Knee Pain In Cyclists

Common Causes Of Knee Pain In Cyclists And How To Correct Them

Everyone is susceptible to knee pain even if your bike has been assessed and setup correctly. This can be due to over-training, which can occur in Spring time. At this time of year cyclists often increase training volume in a short period of time because they have left it too late to get fit for their races.

The most common causes of knee pain in cyclists are:

* Faulty saddle height or position
* Bent pedal axel following a crash
* Crank too long – especially if you have chondromalacia
* Pushing excessively high gears (slow cadence in cold weather)
* Too much leg work in the gym
* Cleat alignment
* Individual cyclist anatomy


Types of knee pain

Patella tendonitis and patellofemoral syndrome can be caused by pushing in big gears. The saddle positioning could also be too low or too forwards and the foot may be too far forward on the pedal. The crank arms may also be too long, or knee pain could be due to leg length discrepancy. So be sure to check these out if you start to develop anterior knee pain.


Pain can also develop at the back of the knee in which case can put tension on the hamstring and calf muscle. This pain can be brought on by saddle being too high or too far back, too much pedal float, or leg length discrepancy. These can be resolved by correcting the set up of the bike to decrease the stress on the back of the knee.


The medial collateral ligament and surrounding tendons can also become painful on the inside of the knee: the cleat position is too wide (toes point out), excessive sideways movement of the knee, or a fixed foot. The cleat can be moved inwards to help with medial knee pain.


ITB pain can also occur on the outer side of the knee and can be due to excessive sideways movements of the knee. The cleat positioning may be too narrow (toes point in) and there could be too little pedal float. By correcting foot alignment, this should stop any irritation of the ITB on the outer side of the knee. If you have had pain over a long period of time and it hasn’t healed with just rest and fixing the foot alignment on the bike, it could be a degenerative meniscus. This is because structures like this have less blood supply so therefore have a longer healing time.


The best thing to do if you get knee pain is not to ignore it. It will most likely not go away by itself because something has aggravated it in the first place that needs to be changed. Take time to rest the knee for a few days and take anti-inflammatory drugs in this time period. Do some hot and cold contrast bathing in this time to stimulate blood supply and speed up the healing process. Start back on the bike with trainers to determine if the cause of your pain is due to cleat setup. However, if the pain still occurs in trainers, it is most likely due to overuse. If it is due to overuse, the best thing to do is start off with smaller rides and gradually increase the time on the bike. Riding in smaller gears is also beneficial at this stage as there is less strain on the knees, if pain still persists, see a Sports Therapist for treatment.

Ensure you are doing at least a 30 minute warm up and doing specific stretches to the quads, TFL muscle that is attached onto the ITB, hamstrings, glutes and lower back.