Cycling Knee Pain

Cycling Knee Pain

10,000  That’s how many pedal revolutions a cyclist will do over the course of an average two hour ride.  If your equipment is not set up correctly, or if you have a muscle imbalance, or are not pedaling efficiently, you have 10,000 opportunities to develop an overuse injury.

Spring is typically when we see a lot of folks coming in with knee pain issues.  A bike fit is the first place we would recommend starting, but it’s important to keep in mind that there may be other factors contributing to knee pain. Here are some of the more common causes of knee pain that we see, and some considerations for correction.

Overuse / over-training:

This is the biggest issue we see, typically in the early season, but not always.  Overuse is people simply doing too much too soon.  Overuse is cumulative tissue micro-trauma and the consequent symptoms.  In overuse injuries the problem is that the cartilage will soften due to inflammation and can pit and wear the cartilage.

Most common issues:

  • Patellofemoral pain, Pain in the front of the knee, or behind the kneecap
  • IT band syndrome, which usually presents as pain on the outside of the knee

Most common causes:

  • Riders increasing the amount of riding volume and or intensity dramatically over a short time period.
  • Improper training and physical conditioning
  • High intensity, harder rides, climbing or riding with a low cadence all of these can place a lot of stress to the knee.

With overuse and over training it is important to rest, and reduce training volume and intensity.  A professional bike Body Geometry Fit at ERIK’S will ensure that the knees are supported.  We also recommend working with a specialist on proper recovery, stretching, and strength/ conditioning to fully heal the problem and support your structures to ensure it doesn’t come back.


Patellofemoral Pain Syndrome:

(PFPS) can also be referred to as Chondromalacia, and is commonly referred to as runner’s knee.  Chondromalacia simply means “abnormal cartilage softening,” and describes the condition of the cartilage on the underside of the knee and/or on the surface that the patella glides along in the groove of the femur. (Chondro is the combing term for cartilage; malacia is the prefix term that means abnormal softening.)  This can be a bit of a catch-all diagnosis, and doesn’t always describe the specific problem.  Some of the symptoms include pain in the front of the knee, especially going up and down stairs, and while kneeling or squatting. Specific to cycling, is the potential for pain while pedaling or after long hard rides, climbing, or using low cadence & heavy gearing. Often, the cyclist suffering from this syndrome may continue to feel soreness in the knees for days after such rides.

As Dr Andy Pruitt puts it, “The knee is the victim of what’s happening at the hip and foot.”

There are many causes of knee pain from an improper bike fit, many of them occur in tandem, but the most prevalent causes of knee pain we see are:


  • Saddle too high
  • Saddle too low
  • Saddle too far forward
  • Saddle too far back
  • Inappropriate saddle selection and width
  • Pedal stance width, also referred to as Q-factor not set appropriately for the rider
  • Internally or externally rotated cleats
  • Lack of supportive footwear


  • Leg length discrepancy, even a small one can have a large affect on the rider
  • knock-knee alignment, (knees go in)
  • bowlegged alignment (knees go out)
  • over pronation (arch collapse)
  • Internal tibial torsion (pigeon toed alignment)
  • Muscle imbalance, (this is very common in cyclists since cycling favors very specific muscle groups)
  • Plica (very rare)  Wiki Link
  • Pes Anserine bursitis  Wiki Link

The bottom line is, if you are having knee pain, we cannot stress enough the importance of addressing all potential bio-mechanical, and equipment issues through a comprehensive fit process like Body Geometry Fit at ERIK’S.  But know that a bike fit alone may not be able to fix all the potential causes and issues that result in knee pain. We highly recommend working with a specialist that can help ensure that you have adequately recovered, can recommend specific stretches, as well as incorporate strength training into your routine. By doing this you’ll get back out on the bike sooner and significantly reduce the chance of re-injury.

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