From beginners to experts, most cyclists will encounter knee discomfort when riding at some time in their careers.
A study of 116 elite cyclists revealed that 94% of them suffered overuse injuries over a year, with 23% reporting knee discomfort.
While professional riders are subject to a substantially larger training load, they also have daily access to physiotherapists and osteopaths. So if more than a quarter of them are experiencing knee pain, you can bet that it will be an issue for a large number of beginners.
This article will look at the knee locations where you can feel pain when riding an electric bike and the specific conditions that might cause knee discomfort when cycling.
We also look at the inner workings of the knee and how cycling overuse injuries can lead to difficulties in three basic categories. Changes in training intensity (cycling-specific), changes in equipment (bike-specific), and our intrinsic physical make-up (cyclist-specific) will all be contributory variables in all of them.
The goal is to figure out which of these applies to you and make a change.
While we can provide you with some basic tactics for getting out of difficulty while you're suffering from knee pain, the adage still holds: keep out of trouble in the first place!
Many knee injuries may be prevented by not abruptly increasing your training regimen or making significant modifications to your ebike setup.
Take care of your legs, and they will take care of you: After each ride, stretch all of the major muscle groups and give them a massage.
Don't overlook core muscular strength — tiny core muscles may alleviate huge loads on much larger limb muscles.
The content of this post is confined to some of the more frequent overuse injuries. Please get appropriate skilled medical treatment if you've experienced an injury or feel unexpected pain or if your symptoms do not improve with this very general advice.
The four most common origins of knee pain in cyclists
Knee pain can be classified into four types: anterior, posterior, medial/lateral, and iliotibial band syndrome. Let's take a look at each of them individually.
Area 1: Anterior knee pain
Because of the architecture of this location, pain at the front of the knee – on and around the knee cap (patella) – is the most prevalent manifestation of cycling overuse injuries.
The huge quadriceps muscles link to the shin bone via the patella. Pedaling forces are transmitted across the patellofemoral joint as we bend our knees, thus squashing them against the thigh bone.
Although it is more prevalent in explosive sports, the tendon that connects the patella to the bony prominence below the kneecap can inflate (patellar tendonitis). If this region is chronically sensitive to the touch, it's time to seek medical attention. Ice, anti-inflammatories, and physiotherapy, with or without strapping, should help.
However, suppose you're reading this and suffer anterior knee discomfort from cycling. In that case, you may have a condition known as 'patellar compression syndrome.'
It is a plague of bikers and runners alike, producing discomfort while off the commuter bike and ride-stopping misery when on it.
Techniques to prevent and manage anterior knee pain when riding
If you experience this form of anterior knee discomfort, try to keep your leg out straight whenever possible.
Keep an eye out for bike-specific issues. Check that your saddle is set to the proper height. Pushing too big a gear or utilizing cranks that are too long might also be an issue.
Working on the vastus medialis oblique muscle can also be of help. Work on strengthening the vastus medialis oblique muscle after a week or so of frequent stretching and self-massage to balance out the stabilizing stresses on the patella. It's gradual and might feel futile at first. However, suppose you keep loosening the lateral side and strengthening the medial side. In that case, you'll notice an improvement in a couple of weeks.
Area 2: Posterior knee pain
Pain behind the knee is far less prevalent and much easier to treat. Overextending the knee is almost always to blame.
Look for bike-specific issues such as a saddle that is too high or too far back, though they are just as likely to create discomfort farther up the hamstrings
A doctor should evaluate persistent pain behind the knee to rule out a Baker's Cyst. You and your doctor can talk about treatment options.
Area 3: Medial and lateral knee pain
Side knee pain is pretty frequent. The reasons are almost invariably the feet, particularly incorrectly fitted pedal cleats.
As a result, such discomfort is frequently felt during or after the first ride with cleats or with a new pair of shoes or replacement cleats.
The tissues causing the discomfort are usually the collateral ligaments, which sit on the outsides of the knee joint and prevent it from bending in the wrong direction.
Methods for avoiding and treating medial and lateral knee pain when riding
Check cleats for excessive wear regularly. Always use a felt tip pen to record the position of round cleats before changing them, and experiment with different cleat kinds until you find one with the correct amount of float for you (too much or too little can both cause problems).
