Cycling knee pain: what causes it and how to avoid it
Cycling knee pain: what causes it and how to avoid it
Learn how to avoid cycling knee pain while riding a bicycle, and what to do if this happens.
Chronic knee pain is something our worst enemy doesn’t want to happen. Usually the discomfort at the beginning can sometimes become chronic, unbearable pain. At best, you need to leave the bicycle, and at worst, it requires surgery and months of rehabilitation. It doesn’t matter whether you are a casual commuter, a local racer, or a professional cyclist surrounded by a team of doctors and physiologists-knee pain affects everyone, but it doesn’t have to be.
By taking the right measures, you can avoid knee pain while riding a bicycle, and if it does start to spread to you, you can also learn to deal with it. In this article, you will learn about the causes of knee pain when riding a bicycle, what steps can be taken first to prevent it, and how to recover from the pain once it starts.
Knee pain when riding a bicycle: an overview
When we think of cycling injuries, we often think of acute injuries, such as clavicle fractures. These are usually caused by collisions or falls.
On the other hand, chronic injuries are more common in cycling. These are the types that develop over a longer period of time and stem from overuse of a certain muscle or muscle group. They include low back pain, tendinitis, and knee pain, and are often accompanied by endurance exercises (such as cycling) that require long periods of training.
A number of studies have found that more than 90% of professional road cyclists have experienced at least one chronic injury in their careers, and the knee is the most common pain site. It is also noted that these injuries are usually severe enough to require getting out of the car for a period of time to heal.
For recreational riders with inexperience and unsuitable bicycles, this number is even worse. Some studies have shown that knee pain in recreational cyclists is more common than in professionals, and this makes sense when we look at the cause more closely. So let’s dive into it: the following are the most common causes of knee pain when riding a bicycle.
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Causes of knee pain
Saddle height is often cited as the main cause of bicycle knee pain, but this correlation is not as strong as suggested. Studies have found that although the height of the saddle does significantly change the biomechanics and kinematics of the knee during riding, this is not the only reason, so it cannot be solved by the “silver bullet” method. Therefore, although changing the height of your saddle will change the way you pedal and which muscles you use more or less, it is not directly related to knee pain.
On the contrary, inappropriate cycling is the main cause of knee pain when cycling. Not only seat height, but also a combination of seat height, reach, foot-shoe-pedal interface (FSPI), and more bicycle fit factors that increase the risk of chronic injury.
Focusing on recreational riders, there is also a correlation between chronic knee pain and increased weekly mileage, lower fitness, fewer gears, and lower experience. Inexperienced riders are more likely to exceed their limits and overtrain in evolving injuries. Poor pedaling kinematics and gear selection can make the problem worse, because using fewer gears to help maintain a normal rhythm can also make the problem worse.
Along these routes, muscle kinematics is also on the list of causes of bicycle knee pain. During pedaling, your knees should move up and down parallel to the sagittal plane (the central vertical line that separates your right from your left) and align at the top of your feet and ankles. In other words, your knees should move in a consistent and stable manner while riding, while pointing forward (rather than outwards or inwards), and your ankles should be kept below your knees, not too far forward or backward . Without involving too many scientific terms, this form of collapse is the main precursor of chronic injury, namely knee pain.
The specific activation pattern of the quadriceps is also associated with knee pain, especially the Patellofemoral Joint Pain Syndrome (PFPS) in cyclists. One study found that cyclists with PFPS had increased biceps femoris activation compared to cyclists without PFPS. These are things you can’t actually test outside the lab, but the correlation is still very attractive.
Therefore, there are many reasons for knee pain when riding a bicycle, but there are also many ways to prevent it.
How to avoid knee pain
Since a bicycle fit is the main cause of knee injuries while riding a bicycle, it is obvious that getting a professional bicycle fit should be the first item on our recommended preventive health care list. Although many companies and applications have begun experimenting with pictures that you can set up at home to assist with bicycle installation, there is no better person than a professional bicycle installer to help you install a bicycle. Doctors and coaches may also be helpful, especially if you have a unique anatomy or requirement for cycling.
A good bike fit is irreplaceable. It is recommended that you receive professional consultation once a year. Not only can you ride faster and more comfortable, but also reduce the chance of chronic injury.
