Can you Stop Knee Pain in Cycling?

Knee pain in cyclists (often at the front of the knee) is one of the most common health issues we see on our Marmot Tours Holidays & Challenges.

During the pedal cycle, the knee goes through around 75 degrees of motion.  The quadriceps provide most of the force with input from the hamstring and gluten muscles.  While the knee extends, it also adducts (how your thigh bone moves relative to your foot).  The foot also pronates during the power phase which causes internal rotation of the tibia that increases stress on the medial (inner side) of your knee.

The repetitive loading of cycling damages the soft tissue of the knee leading to an inflammatory response and further damage of the local tissue.   As the repetitive activity continues the micro trauma becomes a clinical injury.   Chronic cases of knee pain will lead to weakness, loss of flexibility and chronic pain, all of which it would be nice to avoid!

Many of you will have suffered in the past and we wanted to draw together information from articles / features and our own experience.

Top Tips for Avoiding Knee Pain when Cycling

1. Bike fit: Ensure the bike is set up to suit you but also to suit the type of riding you do.  Your set up for a one day sportive should be different to your Bike Fit for a multi day event like a cycling holiday or Raid.  Particular areas to check are Saddle Height, Saddle Position (forward/back), Rotation/Position of your cleats.
2. Training: Get advice on your Training programme (especially post injury & rest period).  Avoid rapid increases in training distance or intensity, particularly early season.  Avoid excessive hill work which can overload the knee joint and surrounding tissues leading to inflammation and damage
3. Gearing: Avoid pushing a high gear ratio: it causes medial knee stress and frankly, for the kind of riding you would do on a Marmot Tours holiday/challenge, it is not sustainable.  Ensure you have suitable gearing for the environment you are cycling in, a compact or a triple, so that you can ‘twiddle’ away in your granny gear if your knees are twinning.
4. Stretching /Core Strength/Balance work: Work on your overall muscle strength and flexibility: Leg length discrepancy, tight ITB band, muscle weakness of either quads or hamstrings, gluts or hip flexors can transfer stress from one part of your body to another (the knee!)  Prolonged riding will tighten both your quads, hamstrings and ITB (iliotibial band), restricting the range of motion around the knee and increasing forces on the joint.   Pilates and using a foam roller can help.  Marmot Tours has one available in each team so no need to bring your own.

Using the type of pain as a clue

1. Anterior knee pain under the centre of the patella, that feels worse when going up/down stairs, during prolonged sitting, squatting or after cycling has stopped, rather than during the ride may be Patellofemoral Pain Syndrome: an early sign that the cartilage of the knee might be softening.  If severe and more of a ‘grating sensation’, it may have developed into Chondromalacia: articular cartilage breakdown or synovial inflammation.
2. Anterior and often lateral pain may be Quadriceps Tendinosis, often caused by repetitive stress or poor bike fit
3. Anterior pain around the patellar tendon during peddling and other knee extension activities with possible swelling around the patella and palpable crepitus may be Patellar Tendinosis which may relate to improperly position cleats
4. Medial knee pain often results from improper saddle height and position, poor leg flexibility and pushing too high a gear.  Insidious onset pain below the knee may be due to an inflammed bursa (Pes anserine Bursitis) which then hurts when the hamstring muscles are contracted or the tibia rotated.  Hamstring stretches can help.
5. Medial knee pain presenting as a ‘popping sensation’ occurring with every pedal stroke’ may relate to Mediopatellar Plica Syndrome: treatment involves adjusting the saddle fit and cleat position plus medial treatment (anaesthetic injections into the knee).
6. Lateral knee pain that is sharp/stabbing and decreases pedalling power due to its intensity may be related to Iliotibial band syndrome where the ITB band becomes inflamed.  Anatomic abnormalities (leg length discrepancy for example) and improper bike fit may be responsible as well as cleat position and riding with too high a saddle.
7. Posterior knee pain is rare in cycling though if a saddle is too high or too far back it can stress the biceps tendon and improper cleat position can increase stress on the back of the knee.

What to do if you experience knee pain from cycling

The aim is to decrease inflammation and allow the tissue to heal.  Decreased inflammation and pain helps increase the range of motion of the joint allowing a faster recovery.   So the drill is:

• Protection
• Rest
• Ice
• Compression
• Elevation
• Medication
• See a physiotherapist before it gets too bad.  If you are getting pain during training then it would be WELL worth trying to sort it out before your Raid as knee pain can stop people from completing the challenge (or even starting it if you allow the problem to become chronic).

Obviously the extent of the action/treatment required will depend on the severity of the pain.  Also required on the Short Term To do list is:

• Check Bike Fit
• Adjust cycling style by using a lower gear at higher cadence (twiddling)
• Warm down & stretch

Take a look at our previous blog entry on recommended Exercises for Cyclists for some advice from Marmot Guide & Physiotherapist Amanda Kemp