Pedal Power Pains: Managing Knee Discomfort While Cycling

Knee pain is a common issue among cyclists, with various factors contributing to its prevalence. Understanding the causes and preventive measures can help mitigate the risk of knee pain when cycling. In this article, we will explore the various causes of knee pain while cycling and provide you with effective ways to reduce and prevent it.

Causes of Cycling Knee Pain

Knee pain when cycling can be caused by a variety of factors. Understanding these causes will help you identify the specific issue you may be facing and take appropriate measures to alleviate the pain.

Cycling Overuse Injuries

Cycling can also lead to overuse injuries. Overuse injuries occur when the body is subjected to repetitive stress without sufficient time to recover. Cycling overuse injuries can lead to specific medical conditions related to the knee, often due to repetitive strain and inadequate recovery.

Some of the most common overuse injuries of the knee joint related to cycling include:

Patellofemoral Pain Syndrome (PFPS): PFPS, also known as runner's knee, is an overuse injury characterised by pain around or behind the patellofemoral joint. It's characterised by dull, aching pain around the knee cap, particularly during or after cycling, and discomfort when climbing stairs or sitting for prolonged periods with knees bent.

Iliotibial (IT) Band Syndrome: IT band syndrome involves inflammation and tightness of the iliotibial band, causing pain outside the knee. Symptoms of ITBS include a sharp or burning pain on the outside of the knee during or after cycling, especially when the knee is bent.

Patellar Tendinitis: Patellar tendinitis, or jumper's knee, involves inflammation of the patellar tendon just below the kneecap. Symptoms of this condition include pain and tenderness around the base of the kneecap, particularly during cycling or when bending the knee against resistance.

Anterior Knee Pain

Anterior knee pain, which refers to pain at the front of the knee, is a common issue experienced by cyclists. Several medical conditions can be associated with anterior knee pain caused by cycling, often attributed to improper bike fit that can lead to various problems, including incorrect tracking, overuse, and muscle imbalances.

Patellar Tendinitis: Patellar tendinitis, also known as jumper's knee, involves inflammation of the patellar tendon just below the kneecap. It's characterised by pain and tenderness around the base of the kneecap, particularly during cycling or when bending the knee against resistance.

Quadriceps Tendinitis: Quadriceps tendinitis involves inflammation of the quadriceps tendon, which can cause anterior knee pain. It's characterised by pain and tenderness at the top of the kneecap, particularly during cycling or when contracting the quadriceps.

Synovial Plica Syndrome: This condition involves irritation or inflammation of the synovial plicae within the knee joint, leading to anterior knee pain. It's characterised by pain or a clicking sensation in the front of the knee, especially during or after cycling.

Posterior Knee Pain

Posterior knee pain, which refers to pain at the back of the knee, can stem from various cycling-related factors. It may be associated with various medical conditions, and understanding such is important for proper diagnosis and targeted management of posterior knee discomfort in cyclists. Here are some of the medical conditions that may cause posterior knee pain when cycling:

Baker's Cyst: A Baker's cyst is a fluid-filled swelling that develops at the back of the knee, often resulting from conditions such as arthritis or meniscus tears. It's characterised by swelling, tightness, and pain at the back of the knee, particularly during or after cycling.

Posterior Cruciate Ligament (PCL) Injury: The PCL, one of the major ligaments in the knee, can be sprained or torn due to sudden trauma or overuse. Pain, swelling, and instability in the knee, particularly at the back of the joint, which may affect cycling performance, are the typical symptoms of this injury.

Muscle Strain or Tendinitis: Strain or tendinitis in the muscles or tendons at the back of the knee, such as the hamstrings or gastrocnemius, can lead to posterior knee discomfort. It's characterised by pain, tenderness, and limited range of motion at the back of the knee, especially during or after cycling.

Popliteal Artery Entrapment Syndrome: This rare condition involves compression of the popliteal artery behind the knee, leading to reduced blood flow and potential symptoms of posterior knee pain during exercise. It's characterised by leg cramping, pain, or numbness during cycling, especially in a rigorous pedal stroke.

Medial Knee Pain

Medial knee pain refers to the discomfort on the inner side of the knee. It can be associated with various medical conditions, including the following:

Medial Collateral Ligament (MCL) Sprain: The MCL, a ligament on the inner side of the knee, can be sprained due to sudden twisting or impact, leading to medial knee pain and instability. It's characterised by pain, swelling, and instability on the inner side of the knee, which may be aggravated during cycling manoeuvres.

Medial Meniscus Tear: A tear in the medial meniscus, the cartilage on the inner edge of the knee joint, can lead to medial knee pain and discomfort. Individuals with this condition may experience swelling, popping or clicking sensations, and pain on the medial aspect of the knee, especially during or after cycling.

Pes Anserine Bursitis: Pes anserine bursitis involves inflammation of the bursa located on the inner side of the knee just below the joint. It's characterised by tenderness, swelling, and pain on the inner side of the knee, particularly when cycling, going up or down stairs, or rising from a seated position.

