Knee Pain in Cycling – How the Pros Avoid the Most Common Injuries

Knee pain affects both professional and amateur cyclists and is often the reason for missed training days if left untreated. In this blog we discuss the common causes and how it can be managed.

This year’s Tour De France is back in its usual summer timeslot, travelling across France over 3 weeks and finishing on the Champs-Élysées on 18th July. The riders are covering 3414.4km over 21 stages, including a 249km stage — the longest in 21 years.

There are many health benefits to cycling, and you do not need to ride the length of the Tour to experience them. It is excellent for developing cardiovascular fitness and can also be an ideal low impact option for those recovering from injury. 

As the mileage adds up however, the repetitive nature of cycling can sometimes mean that overuse injuries occur. These are also known as gradual onset injuries and are not caused by sudden trauma, but build up gradually over time, often when distance or intensity of training increases too quickly.

What can cause knee pain in cycling? #

The most common overuse injury seen in cyclists is pain at the kneecap, or patellofemoral pain. This is usually described as an ache at the front of the knee around the kneecap but can also develop into sharper twinges. It usually worsens with repetitive activity that loads the front of the knee. This differs to patellar tendinopathy — another common source of knee pain in cyclists. This is when pain is localised to the tendon below the kneecap and is often tender to touch. It will usually be worse at the start of a ride, ease off in the middle, and worsen again afterwards.

Some cyclists will experience pain on the lateral side of the knee joint which can be attributable to iliotibial band (ITB) pain. In short, ITB pain is an overuse injury that causes compression to the structures at the side of the knee, which can result in inflammation and pain. Symptoms will typically worsen throughout the duration of a ride. 

Although different structures of the knee are involved, the above conditions are all usually aggravated by repetitive knee extension against resistance e.g., the downward phase of the pedal stroke. The most common cause is a sudden change in training load on the bike, as this increases the demand on these structures without enough time for the body to adapt. 

The appropriate management is often dependent on individual factors but will likely include 3 key elements outlined below.

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Track your training load #

During the summer, longer days and warmer weather inevitably keen cyclists spend more hours on the bike. Without realising, you can rapidly increase your training volume, and with this comes increased potential for injury. Initially riding at a lower intensity can help to reduce your training load and, therefore, your symptoms.

Riding familiar routes can help control the intensity of your ride, it may even help to aim for a higher cadence and lower gear. Tracking your activity on Apps like Strava or Training Peaks can highlight where your training may have spiked and identify where it may be beneficial to add rest days.

Incorporate strength training #

Often strength training is a taboo subject among cyclists for fear of gaining unwanted muscle bulk, but this is actually not the case. Including resistance training in your programme is not only a key part of recovering from an injury, it can also improve your power output and ultimately make you a stronger rider.

A well-rounded leg strength programme targets the main muscle groups (quadriceps, hip extensors and hamstrings) and can be completed just 2 times per week. Our physiotherapists and Strength and Conditioning coaches can provide further advice and tailor a programme to suit you. 

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Check your bike fit #

There are various aspects of your setup that could have an influence on the loading of your knee during the pedal stroke. On average an hour of cycling would require over 5000 pedal revolutions – that’s over 5000 times your knees extend to turn the pedals. So, with an incorrect fit on the bike, a small issue can quickly become a bigger problem over a long ride.

In relation to knee pain, it is primarily your cleat and saddle positions that will be the main factors, and optimum position of these will vary for each individual. Our bike fitters can assess and help you find the best fit.

If you have concerns about an injury that is affecting your cycling, contact us via the form below, or direct to a clinic here and book in with one of our specialist clinicians. 

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