Bicycling knee pain treatment
During the third day of my Rhine River tour, almost at the end of a long bicycle riding day in which we rode 70 miles, I started to feel a severe pain in my right knee. This pain did not stop until the end of our trip and totally disappeared only three months later!
After I returned from the bike trip I decided to learn more about bicycling knee pain. I found out that there are many articles, forums and web sites about bicycling and pain. Still, in most cases, I did not find any source of information was complete, informative and especially easy to read, and understand. In this webpage I will try to produce just that.
Bicycle riding is a relatively safe sport for the knees. While jogging, our knee joints are under tremendous loads, due to the fact that periodically the foot land on the ground. During cycling, the leg moves smoothly and continuously. Note: You can read more information about the subject in the article about running vs. cycling.
Taking this fact into account, it is quite surprising that bicycling knee pain is so common among cyclists. Whether competitive or amateur, most of us bicycle riders have suffered from bicycling knee pain during our careers.
The good news is that cycling knee pain is usually a temporary phenomenon, and it can disappear after a while, with or without treatment. In some rare cases, though, the problem of bicycling knee pain may worsen and even prevent you from continuing cycling!
The knee joint is in the middle between the foot and the pelvis, and thus affected by both. When using bicycling shoes with cleats, the foot is connected directly to the pedal, and the actual movement of the knee is defined by the way the shoe is attached to the pedal, by the length and the width of the crank and other parameters. Riding technique, such as using “power pedaling,” can also affect knee movement.
Did you know…?
Did you know that older cyclists are more susceptible to knee pain?
Knee pain usually occurs when the back of the kneecap is worn away by constant flexing movements such as pedaling a bicycle. The thing is, this sort of wear and tear occurs naturally during the ageing process as well. Thus, if you are a middle-aged cyclist, you’ll want to take special care of your knees!
The Structure of the Knee
The knee joint connects the thigh with the shin and is a “single-axis” joint, as it is able to move in one plane only by flexing and bending (as opposed to the hip, for example, which is a “three-axis” joint). In addition, knee joint surfaces are flat (unlike other joints that are built with concave and convex surfaces), and there-fore the stability of the knee depends only on the strength of its muscles and ligaments.
There pads called the meniscus cartilage located between the femur and tibia. They also contribute to the stability of the knee joints and allow smooth movement. Meniscus ligaments are usually not affected during a routine bicycle ride, but can be damaged when you fall off your bike or as a result of an accident.
In simple terms, the role of the front muscles of the knee (the hamstring muscles) is to straighten the knee. The role of the opposing muscles (the antagonists’ muscles) is to bend the knee.
Read here more about the knee structure.
What Causes Bicycling Knee Pain?
Inappropriate gear selection
A major factor that can cause strain in the knee is over-load of the knee muscles, caused by the use of gears that are too low or too high. Try to use a gear that allows you to pedal quickly, from 70 to 100 strokes per minute.
Incorrect Seat Position
A seat that is too high, too low, too far forward, or too far back can also cause bicycling knee pain. A saddle that is too high will cause the knee of the down leg to extend beyond the optimal 170º angle, potentially causing pain in the back of the knee. A seat that is too low or too far forward might reduce the ability of the knee muscles to produce the required force for the ride. It may therefore divert the knee outward, causing pain in the front of the knee.
Improper Foot Position on the Pedal
Improper foot position on the pedal (or improper cleat alignment) can cause pain on the inside or outside of your knees. After learning about bicycling knee pain I found out that this was the reason for my bicycle knee pain. If you have “duck feet” (your feet point to the outside when you pedal) and you use shoes with straight cleats, your legs twist inward, forcing the knees to twist in the same direction. As a result the knee movement will not be in a straight line but in the form of figure eight. During long rides (such as bicycling tours) this might become a real problem, as it causes knee erosion.
Wrong Crank Length
A crank that is too long causes excessive knee flex, beyond the knee’s ability to bend. This causes the down leg’s knee to twist outwards, causing unwanted lateral knee movement. On the other hand, a crank that is too short can cause excessive load on the knee muscles.
Difference between the Width of the Pelvis and the Pedal Axis Width
For most of us, especially women, the pelvis is wider than the width of the pedal axis. As a result, the hips tend to twist inward while riding. While the hip joint is able to adapt to this change, the knee joint suffers from unwanted lateral loads.
Leg Length Discrepancy
Differences in individual anatomy may also result in cyclist knee pain. Cyclists with slight differences in leg length may have bicycle knee pain because the seat height is only adjusted for one side. Shoe inserts or orthotics can help correct this problem.
How To Prevent or Minimize the Risk of Bicycling Knee Pain
Select the Right Seat Height
The height of the bicycle seat affects the functioning of the knee. Adjust the height of the saddle so that your down leg will extend to an angle of 170º.
Changing Forward/Back Seat Position
The optimal seat position is such that when your front foot is in its most forward position, the knee is just above the crank axis. Adjust the seat forward or backward.
Select the Proper Crank Length
Most adult bikes are equipped with 165 and 175 mm cranks. Make sure that the crank fits to your leg length. Consult the experts in your local bicycle shop or read some material about bicycle sizing.
Choosing the right gear ratio
For many cyclists (including myself), a low gear/low resistance/fast spin is more comfortable than the opposite. Due to their still-undeveloped knee muscles, children should avoid “power riding” completely and should not use cleats.
Use Shoes with Cleats
Using shoes with cleats allows the leg that is moving upward to participate in the pedaling, thus contributing to balanced knee movement.
Align the Cleat
If you are pigeon-toed (if your feet point inward), your feet will be forced by the pedals and the cleats to move in a parallel plane. There will be a slight twist in your leg causing lateral forces on the knee.
To allow your legs to move in their “natural” plane you should take one of these preventive actions:
- Align your cleats.
- Use cleats that allow foot rotation (some of the more advanced cleats are like that).
- Ride without cleats.
Products for Cycling Knee Pain Treatment
Books About Knee Pain
More information about knee pain can be found on several informative books. Take a look at these selected books:
Bicycling knee pain during and after cycling is one of the most significant pains related to cycling. The good news is that this type of pain appears in most cases only during long rides and also tends to disappear after the ride.
As in all other cases of cycling pain and injuries, you should consult with a sports doctor and get professional advice.
You are invited to read some of my other related articles, about: