Cycling is supposed to be easy on the joints. It’s the low impact workout we turn to when our running days are over.
So it’s a cruel joke when your knee starts screaming after a long ride. The truth is, the repetitive motion of pedaling can turn tiny issues into major pain points.
What starts as a small twinge can quickly become a serious problem that sidelines you for weeks. But it doesn’t have to be that way.
What Is Your Knee Telling You?
Think of your knee as a simple hinge. It’s designed to bend and straighten, and not much else (apart from supporting your body, of course).
Pain is simply a signal that something is forcing that hinge out of its natural path. By noting where you feel the pain, you can start to diagnose the problem.
In short: What is causing that pain?
- Front (Anterior): Often called “cyclist’s knee,” this points to issues with your saddle height or position.
- Back (Posterior): Pain here is commonly caused by a saddle that is too high, forcing your leg to overextend.
- Inside (Medial): This usually relates to your cleat position or a lack of foot support.
- Outside (Lateral): This can be a sign of IT band issues, often linked to cleat setup or muscle imbalances.
Most knee pain can be traced back to three key areas:
- Your bike setup
- Your body’s condition
- Your training habits
Let’s get into each…
Key Area 1: Your Bike Setup
Your position on the bike is the number one cause of cycling knee pain. Getting it right is non-negotiable.
💡 Before we get into it, note that bike setup is often very tough to get right. Be all means try to tweak the setup yourself and test.
If that fails, you may be better seeing a bike fit specialist. Sure, it will cost a few hundred bucks, but it could save you a lot of trouble (not to mention, pain!). And then you can actually just get on with enjoying riding the bike.
Saddle Height and Position
Your saddle height is the first thing you should check. It has the biggest impact on how your knee feels.
A saddle that’s too high forces your leg to stretch too far at the bottom of the pedal stroke. This strains the muscles and tendons at the back of your knee.
Conversely, a saddle that’s too low keeps your knee too bent throughout the pedal stroke. This puts a huge amount of pressure on the front of the knee and the patella.
Your saddle’s fore and aft position also matters. If it’s too far forward, it can create excessive pressure on the front of your knee.
Quick Saddle Fixes:
- For Basic Saddle Height:
- Sit on the saddle with your heel on the pedal
- At the bottom of the stroke, your leg should be completely straight
- When you clip in, this creates the proper slight bend
- For Fine-Tuning:
- Back of knee pain? Lower saddle by 5mm increments
- Front of knee pain? Raise saddle by 5mm increments
- Wait 2-3 rides between any adjustments
- For Fore/Aft Position:
- With pedals level, your front knee should align with the pedal spindle
- Use a plumb line from your knee cap to check
- Pain at the front? Move saddle back slightly
Cleat Alignment
Your cleats connect your feet to the pedals, locking your lower leg into a fixed path. Even a slight misalignment here can cause big problems.
Cleats positioned too far forward on your shoe can strain your calf and the back of your knee. Moving them slightly back often relieves this pressure.
The angle of your cleats is also critical. Most people’s feet naturally point slightly outwards.
If your cleats force your heels too far in or out, it twists the knee with every pedal stroke. This leads to pain on the inside or outside of the knee.
Finally, your stance width, or Q-factor, affects knee alignment. A stance that is too narrow can cause pain on the outside of the knee, while one that is too wide can cause pain on the inside.
Quick Fixes:
- For Forward/Back Position:
- Start with cleats under the ball of your foot
- Back of knee pain? Move cleats back by 2mm
- Mark original position with a pencil before adjusting
- For Cleat Angle:
- Start in neutral position (parallel to shoe centerline)
- Outside knee pain? Allow slight heel-out rotation
- Inside knee pain? Allow slight heel-in rotation
- Use float in your cleats until you find your natural angle
- For Stance Width:
- Outside knee pain? Try moving cleats toward shoe’s outer edge
- Inside knee pain? Move cleats toward inner edge
- Consider pedal spacers if adjustments aren’t enough
Pro tip: Take photos of your current cleat position before making any changes. This gives you a reference point to return to if needed.
Other Bike Fit Factors
Less common, but still important, are your crank length and handlebar position.
Crank arms that are too long for your leg length can cause pain in the front of your knee.
Handlebars that are too low or too far away can alter your posture, putting extra strain on your entire body, including your knees.
