Knee Pain Cycling – Causes & Treatment

Knee pain when cycling and knee pain after cycling are two relatively common complaints. In most cases, the pain can be alleviated by taking good care of your knee joints and setting up your bike to suit your body. However, understanding what causes knee pain while cycling is key to riding pain-free. 

Learn how to identify the type of knee pain you’re experiencing, treat it, make smart changes to prevent it from coming back, and when to seek professional medical treatment, such as South Brisbane physiotherapists, for your cycling knee pain. 

Causes of Knee Pain from Cycling 

Figuring out the cause of your cycling knee pain is the first step to fixing it. Here are some of the most common causes of knee pain when cycling. There may be more than one at play in your case, so analyse carefully! 

Incorrect Bike Fit 

A bike that doesn’t fit you properly can lead to knee pain. This is because your body may be forced into awkward positions that strain your joints. 

Saddle Height and Position 

If your saddle is too high or too low, it can cause knee pain. A saddle that’s too high can lead to pain behind the knee, while one that’s too low can cause pain at the front. Make sure your saddle is at the correct height and position if you want to ride without pain. 

Handlebar Height and Reach 

The height and reach of your handlebars affect your posture and how your weight is distributed. If your handlebars are too low or too far forward, it can put extra stress on your knees. Adjusting your handlebars to a comfortable height and distance can help get rid of this issue. 

Overuse Injuries 

Overworking your body without giving it time to recover can lead to knee pain. This is especially true if you ramp up your training intensity too quickly. 

High Mileage without Rest 

Riding long distances without enough rest can overwork your knees, leading to inflammation and pain. It’s important to balance high mileage with good rest days so that your muscles and joints can recover. 

Sudden Increase in Training Intensity 

Rapidly increasing the intensity or duration of your rides can strain your knees, causing pain and potential injury. Gradually increasing your training load allows your body to adapt and helps prevent knee pain. 

Poor Pedalling Technique 

Improper pedalling technique can put unnecessary pressure on the knees. This often leads to pain and discomfort. 

Incorrect Foot Position 

If your feet aren’t positioned properly on the pedals, it can force your knees to track incorrectly, leading to pain. To avoid this, make sure your feet are properly aligned. Moreover, use bike shoes with good support to help maintain the correct foot position. 

Inefficient Pedalling Motion 

Pedalling in a jerky or uneven manner can increase the stress on your knees. Focus on maintaining a smooth, circular pedalling motion to distribute the load evenly and reduce knee strain. 

Symptoms of Knee Pain from Cycling 

Knee pain from cycling can manifest in various ways. It’s important to identify the symptoms early to prevent further injury and speed up your recovery. Here are some common symptoms cyclists may experience. 

Pain in the Knee 

Cyclists often experience pain in different areas of the knee, including: 

• Front of the Knee (patellofemoral pain or anterior knee pain): This is common and is often referred to as “cyclist’s knee.” Overuse, improper bike fit, or muscle imbalances can cause this type of knee pain. 
• Side of the Knee: Pain on the outside of the knee (lateral knee pain) can be due to friction between the iliotibial band and the knee structures. This friction is often caused by poor riding posture or excessive hill climbing. Medial knee pain (on the inside of the knee) is also a common complaint amongst cyclists. It’s frequently caused by muscle imbalance and poorly fitted pedal cleats.  
• Back of the Knee: Posterior knee pain (pain behind the knee) is less common but can occur due to overextension or hyperflexion during pedalling. 

Swelling and Inflammation 

Swelling and inflammation are typical responses to knee pain from cycling. These symptoms can indicate underlying issues such as: 

• Tendonitis: Inflammation of the tendons around the knee, often due to repetitive stress.
• Bursitis: Swelling of the bursa, a small fluid-filled sac that reduces friction in the knee joint, often caused by prolonged pressure or irritation. 

Stiffness and Limited Range of Motion 

Experiencing stiffness and a limited range of motion can significantly affect a cyclist’s performance. This stiffness is usually due to: 

• Joint Effusion: Excess fluid in the knee joint can cause stiffness and limited movement. 
• Muscle Tightness: Tight muscles around the knee, such as the quads and hamstrings, can restrict motion and flexibility. 

