Understanding Knee Pain From Cycling

Cycling is a wonderful sport for athletes at any age.  Whether you’re biking the flat roads here in Florida or braving the endless off-road trails in the Rocky Mountains in Colorado, the speed, fitness and fresh air accompanying the world of cycling is a wonderful escape from the “daily grind”.

Bike riding is considered a partial weight-bearing exercise.  Another benefit of bicycle riding is that by adjusting the many moving parts of a bike, you can control some of the lower extremity joint range of motions.  Both of these two points make cycling an activity that sports medicine specialists like me love to see our patients doing.

Like any athletic event, too much cycling and/or poor biomechanics can easily contribute to knee injuries. With that being said, most knee cycling injuries result from overuse.  Overuse injuries involving the knee joint from cycling usually presents with degeneration of the knee patellofemoral joint with a condition referred to as Chondromalacia.  This breakdown of the articular cartilage on the backside of the kneecap can result in pain, knee swelling, quad weakness and decreased knee range of movement.

The onset of biking knee injuries is commonly associated with a sudden change in the intensity, duration and/or frequency of biking. Too sudden a change simply leaves insufficient time for the knee joint and all of the associated soft tissue to adjust to the new demand.

The injuries associated are pretty vast with patellar tendonitis, ITB syndrome and Chondromalacia heading the list.

Competitive cyclists and recreational riders cycling too vigorously at the beginning of the biking season may be predispose to knee pain.  If the bikers ignore this natural urge, they simply don’t progress like they wish and in the long run, will probably become injured or see their performance suffer.

Improper saddle heights, especially being too low, may contribute to developing knee pain.

There is a reason bicycles have gears and smart bikers use those gears to their advantage. “Pushing too big of a gear” is the easiest way to create cycling knee pain.  Poor feet angles on the pedals and improper cleat selection both play their part in developing knee pain.

Signs & Symptoms of Knee Pain from Biking

  • Dull aching pain around the knee joint, especially above or below the kneecap or patella.  Generally the pain follows activity but in advanced cases, the symptoms may be worse in the morning.
  • Crepitation or grinding behind the kneecap with active motion.
  • Difficulty bending the knee joint secondary to pain and possible knee “lock”.
  • Swelling and tenderness from inflammation.
  • Difficulty with climbing up and descending down stairs.

Professional Treatment for Bicycle Knee Pain

  • Pain-free strengthening exercises for both the quadriceps (anterior thigh) and gluteus muscles (back and sides of side of the butt) are a key step.  Did you notice that the first words that I used were “pain-free”?
  • Aggressive soft tissue massage and self-myofascial release techniques to elongate tight muscles and enhance muscle function.
  • Utilizing the latest physical therapy modalities and rehab devices to reduce swelling and decrease pain.
  • Stretching of the low back, hip flexors, quad muscles, hamstrings and calves should become part of your daily routine.
  • Icing of the knees immediately after cycling and as often as possible throughout the day.
  • Eat healthy to enhance performance and accelerate your recovery.
  • Cross training (swimming, Elliptical Trainer, yoga,..etc.) and easy cycling during the “off days” can help reduce knee and lower extremity stiffness.
  • Check your “Bike Fit” or overall alignment on the bike through the watchful eyes of a certified bike fitter at a local high-end bike shop.
  • Assess your gears, saddle heights, and cleats based on your injury and the advice of your skilled bike fitter.
  • Rest as needed and focus on adjusting your body to be able to cycle pain-free.

Asking the Right Questions like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. Is there a biomechanical alignment issue that needs to addressed to improve my injury?
  2. What is my exact knee injury diagnosis?
  3. What type of exercise or therapy can I do to minimize or eliminate this pain and avoid surgery?
  4. Do I need further diagnostic tests to assess this injury?
  5. Should I be concerned with any long-term issues from this injury?

Elite Sports Medicine Tips from Mike Ryan

  • Down With Hills & Distance: Bike Riding Common Sense 101 > Reduce the miles and stay on the flat roads while rehabbing this injury.
  • Eat Right and Pop Fewer Pills: Use healthy foods and not medicine to allow your body to get stronger while decreasing your pain.
  • P R O G R E SS I O N: It’s that simple.  Start slow and never increase your mileage weekly by more than 10%.
  • It’s More Than You Think: Biking is more than just pushing your pedals in circles.  Get back to basics by improving your pedal stroke by learning key pedal drills and exercises from the biking experts.
  • Maintain a higher cadence: Ahigher cadence (revs per minute) reduces the workload on your knees although it makes your heart work harder. Practice pedaling with a higher cadence to reduce the compressive forces on your patellofemoral joint.