I have suffered from cycling knee pain both on and off the bike. This article discusses my personal insight into cycling knee pain and provides information about what worked for me.

NOTE: I’m not a qualified professional in this area. This is written from my personal experience and is not a substitute for professional medical advice. What worked for me is no guarantee that it will work for you. If you suffer knee pain I recommend that you seek help from qualified medical professionals.

In my mind, there are two types of cycling knee pain or injury.

The first type of cycling knee pain is fairly straightforward and simple to resolve. This is the knee pain that results from some minor tendinitis due to increasing your kilometres too soon or from an accident that results in physical damage to the knee joint like a strain or a tendon tear. Most competent medical professionals can diagnose these problems quickly and have standard and proven surgical and rehabilitation procedures to address them. These are generally problems that resulted from a singular event that triggers the pain; like a fall off the bike or a rapid increase in kilometres. This is the case where you have no history of cycling knee pain prior to the event. When treated correctly, your knees recover within the appropriate amount of time.

The second is a little more difficult to address. Your knees get sore and relate to no apparent singular event. You ride your bike normally and increase your kilometres in a steady fashion and slowly over time your knees get sore. You rest and the pain slowly goes away but lingers. You might find that you can cope with 150km a week and increasing your kilometres over 150km results in pain that doesn’t go away. Your knees hurt at night. You wake in the morning, they still hurt. You go to work and while sitting at your desk you can feel your knees ache. Climbing stairs is painful. It’s frustrating. To solve this type of cycling knee pain it’s important to find a professional that is able to dive deep into and address the root cause of your cycling knee pain and not the symptoms.

Here is a list of things that I have tried to resolve my knee pain:

Seek professional medical advice for cycling knee pain

Critical. You want to find out what you are dealing with so that you can put together an action plan. If you have sore knees and the pain lingers then book yourself in to see a sports doctor and get some MRI scans (if advised by your doctor) done. This will reduce the guesswork, help you find out exactly what the problem is and will speed up the process of getting the issue resolved with the least amount of frustration. In my case, I found that I had worn a hole in my cartridge in my left knee while my right knee was reasonably sound. Once we had this information I worked with my doctor to put together a management plan. More on what we did later in this article.      

Professional physiotherapy therapy for cycling knee pain

Excellent. Firstly it’s important to find a physiotherapist that understands cycling. The sorts of problems that cyclists experience are sometimes different from other sports people. Strengthening exercises did however help but they needed to be functional like the ones that I have on our off the bike strength training program that I created in conjunction with strength and conditioning coach Matt Brindle. Matt Brindle played a large part of my rehabilitation and so I developed the functional strength training series to help cyclists improve their overall body conditioning. Work with your physiotherapist to put together a program for you. I recommend that you use free weights. Stay away from the gym machines as they usually only strengthen your joints in one plane of movement. In my opinion, gym machines are great for bodybuilders to build muscle bulk but death to improving good functional movements required for sports people and general rehabilitation of movement.

Trigger point therapy and massage for cycling knee pain

Excellent. Large improvements within days of being treated. I read a book by Clair Davies called The Trigger Point Therapy Workbook. Made a lot of sense to me. I would recommend it anyone with on-going chronic pain. There are some very good Myotherapists/Massage therapists out there. I found that the ones that could work on my hip flexors to be the most successful. The muscle can’t function properly if it has a trigger point present. I personally don’t know all the facts on why it works but I’ve found it to be the singularly most effective way of sorting out tightness in my legs and help with my general ongoing body maintenance.

Bicycle setup to help avoid cycling knee pain

Critical. Yes, its very important if you have any knee pain to get the best bike fit that you can find. Its really important to pay close attention to cleat placement and any shims, inserts and packers and other devices to help align the foot correctly on the pedal. Seat height and forward/aft position is also important. Bike shops are usually good at getting you close to an ideal position but if you still have issues then you may have to see someone more specialised. I found that a good position was fundamental to resolving my knee pain. I’ve had a lot of people in Australia look at my position and the only person that has been able to resolve it was Steve Hogg.

Pedals and cleat position to reduce cycling knee pain

Critical. Pedal selection and cleat position are critical to good knee function. I have tried several pedal systems. Some have worked better than others.  At the start of 2013, I moved over to the wider “Q” Dura-Ace pedals and have found them to be excellent. My knees prefer to be on a very solid platform as they don’t like the lateral roll that some pedal systems get once they get a little worn. It’s important to try a few different pedal systems until you find one that works for you. You may find that lots of float and slop in the pedal works better for you than a firm tight system like what I have chosen.  Talk to your bike fit specialist.

Check that your seat is straight

Important, check your seat to ensure that its straight! If you have an accident or an old seat take note that they do wear out and bend out of shape. One way to check that your seat is straight is to set your bike up in a home trainer. Then place a spirit level across the back of the seat at right angles to the top tube of your bike to check if it is level. If it has a lean then one of your bum checks is going to be sitting lower than the other. This effectively means that the leg on the higher side of the seat is going to have to reach further towards the pedal than the other leg. Click here for further information.

Pharmaceuticals that help with cycling knee pain

Critical. Anti-inflammatory pain medications and gels are great to help reduce the pain for a few weeks but are certainly not a long-term solution. In the early season when I’m building up my kilometres I suffer a little from tendinitis in my knees. I find that anti-inflammatory pain medications help me cope with the pain until I have built enough strength in my knee joints. I usually find it takes around three weeks before my knees come good.  I would recommend that you work with your sports doctor to put together a management plan.

Pedalling style

A lot of people recommend spinning. That is pedalling the bike at high cadences to reduce the strain on your knees. You may find this helps. Especially when climbing hills. But you may find that loading up your knees helps. Like doing big gear hill repeats at a low cadence. It’s important then to find out what works for you; spinning or grinding the gear. When I moved to a compact crankset (50/33) and an 11-32 rear cassette I’ve noticed a big reduction in my overall knee pain.

Where to next

Check out our off the bike strength training that helps with knee pain

Check out our training programs that help with rehabilitation