Clicking or Popping Sensations 

Cyclists may notice clicking or popping sounds from their knees, which can be alarming! These sensations could be caused by: 

• Meniscal Tears: Damage to your knee’s cartilage can produce clicking sounds, especially if you experience pain while bending your knee. 
• Ligament Issues: Popping can occur from stretched or torn ligaments, which may require medical attention. 
• Knee Misalignment: Incorrect tracking of the kneecap can lead to these sensations, often due to improper bike fit or poor cycling technique. 

How is Knee Pain from Cycling Diagnosed? 

Medical History 

When diagnosing knee pain from cycling, physiotherapists first take a detailed medical history. They ask about the onset of the pain, its location, intensity, and any associated symptoms. 

Your physio will ask about cycling habits, such as frequency, duration, and intensity of rides, as well as bike fit and any recent changes in equipment or technique, are also essential. Understanding the cyclist’s overall health, previous knee injuries, and any other medical conditions can provide context for the diagnosis. 

Physical Examination 

A thorough physical examination is the next step. Your physio will inspect the knee for swelling, redness, and any visible deformities. They will also palpate the knee to check for tenderness and assess the range of motion. 

Special tests may be done to evaluate the stability of the ligaments, the integrity of the meniscus, and the function of the patella. You may need to have a biomechanical assessment done, which would evaluate your gait and how you stand up, sit down, and walk to offer insights into the underlying issue. 

Imaging Tests 

If the initial examination suggests a more serious underlying condition or if the pain persists despite treatment, your physiotherapist will recommend imaging tests. These provide a detailed view of the knee’s internal structures, helping to pinpoint the root cause of the pain. 

X-rays 

X-rays are often the first imaging test ordered. They are particularly useful for identifying bone-related issues such as fractures, arthritis, or bone spurs. X-rays can also reveal alignment issues and joint space narrowing, which can indicate osteoarthritis. However, X-rays don’t provide detailed images of soft tissues like ligaments, tendons, or cartilage. 

MRI Scans 

MRI scans offer a more comprehensive view of the knee’s soft tissues. MRIs are highly effective when diagnosing ligament tears, meniscus injuries, tendonitis, and other soft tissue conditions. This imaging test can also detect subtle changes in the bone marrow and provide detailed images of cartilage. 

Knee Pain After Cycling Treatment 

Understanding how to treat and prevent cycling knee pain is essential for maintaining your cycling routine. Here’s a detailed guide on effective treatments and adjustments. 

Rest and Recovery 

Overuse can lead to inflammation and injury, so it’s important to give your knees time to heal. Take a break from cycling for a few days to a week, depending on the severity of the pain. Use this time to rest and avoid activities that put stress on your knees. Elevate your legs and use compression to help reduce swelling. 

Ice or Heat 

Applying ice or heat can significantly reduce knee pain and inflammation. Ice packs are ideal for acute pain and swelling, typically applied for 15 to 20 minutes every few hours during the first 48 hours. Heat therapy, such as warm towels or heating pads, can be beneficial for chronic pain and stiffness, promoting blood flow and muscle relaxation. Use heat therapy before cycling and ice therapy afterwards to manage pain effectively. 

Anti-Inflammatory Medications 

Over-the-counter anti-inflammatory medications like ibuprofen or naproxen can help reduce knee pain and swelling. These medications work by reducing inflammation in the joints and muscles. However, they should be used as directed and not as a long-term solution. Consult with a healthcare provider if pain continues despite medication. 

Physical Therapy 

Physical therapy can be highly effective in treating knee pain from cycling. A physical therapist can develop a customised program to strengthen the muscles around your knee, improve flexibility, and correct any imbalances. Therapy may include a combination of manual techniques, therapeutic exercises, and modalities like ultrasound or electrical stimulation to reduce pain and promote healing. 

Strengthening Exercises 

Strengthening exercises target the muscles that support the knee, like the quadriceps, hamstrings, and glutes. Strong muscles help absorb shock and reduce stress on the knee joint. 

Exercises like squats, lunges, and leg presses can be beneficial. Start with bodyweight exercises and gradually add resistance as your strength improves. Always keep the proper form to avoid further injury. 

Flexibility Exercises 

Flexibility exercises are important to maintain a full range of motion in the knee joint. Stretching the quadriceps, hamstrings, calves, and hip flexors can help alleviate tension around the knee. Incorporate dynamic stretches before cycling and static stretches after your ride to keep muscles supple and reduce the risk of injury. 

