Cycling Knee Pain – Treatment for Knee Pain from Cycling

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Cycling is known as an aerobic exercise using the large muscle groups of the lower body. It is considered a low impact exercise and recommended for weight loss and patients with joint pain issues.

A regular 30- minute of cycling is known to help meet cardiovascular goals. Cycling is also considered as a recreational activity that helps you burn calories and exercise the lower body as well.

Cycling, being a low-impact aerobic exercise, has several benefits for the body and mind such as the following.

  • Joint mobility
  • Muscle strength and flexibility
  • Reduced body fat
  • Cuts heart disease and cancer risk
  • Reduced stress levels

It is considered better than running as the latter puts more pressure on the joints. Cycling is also being promoted as a healthier alternative to travel as it is environment-friendly and a cheaper mode of transport.

Globally, organizations are encouraging people to use cycles to travel to work. The several benefits of cycling, either as a recreational activity or an exercise, make it a highly considered activity among all age groups.

Arthritis patients are known to be recommended cycling as it helps the heart without putting stress on the leg joints and the back.

However, as with all other exercises, cycling is also associated with injuries. These injuries could be because of improper technique or a sudden increase in intensity and duration. The right equipment used for cycling can avoid most of these injuries.

It is important to understand the cause of cycling knee pain for proper management and treatment.

Muscles that Used for Cycling?

Anatomical features play an important role in assessing the reason for cycling knee pain. Therefore, it is necessary to understand the muscles that are involved in cycling.

The power for cycling is provided by the cyclist’s legs. The repeated action of cycling is carried out by the muscle attached to the shinbone and the thighbone.

The pedaling action is made possible by the contraction of the soleus and gastrocnemius muscles in the calf as well as the hamstrings and quadriceps in the upper leg.

The contraction of the muscles requires an energy source, which is provided by adenosine triphosphate (ATP). The production of ATP is a result of aerobic exercises, which make the muscles draw on oxygen along with the fatty acids and glucose carried by the blood.

The ability to continue aerobic exercises depends on the muscles being delivered oxygen, glucose and fatty acids, which is further dependent on respiration and circulation.

Individuals with a thighbone longer than the shinbone have an extra leverage on each pedal stroke, with the thighbone working as a lever. However, the length of the thighbone depends on genetics. (1)

Can Cycling Cause Knee Pain?

Knee pain is a common complaint among cyclists. As the knee joint is actively worked throughout the activity, it becomes prone to injuries.

Improper equipment and training techniques are known to be the most common causes of knee pain. However, several anatomical features can also make an individual prone to knee pain.

Cycling Knee Pain: Causes

Improper equipment’s, improper training techniques and sudden change in anatomical features can lead to knee injuries that may trigger the knee pain.

Improper Equipment

Cycling is an interaction between an individual and a machine. An improper stress due to misalignment can result in knee pain for the cyclist.

The following bike set up positions could result in pain and injuries.

  • Wrong cleat rotation is known to cause medial and anterior knee pain as it increases the rotational forces on the knee.
  • The knees can be stressed because of a large crank arm length.
  • A too low or too high saddle height can cause knee pain. Similarly, individuals with the saddle too backward or forward are also susceptible to knee pain.

Setting up the equipment based on your height and flexibility is the first step to avoid such injuries.

Improper Training Technique

Increasing the intensity and duration of the activity suddenly can increase the chances of knee pain.

Over training can damage the joints and result in pain and cramps. Muscle flexibility and strength should be improved before increasing the intensity.

Anatomical Features

A sudden change in activity levels could put an individual at risk as a sedentary lifestyle reduces muscle flexibility and soft tissue quality. When such an individual starts cycling, the low muscle flexibility can pose as a risk for cycling knee pain.

Individuals with flat feet could put an excessive stress on the iliotibial band of the knee resulting in knee pain. Also, a discrepancy in the leg length can put the ill-fitted leg in a stressful condition leading to knee and hip pain.

Women are known to be prone to suffer from hip and knee pain because of their wider hips. This makes them more susceptible to ACL injuries during cycling. (2)

Identify the Site of the Knee Pain

The different sites of pain during cycling can indicate the cause, post which management of the condition can be recommended.

Pain at Front of the Knee

Cycling knee pain at the front of the joint can be a result of several conditions such as chondromalacia, patellar tendinosis, patellofemoral pain syndrome, and quadriceps tendonitis.

Chondromalacia Patellae

Chondromalacia is also known as ‘runner’s knee’. The condition is characterized by pain at the area behind the knee cap. 

It is also known as patellofemoral pain, with a grinding sensation accompanying the pain. The condition usually aggravates due to activities such as squatting and climbing.

The condition is a result of the cartilage on the patella’s undersurface deteriorating. The deterioration is caused by an abnormal rubbing between the kneecap and the thighbone.

Chondromalacia could be a result of a direct blow to the patella or repeated stress to the area, for e.g., during cycling.

The cartilage damage is known to repair itself with rest and conventional home remedies.

