Why Do My Knees Hurt When I Bike?

by Michelle Stampe

EndurElite products can do amazing things for cyclists. It’s the real deal.  

But here’s the skinny: the stuff isn't magic, and it can’t fix everything—especially when it comes to knee pain.

man grabbing knee in pain

Identifying Knee Pain

Knee pain is a huge issue for cyclists, with 23% of elite cyclists reporting knee pain in the last year. And anything that keeps nearly a quarter of cyclists off their bikes is a problem worth fixing from our perspective. Luckily, under normal circumstances, it’s totally preventable.

While it is true that riding a bike is objectively good for you, and is easier on your body than a sport like football or hockey, that doesn’t mean cyclists don’t deal with overuse injuries. 

One of the best ways to prevent injury is to recognize discomfort early on, before it becomes a debilitating or chronic issue.

If you’re experiencing knee pain, try a little self diagnosis using these bike fit rules of thumb.

1. Your Bike Seat is Too Low: Patella Pain (anterior)

Anterior knee pain is common, and occurs around your patella or just below the front of your knee. Anterior knee pain usually occurs when your saddle is too low or too far forward.

This forces your quads and/or the fibrous tissue that runs alongside the outer leg (commonly called the IT band), to pull on the patella in an odd way, which can lead to painful tendonitis.

Ideally, you should have a very light bend at your knee during the lowest point of a pedal stroke. Anterior knee pain is also associated with mashing big gears, making single speeders particularly susceptible.

If your saddle height is set correctly and you’re still experiencing anterior knee pain, try riding in a smaller gear with a higher cadence for a month.

2. Your Bike Seat is Too High: Back of Knee Pain (posterior)

Pain behind the knee is almost always associated with overextension.

If you have to dip your toes or rock your hips to complete a pedal stroke, you’re likely over extending your knees, as well. Try lowering your seat.

By the way, if you’re rocking your hips back and forth, you might experience some lower back pain, too.

3. Your Cleats Are Misaligned: Outside Knee Pain (lateral) & Inside Knee Pain (medial)

Lateral and medial pain occur when stress is placed on the ligaments on either side of your knee. Both lateral and medial pain generally occur from misaligned cleats. 

  • Lateral knee pain is usually caused by a cleat that is too far on the outside of the shoes, giving riders a narrow stance.
  • Medial knee pain can be caused by a cleat that is too far on the inside of the shoes, giving riders a wide stance (also called Q-factor).  

If a cleat wasn’t placed in the right position from the start, or if it shifted over time, it can put extra stress on the inside of your knee (specifically, on the collateral ligament). 

If you recently purchased new shoes or pedals, cleat placement is likely the cause of your pain.

Cleats can also move with time. Check to make sure your cleats haven’t “walked” to the inside or outside of your shoes or twisted at an odd angle (the angle of your cleats is called “float”).

Ideally, your cleats should help keep your knees pedaling on a vertical plane, with very little or no lateral movement.

Professional Bike Fits: Not Only for Pros

All pro riders get bike fits. Lots of amateurs don’t bother. They assume that the bike fits them just fine or that they don’t ride enough to notice. 

Then, when they start challenging themselves with harder, longer rides, they end up in a lot of pain. Sometimes they even suffer completely avoidable injuries. 

The deal is, bike fits are for everybody. Pros, enthusiasts, weekend warriors, and fresh faces all deserve a comfortable ride. And most fits are affordable (especially when you consider the cost of an injury). 

Do your knees a favor and ask your local shop, sports medicine doc, or physical therapist about a professional fit.

Ride without pain!

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