This is where getting experienced, qualified help is important as a lot of medical detective work is needed to find the source of the problem. Any of these three areas can cause problems that are hard to detect. This is because the errors may be small in themselves and may not seem significant or noticeable. A lot of knee trouble in cyclists is not treated properly because the person giving treatment may look only at the knee. They ignore the fact that what happens at the knee and knee cap can often be due to foot position.
Some riders have slight malalignment of the knee cap, which can be measured.
Other riders may have tightness of the tendons and soft tissue structures around the knee causing the knee cap to be pulled to one side. The lower back is sometimes a problem too since it may refer pain to the front of the knee, fooling riders into thinking the problem is with the knee when, in fact, it is the back all along. Mechanical faults - Any minor fault in the cranks, pedals or spindles can cause overuse injury. This is most likely to happen after a crash, but even an unspectacular prang could cause slight twisting of the equipment. This often shows itself days or weeks later with pain in the knee cap area.