Cycling Knee Pain: Everything You Need To Know

Personal trainer Ben Gibbons shares his experience on dealing with knee injuries from cycling

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For many, myself included, cycling is a passion, a lifestyle, and a vital way of looking after your health.

The feeling of the wind in your hair, the rhythm of the pedal strokes, and the open road ahead can be exhilarating.

But like any sport, cycling has its challenges, and one of the most common ones is knee pain. As a qualified personal trainer and sports massage therapist, cycling knee pain is a problem that I’ve encountered with clients time after time.

Over time, cycling knee pain can escalate from a minor annoyance to chronic, excruciating discomfort that might force you to take time off from your beloved bicycle. Having to take time off the bike is frustrating, and we want to do our best to help you avoid that.

In this article, we will provide you with comprehensive insights into cycling knee pain, including its causes, symptoms, what to do when it occurs, common mistakes to avoid, and effective strategies to prevent injury.

Cycling Knee Pain graphic

5 Common Causes of Cycling Knee Pain

Working with cyclists over the years has made it clear that understanding the causes of cycling knee pain is essential for prevention and effective management.

Several factors can contribute to knee pain in cyclists:

#1: Overuse

Many cyclists, particularly beginners, often increase their mileage too rapidly before their joints and connective tissues are adequately conditioned to withstand the stress.

Cycling is great fun, and it’s easy to get swept up in the excitement of getting on the bike as much as possible. Part of the problem is that our cardiovascular and muscular fitness improves more rapidly than the conditioning of our cartilage, ligaments, tendons, and bones.

Consequently, cyclists are more susceptible to overuse injuries. It’s challenging to foresee when we might be pushing ourselves too hard; often, by the time a persistent ache in the knee evolves into acute pain, it’s already too late.

This emphasizes the importance of adhering to a structured training plan.

Overuse is relative and depends on the individual cyclist. It hinges on the balance between the applied stress endured when cycling and subsequent recovery in between rides.

The positive news is that you have full control over your training volume and rest.

To assess if you might be overtraining, consider the following factors:

  1. Recent Changes in Training Volume: If you’re new to cycling, gradually increase your mileage. Progress should be gradual. What might be achievable in two months would be excessive now. Allow your body time to adapt. If you’ve been cycling consistently, be vigilant for sudden changes or spikes in your training volume.
  2. Recent Increases in Training Intensity: Upping the intensity will impose more strain on your body. Ensure that you balance high-intensity sessions with sufficient low-heart-rate training.
  3. Sleep Quality: Aim for 7-9 hours of sleep per night, as adequate sleep is crucial for recovery and adaptation. Our bodies strengthen during rest, not during training. Strive to wake up feeling refreshed. Assess your lifestyle for factors that might hinder sleep, such as excessive alcohol consumption, work-related stress, or excessive screen time.
  4. Introduction of New Activities: Think back to whether you’ve recently added new activities to your routine, such as running or strength and conditioning workouts at the gym. Remember to allow your body ample time to adapt to these changes.

Incorporating these considerations into your training methodology will help you avoid overuse injuries and ensure a safer and more enjoyable cycling experience.

#2: Incorrect Cleat Alignment

Improper cleat alignment is a common cause of knee pain in cyclists.

Cleats are the attachments on cycling shoes that connect to the pedals. When they are misaligned, it can result in knee discomfort due to the following reasons:

Misalignment Stress: If the cleats are not correctly positioned on your cycling shoes, it can cause the knees to track in an abnormal path, which results in uneven and unnatural forces on the joint.

Additionally, incorrect cleat alignment can also place undue torsional stress on the knees, leading to an increased risk of knee pain. This can be especially problematic when pedaling under high torque, such as when climbing steep hills.

#3: Incorrect Saddle Position

Saddle position plays a crucial role in maintaining proper biomechanics during cycling. When the saddle is not positioned correctly, it can contribute to knee pain.

Here’s how and why this occurs:

Improper Knee Flexion

A 2011 review has shown that correct saddle height, determined using the knee flexion angle method (usually between 25-30°), is essential to reduce the risk of knee injuries.

When the saddle is too low, it leads to excessive knee flexion during the pedaling cycle. This over-bending of the knees places added strain on the joint, leading to discomfort and, over time, potential injury.

Aside from knee pain, an incorrect saddle height can also hinder efficient power transfer.

When your saddle is too low, it limits your ability to generate power and can lead to compensatory movements, including overextending the knees during the downstroke of the pedal stroke.

#4: Incorrect Cadence

Cadence, or pedal revolutions per minute (RPM), is a critical factor in cycling efficiency.

Riding with an excessively high or low cadence can put undue stress on the knee joints.

A low cadence with high resistance may require more forceful pedal strokes, which can strain the knee extensors. Conversely, spinning at an excessively high cadence may result in overuse of the knee flexors, leading to discomfort.