We mentioned earlier that high volume, low health, and low experience may be the cause of knee pain when riding a bicycle. These are all symptoms of overtraining. Overtraining can cause your body to exceed its physical limits and fail to fully recover. Overtraining can lead to fatigue and burnout; but worse, it can lead to chronic injuries. Similarly, there are coaches, doctors or some other professional guidance that can help you stay on track and strike a perfect balance between training and recovery.
We mentioned that the breakdown of muscle kinematics is another cause of knee pain when riding a bicycle; how do you prevent this from happening? Well, this is a simple but somewhat frustrating answer: become healthier. Fatigue—especially in the core area—is the main cause of muscular dyskinesia, so it’s important to focus on staying in good shape even when you’re working hardest. This is also a good reminder, don’t try too hard every time you train, lest your form and muscle movement begin to collapse. Practice staying strong and stable on the pedals, and don’t twist your feet and knees when you work hard.
Strength training is often touted for its impact on injury prevention, especially core training. A stronger core and well-balanced lower limbs will help combat fatigue, maintain proper knee kinematics, and improve overall stability during riding. It is definitely worth considering adding a few days of preventive strength training a week to your plan, especially if you are over 40 years old or have a history of injury. Focus on improving the basics of lower limbs: squats, lunges, leg lifts and hamstring curls. As a starting point, here are some home strength training exercises for cyclists.
Along these routes, stretching can also be a means of preventing injuries for cyclists. Although the pain around the knee does not seem to be related to a particular muscle, the way our muscles and tendons are connected means that you can relax in many other areas to reduce the pressure around the joints.
Some basic stretching exercises you can try include:
Hamstring stretch-Stand with your left foot slightly higher than your right foot, with the toes of your left foot pointing towards the sky, so you can lean on your heel. Bend your right knee, lean forward, and place your weight on your right thigh. You should feel a stretch on the back of your left thigh. To deepen the stretch, bend your left leg slightly and push the bottom outward.
Hip Flexor Lunge-Kneel on the floor and place your left foot in front of you so you can perform a low lunge with the front knee bent 90 degrees. Move your right knee back slightly so that you can feel a stretch in the front of your right thigh. Focus on rotating the tailbone downward and the hip bone forward, and you should feel more stretch. If this is enough, stay here, or if you need a little more, lean your forefoot and keep your knees above your ankles. Repeat on the other side.
Supine twist-Lie on your back with your legs open and your feet together. Raise your right knee to your chest, place your left hand flat on the outer thigh of your right leg, and put your right hand flat on the ground, with your arms straight, and lead your right knee to the left side of your body. You should feel a stretch on the outside of your right thigh.
You may be surprised that there is no mention of “floating” in the cause of knee pain-or the small amount of rotational movement of the cleats and shoes around the pedals. In fact, floating is not directly related to knee pain when riding a bicycle, but it affects muscle kinematics and overall rider comfort. Increasing the degree of cleats floating may help reduce knee pain by allowing more lower limb movement, although the science behind this is somewhat lacking.
How to recover from knee pain
The topic of knee pain while riding a bicycle is interesting because cycling is often used as an exercise prescription for people recovering from knee injuries. This is because the force on the feet and pedals is 82% lower than the force on the feet when running. However, due to the repetitive nature of cycling—you have to perform thousands of pedal rotations in a single ride—a slight imbalance, injury, or irritation can quickly become a serious chronic injury.
When recovering from cycling knee pain, the most important thing is to take all precautions before restarting training. This means getting a professional bike fit, having the right seat height, and maintaining a consistent and stable position while riding. Check our bicycle installation guide for more information.
Chronic injury is strongly negatively correlated with rest days. In other words, the fewer days you rest, the higher your risk of chronic injury. A well-structured training plan and professional guidance can help you come up with a consistent and balanced plan, while making you faster and avoiding injuries.
To sum up-all the fancy treatments, big words, cycling, and specific exercises-the best and most common way to treat bicycle knee pain is simple: rest.
With enough rest, the body can recover and repair the damage caused to its tissues, which is usually where chronic knee injuries occur. Continuing training will only interfere with this process, will not allow the body to recover, and will only cause greater damage. Listen to your body, trust your coach or training plan, and rest if necessary. Not only will you avoid chronic knee injuries, but you will also get faster.
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