Knee Pain: A Vicious “Cycle”

Posted by Dr. Chris Oswald on 2016-05-31


When you properly stretch before your ride, your bicycle is set up properly and you pick a great trail to ride, not much beats the fun exercise that cycling can deliver. Unfortunately, even the better prepared cyclists are susceptible to knee pain. The stress on the knee can be considered good stress and much like the work of Dr. Robert Salter “continuous passive movement” cycling stimulates cartilage cell growth and actually improves osteoarthritis and degeneration in the knee and hip joints.

Although cycling can cause many muscle and joint aches and pains, no joint in your body is under more stress that your knees. In fact, the stress involved has made knee joint pain is one of the most common complaint and injury prone area involved in cycling.

The complexity in the structure of the knee makes it very difficult to diagnose exactly what is causing discomfort in that area. Many cyclists will improperly self-diagnose their cause of discomfort or knee injury. Due to the fragility of the human knee, when the pain gets to be too intense it’s best practice to seek medical attention.

Knee Joint Pain Caused by Cycling


When cyclists push themselves too far, they are more likely to come into more knee related issues. After longer rides, the continual contractions of the quadricep muscles will make the tissue tighter, which in turn will lead to minor muscle pulls around the knee area.

Anterior Knee Pain

The overuse of the area around the kneecap can also result in patellofemoral pain syndrome or chondromalacia patellae. In these circumstances, the area under surface of the knee cap or patella becomes inflamed, typically due to  tightness or weakness in associated muscles causing the kneecap to move in a way. Irritation and inflamation in the cartilage at the back of the cap can occur when the kneecap rubs against the bones behind it. Other common issues occur in the suprapatellar bursitis and infrapatellar bursitis as well as quadricep tendonitis resulting in retro patellar pain like chondromalacia which is often referred to as “runner’s knee”. Also, if the rider is bowlegged this would place more stress on the outside of the knee.

Knee bursas are small fluid-filled sacs or cavities that by design are meant to prevent friction of the kneecap to the surrounding bone and tissue. They allow muscles and tendons to slip over bones and areas of ligaments. With many bursa in the knee, there is a higher likelihood of them becoming a problem with overuse.

Bursitis, as this inflammation is called, can vary in degree from mild irritation to an abscess formation that causes excruciating pain. Signs and symptoms are tenderness, swelling with redness over the affected bursa, pain on movement, and limitation in the movement of the knee.

* Note if you are a pronator (Under and overpronators have an ankle that rolls inwards when they’re running or cycling, usually due to having flat feet) when walking you will generally overpronate or roll in when cycling and this alters the tracking of the patella on the femur causing grinding which causes the cartilage to wear down causing pain generally on the inside the set of the patella. If you use orthotics when walking use continue to use orthotics or arch supports when cycling.

Medial and Lateral Knee Pain

Lateral knee pain is much rarer, however the pain on the outside of the knee generally stems from an existing sciatic or lower back problem or issues in weakness in the gluteal muscles both of which can cause referred pain down the side of the leg through the iliotibial band to the knee. Again, if the rider is bowlegged this would place more stress on the outside of the knee.

Medial knee pain also results from the rolling in of the ankle wherein the fastest medialis and adductor muscles contract to resist the rolling in placing strain on the medial collateral ligament and eventually the medial meniscus. This end result of this leads to a reduction of blood supply or removal of lactic acid xcetera and nerve compression which leads to pain when you cycle do your best to keep your knee over the foot in a straight line to minimize stress in this area.

Posterior Knee Pain

In 28 years as a chiropractor and as an avid cyclist I’ve found that one of the most common fundamental causes of lower body and knee pain in cyclists is actually a small muscle on the outside of the hip called the posterior glutmedius. When the leg bends at the bottom of the pedal stroke the lower half hamstring and the popliteus muscle contract and literally strangle the nerves and blood vessels causing calf swelling and significant posterior knee pain. Because gluteus weakness is a very common issue in the general population and can cause more stress on the knee and general especially the posterior knee it is important to work on glute activation exercises. This muscle is quite important for stabilising your hip and preventing your knees rolling inwards, and when weakened it can be the cause of many painful problems, including medial knee pain, anterior knee pain and even lower back pain.

In summary, knee pain caused by cycling boils down to usually one point – you’re overdoing it!

How to Avoid and Overcome Knee Pain Cause by Cycling

Cycling is a healthy means of exercise and fun. When pain is involved many people tend to ditch the bicycle. If you are thinking of storing your bicycle in the back of your garage we urge you to consider the following measures in overcoming and preventing further knee joint pain caused by cycling.

Proper Cycling Stretches

It doesn’t matter if you are simply biking to work or travelling small distances for recreation, pain caused by cycling doesn’t discriminate.  Long periods spent a spin class, or long triathlons demand stretching beforehand in order to improve performance and serving as a preventative measure to the pains involved in cycling.

Before and after you take your bicycle out for a spin, it’s always very important to stretch properly. Here are six rules to stretching successfully.

1. Warm up (walk on the spot for 1-5 minutes)

2. Hold each stretch one repetition for 30 seconds

3. Do not bounce (Hold in a comfortable position)

4. Try to be gentle (No pain)

5. Breathe deeply

6. Stretch both sides equally


We urge you to look at this complete guide of Cycling and Mountain Biking Stretches and Knee Burstis Stretches

Adjusting the Bicycle

Before you set up on a cycling expedition, ensure that your bicycle is adjusted properly. Implementing the following adjustments can decrease your knee pain and symptoms and make an enormous impact on performance, pain free cycling and the fun of your ride.

1. Adjust your seat so when your foot is down on the lower pedal that your leg is virtually straight.

2. Line up the bottom of the knee cap or patella (draw an imaginary line/downward) so you knee is placed over the ball of your foot with the pedal at 3 o’clock and then slightly bent with the pedal at 6 o’clock. The line from the patella down stops between the second and third toe where the toes join the feet.

3. Place your hands on the handlebars and ensure your spine up to the neck is straight and there is no kink at base of neck at shoulder level.

Pain Relief

Drugs may reduce the pain and can be used in cooperation with chiropractic care but drug therapy alone will not provide the patient with an understanding of cause and the complex biomechanical issues that often exist. We strongly recommend an assessment and an explanation from a licensed chiropractor to help patients understand their own genetic blueprint or injury.


Muscle care roll on is a great option to use before and after longer rides and serves as an excellent means to minimizing muscle contraction and inflammation. Its portability makes it great to take it with you on your ride to reduce contractions and enhancing performance.

One scientifically proven method of relieving knee joint pain is using MuscleCare and its topical pain relief formula. It’s all natural formula means it’s safe to use and its doctor developed and tested formula provide effective knee pain relief as well as any other muscle and joint pain that comes with cycling. In combination with chiropractic treatments, proper cycling ergonomics and cycling stretches, Musclecare is proven to make a difference to your struggle with the chronic pain in your knees.