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Cycling knee pain: Where pain occurs, causes, and more

Knee pain is the most common injury related to overuse reported by cyclists, both by professionals and those who cycle for recreation.

A 2017 study found that the following factors play a significant role in the rate of knee pain, such as:

  • the type of bicycle
  • the goal of the person cycling
  • body mass index
  • participation in other sports

The study also found that:

  • 27.6% of amateur cyclists experienced knee pain
  • 15.9% of professional cyclists had knee pain
  • 61.6% of cyclists reported only mild knee pain
  • 28.7% of cyclists reported moderate knee pain

Pain caused by cycling can occur in different parts of the knee. These include the anterior, posterior, lateral, and medial areas of the knee.

Anterior

Anterior pain occurs at the front and center of the knee. Cyclists most commonly experience pain in this part of the knee. Anterior knee pain in cyclists is usually patellofemoral pain (PFP).

Symptoms of PFP include:

  • aching pain at the front of the knee
  • pain after a change in activity level
  • pain during exercise or when bending the knees
  • pain after sitting for a long time with bent knees
  • popping noises in the knee when standing up or climbing stairs

Read more about anterior knee pain.

Posterior

The posterior knee, or back of the knee, is the least commonly injured area.

A cyclist may injure the posterior knee if their hamstring muscles and tendons are overworked, their hamstrings are tight, or their saddle is excessively high.

Injuries to the posterior knee are more common when the leg is overextended, or the knee is impacted, such as in a car accident.

Symptoms of a posterior knee injury may include:

  • pain
  • swelling
  • a feeling of instability in the knee
  • difficulty walking

Lateral

Injuries to the lateral collateral ligament of the knee are uncommon in cycling. They usually occur due to an impact to the inside of the knee that pushes the knee outwards. This occurs most often due to contact injuries, such as those experienced by soccer players or athletes.

Symptoms of a lateral knee injury include:

  • pain on the inside of the knee
  • pain on the outside of the knee
  • a feeling of instability
  • swelling

Medial

Medial knee injuries in cyclists may occur because of:

  • a direct blow to the outside of the knee, pushing the knee inward
  • medial collateral ligament bursitis
  • pes anserine syndrome, which is inflammation of the fluid-filled sacs that prevent muscles, tendons, and bones from rubbing together.
  • a medial meniscus tear
  • plica syndrome, which involves inflammation of the synovial folds of the knee

Symptoms of plica syndrome include:

  • snapping or clicking in the knee
  • inflammation
  • pain while bending or flexing the knee

The treatment of knee pain and injuries usually involves:

Application of rest, ice, compression, and elevation (RICE) method:

  • Rest: Do not put weight on the knee.
  • Ice: Apply cold packs to the knee in 20-minute increments throughout the day. Avoid placing ice directly on the skin.
  • Compression: Wrap the knee in an ACE wrapping or soft bandage.
  • Elevation: Raise the knee above the level of the heart.

A doctor may also prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain experienced in the knee.

When to see a physiotherapist

A person should seek physiotherapy or medical attention if:

  • they cannot relieve the pain with over-the-counter medication
  • the symptoms have not improved within a few days
  • their knee is making loud popping noises, accompanied by pain and swelling
  • the knee joint cannot move properly
  • they cannot put weight on their knee
  • the knee is discolored
  • the knee has lumps and appears off-center

Cycling can cause pain in various areas of the knee. However, knee pain may be a result of many other factors. These include:

Specific exercises can help a person improve the strength, range of motion, and endurance of their knees during cycling.

Exercises to stretch and strengthen the quadriceps, such as lunges and squats, help improve stability in the knee. Core exercises can also help strengthen the abdomen and lower back and improve stability overall.

A physiotherapist or masseuse may also help relieve pain with a sports massage designed to target knee pain.

Read more about strengthening exercises for the knees.

Knee injuries in cyclists often occur due to bicycle misalignment, long-distance riding, and a lack of conditioning before cycling. To prevent knee injury while cycling, a person can:

  • adjust the saddle-pedal distance on their bicycle
  • ensure their saddle is in the correct position
  • wear appropriate shoes for cycling
  • increase cycling training gradually
  • warm up thoroughly before cycling
  • perform stretching and flexibility exercises
  • maintain a moderate weight

Knee pain from cycling most often occurs in the anterior area of the knee, in the front center. Knee pain can also result from various medical conditions, injuries, and overuse. A person should contact a doctor if pain persists to determine the cause.

Many people develop knee pain from cycling because their bicycle requires adjustments for comfortable cycling. Adjusting the saddle-pedal distance and saddle height may help reduce knee pain.

Doctors often tree knee pain with NSAIDs and recommend people follow the RICE method. There are also certain changes a person can make to avoid developing knee pain from cycling, such as performing strengthening exercises and warming up before cycling.

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