Knee pain is the number one complaint amongst cyclists. It sort of makes sense, doesn’t it? The knee looks like it is the thing doing the most work when you watch the body on the bike. Its true, the knee goes through the most range of motion of all the joints that make up the pedal stroke. So why do cyclists have pain in the knee? There are several different reasons and most of them are solved with a fairly simple adjustment.
- The first reason I would take a look at is saddle height. For pain in the front of the knee, typically the saddle is set too low. When the saddle is too low there is increased knee flexion which caused increase pressure across the knee cap and this causes pain. If the seat is too high then you could have pain at the back of the knee because you are putting a stretch on your hamstrings which insert in the back of the knee. There are several different ways to get a gross adjustment of your seat height (google will find them for you) which can be ok in a pinch. However getting a bike fitter to precisely set it for you is the best way. Some other adjustments with the saddle that can contribute to knee pain is the fore and aft position of the saddle and the tilt of the saddle. Again, getting a bike fit to dial this in is the best solution.
- Poor cleat alignment can be a contributing factor. I find that a lot of people are riding with a lot of rotation set in their cleats and thy don’t even know it. Sometimes the screws got loose and they just get tightened back down again not realizing there is a precise adjustment that is needed. One of the more typical problems I see is that the person has their cleat set up so that their knee to come in towards the bike when their knee is more naturally aligned to be out a little bit. This can often cause pain on either the inside of the knee or the outside.
- Low cadence, high load pedaling is another one I see that can cause knee pain. This is often done by cyclists who tend to be a little less experienced. Now for some cyclists, they do have a good reason for doing this. Studies show that for amateur cyclists, a higher cadence is actually more tiring. Basically, if you are going slow and not putting out that much power, then pedaling slow, ~60 rpms, is actually pretty efficient. Where it becomes a problem is when you are putting out a lot of power at slower RPM’s. You are in a high gear and mashing down. This is what can cause knee pain over time. When you are able to maintain a high cadence, 80-100 rpms, while also maintaining a high power output, you will require more of your cardiovascular system, but you will put less stress into your knees. This tends to be how the pros are able to pedal because they are in peak shape. Take home message, as you start to go a little faster, see if you can pedal at a higher cadence to take some pressure off your knees. I talk a little more about cadence in the video below.
- Ramping up training load too quickly is another cause of knee pain in cyclists (runner too). I was guilty of this early in the spring when the pandemic started. During quarantine I had more time to ride and was putting in more miles per week than I was used to and started getting a little bit of knee pain. Increasing mileage needs to be gradual over 4-6 weeks if you are able. Ramping up too quickly is one of the most common ways that endurance athletes get hurt.
If you are new to cycling or experienced and you are having knee pain, I can help! I want you out on your bike and enjoying all the health benefits and community the cycling provides. I am a Physical Therapist who specializes in treating cyclists and I am also certified bike fitter. Most of my patients come from Roswell, Alpharetta, Milton, and Johns Creek. You can find out more about my practice at www.missionmovept.com and www.cyclingpt.com . Call me today at 678-400-0300
