The Cyclist's Complaint: Understanding Knee Pain

Knee pain plagues cyclists more than any other injury. Because the knee joint acts as the pivot point in the kinetic chain, any imbalance from the feet, saddle, or hips is amplified here, leading to repetitive strain injury over thousands of pedal strokes.

Where Does It Hurt? Pinpointing the Cause

The location of the pain is the best diagnostic tool, often pointing directly to a specific bike fit error or biomechanical issue.

1. Pain in the Front of the Knee (Anterior)

This is often diagnosed as Patellofemoral Pain Syndrome (PFPS), or 'runner's knee,' involving irritation under the kneecap.

• Primary Cause: Saddle too low or too far forward. A low saddle forces the quadriceps to work harder and compress the kneecap against the femur at the top of the stroke.
• Solution: Raise the Saddle. Aim for a knee angle of 35-45 degrees at the bottom of the pedal stroke. Also, ensure your saddle's fore/aft position isn't placing your knee too far over the pedal spindle.

2. Pain in the Back of the Knee (Posterior)

Pain behind the knee often involves irritation of the hamstring tendons.

• Primary Cause: Saddle too high. An overly high saddle causes the hamstring and calf muscles to excessively stretch (hyperextend) at the bottom of the pedal stroke.
• Solution: Lower the Saddle. Drop the saddle 2-5mm incrementally. If the pain persists, check your crank length—it might be too long for your leg length.

3. Pain on the Side of the Knee (Lateral or Medial)

Pain on the sides usually indicates tracking issues, most commonly Iliotibial (IT) Band Syndrome (pain on the outside).

• Primary Cause: Cleat Misalignment or Foot Issues. Cleats rotated too far inward or outward, or foot pronation/supination (arch collapse) forces the knee to track unnaturally in a 'figure-8' pattern.
• Solution: Adjust Cleats and Foot Support. Ensure your cleats allow your knee to track naturally (often requiring small inward or outward rotation). Use wedges or orthotics inside your shoes to stabilize the foot and prevent knee collapse.

Off-Bike Solutions for Prevention

Bike fit fixes the static problems, but the rider's body must also be addressed to prevent recurrence.

• Glute Activation: Weak gluteus medius muscles are often the root cause of the knee collapsing inward (valgus tracking). Incorporate exercises like glute bridges and lateral band walks.
• Flexibility: Tight hamstrings and hip flexors can pull the pelvis out of alignment, impacting the knee's trajectory. Regular stretching is non-negotiable.
• Cadence: Riding in too high a gear (low cadence) puts excessive load on the knee joint. Maintain a higher, smoother cadence (85-95 rpm) to distribute the workload.