As flat foot individuals are prone to suffer from this condition, shoe inserts to increase the arch can avoid Chondromalacia. (3)

Patellar Tendinosis

This condition is a result of an inflammation of the tendon connecting the shinbone and the knee cap. It is also known as Jumper’s Knee.

The pain is usually felt at the base of the knee cap, sometimes accompanied by a burning sensation and swelling. Initially, the pain is present after cycling but with more damage to the tendon, the pain is noticed during daily activities such as climbing stairs.

The condition is a result of wrong cleat position and soft-tissue restrictions of the hips and legs. The repetitive stress on the knee from cycling can result in tiny tears in the tendon.

The most common causes include improper shoes, misaligned legs, and tight leg muscles.

The treatment includes a physical therapy program to strengthen the thigh and leg muscles. Eccentric exercises performed on a decline board are known to relieve pain and inflammation. (4)

Quadricep Tendinosis

A degeneration of the quadriceps tendon can result in pain at the top of the kneecap. The pain could be present during and after cycling.

The quadriceps muscle inserts at the top of the kneecap, therefore the pain can also be accompanied with stiffness for the cyclist. It is extremely important to consider quadriceps tendinosis if the site of pain is above the kneecap, as the condition could deteriorate gradually.

If detected in the initial stages, the recovery period is said to be two to three months, which increases to six months in the later stages.

Stopping the activity immediately when the pain is noticed is imperative to avoid further damage to the area. Conservative treatment is known to provide relief and help improve the recovery process.

Patellofemoral Pain Syndrome

Increased stress between the patella and the femur can result in degeneration of the cartilage on the patella. The pain is known to be felt at the center of the kneecap and is prominent usually after exercise.

The condition is a result of muscular dysfunction or soft-tissue problems that lead to an abnormal movement of the patella.

Physical therapy focused on the iliotibial band and quads can help improve the healing process. (2)

Pain at Side of Knee

Improper equipment setting and anatomical features play an important role in detecting conditions that can cause pain at the inner and outer side of the knee.

Medial knee pain, which is at the inner side of the knee, can be because of mediopatellar plica syndrome and pes anserine bursitis. Incorrect saddle height could cause such conditions.

Mediopatellar Plica

The knee flexion activity during cycling can cause the plica to intrude on the femoral condyle. This can result in inflammation at the medial side of the knee.

The signs of this condition include locking of the knee, with pain aggravated by sitting, standing, and climbing.

Medical intervention should be recommended if the condition does not improve in six months.

Pes Anserine Bursitis

Knee bursae are small sacs that prevent friction between the muscles and bones. The pes anserinus area contains three conjoined muscles on the tibia. Inflammation of this bursa is know as pes anserine bursitis.

The pain noticed in this condition is a result of overuse or repetitive action of the knee, such as cycling. Along with pain, the condition is also characterized by swelling and tenderness.

Conservative methods, as well as physical therapy, can relieve the symptoms.

Iliotibial Band Syndrome

The inflammation of the fascia of the iliotibial band can result in pain on the outside of the knee. The condition can also cause a tight and painful outer thigh.

The iliotibial band is a layer of connective tissue situated from the hip to the knee. The iliotibial band syndrome is a result of repeated rubbing on the femur’s lateral epicondyle.

Additionally, the condition is also known to be a result of leg length discrepancy, incorrect saddle positions, and inflexible leg musculature.

Physical therapy can help offer relive the pain and inflammation.

Pain at Back of Knee

Biceps tendinosis is known to be the cause of pain at the back of the knee. However, it is a rare occurrence in cyclists.

The condition is usually a result of improper saddle positioning, which can aggravate the biceps tendon. The correct saddle height is important to prevent posterior knee pain.

This pain could also be a result of leg length discrepancy and excessive internal rotation of the cleats. (2)

Cycling Knee Pain Treatment

Knee pain indicated during or after cycling can be relieved with conservative methods and physical therapy. The self-care options can be used as the first line of treatment.

However, it is important to understand the condition that is causing the pain as proper management is necessary to treat the underlying cause.

For Immediate Pain Relief

The following treatment options can be used as the first line of treatment. However, as the condition could be a result of a combination of factors, it is important to assess the cause of the condition before resuming cycling.

Rest: Immediate rest is recommended after noticing knee pain. If the knee pain happens during the activity, it is advised to stop cycling and rest the knee. It is necessary to avoid cycling through the pain as it could result in further injury.

ICE: Ice, compression, and elevation can relieve pain and inflammation. Ice packs can offer relief from swelling and improve the healing process.

Medication: Painkillers such as NSAIDs can be used for short-term relief from pain. Ibuprofen is a widely used painkiller for knee pain.

Strengthening Exercises for Knee Pain

Cycling involves the core muscles, which include the abs, lower back, glutes, and hip flexors.

It is important to have a strong core to improve muscle strength and flexibility while reducing the probability of knee pain.

Strong Core

Following exercises will help you to build the strong core that will be helpful for preventing pain from cycling.

Exercise 1: Stand straight with the legs hip-width apart. Start with the left leg and arm. Raise them and try to touch the arm to the floor where the foot would be. It is important to avoid putting too much pressure on the standing knee. Repeat this exercise for eight times on each side.

