB gets irritated.

But, honestly, I think the best thing is to revisit the fitter and talk about what's happening. A few tweaks might be in order.

[Crankin]

I have never been able to ride anything except 165s. I am short, but still, when I tried the 170s it was torture.

[Owlie]

Don't know how long your legs are, but at 5'3" I can't ride anything longer than 165 without irritating my kneecaps and Achilles.

I'm a 5'6.75" with long legs. Fitter never mentioned crank length as being an issue.

Indy, that definitely made sense. My fitter knows I don't want to put too much money into the bike right now, as I'm saving up for a new one (a de facto compact double), but encouraged me to get a CD when I bought a new bike or upgraded the drivetrain on this bike.

I went on a short, slow ride (12.5 miles, or thereabouts) this evening. Honestly, the "sit bone" pain (which isn't actually on my sit bone, but slightly further forward) and chafing were bigger issues than the knee pain today. I now have an explanation for about half the stuff that's been bothering me. Apparently I'm not actually sitting on the "sit spots" on the saddle. I'm sitting weirdly...I don't even know how, since I can't replicate it on the trainer or with the bike against the wall. There is definitely a sweet spot on the saddle where my sit bones are in the right places and the knee pain is nearly gone, my left side isn't as irritated and my weight is more normally distributed on the saddle. Once I find it, the issue is keeping myself there.
I have a feeling that the weird position I'm sitting in has something to do with my overall position on the bike. It seems I prefer to be somewhat more aggressive than the bike will let me. The fitter did say that the stem I have on there is about 5mm too short, and I think that might have something to do with it, since I feel like a slight tweak lengthwise would help my shoulders as well. I'll have to give him a call and see what we can arrange.

[Owlie]

Did another ride today. My knee is still very unhappy with me.

I'm calling the fitter/LBS tomorrow. Since it's in Cincy, I need to schedule it for my day off. I'm contemplating new pedals and shoes anyway. Thoughts? (I'm thinking either Look Keos or Speedplays.)

Is there anything I can do in the meantime, beyond rest, ice and NSAIDs if necessary?