What are the most important things to know about knee pain with cycling?

Knee pain can be excruciating. It can hinder your ability to cycle, or at least take the joy out of it.  For effective treatment, the most important thing is you first need to consider where you’re having the pain. Is it in the front of the knee, the inside of the knee, the outside or the back?

We also need to determine when you are having the pain. Does it flare up during cycling? Does it happen right away and then fade out? Does it happen mid-ride and stay with you, or does it come on after your workout?

Now we evaluate the nature of the pain. Is it sharp? Dull? Aching? Stiff? Full? Perhaps tight? These are all descriptions people use when they visit our office for physical therapy.

This is where my specialty comes into play. If you’ve already had a formal bike fit and you’re still having pain, it would be best to go to a physical therapist who does bike fittings.  My niche is in comprehensive treatment of the cyclist. Often, we can resolve knee pain – and prevent it from happening again– with a bike fitting that’s highly customized to your unique physique.

Let’s break it down. If you’re over the age of 30 and your primary goal is to stay healthy and ride pain free as many years as you can – in other words, if your goal is longevity -- that’s a determining factor for seeking out a physical therapist for a bike fitting. Yes, you can go to a bike shop where they’ll use software to plug in your age, your weight, your general fitness level and the type of riding you do, then the program will spit out some numbers that tell you where you should be.

But that doesn’t take into account your individuality, how flexible, mobile or strong you are. Or any other health factors, like maybe a knee surgery you had three years ago.

If you’ve had a fit at a bike shop and you still don’t feel right, don’t try to adjust your body to suit the computer’s numbers. Down that path lies pain. If something feels wrong, trust your gut. You spend 24/7 with your body.

When people come to see me, we’re fitting the bike to their body and not the other way around. A proper bike fit is imperative in order to be a truly happy and efficient cyclist.

Here are some of the most common issues I see with cycling and an improper bike fit that causes knee pain:

• When we’re in our teens and 20s we probably don’t have to warm up, but once you hit about 30 you need to warm up. That will increase the blood flow to your muscles and prepare your joints for action.

• If you’re increasing your volume of miles too quickly, this can overload your tissues and increase front of knee pain.

• If the saddle is pushed forward more than it should be.

• If the saddle nose is pointed down too far, you’re basically falling toward the front of your legs as you pedal.

• If the saddle is too low, that’s a common factor for knee pain because the kneecap never gets a break from excessive forces.

• If the set-up of your cleats (clipless pedal system) is improper, this can place abnormal stress on your knees.  

• If your width of stance (distance between your feet) is too wide on your pedals, that can cause mainly side of knee pain.

Now let’s look at pedaling mechanics.  “Pedal mashers” end up overusing the muscles on the front of the thigh because they are focusing mainly on pushing down, rather than incorporating the “pull” on the back end of the pedal stroke which will brings the hamstrings into the picture. The ideal pedal stroke is quite even throughout and is one that minimizes “gaps” in muscle activity.  But so many people resort to surging on the front end, and this places a lot of stress on the kneecap, quadriceps muscle and patellar tendon.

As a physical therapist, I always consider what’s going on at the joints above and below the main area of pain or dysfunction.  So if someone is seeing me for their knee, I’m going to look at the hips and ankles, as well as the lower back, to make sure those joints are moving properly. Mobility issues in these areas can also cause knee pain.

Outside of my physical therapy practice, I’m an avid cyclist. My background is in road cycling and triathlon. So I have a passion for helping cyclists alleviate pain because I know firsthand how awful it can be to try to ride through that pain.  

At Bike & Body we are here to help you alleviate pain through physical therapy for active people and those who wish to be.  We’re here to help you stay fit, healthy and mobile for the rest of your life. 

Bike & Body is a private studio dedicated to promoting WELLNESS and LONGEVITY in ACTIVE-MINDED PEOPLE through Physical Therapy and Bike Fitting.  The owner, Dr. Deb Slota, is a fully licensed Physical Therapist and Certified Bike Fitter in Milwaukee, WI. We believe in devoting our full attention and expertise to every client that walks through our door.  You will leave with an elevated sense of well-being, improved ease of movement, and the knowledge to make it last.  Whether you are battling a nagging injury, have just sustained an injury, or something just doesn't feel right, we are here to help.

To schedule a free initial consultation, get started here.

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