An incorrect cadence can also lead to suboptimal muscle engagement in the kinetic chain.

For instance, excessive force at low cadences may cause you to rely heavily on the quadriceps, while a very high cadence may under-engage these muscles, leading to potential instability in the knee joint.

#5: Poor Flexibility and Strength of Core, Pelvis, and Lower Limb Kinetic Chain

Insufficient flexibility and strength in the core, pelvis, and lower limb kinetic chain can contribute to knee pain in cyclists.

The core, pelvis, and lower limb muscles play a pivotal role in stabilizing the body during cycling. Poor flexibility and strength in these areas can lead to biomechanical imbalances, affecting how your knees track during pedaling.

Inadequate muscle strength can lead to an increased reliance on the knee joint for force production. As a result, the knee may absorb more stress during pedaling, potentially leading to pain and discomfort.

Addressing these factors through proper bike setup, cleat alignment, cadence management, and targeted strength and flexibility exercises can significantly reduce the risk of knee pain in cyclists and promote a more enjoyable and injury-free cycling experience.

Black and white graphic of a knee injury in a cyclist.

Cycling Knee Pain: Common Injuries

You should always seek out the help of a medical professional when trying to diagnose your knee pain.

Here are a few of the most common knee injuries in cycling:

  1. Iliotibial Band Syndrome (ITBS): Iliotibial Band Syndrome is a condition characterized by a gradual onset of pain on the outer side of the knee. This discomfort can be sharp and is often attributed to inflammation of the fat pad and overuse. Over time, the pain tends to worsen progressively.
  2. Patellofemoral Pain Syndrome (PFPS): PFPS is a general term used to describe knee pain centered around the patella or kneecap. Symptoms include a persistent ache in the knee joint, primarily at the front, below, and around the patella. This pain can be experienced both during physical activity and at rest.
  3. Hamstring Tendinopathy: Hamstring Tendinopathy can develop from recurrent overstretching of the hamstring insertions, often due to tight hamstrings or an elevated saddle position. This condition typically results in a dull throbbing or stabbing sensation near the hamstring insertions.

How To Prevent Knee Pain After Cycling

So we’ve looked at the common causes and most likely injuries surrounding knee pain, but how are we supposed to prevent it?

#1: Embrace a Gradual Training Approach

Constructing a solid cycling foundation – it’s a process that demands both time and meticulous planning. In your cycling journey, patience and gradual progression are your allies. Avoid the temptation to dive headfirst into high-intensity training.

Think of it as the methodical laying of bricks for a robust foundation. Just as you add bricks one by one, incrementally increase your cycling speed, distance, and intensity over time.

#2: Get a Bike fit

If you feel awkward on the bike and can’t seem to work out how to correct it, investing in a professional bike fit assessment will ensure that your bike is adjusted to your body’s specifications.

A proper bike fit can significantly reduce the risk of knee pain.

#3: Incorporate Cross-Training for Versatility

Diversify your training regimen to build resilience and reduce the risk of cycling-related injuries. Specializing in a single sport can expose specific muscle groups to repetitive strain.

Cross-training introduces variety and a fun element to your training. Activities like swimming or gym workouts provide low-impact, diverse exercises that enhance cardiovascular fitness without overburdening vulnerable muscle groups.

What’s more, cross-training doubles as a potent recovery strategy, promoting healthy blood circulation and lowering the risk of injuries.

#4: Begin Strength Training

Building strength in your lower extremities is a pivotal strategy for reducing the likelihood of cycling-related injuries.

Incorporate resistance training will increase your body’s physical resilience, boosting joint stability, and minimizing injury risks.

Commence with manageable weights and consider seeking guidance from a qualified professional for tailored strength and conditioning exercises.

knee pain Biking: Summary

Your cycling journey should be an exhilarating ride filled with adventure and exploration, and the last thing we want is for knee pain to become a roadblock.

By embracing a gradual training approach, ensuring the right bike fit, incorporating cross-training into your regimen, and introducing strength training, you can significantly reduce the risk of knee pain and injuries.

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As a qualified sports massage therapist and personal trainer with eight years' experience in the field, Ben plays a leading role in BikeTips' injury and recovery content. Alongside his professional experience, Ben is an avid cyclist, splitting his time between his road and mountain bike. He is a particular fan of XC ultra-endurance biking, but nothing beats bikepacking with his mates. Ben has toured extensively throughout the United Kingdom, French Alps, and the Pyrenees ticking off as many iconic cycling mountains as he can find. He currently lives in the Picos de Europa of Spain's Asturias region, a stone's throw from the legendary Altu de 'Angliru - a spot that allows him to watch the Vuelta a España roll past his doorstep each summer.

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