Bike Fit and Knee Pain

Bike Fit and Knee Pain

Knee pain is the second most popular injury experienced when riding a bike. Pain in the low back, pelvis, sacrum is reported as being the most popular, however statistically knee pain has a nasty habit of hanging around longer causing people more days away from the bike to heal. Since re-opening following the Covid-19 virus shut down, 80% of my bike fit clients have reported some type of symptom located around their knee(s).

This is not uncommon, as the literature shows knee pain while riding is most prevalent at the beginning of the year and usually tappers off as the season progresses and our soft tissue tolerance to abuse goes up. I wanted to give the Trirudy community a list of some of the most common knee injuries I see in cyclists and discuss in depth, what to look for and perhaps what one might do to help alleviate those symptoms in the number one knee injury that accounts for 50% of all cycling related knee pain.

Patella femoral pain syndrome is by far the most common knee injury I see in clinic related to cycling and overuse followed by patellar tendonitis, pes anserine bursitis and finally IT band friction syndrome.
Patella femoral pain syndrome is an inflammation of the joint where the back of the knee cap, rubs awkwardly against the front of the femur.

If you are experiencing pain around the knee cap here is what to be on the lookout for regarding your bike fit:

  1. limited knee extension at the bottom of the pedal stroke: a saddle that is too low will increase pressure on knee due to excessive knee bend at the bottom. Try raising the saddle in 2-3mm increments
  2. poor knee alignment observed from the front, particularly knees dropping in: causes more stress in the knee because the knee cap will track poorly against the front of the thigh bone: Try sliding the cleat on the bottom of your shoe towards the small toe, this will help bring your foot better underneath the knee
  3. flat feet (admittedly hard to observe while riding in cycling shoes): If you know you have flat feet or perhaps already wear a custom orthotic inside your running shoes, this might be something to consider as a source of your knee pain. Try rotating your cleat on the bottom of your shoe 1-2 degrees to bring your heel a little closer to the crank arm, alternatively slip a pair of over the counter arch supports into your cycling shoes, this will allow for better hip, knee, ankle mechanics
  4. tight hamstrings: does not allow for enough knee extension at the bottom of the pedal stroke causing increased knee pressure due to excessive knee bend under load. Diligently stretch your hamstrings, think frequent, low intensity, long hold (2 minutes minimum)

If you have any questions, are experiencing knee pain while riding or have never had a bike fit do not hesitate to reach out, happy to help any way I can.

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