How to Treat Knee Pain From Cycling

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Cycling knee pain is a prevalent issue experienced by many cyclists, often resulting from the repetitive pedaling movements that place undue strain on the knee joint.

how to treat knee pain from cycling
how to treat knee pain from cycling

If you are experiencing knee pain while cycling, this article provides comprehensive solutions, bike settings, and explanations to effectively manage and alleviate this discomfort.

The Causes of Knee Pain in Cyclists

The first primary cause of knee pain is incorrect adjustments of the position on the bike, leading to poor pedaling technique and an inward movement of the knee joint. Such improper positioning can result in undue strain on the knee joint, causing discomfort and pain.

Another significant cause of knee pain in cyclists is muscle imbalance. Imbalances between the hip adductors (too strong) and the hip abductors and external rotators (too weak), quadriceps and hamstrings, or the vastus medialis of the quadriceps and the vastus lateralis can lead to knee pain.

Stiffness in thigh and hip muscles can also contribute to knee pain. Tightness or reduced flexibility in these muscles can limit the joint’s range of motion, causing additional strain on the knee joint during cycling.

the causes of knee pain in cyclists
the causes of knee pain in cyclists

Poor training management is another key factor that can lead to knee pain. Rapid increases in training volume or intensity can overload the knee joint, leading to discomfort and pain.

Cyclists who participate in other sports besides cycling, such as running or football, are more likely to develop knee pain. These sports can place different types of stress on the knee joint, exacerbating any existing imbalances or weaknesses.

Lastly, incorrect cleat settings or shoe models can also contribute to knee pain in cyclists. Inadequate or unsuitable footwear can result in improper foot alignment, leading to increased stress on the knee joint during cycling.

Pain in the Front of the Knee

The two most common types of pain experienced in the front of the knee by cyclists are patellar syndrome (patellofemoral) and patellar tendonitis.

These injuries are often the result of repeated pedaling motion that disturbs the structures around the patella and triggers anterior knee pain.

Several adjustments to the bike may cause pain in the front of the knee. A saddle that is too low or too far forward can increase the forces exerted on the front of the knee, leading to discomfort and pain.

pain in the front of the knee
pain in the front of the knee

Similarly, an incorrect position of the foot on the pedal, such as turning too far inward, outward, or too far forward or backward relative to the pedal, can increase stresses on the knee joint.

In addition, using cranks that are too long can reduce the pedaling rate and increase the forces exerted on the knee, leading to discomfort and pain.

To treat front knee pain, it is recommended to modify the bike’s settings and carry out rehabilitation exercises. Exercises and stretches specific to patellar syndrome and patellar tendonitis can help reduce discomfort and promote healing.

By addressing these adjustments and following appropriate rehabilitation exercises, cyclists can prevent and manage front knee pain effectively. Seeking medical advice from a qualified healthcare professional is recommended for persistent or severe pain.

Pain Behind the Knee

pain behind the knee
How to Treat Knee Pain From Cycling

Pain at the back of the knee can be caused by tension or inflammation of various tendons, including those in the muscles at the back of the thigh (hamstrings), calf muscles (gastrocnemius), and the popliteal muscle at the back of the knee.

A saddle that is too high and stiffness in the muscles of the posterior muscle chain can also potentially contribute to this type of pain.

To alleviate pain at the back of the knee, it is recommended to make necessary adjustments to the bike and practice stretching exercises for the calves, hamstrings, and glutes.

Proper bike fit is essential to ensure that the saddle height is appropriate, reducing the stress placed on the tendons at the back of the knee.

Stretching exercises can help loosen the muscles and tendons in the posterior muscle chain, reducing the tension that can cause pain at the back of the knee. Incorporating regular stretching into a cycling routine can also help prevent future pain and injuries.

Internal Knee Pain

internal knee pain
internal knee pain

Internal knee pain is a common issue among cyclists and can be caused by various factors. Tendonitis of the sartorius and gracilis muscles, also known as the crow’s feet muscles, is one possible cause.

Another common cause of internal knee pain is internal patellar “tendonitis,” which causes pain on the inner side of the patellar fin.

