If you suffer from knee pain when cycling, you know how frustrating this can be. With the weather finally warming up here, it is time to start getting back on the bike and building up your fitness over the summer. Whether you are training for a race or just interested in social exercise, the amount of time you are spending on the bike naturally increases. This can create muscle stiffness which can contribute towards joint pain.

However, there are some steps you can take to help avoid knee pain.

What we will cover in this article:

1. Anatomy of the knee

2. Types of knee pain

3. How to prevent cycling knee pain

4. Top 3 stretches for cycling knee pain

To understand knee pain, it is helpful to have a basic idea of what lies beneath the skin. Think of the knee as a hinge joint where the quadriceps muscles pull the knee straight and the hamstring muscles bend the knee. The quadriceps run from the front of the femur (thigh bone) to the patella (knee cap). Hamstrings on the other hand run from the lower point of your pelvic bone (the point that you hopefully sit on whilst riding) to deep behind the knee on the tibia (shin bone).

The infamous ITB runs down the outside of the thigh and blends into the outside of the knee. ITB stands for iliotibial band and is a well-known potential source of trouble for cyclists, runners, and active people in general. The ITB is also attached to your gluteal muscles (buttock muscles) and hip flexors. Often when looking for the source of knee pain we must pay close attention to hip flexibility and control.

The most common type of knee pain in cyclists is often described as patello-femoral pain. This is referring to pain in the region around the knee cap. Patello-femoral pain can be mild in nature or quite debilitating depending on its severity. It is often but not always a result of a tight quadriceps, a tight ITB and poor strength in the quadriceps and gluteal muscles. Bike setup can also play a part and should not be overlooked.

The ITB can also create pain at the front or outside of the knee if it is too tight. If the hip stabilizing muscles are too weak this can also cause a greater pull on the ITB which leads to abnormal loading on the structures at the front of the knee. In these cases, the predisposing factors are very similar to the ones found in patellofemoral pain. However training volume and changes in training types needs to be taken into account as tendons do not respond to change as quickly as some of the other structures in the body. Consequently, the patella tendon can become irritated and cause pain at the front of the knee.

Prevention is always better than cure!!

Read on to find out ways of keeping the knee happy whilst the volume and intensity of training increases. All of the conditions mentioned above are treatable. If caught quickly, the treatment time can be significantly reduced. Physiotherapy is usually effective in treating the types of knee pain described above so there is no need to be a hero and put up with the pain. Treatment will be different for each person based on an assessment as to which muscles are tight and which areas are weak.

Massage, soft tissue release and foam rolling can all be effective in reducing muscle tightness in conjunction with a home stretching program. Often strength exercises also need to be prescribed. These stretches will help to decrease load on painful structures, improve the health of irritated structures, or alleviate biomechanical abnormalities.

In severe enough cases anti-inflammatory medications may be required. Or in certain situations, even a cortisone injection may be beneficial. It is important to remember that these last 2 remedies may take the pain away, but the predisposing factors still need to be treated to get an optimal outcome and prevent the pain from re-occurring.

Firstly, let’s get the bike right. Knees are most commonly affected by a seat being too low, too far forward or the wrong cleat position. If this seems to be a problem for you it may be time for a bike fit. Maintaining flexibility is important for injury prevention as tight muscles can lead to overuse injuries.

For cycling related anterior pain (front of the knee) the main muscles to pay attention to will be the quadriceps, hip flexors, and gluteal muscles. There are several ways to stretch these, but we’ve just shown a few simple versions below.

Sometimes during periods of higher training load you will need to stretch more frequently if you start to notice your flexibility decreasing.

KNEE PAIN WHEN CYCLING?

BY FREE MOTION PHYSIOTHERAPY

1. ANATOMY OF THE KNEE

2. TYPES OF KNEE PAIN

3. HOW TO FIX CYCLING KNEE PAIN

4. HOW TO PREVENT CYCLING KNEE PAIN

5. TOP 3 STRETCHES

1. GLUTEAL STRETCH

Supine Gluteus Stretch

Seated Gluteus Stretch

Standing Gluteus Table Stretch

2. HIP FLEXOR / ITB STRETCH

3. QUADRICEPS STRETCH

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