6 Tips to Prevent Cycling Knee Pain
Key takeaways:
Knee pain affects 40% to 60% of cyclists. Cycling knee pain can occur in the front of the knee, within the knee, or at the inner or outer side of the knee.
Common causes of knee pain from cycling include patellofemoral pain syndrome, patellar or quadriceps tendinopathy, iliotibial (IT) band syndrome, and osteoarthritis.
Properly warming up and cooling down, keeping your resistance low, and adjusting your seat height can help prevent pain.
Whether you’re an avid cyclist or casually ride a bike for exercise, you may find knee pain holding you back. Knee pain is the most common injury caused by cycling, affecting between 40% to 60% of all bike riders.
But knee pain from indoor or outdoor cycling doesn’t have to put the brakes on your rides. Learn common causes of cycling knee pain and tips to prevent it.
What causes knee pain from cycling?
Cycling is a low-impact form of exercise that can improve your leg strength and range of motion. While it places less strain on the knees than walking or jogging, cycling can still lead to knee pain.
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The repetitive motion of bending and extending the knees with cycling can lead to overuse injuries, or overtraining. These conditions result from repeated activity in the same pattern of motion. With cycling, this irritates structures in or around the knees.
Where does cycling knee pain occur?
Knee pain from cycling can occur in a few different areas. It’s most common in the front of the knee. High resistance and frequency of cycling can irritate the kneecap or patellar and quadriceps tendons that attach to it. This is especially common if the quadriceps muscles don’t have enough strength to keep up. This can lead to conditions like patellofemoral pain syndrome, patellar tendinopathy, and quadriceps tendinopathy.
Another common cause of cycling knee pain is iliotibial (IT) band syndrome. The IT band becomes easily irritated as it rubs against the bottom of the thigh bone (femur). This results in pain at the lateral (outer) side of the knee.
For conditions like knee osteoarthritis, you will feel pain within the entire knee joint, or more toward the medial (inner) side of the knee. Back of the knee pain is less common, but may occur if you strain the hamstrings muscles.
How can you prevent knee pain from cycling?
Making some key adjustments to your cycling routine can help prevent knee pain. Keeping your joints in good alignment and keeping intensity low are good places to start.
1. Warm up and cool down
Warming up and cooling down prepares your body for exercise. They allow time for your muscles to adjust to an increase and decrease in physical activity. They’re key for preventing injury and helping with recovery from your workout.
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2. Adjust your seat height
Your seat’s height can have a big impact on making cycling comfortable or uncomfortable. Lower seat heights increase the amount that your knees bend, which ups the pressure around the knees. For knee joint pain, opt for a higher seat height, which is often more comfortable if you have knee osteoarthritis.
But for other types of knee pain, a lower seat height may actually be better. IT band irritation occurs when the knee is repeatedly bent to 30 degrees. A lower seat height requires bending the knees more than 30 degrees, which can help avoid friction on the IT band. A lower seat height may also be beneficial for ACL injuries to avoid shearing stress.
3. Wear supportive shoes
Wearing supportive shoes helps keep your feet securely in the pedals. This will prevent your feet from slipping or coming loose during cycling. Unsupportive shoes, like flip-flops or slip-ons, may make you awkwardly position your feet to keep your shoes from falling off.
Because cycling is a highly repetitive activity, any awkward positioning can easily lead to strain or injury. Unsupportive shoes may also lead to increased foot pronation, a risk factor for cycling knee pain.
4. Check your bike's resistance
If you’re having pain with cycling, try decreasing your bike’s resistance. Although cycling is relatively low impact, too much resistance can still irritate the knee joints. Higher resistance places more pressure on the medial (inner) side of the knee joint. This area is often painful for those with knee osteoarthritis. Cycling with less resistance can help decrease knee joint irritation.
5. Focus on your form
Having good form avoids awkward positions of your joints that can lead to strain. The Athletics and Fitness Association of America recommends making large circular motions when you pedal. This prevents jerky motions of your knees into bending and extending. Keeping your chest up and not slouching also allows for easier breathing. This can make your workout more effective and prevent awkward positions on your joints.
6. Cross train
Too much of any exercise, especially a repetitive one like cycling, can lead to overuse injuries. Cross training is an effective way to prevent these issues. Cross training involves combining different types of exercises into your workout routine. Try mixing aerobic exercise, strength training, and flexibility exercises for a comprehensive exercise program.
How to relieve knee pain from cycling
At-home treatment can help treat knee pain from cycling. In addition to making adjustments to your cycling, you can also try:
Topical pain-relieving medications
Knee braces
When should you see a doctor for cycling knee pain?
Making adjustments to your cycling routine or taking a short break should help relieve knee pain from cycling. But if you have pain during or after every bike ride, something’s not right.
Cycling can cause or worsen certain knee conditions. If none of these tips help with your cycling knee pain, talk to a medical professional. You may need to take a break from exercise altogether to help inflammation resolve. A physical therapist can also address specific knee conditions or injuries to get you back to pedaling pain-free.
The bottom line
Cycling knee pain is common, but it doesn’t have to interfere with your workouts. The repeated motion of indoor or outdoor cycling can lead to strain and overuse injuries. But simple modifications — like adjusting your seat height, lowering your resistance, and warming up and cooling down — can help prepare you for a more comfortable ride. Talk with your health professional or a physical therapist if knee pain continues to limit your ability to exercise.
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References
Challoumas, D., et al. (2021). Management of patellar tendinopathy: A systematic review and network meta-analysis of randomised studies. BMJ Open Sport & Exercise Medicine.
Fang, Y., et al. (2016). Effects of workloads and cadences on frontal plane knee biomechanics in cycling. Medicine & Science in Sports & Exercise.
Hadeed, A., et al. (2023). Iliotibial band friction syndrome. StatPearls.
Isaly, A. (n.d.). Indoor cycling form: A complete guide. AFAA Blog.
Jones, B. Q., et al. (2015). Nonsurgical management of knee pain in adults. American Family Physician.
Johnston, T. E., et al. (2017). The influence of extrinsic factors on knee biomechanics during cycling: A systematic review of the literature. International Journal of Sports Physical Therapy.
Mulcahey, M. K. (2020). Cross training. OrthoInfo.
Pegrum, J., et al. (2019). IT band syndrome: Information for patients. The BMJ.
Yum, H., et al. (2021). Cycling kinematics in healthy adults for musculoskeletal rehabilitation guidance. BMC Musculoskeletal Disorders.
