How to Prevent and Treat the Knee Pain from Cycling

knee painI recently began mountain biking again after more than ten years away from the sport. My knees immediately began bothering me. Knee pain during or after biking can have a number of causes. After hours of research and a trip to my doctor, I learned a lot about how to prevent and treat the knee pain I experienced. If you want to have healthy, pain-free knees and be able to enjoying biking, here are some recommendations.

How to prevent

The best way to deal with knee pain is to prevent it in the first place. By stretching and warming up prior to exercise, you will prevent injuries caused by overstressing tight muscles and tendons. Before you begin biking, start doing exercises at home to gain flexibility in your knees, ankles, and hips. You should concentrate on the muscle groups on all four sides of the knee – front, back, inner, and outer knee. Follow your stretching with some light exercises to tone the muscles. Begin this regimen four to six weeks prior to the beginning of biking season. This will allow you to build up strength and flexibility over time so that your body isn’t prone to injury when you get back on the bike again.

Here are a few warm-up stretches you can do prior to each ride, and afterward as a way of cooling down. When stretching, remember not to bounce. Just hold the stretch gently. The idea is to give the muscles time to ease into a workout slowly.

The first exercise will warm up the thigh muscles, which are important in biking. Stand with your feet shoulder width apart, with a chair or table behind you. Lift one foot and place it on the chair, so that are standing on one leg, with the other bent behind you and the thigh pointing straight down. Slowly rotate your hips upward until you feel a stretch on the front of the thigh. Hold it for 30 to 60 seconds. Then switch legs. Repeat three times.

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To stretch your calf muscles, stand in front of a wall with one foot forward of the other. Keep your heels on the floor at all times. Place your hands on the wall and bend the front knee forward until you can feel a stretch in the calf of the back leg. Do not bounce. Hold the stretch for 30 to 60 seconds. Then repeat with the other leg. Do the exercise three times for each leg.

The hamstrings get tight if they are not stretched. To warm them up, lay on your back on the floor with one leg elevated and bent at a 90 degree angle from your hip. Next, raise your foot, bending just from the knee, until you begin to feel the stretch along the back of your leg. Hold the position for ten seconds, and then do the other leg. Repeat the exercise ten times. You will find that you will be able to stretch further each time as the muscles warm up and gain flexibility.


Bicycling is a low-impact sport, but there are other stresses placed on the body by the repetitive nature of the activity. One of the most frequent causes of knee pain is improper bike fit. If you think of the bike and rider as a machine, you will see that physics has a lot to do with how efficiently the rider’s efforts move the bike forward. When a machine has a part out of alignment, the usual result is that something breaks. This analogy applies to biking. When the rider’s knee is improperly aligned, this can cause excessive stress and lead to pain or injury. The knee makes hundreds of revolutions during each mile of riding. In the course of an hour, your knee can make over 5,000 revolutions. Bicycling thus creates repetitive stress on the knee joint. Over time, this can lead to overuse injuries.


If your saddle is set too low, your knee will be forced to bend too much during the down stroke, which can lead to pain in the front of the knee, below the patella (kneecap). To achieve proper fit, sit on your bike and put one leg on the pedal in the lowest position. Measure the angle of bend at the knee while the leg is thus extended. The angle should be no more than 25 or 30 degrees. Test it by riding a short distance. If your hips rock back and forth with each stroke, then you need to adjust the saddle height lower until they no longer rock. With proper saddle height, knee pain should be reduced.

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Your saddle should also not be set too far forward or back. If your saddle is back too far, you will be forcing your legs to stretch forward to reach the pedals, leading to an inefficient down stroke with little power. This also places stress on the knee and can lead to pain. To properly set the saddle distance, sit on the bike with your foot on the pedal, and with the pedal in the 3 o’clock position. You may need to have a friend help you with this one. Take a piece of string and hold it on your kneecap. The other end of the string can be weighted down by tying it around a pen or other small object to get a good straight line. Drop the weighted end of the string and see where it comes to rest. If it is above the pedal axle, where the ball of your foot normally sits, then you have proper saddle distance. If not, then you should adjust your saddle forward or backward until the string intersects the pedal axle correctly. This adjustment should help in decreasing your risk of knee pain.

Foot position

Improper foot position on the pedals can also lead to knee pain. Make sure your foot is positioned so the ball is over the pedal center axle. This gives you the most efficient and powerful stroke. Your foot should not be turned outward or inward on the pedal as this causes rotation in the knee. Over time, this rotation, combined with downward force on the knee, can lead to pain and injury. Keep your toes pointed forward on the pedals. Be aware of the tilt of your foot as well. Tilt inward or outward at the ankle will lead to pain. Keep the foot straight and level when pedaling.

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The knee joint is a very complex one. Muscles, tendons, bones, ligaments, nerves, and fluids all work together to bend the joint and move you around. If there is inflammation or deterioration in any of these structures, you will likely experience pain.

The patella, or kneecap, is attached to the quadriceps muscle, which is the large muscle on the outer thigh. If the quadriceps is weak, such as from a lack of training, the patella may not track correctly, which can lead to pain. This is the type of pain I experienced when I tried to get back into biking after a long absence. The solution was to build up to a higher level of training gradually. My quadriceps muscles needed some time to build up strength and flexibility. Start by riding on more level trails and roads at first. Give this some time, as muscle tissue doesn’t build up quickly. After six weeks of riding on the shorter, easier routes, you can begin to introduce more difficultly. Add some small hills and inclines to your route, and increase your distance gradually. Try not to push the low gears when you first get back on the bike. Warm up to them over time. If you try to push too hard before your body is ready, you are more likely to cause injury. A gradual build-up to longer rides and more difficult routes will help prevent knee and other injuries and the associated pain.