Cycling Knee Pain: Causes And Treatment


It is not uncommon for cyclists to feel a sharp twinge in one or both knees. Affecting both professional and beginning bike riders, cycling knee pain can make a biker hate getting on his/her bike.

Cycling-related knee pain often results from over-use injuries. If a biker rides harder and/or longer than his/her body is conditioned to, he/she may end up straining the connective tissues, causing inflammation and pain. 

The good news is that knee pain from cycling can be easily fixed. All you have to do is figure out the exact position being affected by the pain and then implement the necessary solutions. In this guide, we will discuss the knee zones that are commonly affected by knee pain. We will also show you the solutions you can use to eliminate the pain. 

Causes and Treatment of Cycling Knee Pain 

Knee pain from cycling affects 4 main areas – the posterior, anterior, iliotibial band, and medial/lateral zones. Our guide will take a deeper look at all these zones:

1. Anterior Knee Pain 

Affecting the front of the knee (on and around the patella or knee-cap), the anterior knee pain is the most common symptom of cycling overuse injuries. In part, this is because of the anatomy of this knee area. 

The huge quadriceps muscles attach to the rider’s shin bone via the patella. For this reason, the pedaling forces are transmitted across your patella-femoral joint every time you bend your knee. This means that the force gets squashed back against your thigh bone. 

Anterior knee pain from cycling results from a condition known as patellar compression syndrome. The scourge of both runners and cyclists alike, the condition can completely floor you, causing a lot of pain when you are off your mountain bike and ride-stopping agony when riding your budget road bike

When pushing the bike’s pedals, riders seldom complete the last thirty-five degrees of the knee extension. Over a long period, the muscles down the thigh’s outside become tighter and stronger than the less used medial muscles. The patella (knee cap) gets subtly pulled off-kilter and forces through the rider’s patella-femoral joint increase, leading to pain around the knee cap. 

How to Fix Anterior Knee Pain 

The key to eliminating anterior knee pain is to loosen the lateral structures around the patella before trying to build the medial muscle bulk and redressing the balance. There are various ways of achieving this, all of which focus on reducing the forces through the rider’s patella-femoral joint. Below, we have outlined the best treatments: 

  • Whenever possible, try to keep your legs straight. 
  • Use an ideal bike seat height. This will encourage your leg to straighten out fully when pedaling. 
  • Regular cycling stretches that focus on your leg. Also, massage the affected knee regularly. 
  • After a week of stretching and massages, work to build up your Vastus Medialis Oblique muscle. This will help with balancing out stabilizing forces on your patella. 
  • For resistant cases, consider visiting a physiotherapist. A good sports physio can work specifically on mobilizing your tight lateral tissues around your patella.

2. Posterior Knee Pain 

Pain behind the cyclist’s knee is not very common. However, in almost all cases, it is caused by over-extending the knee. Some of the bike-specific problems that could cause the posterior knee pain include a bike saddle that is too far back or too high. 

From a bike fit point of view, when the MTB saddle is too high, the leg muscles can get very tight and the knee can’t cope with the degree of flexion. Your hamstrings are being pulled – you will end up getting pain in your hamstrings where your muscles insert around the knee. 

Another cause of the posterior cycling knee pain is the popliteus muscle, a muscle that sits across the back of your knee. If you fail to optimize your round pedal stroke, you can put it under too much stress, causing irritation. 

How to Treat Posterior Knee Pain 

Once you find out that you are dealing with posterior knee pain, the first thing you should do is adjust the saddle height and fore/aft. Ensure that it is not too far or too high. After adjusting the seat height, use the solutions below to treat the pain: 

  • Ice the posterior part of the knee for 5 minutes every hour. 
  • Foam roll and stretch your posterior chain – that is, the glutes, calves, and hamstrings.
  • Stretch your leg – For example, shifting forwards on your hardtail mountain bike and hanging your feet off the mountain bike pedals for about 10 seconds can help stretch your hamstrings and calves.  

3. Lateral and Medial Knee Pain 

Lateral knee pain is on the outside of the knee while medial pain is felt on the inside. Pain on the knee sides and inside is fairly common for cyclists. The culprits, in most cases, are the clipless pedal cleats. Lateral and medial knee pain is often noticed after or during the first ride with cleats, or with a new pair of biking shoes or replacement of cleats. 

The body structures that cause the pain are, in most cases, the collateral ligaments, which sit outside the knee joint, keeping the knees from bending the wrong way. Badly placed cleats affect the Q angle – that is, how far apart the rider’s feet are positioned – or cause excessive rotation of your knee joint, stressing the collaterals. 

Riders deal with lateral cycling knee pain if the cleat is too near the outside of their shoe. It also results from a decreased Q angle.

Medial knee pain, on the other hand, results from the cleat being too near to the shoe’s inside. It is caused by an increased Q angle. 

How to Treat Lateral and Medial Knee Pain 

The best way to fix lateral and medial knee pain is to adjust the cleat position on your pedals. You must ensure that the cleats are set up straight. If you are new to cleats, one tip for getting an ideal starting position is sitting on the edge of a table with the knees, ankles, and hips relaxed at 90 degrees. Look down: the angle at which your feet naturally dangle should be replicated on your cleats. 

