Most cyclists encounter knee pain at some point in their careers: In fact, some studies estimate 33% of riders deal with some degree of chronic knee pain at some point. This shouldn’t be surprising given what we ask our knees to do. Our very repetitive sport asks our knees to move through a range of motion between the hip, which is attached to the saddle, and the foot, which is fixed to the pedal. While knee pain is prevalent, there are some easy solutions to early signs of knee pain. For more chronic pain there are approaches to take if you can have some patience and keep an open mind.
CAUSE #1: DOING TOO MUCH, TOO SOON
Having a solid foundation of fitness and building on it gradually is the ideal way to progress in any sport. While it’s not comforting to realize your knee pain is due to that one huge ride or intense block of training you did off the couch, there is a lesson to be learned by this realization.
Loading errors like these happen when we don’t gradually increase our training load. It isn’t surprising when our body breaks down when we don’t follow a well-conceived training plan or go from the couch to an intense big ride. Our lesson is to avoid big changes to our weekly volume by training consistently (and specifically) toward goals and bigger training rides, weeks or camps.
CAUSE #2: BIKE FIT
The principle of too much too soon applies here, too. While your bike fit could be ‘wrong,’ it may also be that you need to let your body get used to it; so a 5-hour ride or big race the day after a major change to your bike setup is high-risk for knee pain.
Your bike setup is important to maximize performance. A professional bike fitter can set your bike up using best practices to reduce the stress on the knee joint. Ranges around ~25 degrees at the bottom of the pedal stroke are considered ideal, with a slightly lower saddle and more knee bend if you’ve got pain in the back of the knee or lateral (IT band) pain.
If you like your fit and have been performing well, you can also use your current setup and the symptoms you have to guide small tweaks that might help. To make tiny changes, first, tape your seat post to mark your current seat height and measure a small increment (e.g., less than 1/4-inch) to change.
TROUBLESHOOTING YOUR BIKE
- Check that your shoe cleats are not jiggly or worn as too much movement in the cleat can lead to knee pain.
- Front of knee pain: Try raising and/or moving the saddle rearward 1–2mm.
- Back of knee pain: Try lowering and/or moving the saddle forward 1–2mm.
The nice thing about solving a bike fit issue is you have a likely cause for your knee pain. A few days off and a gradual resumption of training, and you will likely not have long-term issues. But, listen to these warning signs early.
For the already injured cyclist, a correct fit in addition to consultations with a physiotherapist on tissues/movement is your ticket to recovery.
IF THE PAIN IS ACUTE OR NEW …
“The point of pain is to get you to do something. Ideally, it’s telling you to protect yourself. Pain is an alarm, and alarms are designed to create action,” says Greg Lehman, a physiotherapist and chiropractor who helps clients work through their pain using movement and considers psychological and social elements of an athlete’s sport and life that may influence that pain.
When we first feel pain, we should consider it an indication to tweak our approach, but not that we need to abandon our sport altogether. “Does changing technique change their pain? Is there something to change the loading?” This could include adding strength training to your regimen, adjusting your cleat position, using flat pedals for some of your rides, trying a higher cadence, switching to a different bike or standing up more regularly while riding as options to change the load your knees are under while riding.
IF THE PAIN IS CHRONIC …
“An athlete may need to take 2–3 weeks easy to let it reset, then start to gradually resume,” suggests Lehman. Part of this time off is to let the body relax and reduce the ‘alarm,’ which can become overactive if pain persists for a long time.
In his pain workbook, Lehman also discusses how improving lifestyle factors and learning more about what pain is can help our recovery. This is a motivating message if you are taking time off to recover your knee: Focus on mitigating stress and improving healthy habits in other areas like nutrition and sleep, and you may find your knee pain improves.