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How do I stop my knees hurting when I ride?

Cyclist magazine
29 Dec 2021

A bike fit and the right kit can go a long way to addressing knee pain. The rest is up to you

The first thing to consider when talking about knee pain is that we need to look not only at kit, but at you. You’re adaptable; kit is adjustable.

So while kit can be adjusted instantly, changing you might be harder – and you might be the problem.

The knee is the most commonly injured joint for cyclists. On the plus side, riding a bike doesn’t involve eccentric forces – the ones you get from your feet landing, twisting or turning when running – which cause micro-damage to the tissues and can lead to injury.

But knee pain is nonetheless common among cyclists, too. That’s because you’re performing numerous repetitions with constant loading in a fixed position.

Your feet, hips and backside are locked in to the shoes and to the saddle, but the knees aren’t, so they have to cope with damaging stresses and loads.

Equipment is important as a potential contributing factor to knee pain (although all kit-related issues can be fixed with a proper bike fit).

Check saddle position

If your saddle is too low you can get frontal knee pain, as if you’re doing a deep squat. If the saddle is too high you’re likely to get pain at the back of the knee.

Too far forward and you’ll squash the front of the knee; too far back and you stretch the back of the knee.

Check cleat position

Cleat position is another factor – if your knee is forward of the foot it’s like doing a really long, extended lunge, which compresses the kneecap.

Our biomechanics need accommodating, and there’s a clue in the way you walk. Some of us walk with our heels and toes straight, but some people walk like ducks, with their heels in and toes out.

This is where float is crucial. If you walk like a duck, a fixed cleat will stop you dropping your heel in on the downstroke – in that case the forces go up to your knee, which can cause tightness in the iliotibial band, the connective issues on the outer thigh and knee.

Check crank length

Another thing a lot of people don’t consider is crank length. You can have a shorter crank without compromising power and performance and that’s something even the pros have been slow to grasp.

At the Rio Olympics in 2016, Team GB had a crank length of 165mm because it opens up the hips and the knee doesn’t have to travel as far.

Make sure your shoes fit right

Shoes are also important. Cycling is a sport in which you use load through your forefoot, like skiing, so get your feet assessed. Sometimes support from insoles can solve knee pain altogether.

Stretching and strength training

Then there are things you can do. A good stretching regime is important, and foam rollers and massage can help.

Sometimes knees hurt because they’re required to do everything – they take a lot of strain if you’re weak or have poor trunk stability. Can you do a one-legged squat?

If not, or if you’re very unsteady, work on your core strength to give you greater stability and take some of the load off your knees.

People also talk about pedalling technique – and they talk a lot of nonsense. It’s hard to change someone’s technique by talking to them, but you can change the environment in which they pedal.

Invariably it’s your position on the bike that’s the issue so we need to manipulate the environment, in the same way that a tennis player can manipulate their shots by tuning the strings on their racquet.

And that all comes back to finding someone who can put you straight.

If you suffer knee pain regularly see your GP or, better, a physio who understands the sport. Anyone should be able to ride a bike without pain.

The expert: Phil Burt is an experienced physiotherapist and bike fitter who spent 12 years as head of physiotherapy at British Cycling and five years as consultant physiotherapist at Team Sky. Find out more at philburtinnovation.co.uk

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