Anterior knee pain – starting to get serious

Hi Folks,

Looking for some advice here (preferably not of the “don’t ride a bike for a few months and see if it gets better” sort which my Doctor wife recommended).

A little bit of background:

I got my first road bike about 8 months ago, loved it, and have been doing a fair amount of cycling (30-80 miles once a week) over the last few months. I’ve been riding for years but had been of the bike for a little while and I never used to go out four 4+ hours on the MTB.

For the first seven months, the only pains I had were in my back and shoulders. I followed some advice from here and started doing some targeted core training which helped a lot. Things were getting better on that front.

I got myself a new saddle bag for my birthday (end of May) which didn’t fit on the bike as-is. I had to move my saddle backwards around 1cm in order to fit the thing. I went out for my “normal” 65 mile loop around Surrey and after a couple of hours started getting pain in my right knee (specifically on the front and inside of the knee – it’s especially pronounced when I push hard. If i’m just spinning out it’s fine, climbing and getting out of the saddle make it much worse).

The next week, with the saddle remaining unchanged I went out for a quick loop of Box Hill (35 miles) – knee pain again returned after an hour. At this point I put the saddle back how it was and took the new saddle bag off the bike.

I took this as a sign that I really should get a bike fit done. So I popped off to my LBS and ended up spending £450 on a bike fitting + new shoes/bars/stem, ouch. I guess that’s what you get if you buy everything of the internet and haven’t had your feet measured in 20 years. The chap didn’t have to change much, my saddle was already in the “ideal” position, the reach was too long and my shoes way too big. I went out for another quick loop of Box Hill and the pain was still very present, but I figured I’d tweaked something at this point and needed a rest.

I knew I had a Sportive coming up on the weekend just gone, so I took two weeks off riding. I still went to the gym a bit, but stuck to core and upper-body – I left my legs alone for two weeks.

I did the Wiggle Chiltern Classic (75 miles) on Saturday and my knee is worse if anything. My left leg/quads are now really sore as well – I suspect from over-compensating for my weak right knee. On the plus side, shortening the reach and narrowing the bars with the new stem/bars has eliminated the back and shoulder problems entirely.

My wife is of the opinion that I should stop riding for a while (funny that) and see what happens. I’m not particularly enamored with that idea, it’s not like I ride a huge amount anyway – once a week maximum.

Has anyone had any similar issues? Assuming the bike fit was good, could this just be my body trying to adapt to an “ideal” cycling position?

Right now I see my options as:

– Stop riding and hope it fixes itself, then build up the miles again slowly.
– Do a bunch of strength training, squats etc, focusing on the problem muscles. Try riding local 4-5 mile loops and build up the distance until the knee pain starts again. Essentially train through it.
– See a doctor and be told, “if it hurts, don’t do it”. I’m not a big fan of this as you may have guessed, every other muscle injury I’ve had (and there’s been a few, I did a lot of gym work when I was younger) I’ve worked through with targeted training and they’ve fixed themselves.
– Try playing with my bike adjustments to see if I can sort something myself, this strikes me as massively iterative and hard to judge as to whether or not it’s the current injury getting inflamed further or actually making things worse.

Any other suggestions?