How to Prevent Knee Pain Cycling 

Proper Bike Fit 

Making sure that your bike fits your body correctly can make a big difference in preventing knee pain from cycling. 

• Saddle Height: Your saddle should be high enough to allow a slight bend in your knee at the bottom of the pedal stroke.
• Saddle Position: The saddle should be positioned so that your knee is directly above the pedal axle when the pedals are horizontal.
• Handlebar Reach: Adjust the handlebars so you don’t have to overreach, which can strain your back and knees. 
• Cleat Position: If you experience pain in the back of the knee, try moving the cleat slightly backwards. For pain in the front of the knee, try moving the cleat slightly forwards. Make small adjustments (2 to 3 mm) at a time and test the changes on short rides to avoid over-correcting.

Regular Bike Fitting Sessions 

Regular bike fitting sessions with a professional can make sure your bike remains a perfect fit as your body and riding style evolve. Even small changes in your posture or strength can affect how you fit on your bike. 

• Professional Assessment: Have a bike fit professional assess your position at least once a year. 
• Adjustments for Changes: Adjust your bike setup if you notice any discomfort or after significant changes in your training routine. 

Gradual Increase in Intensity 

Increasing the intensity of your rides too quickly can lead to knee pain. It’s important to build up your intensity gradually to allow your body time to adapt. 

• Start Slow: Begin with low-intensity rides and gradually increase the duration and intensity.
• Monitor Pain: If you experience knee pain, reduce the intensity and allow time for recovery. 
• Structured Programs: Follow a training plan that incrementally increases mileage and intensity. 
• Rest Days: Incorporate rest days to allow your muscles and joints to recover. 

Strengthening Exercises 

Strengthening the muscles around your knee provides better support and reduces the risk of pain. Focus on exercises that enhance both core and leg strength. 

Core Strengthening 

A strong core stabilises your entire body and can improve your cycling efficiency, reducing strain on your knees. 

• Planks: Effective for building core stability 
• Russian Twists: Improve oblique strength and rotational stability 
• Bridges: Strengthen the lower back and glutes, contributing to a stronger core 

Leg Strengthening 

Strengthening your leg muscles, particularly the quadriceps, hamstrings, and calves, is essential for knee health. 

• Squats: Target multiple leg muscles and improve overall strength 
• Lunges: Great for balancing strength between legs and enhancing stability
• Leg Press: Focuses on the quadriceps and hamstrings, essential for strong knees 

Correct Pedalling Technique 

Proper pedalling technique is key to minimising knee pain. An efficient pedal stroke reduces unnecessary strain on your knees. 

Pedal Stroke Analysis 

Analysing your pedal stroke can identify inefficiencies and areas for improvement. 

• Professional Assessment: Have a cycling coach or professional analyse your pedal stroke. 
• Smooth Motion: Aim for a smooth, circular pedal stroke to distribute the effort evenly and reduce knee stress. 
• Cadence: Maintain a high cadence (80 to 100 RPM) to lower the strain on your knees. 

When to See a Doctor for Your Knee Pain 

While some knee pain can be managed at home with rest, ice, and over-the-counter pain relievers, certain symptoms indicate a more serious problem that needs medical attention. Here’s how to know when your knee pain needs attention from a medical professional. 

Persistent or Severe Pain 

If you experience persistent or severe pain in your knee that doesn’t improve with home remedies, it’s time to consult a doctor. Pain that lasts for several weeks or interferes with your daily activities could signal an underlying condition such as arthritis, a ligament injury, or a meniscus tear. 

A healthcare professional can perform a thorough evaluation, including imaging tests like X-rays or MRIs, to diagnose the problem accurately and recommend appropriate treatment options. 

Swelling and Redness 

Swelling and redness around the knee are signs of inflammation and could indicate an infection, bursitis, or gout. If you notice these symptoms, especially if they’re accompanied by fever or a general feeling of being unwell, seek medical attention promptly. Early diagnosis and treatment are important to prevent complications and speed up your recovery. 

Pain Not Relieved by Rest

Rest is often the first line of defence against knee pain. However, if your knee pain persists despite taking a break from activities that stress the joint, it could be a sign of a more serious issue. 

Conditions like tendonitis, cartilage damage, or even fractures can cause pain that doesn’t subside with rest. A doctor can help identify the cause and suggest treatments such as physical therapy, medications, or even surgery if necessary. 

Knee Pain Cycling FAQs

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