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What is My Knee Pain? Cycling with Knee Pain

Explore the three types of knee pain most common in cycling and some easy solutions.
Written by
Clay Higginbotham
Published on
Feb 27, 2024

With cycling comes thousands of pedal revolutions. Each stroke places a unique torque on the knee.  Because of this, it is common for riders to experience knee pain somewhere in their cycling career. It can be frustrating when your pain is different from what you find on a quick internet search. That is where this article aims to help. After this quick read, you should be able to pinpoint the likely cause of your knee pain and some solutions.

The knee itself is a simple hinge joint between two bones, the femur and the tibia. However, there are over 10 key muscles and 4 major ligaments that act on the knee to create motion. WIth so many lines of pull acting on the knee, and the revolutions of the pedal stroke being a perfectly symmetric motion, it is easy for the knee to become agitated if just one small thing is out of line. Here are a few common knee injuries, their likely cause, and what can be done to keep you biking. 

Anterior Knee Pain

One of the most common areas of knee pain is directly in front of the knee (anterior knee pain), just below the knee cap. This stems from the patellar tendon, a tendon that connects your knee extensors to the tibia, allowing you to straighten your leg. 

When the patellar tendon is inflamed, pain comes with active knee extension. The associated pain can be high enough to keep you from riding altogether. In order to keep you on the bike it is key to identify the root of your pain and fix it as soon as possible.

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The likely cause of this pain is poor bike saddle position. This is a great justification for completing a professional bike fit. When the seat position is too low, your knee will never extend enough to remove pressure from the patellar tendon, creating constant tension and friction on the tendon. 

Additionally, if the seat is too far forward, this will push your knee excessively in front of the pedal. This increases the pressure and load placed on the tendon with each pedal stroke. It could also be a combination of these two positional mistakes. A bike fit will identify and correct both of these positional problems.

If you are already experiencing patellar tendon pain, it is important to stay consistent with your rehab to recover as soon as possible and get you back on the bike.  Research shows that physical therapy is an extremely effective method for recovering from and preventing this pain. If you are in the Birmingham, Alabama area, click here (Vulcan Performance website) to schedule a visit with us and we will get you taken care of. 

Until then, here is an exercise to get your back on your bike. High repetition, isometric knee extension can calm down the tendon and decrease pain. While it may sound complicated, this exercise is fairly simple.

As shown below, set yourself somewhere where you can kick into an immovable object (a wall, solid table leg, etc.). From here, kick into the object with roughly 20 percent of your force and hold for 5 seconds. Perform 3 rounds of 20 repetitions. 

Posterior Knee Pain

Pain behind the knee - or posterior knee pain - originates in the muscles that are responsible for bending or flexing your knee. This includes the 3 hamstrings and the proximal portion of the gastrocnemius (calf muscle) - the portion closest to your knee. 

For cyclists, this area can become painful due to poor bike set up. Once again, a proper bike fit will not only help you ride more efficiently, but will also prevent unnecessary pain or injury. Pain originating behind the knee is a result of the saddle being too high. When the saddle is too high, the rider must overreach at the bottom of each pedal stroke. Reaching for the 6 o'clock position creates additional stress on the muscular group we call the hamstrings - semitendinosus, semimembranosus, and the biceps femoris. Additionally, riding with an excessive saddle height is a sure way to have a loss in power.

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Riding in this position can result in the rider straining one of the hamstring muscles. An athlete with a hamstring strain may benefit from a stent of physical therapy, especially the BFR techniques used at Vulcan Performance

In addition, here are a few rehab exercises to get your recovery started:

(1) A common glute bridge can be modified slightly to target the hamstrings. For the set up, leave your knee slightly straighter than a traditional glute bridge. Move at a slow, controlled pace through the movement as you press your hips towards the ceiling. Move at a tempo of 3 seconds up, then 3 seconds down for 3 rounds of 15 repetitions.  

(2) A second exercise to help with posterior knee pain is a standing band press down. For this exercise, set up a medium resistance band around knee height. From here, press the band to the floor. Then, when returning the knee to the top, move at a 3-second tempo. Perform 3 rounds of 20 banded press downs. 

Lateral Knee Pain

Another common area for pain in the cyclist's knee is the lateral knee (outer knee). Typically this pain comes from the iliotibial (“IT”) band. The IT band is a dense band of connective tissue that runs from your tensor fascia latte and gluteus maximus down to the outside portion of your knee. 

Image Source: Holabird Sports

This area can flare up when there is pedal stroke asymmetry, and is best addressed with the assistance of an expert eye in a bike fitting to identify the impaired position or the muscle causing the asymmetry. Improper cleat position on your shoe, or an alteration in the angle of your tibia (lower leg) due to muscular imbalance can lead to this. When there is a muscular imbalance at  the hip, this can cause rotation of the leg. This rotation impacts the body down the chain by shifting your pedal stroke into a position that is oblique to vertical. As soon as this occurs, additional sheer force is put on the IT band and can result in IT band friction syndrome or bursitis. 

On exercise to help you hop on the road to recovery from this is the side lying clamshell. With this exercise, make sure to train both sides of the body even if only one side is experiencing pain, as the intent is to correct any muscular imbalances of the hip. Start with 4 rounds of 8 per side of this exercise. 

Next Steps

Hopefully after reading about these three areas of knee pain, you have a better understanding of what may be causing your pain while biking and what you can do about it. Most knee pain from cycling comes from an improper bike fit and/or overuse. Muscular imbalances and an improper bike fit are both things that can be fixed with the assistance of your physical therapist at Vulcan Performance in Birmingham, Alabama.

If you are experiencing any of these aches and pains mentioned above, give the example exercises a shot. They are a starting point to get you back to riding pain free.

For assistance in your speedy recovery, injury prevention, and  bike fitting information visit our website, or give us a call at Vulcan Performance and we will get you set on the path to success. 

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