CYCLING KNEE PAIN

Cycling knee pain is nearly always an overload of one structure, caused by a position that asks that structure to do slightly too much, thousands of times per ride. Fix the ask and the structure usually settles down on its own.

The most common cycling complaint by a wide margin. Typically an irritation of the tissue behind or below the kneecap from high compressive load through a bent knee — grinding a big gear at a low cadence with the saddle too low is the classic recipe.

What usually causes it

• Saddle too low, so the knee never opens out and stays under load through the whole stroke.
• Saddle too far forward, pushing the knee ahead of the pedal axle.
• Cadence too low and gearing too big, spiking peak pedal force.
• A sudden jump in volume or in low-cadence torque work.
• Cleats set too far forward, so the ball of the foot sits behind the pedal axle centreline.

What to change, in order

1. Raise the saddle 3-5mm. Ride three sessions. Repeat once if it helped but did not resolve.
2. Move the saddle back 3-5mm if your knee sits clearly ahead of the pedal axle with the crank forward.
3. Slide cleats 2-3mm rearward, which reduces load through the front of the knee.
4. Add 10rpm to your usual cadence for a fortnight and drop all low-cadence torque intervals.
5. Cap sessions at 45 minutes of zone 2 while it settles, then rebuild by roughly 10% a week.

Pain at the back of the knee usually means you are reaching for the pedal at the bottom of the stroke: the hamstrings and the back of the joint get stretched and loaded at the same time.

• Saddle too high is the first suspect. Drop it 3-5mm.
• Saddle too far back has the same effect. Slide it forward slightly.
• Hip rocking side to side while you pedal is a clear sign the saddle is too high.
• Very tight hamstrings and calves make a borderline saddle height feel too high — see the prehab routine.
• Cleats set too far rearward can also do it, especially with a high saddle.

Sharp or burning pain on the outer knee, sometimes appearing suddenly mid-ride and easing when you stop, is typically the iliotibial band being rubbed by a repeated, slightly misaligned knee path.

• Cleat rotation is the usual culprit: if your foot is held straighter than it naturally wants to sit, the knee tracks inwards.
• Give yourself more cleat float, or rotate the cleat to match your natural foot angle.
• Stance width matters. Pedal spacers or a wider axle can help riders with wide hips.
• Look for a rapid volume increase, especially new indoor hours with no coasting.
• Weak glute medius lets the knee fall inwards under load — side-lying and banded work helps.

Less common on the bike. Usually a stance-width or foot-mechanics issue: cleats too far outboard, a collapsing arch, or a knee that drifts in towards the top tube under load. Narrow the stance slightly, try a supportive insole, and film yourself from the front on the trainer to see the knee path.

• Swelling, heat, or a knee that looks different to the other one.
• Locking, catching or giving way.
• Pain that wakes you up or hurts on stairs and while walking.
• Pain following a fall or a twist.
• No improvement after two or three weeks of reduced load and sensible fit changes.