Begin on the right foot. If you're new to cleats, an excellent beginning posture is to sit on the edge of a table with your hips, knees, and ankles relaxed at 90 degrees. Look down: the cleats should match the angle your feet naturally dangle.
Area 4: Iliotibial band syndrome
The term 'iliotibial band syndrome' refers to another painful ailment deeply linked to patellar compression syndrome.
The iliotibial band is a thick fibrous tissue strap extending down the pelvis's lateral thigh to just below the knee. Suppose your vastus medialis oblique muscles aren't strong enough to compensate. In that case, the structure has a history of tightening up over time and dragging the patella off-center.
Because of where it sits, it slides back and forth along the knobbly end of the thigh bone immediately above the knee, cushioned by a fluid-filled bursa when the knee is repeatedly bent and straightened. At this place, inflammation can arise, which is then aggravated when the knee is bent.
It's a bothersome condition that's most typically found in runners. It's likely to be aggravated by gluteus medius muscle deficiency - another important core muscle that cycling neglects – and wearing cleats that point the toes too far inwards.
Iliotibial band syndrome: How to Treat It
The majority of treatment in the acute period of the injury is the same as for any inflammatory condition: rest, ice, and frequent anti-inflammatory drugs such as Ibuprofen, if tolerated.
After this, rehabilitation is reasonably similar to that described above for patellar compression syndrome, but with an emphasis on building up the gluteus medius muscle instead of (or in addition to) the vastus medialis oblique.
Stretching, particularly of the iliotibial band, should come before strengthening activities. Returning to usual activities should be done gradually, guided by (lack of) discomfort. Cases that are highly resistant to treatment can be operated on, although this is rarely necessary if the following routine is followed.
Knee Pain Prevention
Here is some general advice to help you prevent knee pain while cycling.
Warmup: As with other sports, a short warmup to get the blood flowing and the muscles ready is a good idea. Aim for at least 15 minutes of moderate spinning before attacking the local hill or going hard on the flats.
Spin: If you watch videos of the pros in action, you'll notice how fast and fluid their pedal strokes are. To enhance your pedal stroke, try this drill: Use a gear at least two teeth lower (and hence easier) than normal the next time you go up to your favorite climb. This faster pace is less taxing on your joints. Consider pedaling in circular circles rather than ovals.
Gradually increase your mileage: Your first ride after the winter offseason should not be five hours long. Instead, begin with a lesser distance and progressively increase it, increasing your overall mileage by no more than 10% every week.
Be Wary of Change: Because your body prefers consistency, your knees frequently rebel when you change your equipment. Whether you're getting a new bike, new shoes, new pedals, or changing the length of your stem, take it slowly at first to allow yourself time to adjust.
Stay Warm: Riding in 40-degree temperatures with raw, chapped knees is a formula for disaster. When the temperature drops below 60 degrees, pros cover their legs in training—hence the existence of knee warmers! While everyone's tolerance is different, there's no harm in keeping muscles and joints warm. If you use warmers, you may quickly remove them mid-ride if you start to warm up.
Consider a Bike Fit: If your knee pain persists, you might consider having a professional bike fit. A professional bike fit should involve
- an interview procedure,
- off-bike flexibility testing, and
- on-bike measurements and adjustments with a professionally trained fitter.
Yes, it is an expense (often between $200 and $300), but it is well worth riding pain-free. It may be the most incredible money you've ever spent on your riding habit.
Fix Muscle Imbalances: If you're still having cycling-related knee pain after doing everything listed above, including getting a professional bike fit, it might be due to muscle imbalances, such as weak glutes, hips, or cores. To determine the best course of therapy for you, talk with a physical therapist.
There's only so much you can learn on the internet, and it's critical to recognize that lack of strength, flexibility, and bike fit are all interwoven. Suppose you're experiencing long-term, chronic, or ride-stopping discomfort. In that case, it's a good idea to see a physiotherapist, osteopath, or healthcare professional. You should also schedule a bike fit with someone who will assess your flexibility and limitations and your riding style and volume.