Knee Pain in Cyclists

Knee pain in cyclists

Everyone is likely to develop knee pain even if your bike has been assessed and setup correctly. This can be due to over-training, e.g. in Spring time when cyclists often increase their training volume in a short period of time because they have left it too late to get fit for their races.

The most common causes of knee pain in cyclists are:


* Incorrect saddle height or position.
* Broken pedal axel following a crash.
* Crank too long - especially if you have chondromalacia.
* Pushing excessively high gears (slow cadence in cold weather)
* Too much leg work in the gym – not enough stretching and mobility work!
* Cleat alignment – can affect the menisci, ITB or patella maltracking if tibial rotation occurs.
* Individual cyclist anatomy – everyone has different sized pelvic frames and this affects knee alignment so be sure to get a bike with a Q factor to suit your pelvis. This only really applies to people with wide hips or very slim people.

Types of knee pain

Patella tendonitis and patellofemoral syndrome can be caused by pushing yourself too in big gears, or having the saddle positioned too low or too forwards, or having the foot too far forward on the pedal. Therefore, when the crank is vertical, the quads become too dominant. Other ways of developing these injuries can be when the crank arms are too long, or there is a leg length discrepancy in the cyclist. So be sure to check these out if you start to develop anterior knee pain.

Pain can also develop at the back of the knee in which case can put tension on the hamstring and calf muscle. This pain can be brought on by the saddle being too high or too far back, or if there is too much pedal float, or again a leg length discrepancy. These can be resolved by correcting the set up of the bike to decrease the stress at the back of the knee. Excessive dorsiflexion of the ankle when the crank is near enough horizontal can lead to stretching of the calves and hamstring tendons behind the knee. Having an arch support or calf strengthening exercises will help overcome this.

The medial collateral ligament and surrounding tendons (pes anserine) can also become painful on the inside of the knee. Causes can be when the cleat position is too wide (toes point out), excessive sideways movement of the knee, or a fixed foot. The cleat can be moved inwards to help with medial knee pain.

ITB pain can also occur on the outer side of the knee and can be due to excessive sideways movements of the knee, having the cleat positioned too narrow so that the toes point in or having too little pedal float. By correcting foot alignment, this should stop any irritation of the ITB on the outer side of the knee. If you have had pain over a long period of time and it hasn’t healed with just rest and fixing the foot alignment on the bike, it could be a degenerative meniscus. This is because structures like this have less blood supply so therefore have a longer healing time.

Knee assessments can help find out why you are getting pain when cycling.

The best thing to do if you get knee pain is not to ignore it. It will most likely not go away by itself because something has aggravated it in the first place, which means something needs to change. Take time to rest the knee for a few days and take anti-inflammatory drugs (I prefer to take natural anti-inflammatories such as arnica oil or pills) in this time period. Do some hot and cold contrast bathing in this time to stimulate blood supply and speed up the healing process. Start back on the bike with trainers to determine if the cause of your pain is due to cleat setup. However, if the pain still occurs in trainers, it is most likely due to overuse. If it is due to overuse, the best thing to do is start off with smaller rides and gradually increase the time on the bike. Riding in smaller gears is also beneficial at this stage as there is less strain on the knees, if pain still persists, see a Sports Therapist for treatment.

Ensure you are doing at least a 30 minute warm up and doing specific dynamic stretches to the quads, TFL muscle (attached onto the ITB), hamstrings, calves, glutes and lower back.


There is so much research to show that we get knee pain because of weak glutes and a weak core. Are you incorporating glute and core strengthening into your cycling training? Activating your core and glutes will improve posture and help keep your body aligned so it stays pain free. 

If you would like any further advice on stretching or need to book in for treatment please contact Sports Corrective Therapy. They will take you through a thorough assessment and alleviate your pain and set you up on a rehabilitation to prevent your pain from coming back!