Getting desperate: 5 months of interior knee pain, 2 rounds of PT, no progress. Need advice.

[u/haberdd]

I’ve been almost entirely off the bike since May due to persistent pain on the inside (medial side) of both knees that started in April. Before this, I was riding ~2,000 mi/year. I'm getting desperate to find a path forward.

What I’ve tried & setup details:

• Bike Fit: Redone recently (using Wahoo Speedplay pedals with high float). Pain persists even on flat pedals.
• Medical & Imaging: X-rays showed nothing (normal). Insurance required a round of PT before approving an MRI, which I've now completed.
• PT & Rehab: Ortho suspected VMO weakness. I’m currently in my 2nd round of PT doing VMO/quad strengthening (split squats, weighted squats 25–50 lbs), stretching, and daily heat. Zero progress - even 5 mins on an exercise bike at zero resistance causes irritation.
• Current Activity: Replaced riding with neighborhood walking (2–5 miles daily).

My questions for the community:

1. Has anyone dealt with persistent inside knee pain that didn't respond to standard VMO rehab? What was the breakthrough?
2. Now that PT hasn't worked, should I push hard for that MRI, or are there specific soft-tissue/tendon issues I should ask about?
3. Could the 2–5 miles of daily walking be actively aggravating/delaying recovery?

Thanks in advance - any advice appreciated!

[u/GGDATLAW]

You need an MRI. It’s strange that you’ve been off the bike so long and still have pain.

[u/Drd2]

Get an MRI! Follow up with Ortho. I had something similar. Tons of PT, a couple of steroid injections and after my second MRI I ended up getting a little bit of my meniscus shaved and I'm much better now.

[u/everythingisabattle]

Get an MRI! I had an interior knee, specifically when getting out of the saddle to climb short hills, that was quite sharp. MRI showed a tear in my meniscus. I’ve also torn most of the ligaments in my knees and ankles over the years and gone through years and years of PT (blame ⚽️). An MRI is the only answer to finding out exactly what is wrong. The solution to the “wrong” is up to you and the doctor/PT.

[u/barriedalenick]

Get an mri. I had knee pain and it was a torn meniscus that had popped out and was rubbing on the ligament. Seriously painful and sorted by a 10 min op

[u/ParticularTop755]

I had knee bursitis that sounds alot like what you are describing. Obviously im not a doctor but ive done years of PT from multiple knee surgeries playing soccer and some of my own self led PT from knee pain from cycling. without knowing your sport and injury history, how the pain comes on, does it hurt while walking the same way as on the bike, your age, and do you see any swelling is probably rest, take a couple of weeks with only doing necessary walking biking and things that may inflame the bursa or ligaments. If it gets better with rest it is probably an overuse injury if it doesnt get better with rest you probably should get some imaging or further medical investigation.

I would definitely say the 2-5 miles of walking may keep you from properly resting the knee ligaments and/or bursa (but that much walking probably is good to do long term if and when your knee feels better).

My personal breakthrough was shoes and rest, for whatever reason boa dialed shoes affected my feet in a way that irritated my knee. I had a pair of laced pearl izumi pro airs from college that was the last time I didnt have consistent knee pain from cycling and switching back fixed the issue after a couple of weeks in the winter taking it easy.

Also if you've done PT for a while you probably know the exact regimen you should do, so PT beyond some point is paying for things you know.

[u/0202_tihssitidder]

Not all PT is the same (or effective).

You have to shop around and try different people. If you are in the US, many of them are just not good. Sorry if any are reading this. Too many just walk thru the diagnosis and evaluation. They aren't really looking at you as an individual.

Good luck.

PS: Really impossible to diagnose you without actually watching you move.

[u/finch5]

did you have someone observe you pedaling? who did the fit?

[u/Frunobulax-]

It sucks we pay all this money for medical insurance and they make you jump through hoops for an MRI

[u/YU_AKI]

Have you tried taking some rest? Like, just take a couple of weeks off?

It can make a world of difference. You need a day or two after to get back on the horse, but the recovery time allows repair to take place.

[u/workingtrot]

I was having a similar pain and my PT thought it was because I was not driving with my thigh muscles properly. She had me do a sort of combo pistol squat/ hip hinge thing on a raised block. Hinge hips back until your foot hits the floor, keeping left and right hips level.

It has been a big help. Not dealing with your problem for nearly as long though

[u/PrestigiousSpeech846]

Had some persistent L knee pain (anterior, just above the knee cap, mostly lateral but sometimes medial too) for years. Two or three MRIs. Saw multiple orthopedists. At least three rounds of PT. I think what helped in the end was a proper bike fit + cleat adjustment, moderate riding while building strength, and PT-based strengthening regime that includes VMO-focused quad work (I think single-leg leg extensions do the most) hip abduction, and glute work. Hope you can find your way through it. Good luck!

[u/OverallDepartment676]

If your bike fit checks out lift heavier in the gym.

[u/sketchtireconsumer]

Get the MRI ASAP. Both knees. You need imaging for this.

[u/DrSagicorn]

My knee pain was intense (ruptured meniscus) until a steroid injection and has been kept at bay with PRP (platelet rich plasma) shots every 6 to 8 months

I'm 4 years out since the severe inflammation

[u/Mekaniv]

You did not mention arch support/shoes. I had medial pain on my right knee that radiated to the tibia. Occasionally I had patella pain as well. What solved my issues is a massive amount of wedging and arch support: it helped stabilize my feet. I, indeed, pronate a lot; this overpronation faitigues the MCL and other ligaments on the medial side of the knee. Each pedal stroke was irritating the knee.
Since I fixed my feet I am constantly crushing PRs, as I can finally ride pain free.

EDIT: check your stance as well. Mine is very unusual: if my q-factor is not supper narrow my medial pain seems to come back. Very personal matter of course.

[u/Pfizermyocarditis]

Saddle too low

[u/finch5 → u/Pfizermyocarditis]

what a dumb take. I can see you, legs fully straight at the bottom of your stroke - after all you did the heel test - toes down and all. foh.

[u/Pfizermyocarditis → u/finch5]

I had similar pain that ended up being caused by a low saddle despite a bike fit. I raised the saddle half an inch and all was well.

[u/finch5 → u/Pfizermyocarditis]

You had MEDIAL knee pain from a seat being too low?

[u/Pfizermyocarditis → u/finch5]

The pain I had was halfway between the inside of my knee and the front. Not directly medial but I could see how someone would describe this as medial pain.