Even though cycling is renowned for its low-impact nature, knee pain is a common issue among cyclists.

From minor discomfort to severe aches, cycling-related knee pain can significantly impact your performance and long-term health if left unchecked. In this article, we’ll delve into the possible causes of cycling knee pain and offer practical solutions to help you ride comfortably and injury-free. 

Whether it’s a matter of bike fit, muscle imbalances, or training blunders, understanding the root causes is the first step to preventing and addressing knee pain.

Types of Cycling-Related Knee Pain

In this section, we'll explore the main types of knee pain, their causes, and various contributing factors, such as rest and recovery, to help you ride without pain.

Inner (Medial) Knee Pain  

Inner knee pain in cyclists is frequently associated with overuse injuries or misalignment issues during the pedal stroke. Key factors contributing to this type of pain include:  

• Medial collateral ligament (MCL) strain: This occurs due to repeated inward movement of the knee (valgus strain) while cycling, which can place stress on the MCL.  

• Pes anserine bursitis: Inflammation of the bursa located near the inner knee can result from excessive friction, often caused by improper saddle height or cleat positioning.  

• Tight adductor muscles: Muscles that are overly tight can exert additional pull on the knee joint, leading to discomfort on the medial side.

Outer (Lateral) Knee Pain  

Outer knee pain is commonly linked to "IT band syndrome" or "improper biomechanics" during cycling. Contributing factors may include:  

• Iliotibial (IT) band friction syndrome: This condition arises when the IT band rubs against the lateral femoral condyle during repetitive pedaling, particularly if the saddle is positioned too high or the cleats are misaligned.  

• Lateral collateral ligament (LCL) irritation: Excessive outward motion of the knee (varus strain) can stress the LCL, often a result of poor bike fit. 

• Tight hip abductors or glutes: Weakness or imbalances in these muscle groups can lead to strain in the lateral knee.

Front (Anterior) Knee Pain  

Anterior knee pain is often associated with "overloading the patella" or "improper cycling posture."  

• Patellofemoral pain syndrome (PFPS): Commonly referred to as "cyclist's knee," this condition arises from excessive pressure on the kneecap, frequently due to a saddle set too low or positioned too far forward.  

• Quadriceps overuse: Relying heavily on the quadriceps during pedaling can put a strain on the patellar tendon, potentially leading to tendinitis or issues with patellar tracking.  

• Weak hamstrings or glutes: Inadequate strength in these muscles may disrupt balance during pedaling, placing additional stress on the front of the knee.

Rear (Posterior) Knee Pain  

Pain located behind the knee is often indicative of "muscle or tendon issues."  

• Hamstring tendinopathy: A saddle that is too high can cause overextension of the knee, straining the hamstring tendons.

• Popliteus strain: This small stabilizing muscle at the back of the knee can become irritated due to excessive climbing or improper pedaling mechanics.

General Contributing Factors  

Improper bike fit, including adjustments to saddle height, cleat position, and handlebar reach, is critical to prevent knee pain. Additionally, overtraining can contribute to knee strain, especially when there are sudden increases in cycling intensity or duration without adequate recovery. 

Moreover, muscle imbalances, characterized by weak or tight muscles around the knee, can disrupt proper joint alignment and movement patterns, further contributing to discomfort.

Fixes and Treatments for Cycling Knee Pain

Cycling knee pain can disrupt your training and overall enjoyment, but effective fixes and treatments can get you back on the bike pain-free. Addressing the root cause, whether it's bike posture or fit, muscle imbalances, or overuse, is essential for long-term relief. 

Inner (Medial) Knee Pain  

• Immediate Rest: Cycling should be avoided until the pain subsides to prevent exacerbating the condition, such as MCL injury or bursitis.  

• Ice and Anti-Inflammatory Measures: Applying ice can help reduce swelling and inflammation.  

• Physical Therapy: Engaging in targeted exercises can help improve hip and knee alignment. 

• Cleat Adjustment: Slightly moving your cleats outward can diminish inward knee movement.  

Outer (Lateral) Knee Pain 

• Stretch the IT Band: Incorporating stretches like standing side bends or the use of an IT band foam roller can alleviate tension.  

• Strengthen Hip Abductors: Exercises such as clamshells and lateral band walks can help stabilize your knee and reduce strain on the IT band.  

• Bike Fit Adjustments: Lowering the saddle slightly and ensuring the cleats are not angled inward excessively may alleviate IT band issues.  