To avoid or alleviate internal knee pain, it is crucial to make proper adjustments to the bike’s wedges and saddle height to reduce the medial projection of the knee, which can lead to overuse and irritation of the internal structures.

In addition to bike adjustments, cyclists can benefit from leg muscle strengthening exercises to promote better knee stability and support. Furthermore, stretching exercises for the hip and thigh muscles can also be beneficial in relieving knee pain and preventing further injuries.

External Knee Pain

external knee pain
external knee pain

Windshield wiper (iliotibial band) syndrome is a common cause of external knee pain in cyclists. This condition occurs due to repetitive mechanical friction between the iliotibial band and the lateral femoral condyle.

Pain is felt on the outside of the knee and patella and is most intense at 30 degrees of knee flexion, the angle at which the iliotibial band “sweeps” over the femoral condyle.

To treat this condition, it is important to adjust the bike properly. The height and setback of the saddle should be adjusted, as well as the cleat position.

In addition, specific exercises and stretches can help alleviate the pain associated with iliotibial band syndrome. These exercises and stretches include foam rolling, lateral leg raises, and hip stretches.

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Bike Settings

It is important for cyclists to have proper bike fit to prevent knee pain. Poor adjustment of the bike can lead to increased stress on the knee joint, which can cause pain and tissue damage.

The height and setback of the saddle play a crucial role in determining the stresses exerted on the knee during cycling.

While research does not demonstrate a definitive correlation between a specific position and the onset of knee pain, certain adjustments can be made to improve bike fit.

Common errors include a saddle that is too low or too high, too far forward or too far back. Improper adjustment of cleats or pedals, and cleats with limited freedom of movement or excessive wear can also lead to knee pain.

Therefore, it is recommended that cyclists pay close attention to their bike fit and make necessary adjustments to prevent knee pain.

Saddle Height Adjustment

It is strongly recommended for cyclists to adjust the saddle height in order to achieve 25 to 30° of knee flexion at the 6 o’clock position (Holmes method). However, the angle may vary depending on the location of pain:

For anterior pain, a 25° knee flexion is recommended. For internal pain, a knee flexion of 25 to 30° is recommended. For external or posterior pain, a knee flexion of 30 to 35° is recommended.

In the absence of a goniometer, the heel method can be used to measure the saddle height. This involves adjusting the saddle height so that the knee is fully extended when the heel of the foot is on the pedal and the pedal is at the lowest point (6 o’clock position).

It is important to note that the foot should not be wiggled when measuring.

Saddle Setback Adjustment

In order to achieve an optimal cycling position, it is important to ensure that the front of your ball joint lines up with the pedal axle when you are seated on the bike with the crank in a horizontal position.

To measure this, a plumb line should be used, which must pass through the axle of the pedal and the front of the kneecap. If this alignment is not achieved, it may be necessary to adjust the saddle setback to obtain the correct setting.

Adjusting the Pedals and Cleats

For cyclists who use clipless pedals, it is essential to adjust them properly to adhere to two fundamental principles:

Firstly, the inner ball of the foot near the big toe, and the joint of the little toe must align with the axis of the pedal.

Secondly, the foot must remain parallel to the crank, which helps avoid excessive inward or outward rotation of the ankle.

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Recommended Treatment

Recommended treatment for cycling knee pain includes the following:

  • Wear orthopedic insoles, only if necessary, in consultation with a sports podiatrist.
  • Massage the knee for 5 to 10 minutes with an essential oil of wintergreen , which has natural pain-relieving and anti-inflammatory properties.
  • Do stretches of the hip, thigh, and calf muscles to relax the muscles.
  • Put cold on the knee, at the level of the painful area, for 15 minutes, the first few days.
  • Rest the knee for a few days, avoiding all painful activities.
  • Consult a sports doctor, or a physiotherapist, to obtain the correct diagnosis.
  • Manage your training by avoiding cycling if knee pain increases, and replacing cycling with another sport (brisk walking, swimming, running, bodybuilding, cardio, etc.).
  • Take an anti-inflammatory, only for a very short period , and if the pain is too strong to bear.
  • Use a natural painkiller, such as turmeric or capsaicin .
  • Practice rehabilitation exercises , to strengthen the knee, hip, calves and abdominal strap ( sheathing ).