9 December 2021
Knee pain is one of the most common complaints we see in Musculoskeletal healthcare from cyclists, and in many ways it is not an honest or straight forward issue – the issue can be elsewhere. This is because the knee acts as a hinge to transfer lots of power from the large hip muscles down, through the ankle and foot and into the pedals.
Why do cyclists get knee pain?
As a joint it deals with a lot of stress and strain and many variables contribute to knee pain.
Poor bike fit and cleat position can mean that during in particular the downward pedal stroke many of the structures within the knee are bearing too much pressure – couple this with the fact that during a 2 hour bike ride the average cyclist will complete circa 10,000 pedal revolutions and its easy to see how the knee can become painful.
Tissue overuse and overload can easily be a result of incorrect bike fit, but also can be from too much force through the knee or training error particularly through volume most commonly in the anterior (front) compartment of the knee. Muscular tightness is another factor worth considering. The patella (kneecap) floats within the quadriceps, and if there is some tightness here, within the glutes or IT band then the patella can fail to track smoothly leading to pain. Lower back tightness or poor core/pelvic stability can be the type of issues which lead to all manner of compensation patterns on the bike. These could include sitting off to one side potentially overloading one particular knee leading to pain, or potentially the dreaded saddle sores because of weight bearing through the saddle. Another source of anterior or medial (inside) knee pain can be muscular weakness in particular in the quadriceps and gluteal muscles. The glutes in particular being weak can lead to something called valgus knee posture when cycling (shown in the image below). This is where the weakness of the glutes means they cannot effectively keep the thigh bone rotated outwards in relation to the shin bone, and therefore the knee joint tracks inward. This will place a lot of stress through the soft tissue structures over the front and inside of the knee joint.
How do I fix my knee pain?
A bike fit is one of the most effective ways you can address aches and pains affecting you during or after rides. At our Knutsford location within Apus Peaks cycle hub they utilise the Guru Bike fit system which is an incredibly intuitive, collaborative approach to bike fit and we cannot recommend it enough. In particular looking at optimal saddle height, fore and aft is going to benefit reduction or prevention in knee pain, and the Guru system allows this all to be comparatively tested without the rider having to unclip and dismount.
Weakness in the key muscle groups we have explored should be addressed, there is no time like the present to take a look at these issues but the off-season will often provide an excellent opportunity. There is a lot of variety of exercises out there recommended for cyclists off the bike, and this can be a great place to start. However an individualised assessment and management plan from one of our Physiotherapists or Sports Rehabilitators might be something you are looking for from our Knutsford location in Apus Peak cycle hub Tuesdays and Thursdays. We have experience providing Physiotherapy consultancy with Team Ineos, Red Bull mountain bikers, and our own Charlotte Dawes helped support Team GB Paracycling in Tokyo at the Paralympics! She is an expert at looking at Lumbar/Pelvic stability, providing individualised training regimes and mat based/Reformer Pilates to optimise on-bike stability.
Stretching, foam rolling, or manual tissue work/massage are great options for addressing tightness and restrictions which could be giving you pain and discomfort on the bike. Our experienced sports massage therapist Colin is available at our Knutsford Clinic in addition to our other Greater Manchester Clinics.
Book online with our Knutsford or other Greater Manchester locations.