Knee Cycling Injuries

Cycling is a sport that has been taking the nation by storm. With the number of new cyclists picking up the sport – it is also natural that more are experiencing cycling-related musculoskeletal injuries. In this article, we explore the common causes of knee cycling injuries and what you can do about it.

25% of cyclists experience knee cycling injuries

The knee is the most common area for injuries to take place and 1 in 4 cyclists have experienced knee pain due to cycling. But why is knee pain among cyclists so prevalent? Keep reading to understand why the knee is so susceptible to injury and the common knee cycling injuries that cyclists experience.

Why does knee pain occur?

Most knee cycling injuries happen because of 2 main reasons.

  1. The structures in the knee are overloaded
  2. Misalignment of the body

This occurs when a cyclist’s Q-factor is off, seat too high or seat too low. A cyclist’s Q-factor refers to the distance between the bike’s pedal points to the crank arms.

knee cycling injuries


What does the bike’s Q-factor have to do with knee cycling injuries?

How the Q factor relates to knee pain, is that when the rider’s hips are too wide in relation to the pedal width, the rider tends to drop the hips or collapse the knee inwards in an attempt to complete the downstroke. This will place uneven stress on the soft tissue of the lower limbs, potentially causing knee pain.

4 types of knee pain

We will analyse knee pain that occurs on the 4 sides of the knee – the front, inner side, outer side and back of the knee.

Front of the knee pain

Structures that can be potentially injured at the front of the knee are the quadriceps or the patella tendon. If the kneecap tracks well down the notch, the stress placed on the knee joint will be even. However, when the knee joint is pulled out of alignment, there is increased pressure on one side of the cartilage, causing knee pain. Over time, pain or inflammation can cause swelling to flow down and irritate the patella tendon

If the bike’s seat height is too high or too low, the body overcompensates for this misalignment by working the quadriceps a lot harder than it should. This can cause microtrauma, inflammation, and in some cases, tendinopathy.

Pain on the inner side of the knee

The most common structure to be irritated in the knee is the pes anserinus. The pes anserinus is a combination of 3 different muscles converging up to a point. This irritation occurs when the knee collapses inward during the downward stroke, increasing pressure on the passive and active structures of the middle side of the knee, causing pain

Outer knee pain

A common cause of pain at the outer side of the knee is ITB friction syndrome. The ITB usually gets irritated when there is a different plane of motion at the knee. When there are forces whipping the knee into an inward plane of movement, accompanied by a training volume or intensity that is too high. With repeated movements over time, this will develop into ITB friction syndrome.

Pain at the back of the knee

Pain at the back of the knee is an uncommon complaint and the cause of this is likely to be related to the Poplieteus muscle.
Caused by excessive internal rotation of the foot, whose forces travel up into the knee joint. The poplietus muscle’s role is to control rotation at the knee. As it is a small muscle it tends to get irritated easily.

Another possible reason would be hamstring tendon injuries. They tend to happen when the seat height is too high or too low, causing excessive movement in the knees when the hamstrings repeatedly unlock the knee joint. This places the hamstrings in an extremely lengthened/shortened position, and accompanied with excessive load, this causes pain.

Seek physiotherapy help for knee cycling injuries

We hope this article has helped you to understand a little bit more about knee pain when it comes to cycling. Riding a bike should be enjoyable, and some aches are a part of the game when going for long distances. However, riding a bike should never be painful. If you are experiencing knee pain from cycling, do make an appointment to get it checked out by a physiotherapist.