Exercise 2: While lying on the back with legs at hip width, keep the legs bent at 90 degrees. The action involves pushing the legs away from you. A slight arch should be formed at the back with this action. This exercise engages the core and pelvic floor. (5)

Strong Quadriceps

Sit on the floor with a foam roller or a rolled up towel under the knee. Contract the quads to lift the foot off the floor. The action should result in a slight stretch at the front of the thigh. Maintain the position for 10 seconds and rest.

Strong Glute

A weak glute is usually the cause of cycling knee pain as it makes the quads and hamstrings take on extra pressure.

While lying on the floor, clench the buttocks and hold for three seconds. Repeat this action for 10 to 20 times a day. (6)

Lifestyle Changes

A cyclist’s diet and lifestyle also play an important role in treating knee injuries. It is important to stay hydrated during and after the activity.

An anti-inflammatory diet can help improve the healing process and relieve knee pain.

Include the following in your diet.

  • Omega 3 fatty acids found in fish
  • Leafy vegetables such as spinach
  • Spices such as ginger and turmeric

It is recommended to avoid the following in your diet.

  • Refined carbohydrates
  • Alcohol
  • Caffeine
  • Trans-fats

Other natural therapies to reduce inflammation and pain include the following.

Epsom Salt: Soaking the leg in a warm Epsom salt water can improve circulation and reduce the pain.

Eucalyptus Oil: Applying the oil to the knee joint can suppress pain and reduce inflammation. (7)

Bike Set-Up

As cycling knee pain can also be a result of improper equipment, it is important to assess the cycle to treat the pain.

Cycling should involve a smooth movement of the legs, if you need to exert too much pressure on the heels or the arms are feeling sore post cycling, it is necessary to check the bike.

The bike should be set up as per your height and fitness levels. A proper cleat positioning can avoid most of the cycling knee pain conditions.

Also, make sure the saddle and handlebar positioning is maintained as per your height

How to Prevent Pain from Cycling?

Knee pain caused by cycling can be prevented by ensuring that the body and the cycle are functioning properly.

Equipment Check

It is imperative to check if the bike is fit and is the right type for your activity.

  • Choose the right bike for your level of activity. Different bikes are available for different terrains, choose one which suits your needs.
  • The saddle height should be maintained as per your height. A too low or high saddle positioning can cause knee pain.
  • The crank arm length should not be too large.
  • A correct cleat positioning is required to avoid excessive rotation of the knee joint.

Fitness Check

A sudden increase in activity can injure your muscles. Start off with shorter durations of cycling and increase the speed gradually.

Strengthening exercises can be performed to build a stronger core, which is necessary for cycling. If knee pain strikes during cycling, make sure to avoid cycling and allow the body to rest for some time.

Stretching exercises should be performed before strengthening the muscles.

You can stretch the iliotibial band with the following exercise.

While standing straight, cross the bad knee behind the good one and lead sideways gently. The leaning position should be carried out from the waist to the good side.

It is important to ensure that the knee is locked behind the good knee. If you need support, place a hand on a wall while leaning on the opposite side. (8)

Technique Check

An improper pedaling action is usually a common reason for cycling knee pain.

Pedaling should be in smooth circles. Avoid pushing down on the pedals as it could put stress on the hamstrings and gluteus muscles.

The pedaling technique and pedal stroke should not involve the knees to be pushed outwards or inwards. (2)

Cycling is considered a good exercise for the joints and is recommended for overall body fitness. It is known to be better than running or walking as it does not exert any pressure on the ankles and knees.

However, cycling should be treated as an exercise that requires proper posture and equipment. An improper bike set up can lead to knee injuries, some of which could affect mobility for a few weeks.

Cycling is associated with weight loss, but overtraining can result in more harm than good. If you have started cycling as an activity after a sedentary lifestyle, it is necessary to gradually increase the intensity to avoid knee injuries.

It is recommended to develop muscle strength and flexibility before pursuing cycling as a physical activity.

The site of knee pain as a result of cycling is an indicator of the underlying condition. Most of these conditions can be treated with conservative treatments.

However, the duration of the healing process increases with the intensity of the injury. Therefore, it is important to rest the moment you feel knee pain. Pushing through the pain and continuing the activity can aggravate the injury and cause more damage.

Proper equipment is the vital requirement to avoid cycling knee pain. Several bike designs are available depending on the type of terrain and an individual’s need and fitness level. Choose a bike that suits your level of activity.

Maintaining a proper posture while cycling is imperative. The knees should not be allowed to bend too outward or backward while pedaling.

There are many physical anomalies that can make an individual prone to suffer from cycling knee pain. Flat footed individuals are known to be more susceptible to knee pain. Shoe inserts that arch the foot can be worn during cycling to avoid knee pain.

Overall, a stronger core can help a cyclist perform better without any injuries. Develop a stronger core with strengthening exercises.

As with any other exercise, caution and preparation will yield better results and make the activity more enjoyable.

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