Knee pain when Cycling

Whether you’re a beginner or experienced cyclist, there’s a good chance you’ll have experienced discomfort or 'achey knees' at some point in time. Hopefully this has simply come and gone but sometimes discomfort lingers and can transition to frequent knee pain when cycling.

So, what should you do if it lingers?

I always recommend seeing a medical practitioner such as a Physiotherapist, Osteopath to have the knee clinically assessed. This will help gain insight into structures that may be causing the pain and why these are getting irritated.

One of the other vital things to do is to ensure you've had a Professional Bike Fit to ensure you setup is optimal. The repetitive nature of cycling means if something isn't quite right with your position, performing thousands of pedalling repetitions and spending lots of time on the bike may result in some irritation.

What are some of the main causes of knee pain on the bike?

Most injuries are multi-factorial but here's some of the common causes we've seen over many years of Bike Fitting in London...

1. Insufficient leg extension during pedal phase

Not enough leg extension results in an increased amount of force that is passed on to the knee and its surrounding structures. These include the patella (kneecap), patella ligament, meniscus, synovial plica and muscular tendons attaching around the knee. In short, we need an optimal leg extension to lower the chance of irritating any of these structures.

2. Excessive leg extension

This usually results in sub-optimal knee tracking where the knee drops in at the bottom of the pedal stroke as well as excessive calf pointing aka plantar flexion when pedalling. Together these factors can irritate the iliotibial band (ITB) and bring on ITB friction syndrome, load the medial meniscus, medial & lateral muscular tendons more than is ideal which can lead to irritation, discomfort and sometimes pain.

3. Limited mobility at the hip

As the leg comes up towards the top of the pedal stroke, we experience hip flexion. If we don't have enough of this movement, we'll usually see altered knee tracking, moving up and out followed by down and in towards the top tube. Left unattended we not only risk upsetting our knees, hips which can result in lower back pain (visit our blog post on this), instability of our pelvis and a loss of both efficiency and performance.

4. Insufficient glute strength around the hips

Due to cycling being a very quad dominant sport along with the desire to simply do more cycling to improve, we often have weaker glutes than is desirable. Not only will weaker glutes increase the risk of lower back pain when cycling but we can also lose efficiency due to sub-optimal pedalling action. Our knee can drop in towards the top tube during the drive phase of the pedal stroke. This in turn can lead to irritation of the iliotibial band and one of the many medial structures of the knee (menisci, plica, hamstring/adductor tendons and medial collateral ligament).

5. Foot instability

If our arches have lots of mobility in our cycling shoes, due to being 'locked' in to the pedal, we'll often see a very subtle (sometimes significant) movement of the heel inwards and outwards. When we look from the front, we'll usually see this results from the tibia (shin bone) twisting inwards due to its relationship with the foot. This results of our knee moving inwards towards the top tube which can result in irritation of the structures listed above.

This not only can result in a loss of efficiency and performance but can also irritate the plantar fascia on the sole of the foot and increase demand of the calf musculature.

6. Riding with excessively pointed heels

This can be due to limitations in hamstring and calf mobility, trying to pedal circles on the bike, being too far forward on a TT setup or just because someone isn't aware of their pedalling action.

When the foot is pointed signficantly (foot is plantarflexed), this results in an increased load being subjected to the knee and potentially its surrounding structures. The first thing to do is to stop trying to pedal circles! The next is to understand what may be driving this foot position.

In Summary

You can see there are a number of factors that may contribute to knee pain on the bike. It's hard to know which is the main drive to your knee pain but is one of the reasons that if you haven't had a Professional Bike Fit, it's something we'd highly recommend.

Our comprehensive Bike Fits look at you both on and off the bike to truly understand what could be the cause of your knee pain when cycling. Check out our 2 Hour Foundation Bike Fit, 3 Hour 1 Position Fit and 4 Hour 2 Position Fit to see what is right for you.

Not sure which service to go for? No problem, Get in touch and we'd be happy to chat!