Additionally, you will need to check the cleats for excessive wear regularly. Use a felt pen to mark the position of the cleats before replacing them, and be sure to experiment with various types of cleats until you find one that features the right amount of float for you – too much or too little can lead to problems. 

Some of the treatments you can use to fix the lateral and medial knee pain include: 

  • Stretches – these should help your collateral ligaments get back in shape. 
  • Limit physical activity until the swelling (if it is there) and pain is gone. 
  • Use a knee immobilizer (brace) or crutches to protect the knee. 

4. Iliotibial Band Pain 

Closely related to the patellar compression syndrome, the iliotibial band pain results from a condition with a similar name – the iliotibial band syndrome. The iliotibial band is a fibrous strap of thick tissue running down the lateral thigh, from the pelvis below the knee. This structure tightens up over time, pulling the knee cap (patella) off the center if the VMO – Vastus Medialis Oblique – muscles are not strong enough to counteract. 

Because of its location, as the knee is bent and straightened repeatedly, it keeps moving back and forth over the knobbly end of the rider’s thigh bone just above the knee. Although the knee is cushioned by a fluid-filled bursa, it is during the motion that the inflammation occurs. The injury is then irritated every time the rider bends his knee.

This unpleasant knee pain from cycling is thought to be exacerbated by the gluteus medius muscle weakness – another important core muscle that gets neglected by mountain biking – and also by wearing cleats that point too far inwards. 

How to Treat Iliotibial Band Pain 

In the acute stage of the iliotibial band syndrome, the most effective treatments include: 

  • Rest
  • Icing 
  • Regular anti-inflammatory medications – for example, Ibuprofen
  • Near-religious stretching, especially of your iliotibial band, which should precede your strengthening exercises. 

After this, rehabilitation is very similar to the one we had described in the patella compression syndrome section. However, you will need to put more focus on building up your gluteus muscle instead of – or as well as – your Vastus Medialis Oblique. 

A return to normal biking trips should be phased in gradually, being guided by a lack of pain. Do not use your touring bike for long bikepacking trips until you feel that your knee doesn’t have any pain. In the case of very resistance cases, your knee may need to be operated on – however, this is rarely required if you follow the tips described above. 



Q: Is It OK to Cycle with Knee Pain?


If you are dealing with too much knee pain, cycling may not be wise. You will feel too uncomfortable such that your biking trip will feel much like a punishment – in such a scenario, you should rest up and wait for the pain to go away. If the knee pain is minimal, you can cycle – however, fix all the bike issues that may be contributing to the knee pain before going biking.

Q: How Do I Stop My Knees from Hurting When Cycling?


To keep your knees from hurting, you need to ensure that your bike is fitted for your body. For example, ensuring the saddle is not too high, too low, or too far back will help you avoid posterior knee pain. Ensuring the cleats on your pedals are set properly will eliminate lateral and medial knee pain.

Q: Why Do My Knees Hurt After Cycling?


Knee pain from cycling is often a result of overuse injuries. If you ride your commuter bike harder and/or longer than your body is conditioned to, you may end up straining the connective tissues on your knees, causing inflammation and pain. Also, having an improperly fitted bike can cause knee pain – for example if the bike seat is too high, you may end up dealing with posterior knee pain.

Q: Can Cycling Cause Knee Problems?


Yes, cycling can cause knee issues. Two main knee problems that result from cycling include the patellar compression syndrome and iliotibial band syndrome. The patellar compression syndrome is associated with the patellar (knee cap) being pulled off-kilter and forces through the patella-femoral joint increasing when riding a bike. The iliotibial band syndrome results from the iliotibial band becoming inflamed by cycling.

Q: Is Stationary Biking Good for Bad Knees?


Stationary biking will be good for the knees if your bike trainer is set up correctly. For example, if the trainer’s seat or pedal cleats are not optimized for your body, you may end up worsening the pain in your already injured knees.

Q: Is Cycling Good for Strengthening Your Knees?


Biking is one of the best exercises for strengthening the knees. A routine of bicycling will keep your knees moving through their motion range. At the same time, pedaling will strengthen the muscles that support the knees. It is important to note that you will only get these benefits from cycling if your bike is fitted properly – the seat height and fore/aft location should be ideal and the cleats on your pedals should be set up correctly.

Globo Surf Overview 

Although cycling is a sport featuring almost zero impact forces – provided you do not fall off – and a very predictable pattern of movement, people still suffer from cycling knee pain. Although overuse injuries are the leading causes of knee pain from cycling, bike fit is also a major cause of the pain. If the saddle and pedals are not adjusted to fit the rider perfectly, he/she will end up exerting the wrong motion range on the knees, leading to inflammations, injuries, and the accompanying pain. 

This article has the solutions you can use to stay knee-pain free. Keep in mind that prevention is better than treatment. Hence, always take the necessary precautions when riding your aluminum road bike.

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Globo Surf
My name is David Hamburg. I am an avid water sports fan who enjoys paddle boarding, surfing, scuba diving, and kite surfing. Anything with a board or chance I can get in the water I love! I am such a big fan I decided to start this website to review all my favorite products and some others. Hope you enjoy!