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Cycling with Knee Pain?

By Sheila Ascroft

Cycling with knee pain

Courtesy of CycleFit Chicks Cycling Club

Ouch. My knees.

If this has become your cycling theme song then welcome to my club. Even though cycling isn’t a jarring-impact sport like running (except if you crash!), it may still cause you pain.

Regardless of the various terms for knee-related injuries: chondromalacia, IT band syndrome, patellar femoral ligament tendinitis – they pretty well all stem from either improper bike fit or improper pedalling technique.

Before I developed knee pain, I used to ride with my saddle – actually the seatpost – too low. One leg felt great, however the other, which was a tad longer, was bent too much. It took a while for the problem to show up, but it did. Ouch.

With the seat post too low, I was putting extra stress on my knee and the patellar and quadriceps tendons. I now ride with a higher seat post and use a shim for my shorter leg. Don’t make my mistake. Raise your seat post until your hips are rocking and then lower it a touch. If the seat post is too high, you may over stretch the tendons and pain may develop behind the kneecap (patella).

Another mistake I made was with my cleat/shoe alignment. One foot was toed-in too much and the resulting twist on my lower leg led to stress on the knee joint and my IT band. (Wee anatomy lesson: the IT (iliotibial) band is the thick fibrous band of tissue running down the outside of the leg from the hip to the knee. Because of the constant up and down leg cycling movement, the IT band becomes stretched – and tight. Pain arrives as the band rubs over the bony prominences of the hip (greater trochanter) and/or the knee (lateral condyle) and becomes inflamed.)

Fortunately, an experienced cyclist noticed my problem and straightened me out – literally. The idea is to keep your feet in a natural or neutral position. Alter your cleats to allow that to happen – don’t force your foot to point forward if it doesn’t naturally do that. Many cleat/pedal systems now have “float,” which allows your foot some freedom to rotate naturally (without disengaging from the pedal).

The forward/aft position of the shoe cleat makes a difference too. All the experts say to start with your cleats positioned so that the ball of your foot is directly over the axle of the pedal. Then adjust slightly as needed.

Pain can also be caused poor pedalling technique. The late Sheldon Brown, who knew just about everything about cycling, solved his knee problems by making “a conscious effort to avoid lateral knee movement during the pedal stroke.” He said to look at your knees while pedalling (in a low-traffic setting!) to make sure there is no sideward motion. He thought this was a major contributor to chondromalacia.

For those wanting more anatomy: chondromalacia is the softening and degeneration of the cartilage on the back of the kneecap or patella. According to Andy Pruitt, author of, Complete Medical Guide for Cyclists, this starts as irritation, but can lead to arthritis and is often accompanied by other inflamed tendons or bursa.” Tell-tale symptoms are a clicking or grating sound along with pain behind the kneecap when you’re pushing hard gears with a slow cadence. The wrong gear selection can really over-stress the knees. Try pedalling faster or use easier gears until your legs are stronger. Don’t do too much hill climbing too early in the season either.

Another thing I found out the hard way. Make sure to cover your knees with leg warmers or tights if the air temperature is lower than 65˚F (or 18˚C).” The knee tendons lie exposed near the skin’s surface and riding bare knees in chilly temperatures is asking for trouble.

Finally, your own anatomy may be against you. Being bow-legged, flat footed, or having a leg length difference can all contribute to knee and hip pain. Some things that may help include: gentle stretching, strengthening the quadriceps muscle (just  remember to avoid workouts that include leg extensions or full squats), warming up before asking too much from your knees, increasing your mileage by only 10% a week, and consider using orthotics. If you haven’t had a proper bike fit, it may be worth getting one before the spring cycling season starts.

If the pain keeps occurring, visit your doctor or sports clinic for an accurate diagnosis and the correct treatment. Do whatever it takes to keep your knees happy.

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