How to prevent knee pain when cycling

In our changing world, many people took up cycling as the pandemic hit.

Many people like cycling as a form of exercise because it gets them outside and it’s considered a low impact activity.

But, this has seen more people presenting with knee pain to physiotherapy, which is the most common injury with cycling.  There are a few things that you need to be aware of to prevent knee injuries. However, if you already are struggling with a knee injury there are a few things to try to relieve it as well.

Common cycling knee injuries are:

Patellofemoral syndrome

This is often felt as an ache pain in the front of the knee, often during activity or after prolonged sitting. You may also notice cracking or popping in the knee with bending or straightening the knee under load, such as climbing stairs.

Tendinopathy

You may have heard the older term tendinitis or tendinosis, which meant inflamed tendon or abnormal tendon. The newer term “-opathy” meaning disease. This refers to the tendon not responding correctly to load. This results in the knee drawing in fluid to try and get strong to cope with the load. The trick to managing your tendon is in how you manage your training load. The typical tendon pain will be achey on waking or after rest. It may feel better as you “warm up” and then begin to ache again after it cools down. As the tendon moves into more disrepair, the pain may not resolve as you warm up. Tendinopathy is most common with the patella tendon, below the knee cap, sometimes the inside or outside of the knee may be affected as well.

Chondromalacia Patella

This is when the cartilage under the kneecap begins to deteriorate and softens. Typically, Chondromalacia Patella will present as pain in the knee region, known as patellofemoral pain. You may feel a sensation of grinding or cracking when bending or extending your knee. Pain may worsen after sitting for a prolonged period of time or during activities that apply extreme pressure to your knees, such as standing for an extended period or exercising.

Common mistakes that cyclists make that may lead to knee pain:

• Increasing your training load too quickly – includes intensity and distance
• Adding in too much hill work too quickly
• Riding in an incorrect gear
• Incorrect seat position
• Positioning your cleats incorrectly
• Muscle imbalances – having muscles that are too weak and/or too tight to support your knees while riding your bike.

How to prevent knee injuries:

Appropriate Load

Work on only increasing your intensity, including hill work or distance. Do this by a max of 30% when in the lower ranges, and by maximum of 10% when already doing a decent volume or intensity. A lot of people ride with wearables these days, giving even you weekend warriors, valuable data on how hard you are working.

Get a bike fit

There are plenty of physiotherapists around these days that can ensure that your bike is fitted to you and not the other way around. This can make all the difference to your riding comfort and how much effort you have to put into your ride.

Stretch and strengthening

If you sit all day at work then I can almost guarantee that your hip flexors will be tight and often weak. Other muscle imbalances between the quadriceps and the hamstring can lead to overload around the knee.

Correct muscle imbalances

Here at Vitalis Physiotherapy we pride ourselves on taking a holistic view to your injury and will assess your entire body to find the muscle imbalances. We will teach you how to correct them and progress your load to get you back to riding as soon as possible with reduced flare ups.