Medial Plica Syndrome: This condition involves irritation or inflammation of the medial plicae within the knee joint, leading to medial knee pain. It's characterised by pain, clicking, or a sense of catching on the inner aspect of the knee, especially during or after cycling.

Lateral Knee Pain

Lateral knee pain, which refers to discomfort on the outer side of the knee, can be attributed to various cycling-related factors. Understanding the potential medical conditions associated with lateral knee pain is crucial for accurate diagnosis and effective management.

Lateral Meniscus Tear: A tear in the lateral meniscus, the cartilage on the outer edge of the knee joint, can lead to lateral knee pain and discomfort. It's characterised by swelling, popping or clicking sensations and pain on the lateral aspect of the knee, especially during or after cycling.

Lateral Collateral Ligament (LCL) Sprain: The LCL, a ligament on the outer side of the knee, can be sprained due to sudden twisting or impact, leading to lateral knee pain and instability. It's characterised by pain, swelling, and instability on the lateral side of the knee, which may be aggravated during cycling manoeuvres.

Biceps Femoris Tendinitis: Tendinitis of the biceps femoris tendon, located on the outer side of the knee, can cause lateral knee pain and tenderness. It's characterised by pain, swelling, and tenderness on the lateral aspect of the knee, particularly during or after cycling.

Ways to Reduce Knee Pain When Cycling

Experiencing knee pain while cycling doesn't mean you must give up on your beloved hobby. There are several effective ways to avoid knee injury, reduce knee pain, and continue enjoying your rides.

Take Time to Do Professional Bike Fitting

One of the most crucial steps in preventing and alleviating knee pain when cycling is getting a professional bike fit. A professional bike fit specialist will assess your body's biomechanics and make adjustments to your bike's position, including saddle height, fore-aft position, and cleat position.

A correct bike fit helps distribute the workload evenly across the major muscle groups involved in cycling, thereby reducing the risk of muscle imbalances that can lead to too much pressure on the muscles and kneecap that can contribute to knee pain.

Ultimately, a bike that is fitted to the rider's body dimensions and cycling style promotes comfort and efficiency, reducing the likelihood of adopting compensatory movements that can strain the knees.

Apply Ice and Use Compression Devices

If you feel that your knee hurts, especially after a long ride, applying ice to the affected area can help reduce inflammation and numb the pain. Ice can be applied for 15-20 minutes several times a day. Additionally, using compression devices, such as knee sleeves or compression socks, can provide support to the knee joint and reduce swelling.

Do Foam Rolling Exercises

Foam rolling is a type of soft tissue therapy that aims to alleviate tension and enhance flexibility by applying pressure to tight muscles, such as after cycling. It's a form of self-myofascial release that can offer many health benefits, especially for cyclists experiencing knee pain.

Cycling can lead to tightness in the quadriceps, hamstrings, and iliotibial (IT) bands, which can contribute to knee pain. Foam rolling these tight muscles can help release tension and alleviate discomfort.

Foam rolling also offers many health benefits, including improved blood flow, increased flexibility, and enhanced muscle recovery.

Take Pain Medication

OTC pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), work by inhibiting the production of prostaglandins, which are chemicals in the body that promote inflammation, pain, and fever. By reducing the levels of prostaglandins, these medications help alleviate knee pain and reduce inflammation.

Physiotherapy

Physiotherapy knee pain is a valuable treatment option for cyclists seeking to alleviate knee pain and enhance their cycling experience. Through a combination of tailored exercise programs, manual therapy, biomechanical analysis, pain management strategies, and education, our physiotherapists at Phoenix Rehab can play a crucial role in addressing the root causes of knee pain from cycling and fostering recovery.

Surgery

In severe cases where conservative treatments fail to alleviate knee pain, surgery may be considered. Surgical interventions, such as arthroscopy or knee replacement, are typically reserved for severe injuries or conditions that significantly impair your quality of life. It's important to consult with a qualified orthopaedic surgeon to determine if surgery is the right option for you.

Is It Okay to Ride the Bike With Knee Pain?

Riding with knee pain can exacerbate the underlying issue and potentially lead to more severe knee injuries.

If you experience knee pain while cycling, it's advisable to take a break from riding until the pain subsides or seek professional advice to address the root cause of the pain.

When to See a Doctor

Worsening or persistent pain despite trying conservative treatments warrants seeking medical attention. A healthcare professional, such as an orthopaedic specialist or a sports medicine physician, can assess your condition, provide a proper diagnosis, and recommend appropriate options to treat anterior knee pain (or knee pain in other positions) suitable for you based on the assessments done. They may also opt to order imaging tests, such as an X-ray or MRI, to get a better understanding of the underlying issue.

Final Words

Experiencing knee pain when cycling can be a frustrating and discouraging experience. However, by understanding the causes of knee pain and taking appropriate measures to address them, you can continue enjoying your rides pain-free.

Remember to prioritise proper bike fit, strengthen and stretch the muscles around the knee, and listen to your body. If knee pain persists or worsens, seeking medical advice is crucial to prevent further damage and ensure a swift recovery.