While cycling is a more low-impact physical activity, knee pain is often a common complaint. Knee pain is the most common location for overuse injuries in cycling, resulting in 40% to 60% of cyclists experiencing cycling-related knee pain in their careers.
Though knee pain from cycling is an overuse issue, several factors can contribute to its occurrence. Biomechanics, shoe fit, bike fit, and other factors can all play a role in contributing to knee pain.
Understanding how these factors contribute to knee pain and using helpful techniques to decrease the chance of knee pain will help you maintain a long and healthy cycling career!
Look at Your Anatomy
The knee joint is comprised of two long bones, the femur and tibia; the patella or kneecap, that sits in the trochlea groove; four ligaments; the ACL, PCL, LCL and MCL and cartilage.
This joint also provides attachments of many muscle tendons like the quadriceps, hamstrings, IT band, and the patellar tendon which connects the patella to the tibia. With physical activity, all these components of the knee joint work together to provide movement and stability.
While they provide stability, repetitive movements in cycling can cause the ligaments, tendons, and cartilage within the knee joint to become inflamed and possibly degraded over time. This pain can be represented on the anterior (front), posterior (back), medial (inside) and lateral (outside) areas of the knee.
Low-Impact Doesn’t Mean No Pain
Knee pain can be represented in different ways and can be caused by several factors while cycling. These factors are based on biomechanics, anatomy, and bike fit. Because of these different factors, knee pain can be represented in different locations on the knee. Understanding how these factors cause knee pain can help you decipher exactly how to remedy your cycling routine to avoid future knee pain.
4 Common Reasons for Knee Pain in Cycling
If your bike seat is settled too high, you may experience pain along the back/outside of the knee. As the seat is too high, you will overextend your knee repetitively while peddling. This can cause stress and inflammation to the hamstring tendons (located behind the knee) and the IT band (located on the outside of the knee).
Conversely, if your bike seat is too low, this will cause more shear forces to be placed on your patella. This is due to the knee joint becoming restricted to maintain a flexed position with little deviation during peddling. This position will put stress on the front of the knee which can cause tendinitis and cartilage issues over time.
Your physical anatomy and physiology are just as vital in cycling as the bike itself. While certain muscles are used in cycling, individuals with certain flexibility or mobility deficiencies may have difficulty going through proper movements.
For instance, individuals with a “knocked knee” (inward knees) or “bow-legged” (outward knees) stance can put forces on the medial and lateral aspects of the knee, causing pain and discomfort. These stances are often caused by weak glutes, tight adductors, and even weak core muscles. It is important to address and treat these imbalances before strenuous cycling activities.
Proper foot placement along the pedals is a small, but important component in avoiding knee pain. If feet are placed too close or too far apart, the knee joint can be stressed medially or laterally. These placements of the knee put forces on ligaments and tendons that stabilize the knee. Continued stress will cause inflammation and degradation to the joint and stabilizing ligaments.
With novice and elite cyclists, training load, and duration are vital components of a successful cycling routine. Increasing biking distance before your body is properly recovered will increase the chances of knee pain and soreness. Gradually increasing distance and duration of bike routes and allowing more time for recovery can reduce the risk of injury and time away from your bike routine.
Prevention Will Keep You on The Bike
Prevention is a huge asset to cyclists trying to protect themselves from debilitating knee pain. Incorporating these preventative measures in your cycling can make sure you stay on the bike and avoid costly time off due to knee pain.
Proper bike fit
Perhaps the most important external factor causing knee pain is the bike itself. While there is no one-size-fits-all notion for a bike fit, there are helpful tips to ensure a safe and comfortable fit for any cyclist.
Managing saddle height & position
Important to set saddle at a height that the cyclist is comfortable getting full power, but not overextending their knees with each peddle motion. Saddle position relates to the saddle being set toward the handlebars or the rear of the bike. Being seated in a position where the knee joint can sit directly above the peddle through full-motion will help limit strain to the front of the knee and reduce risk of pain and discomfort
Stretch shortened or weak muscles
To limit the risk of tendinitis and joint pain, proper stretching of quadriceps, hamstrings, calves, adductors and abductor muscles is required before and after cycling. This stretching contributes to improving flexibility and mobility of muscle fibers and reduces shear forces placed on tendons attaching to the patella.
While cycling is a low-impact activity, having a proper warm-up to get blood moving and muscles stimulated should not be overlooked. Simply jogging in place, doing jumping jacks, or even going on a light bike ride can get your body warmed up and ready for a more grueling bike ride. Keeping muscles stimulated and elongated(through proper stretching) will reduce the risk of not only knee pain but will give you a sense of your own body’s fatigue limits.
Doing exercises focusing on quadricep, hamstring, and glute strength in between cycling sessions can reduce the risk of knee pain while also providing stability at the knee joint.
Get Treated, Stay on Track
Though preventative measures can be taken, discomfort, soreness, and pain within the knee can still be a lingering presence while cycling. Understanding what you can do for acute knee pain can limit the chances of it returning and becoming a chronic issue.
- Ice: Even if you are experiencing mild soreness or discomfort after cycling, applying ice will help reduce lingering soreness hours after you have finished your session.
- Self-myofascial release (SMR): Using foam rolls or tennis balls on tight or sore muscles to improve muscle recovery, flexibility, inhibit overactive muscles and reduce pain.
- Sports massage: 20-30min duration immediately after or up to 2 hours after cycling
- Stretch: Best to use before AND after cycling.
- Medications-over-the-counter: Pain reducers help control pain symptoms before and after activity.
- Doctor’s referral: in extreme cases of knee pain, and if conservative treatments are not effective, seeing a physician is often the next step in recovery. Physicians can prescribe medications, physical therapy, imaging and even bracing to combat symptoms of knee pain.
Stop the Cycle of Pain
Knee pain in cyclists can be caused by many factors, including the bike itself. Understanding how these factors cause knee pain and how to resolve them are vital to ensure a safe and prosperous cycling career. By practicing proper prevention, recovery, and treatment techniques, you can reduce your chance of knee pain and stay on your bike!