Quick Fixes:
- For Crank Length:
- General rule: Riders under 5’8″ (173cm) often benefit from 170mm or shorter cranks
- Front knee pain? Consider dropping crank length by 2.5mm
- Most bikes come with 172.5mm – check yours with a ruler
- For Handlebar Position:
- Raise bars if you feel stretched or your back rounds
- Start with a 5-10mm spacer under your stem
- Consider a shorter stem if you’re reaching too far
- Rule of thumb: You should feel about 60% of your weight on your feet, 40% on your hands
Remember: While you can adjust stem height yourself, changing crank length requires new parts. If you’re considering this investment, a professional bike fit might be worthwhile first.
For more detailed scientific evidence, see Johnston TE et al. (2017). “THE INFLUENCE OF EXTRINSIC FACTORS ON KNEE INJURY RISK IN CYCLISTS.”
Key Area 2: Your Body’s Condition
Sometimes, the problem isn’t the bike. It’s you.
Muscle Imbalances and Weakness
Your body is a chain of muscles working together. A weak link in that chain can cause your knee to suffer.
Weak gluteal muscles are a classic example. When your glutes aren’t firing properly, your knee can drift inward during the pedal stroke, causing strain.
Tight muscles, like your hamstrings or IT band, can also pull the knee out of alignment.
Quick Fixes for Muscle Issues:
- For Weak Glutes: Perform bodyweight squats and single-leg bridges three times a week. Start with 2 sets of 10 repetitions and gradually increase.
- For Tight Hamstrings: Hold gentle hamstring stretches for 30 seconds, twice daily. Avoid bouncing or forcing the stretch.
- For IT Band Issues: Use a foam roller along the outside of your thigh for 1-2 minutes before and after rides. Start gently – it shouldn’t be excruciating.
- General Strength: Include lunges and step-ups in your weekly routine. These exercises mirror the cycling motion while building strength.
Foot Support and Asymmetry
Your feet are the foundation of your pedal stroke. If that foundation is unstable, it creates problems up the line.
Many cycling shoes come with flat, unsupportive insoles. If your foot arch collapses during the power phase, it can cause your knee to track inwards.
We also aren’t perfectly symmetrical. Many riders have a slight leg length discrepancy or a tendency to lean to one side.
This can cause you to overload one leg, leading to pain in just one knee.
Quick Fixes for Foot and Asymmetry Issues:
- For Poor Arch Support: Invest in quality cycling-specific insoles. Brands like Specialized BG or G8 Performance offer various arch heights to match your foot type. Start with a medium arch height if you’re unsure.
- For Foot Tilt Issues: Consider adding wedges under your cleats. Start with a small 1-degree wedge and assess how it feels before adding more.
- For Leg Length Differences:
- Small differences (under 5mm): Try cleat shims under the shorter leg’s cleat
- Larger differences: Consult a professional bike fitter who can assess whether you need a more comprehensive solution
- For Side-Leaning Tendencies:
- Check your saddle is perfectly level
- Have someone film you from behind while riding on a trainer
- If you notice a consistent lean, a professional bike fit can help identify if it’s a flexibility issue or requires setup adjustments
Key Area 3: Your Training Habits
How you ride is just as important as how your bike is set up. Poor training habits are a fast track to injury.
Overuse, Intensity, and Technique
Knee pain is often a simple case of doing too much, too soon. Your joints and tendons need time to adapt to new stress.
A sudden jump in mileage or a week of intense hill climbing can easily overload your knees. Pushing big gears at a low cadence also puts a lot of force through the joint.
A smooth, efficient pedal stroke is your best friend. A jerky, inconsistent motion puts unnecessary stress on your knees.
Quick Fixes:
- For Training Load: Follow the 10% rule – never increase your weekly mileage by more than 10%
- For Hill Climbing: Use easier gears and stay seated when possible
- For Pedaling Technique:
- Practice spinning at 90-100 RPM on flat roads
- Use your bike computer or watch to monitor cadence
- Think “circles not squares” when pedaling
- Drop to an easier gear before you start struggling
For a systematic review of overuse and training errors in cycling-related knee pain, see Bini RR et al. (2018). “Potential factors associated with knee pain in cyclists: A systematic review.”
Finding the Solution To Your Knee Pain
Fixing knee pain isn’t rocket science, but it does require a systematic approach. Start with the basics: check your saddle height, strengthen your core, and be honest about your training load.
Make one adjustment at a time and give your body time to respond. If pain persists or you notice swelling, don’t play hero – get professional help from a bike fitter or physical therapist.
Remember, your knees are meant to last a lifetime. Taking care of them now means more miles and smiles down the road.
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