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The Left Knee Persists in Griping

My left knee continues to be unhappy; some ache that I cannot even localize and after hard rides (next day) increased crepitation and even a small click. Yet the February MRI showed only mild inflammation in otherwise healthy knee tissues.

As it is, there is no h0pe of training hard enough for any event; the knee can’t accept the training load. My plan at present is to continue training in the hope that the issue slowly improves. Which might be a good plan or a terrible one—I don’t know.

I made an adjustment to road bike cleats and I’d have to say that my knees are tracking vertically as well as ever, and probably better. It doesn’t seem to fix anything. I rode my mountain bike for two (fairly hard) days. That setup has not changed, but my left knee tells me that it is just as unhappy. So more and more I am not thinking this is a fit issue, with the caveat that healing in connective tissue is very slow and thus very hard to say without an extended period of trial.

Pedal offset

The left leg pedal offset is different now: most of 2012 I rode the Cannondale Hollowgram SL crankset, and it had and has a 6mm asymmetry which twisted me up after 10K miles of riding, see Make Sure Pedals are Symmetric!.

That left/right leg asymmetry has been addressed by using the long spindle Shimano DuraAce pedal on the left side; together with appropriate cleat placement so that my left and right feet and knees now have the same offset. This can be seen and the knee tracking is very vertically confined, showing good positioning (really minimal “looping” of the knee).

Unfortunately, James A might be on to something.

James A writes:

Is it correct that the knee issues stem from the bike fit in the city late last year? I know it improved your power output but the joint memory of many years of cycling is what MAY be causing the pain.

It is doubtful from a medical standpoint that continued use will fix the problem. There can be subtle grooving etc. in any mechanical system that is now out of alignment however slightly. Is it an option to go back on one of your older bikes that was set up during your pain free period and train on it. If the pain improves the diagnosis is made and the added power of the new setup may need to be sacrificed for a long term painless ride. Just my thoughts.

Lloyd: At this point I am reluctant to blame the fit because my mountain bikes (setup unchanged) don’t seem to make my left knee any happier, and I also see excellent knee tracking on the road bike. Of course it could be just a different angle to the pedal as well as loading of the knee as well as offset: it’s tricky.

However, the point James A makes is a troublesome one if true: if I have to go back to the 2012 setup, I don’t really want to build in that 6mm asymmetry (seems like a bad long term idea if nothing else), and it is also a problem for any future crankset change, which I plan to make in June/July. As well, all my other bikes have a symmetric crankset. So I could “go back” but this not be strictly speaking the same with a symmetric crankset arrangement.

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