5 Causes and Cures for Knee Pain in Cyclists

Marc Lindsay
by Marc Lindsay
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5 Causes and Cures for Knee Pain in Cyclists

While cycling is a low-impact sport that places a relatively small amount of stress on the knees, this doesn’t mean that injuries don’t occur.

In fact, if you ignore your body position on the bike, a knee injury will likely occur — it’s simply a matter of when.

To lower your risk, follow this guide for common causes and cures to keep your knees healthy and the wheels spinning.

Cause 1: Low Saddle Height

Symptoms: Most often when pain develops around the kneecap, it’s caused by the compression forces of the patellofemoral joint. Cyclists who feel pain in this area may experience discomfort with each pedal stroke — and it may continue even when off the bike.

The fix: A low saddle height will place more stress on the front of the knee. Raise your seat to allow for 27 to 37 degrees of knee flexion at bottom dead center (6 o’clock).

Cause 2: A Saddle Height That’s Too High

Symptoms: Pain behind the knee or along the outside of the knee.

The Fix: A saddle that is too high will cause you to reach for the pedals, placing more stress on the hamstring tendons behind the knee and the iliotibial band on the outside of the knee near its point of insertion. Lowering your saddle so that there is at least 27 to 37 degrees of knee flexion will prevent you from extending the legs and hips more than necessary during the pedal stroke.

Cause 3: Fore/Aft Position of the Saddle or Cleat

Symptoms: Swelling or pain directly above or below the knee in the general area of the patellar tendon.

The Fix: A saddle that’s pushed too far forward (toward the handlebar) or a cleat that’s placed too far backward (away from the toe of the shoe) will cause excessive knee flexion at the top dead center of the pedal stroke (12 o’clock). Moving your saddle back and adjusting your cleat position to a slightly more forward position can help decrease this angle and reduce stress on the patellar tendon.

Cause 4: Big Gears

Symptoms: This overuse injury can cause patellar tendinitis or patellofemoral pain syndrome, which will either cause pain just below the knee or a generalized discomfort around the kneecap.

The Fix: Grinding out a long climb in a big gear or similar situation that causes you to rely on a low pedal cadence for extended amounts of time can place undue stress on the knee joint. The fix is to adopt a slightly higher pedal cadence above 90 revolutions per minute. If your current setup won’t allow for this, consider switching to a compact crankset or a larger rear cassette. If you generally feel more comfortable pedaling at a lower cadence, working on your quadriceps strength (and the vastus medialis) may also help.

Cause 5: Overtraining

Symptoms: Can be any of the symptoms described above, including pain around the knee cap, behind the knee, below the knee or on the outside of the knee.

The Fix: Increasing your mileage by more than 10% each week or incorporating hard climbing intervals in back-to-back sessions is a surefire way to get a knee injury. To avoid getting hurt, follow basic training principles such as:

  • Increase your mileage gradually
  • Allow for recovery days between hard or long rides
  • Measure your heart rate variability to determine if your body has recovered properly from a workout before doing another one.


Things to Consider

Adjustments to your position should always be made in small increments. Be sure to keep a log of any changes you make, along with a note that states whether these changes increased or decreased your symptoms.

Other things you’ll want to consider if you’ve had a history of knee problems or if small changes don’t seem to be working:

  • See a bike-fit specialist. Small changes can solve minor problems, but if major problems exist, you’ll need to get fit by an expert. Crank length and frame sizing are two other important factors that should be taken into account.
  • Work on your pedaling technique. Relying too much on the push phase of your pedal stroke can also lead to injury. Once you begin using clipless pedals, you’ll have to re-learn how to pedal. Doing single-leg drills that teach you how to pedal in smooth circles instead of mashing down on the pedals will help your efficiency and decrease your chances of an anterior knee injury.
  • Schedule an appointment with a medical professional. Be smart and see a doctor if your pain gets worse or symptoms don’t subside in a reasonable amount of time. An underlying issue can also be a factor that should be considered.

About the Author

Marc Lindsay
Marc Lindsay

Marc is a freelance writer based in Scottsdale, Arizona. He holds a master’s degree in writing from Portland State University and is a certified physical therapy assistant. An avid cyclist and runner of over 20 years, Marc contributes to LAVA, Competitor and Phoenix Outdoor magazines. He is the former cycling editor for Active.com.


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