Front (Anterior) Knee Pain  

• Saddle Positioning: Raising or slightly moving your saddle backward can help reduce pressure on the patella.  

• Strengthen the Glutes and Hamstrings: Engaging in exercises that balance quad dominance, such as deadlifts and step-ups, can be beneficial.  

• Patellar Taping or Knee Braces: These can provide temporary relief and support during the rehabilitation process.  

Rear (Posterior) Knee Pain  

• Stretch Hamstrings and Calves: Gentle stretching can reduce tightness that may be exerting pressure on the posterior structures of your knee.  

• Adjust Saddle Height: Lowering the saddle slightly can prevent overextension while pedaling.  

• Avoid Overreaching: It's vital to check your handlebar reach to ensure it doesn't force the knees into excessive extension.  

Bonus Tips  

• Massage Therapy: Regular massages can aid in releasing muscle tension and improving circulation, promoting faster recovery.  

• Cross-Training: Incorporating other "non-impact activities," such as swimming or elliptical training, can help maintain fitness during the recovery process.  

• Orthotics or Insoles: If foot mechanics contribute to knee pain, custom orthotics may improve alignment and reduce stress on the knees.  

NOTE: Consult a Specialist: If pain persists, seeking advice from a sports physician or physical therapist is recommended. They can diagnose potential underlying issues, such as cartilage damage or tendinopathy.

Preventing Knee Pain with Seat Height and Posture

To prevent knee pain while cycling, it's critical to take proactive measures that improve comfort, efficiency, and proper biomechanics. Making adjustments to your bike fit and adopting smart training practices can significantly lower the risk of injury. 

Bike Fit Adjustments 

• Saddle Height: It's critical that your saddle is adjusted to the correct height for your body. A saddle that is too high can lead to posterior knee pain, whereas a saddle that is too low may result in anterior knee pain.  

• Cleat Position: Proper alignment of cleats is essential to prevent medial or lateral knee strain. Consulting a professional bike fitter can provide significant benefits.  

• Handlebar Position: Adjusting the reach and height of your handlebars can help avoid excessive forward leaning, which may result in knee overload.  

Gradual Training Progression

• To prevent knee injury, it’s important to avoid sudden increases in cycling volume or intensity. Gradually building your endurance and incorporating rest days will facilitate recovery.  Additionally, a thorough cycling-specific warm-up will further help mitigate the chance of injury. 

Strengthening Exercises

• Focus on strengthening key muscle groups such as the quadriceps, hamstrings, glutes, and hip stabilizers, as this will support your knee alignment during pedaling. Recommended exercises include squats, lunges, and single-leg bridges.  

Stretching and Mobility Work

• Stretching important muscle groups, including the quads, hamstrings, IT bands, and hip flexors, can help reduce tension around the knee joint. Foam rolling the IT band and calves can also aid in releasing tightness.  

Pedaling Technique

• A smooth pedal stroke with a proper cadence is vital (aim for 80–100 RPM). It's best to avoid mashing in a difficult gear that places excessive stress on the knees.  

What is Cyclist’s Knee?

Cyclist's knee, also known as "patellofemoral pain syndrome" (PFPS), is a common overuse injury characterized by pain around the kneecap. It often results from repetitive stress caused by factors such as improper bike fit, poor pedaling technique, or muscle imbalances.

Does Cycling Help with Knee Pain?

Yes. Cycling can be beneficial for alleviating knee pain, as it helps strengthen the muscles around the knee and improves joint mobility. However, this is effective only if you maintain a proper bike fit and use low resistance. Be cautious of overtraining or maintaining poor posture, as these can worsen knee pain.

Is It Okay to Bike with Knee Pain?

It's generally acceptable to bike with mild knee pain, provided you use low resistance and maintain proper form. However, if the pain worsens or becomes sharp, you should stop cycling and consult a medical professional for evaluation and advice.

Understanding Cycling Knee Pain

Cycling knee pain can be a frustrating hurdle, but with the right approach, it’s manageable and preventable. The JOIN cycling training app offers an innovative way to mitigate injuries through personalized and adaptable training plans.  

JOIN creates a customized training plan tailored to your fitness level and goals while accounting for crucial factors like rest and recovery. With dynamic adjustments based on your readiness and perceived exertion, JOIN helps you avoid overtraining, one of the leading causes of cycling-related injuries.  

Our Readiness Feature ensures your training matches how your body feels. This data, combined with your availability, allows JOIN to adapt your plan in real-time, keeping your progress steady and pain-free.  

Try JOIN for free today