Cycling Knee Pain? Pedal Solutions for Common Knee Issues

Many of us have been there, pedaling along without an issue and then you begin to feel a sharp twinge of pain in your knee…now what? If you’ve ever experienced knee pain while cycling from either cleat or seat positioning, you are not alone. Knee pain is one of the most common injuries cyclists experience at one point or another. 

Just because you are one of many, does not make the injury or pain any easier. Getting to the root cause of your pain can help not only alleviate your current injury but also prevent future occurrences. There are many different causes of knee pain, and while we will not cover all knee injuries, we will take a look at some of the common knee issues and common solutions.

Anatomy of the Knee

It is important to understand how the knee works before diving into the reasons why your pain may be occurring. The knee joint is a hinge joint made up of your femur (thigh bone), tibia (shin bone), and patella (kneecap). The knee is responsible for bending and extending your leg and produces very little to no rotational movement by design. The knee, like other joints, is surrounded by soft tissue; ligaments, tendons, and muscles, as well as connecting cartilage. Soft tissue is what guides and controls knee movement. Essentially, the connecting surface of the bones is meant to allow motion in a bending and extending pattern; cartilage around the knee serves as a shock absorber and guide for clean movement. Ligaments around the knee support the joint and provide stability. However, it is the muscles and tendons that are the workhorses of controlling and balancing what happens at the knee joint. 

The prime movers of the knee joint are the quadriceps, hamstrings, adductors, and calf muscles. We think of the quadriceps as knee extenders or the muscles that press down on the pedals to straighten your legs, and the hamstrings as knee flexors or what pulls your leg back up as through the return phase of the pedal stroke; and for the most part this is what happens. You also get help on the upstroke from your hip flexors and calves and help on the downstroke from your glutes and calves as hip and ankle extenders respectively. 

One thing to remember is that joints need to be balanced to function properly. You want just the right amount of movement; too little and it will limit your range of motion and put extra stress on other joints, too much and you will lose stability and control, again putting extra stress on other tissue. This leads to the importance of proper muscular tension, activation, and range of motion to ensure that one structure is not pulling or creating greater tension than another….which leads to imbalance and injury.

The stability of your knee comes primarily from the length-tension relationship of the muscles that surround the knee joint. This length-tension relationship is influenced by the position and stability of the joints above and below (The Hip/Pelvis and Foot/Ankle) Since we are doing thousands of pedal strokes on the bike on every ride, it is critical that your position is dialed in, as well as cleat and pedal position.

Common Knee Pain

All of these pain locations can help yourself or a fitter determine a course of action and where to begin looking for potential issues with cleat positioning or fit. 

Pain in the front of the knee (Anterior):

Pain felt directly on the front of the kneecap or patellar tendon is generally attributed to your quadriceps. Your rectus femoris is directly attached to your patellar tendon and tension in this muscle can cause irritation to the anterior side of your knee. Why is this happening? These sensations are usually attributed to a saddle that is either too low, too far forward or a cleat that is too far forward.  

Pain on the inside of the knee (Medial):

Having improper tracking can lead to tension on the ligaments located both on the inside and outside of your knee that can lead to irritation and pain. If you find yourself fidgeting in the saddle to turn your heels inward/outward in the pedals, then potentially your cleat positioning is causing you to have too wide of a stance. Why is this happening? When pedaling you want to have your hip, knee, and ankle joints tracking as linearly as possible (every individual is going to have some nuances). Having improper tracking can lead to tension on the ligaments located both on the inside and outside of your knee that can lead to irritation and pain. How can you fix this? This may be time to take a look at your cleat positioning. It is also wise to check the float on your cleats. Having too much float can also lead to inside knee pain. Float is the ability of the foot/ cleat to move freely while remaining clipped into the pedal.

Pain on the outside of the knee (Lateral Knee Pain):

Pain felt directly on the outside of the knee can be due to tight lateral muscles, especially muscles that attach to your IT (iliotibial) Band. Why is this happening? This thick band of connective tissue runs from your hip to the outside of your knee joint and when tight and irritated can cause sharp pain on the outside of your knee. Another culprit to investigate can be your outer lower leg muscles. Your peroneal muscles located on the outside surface of your shin may not directly attribute to knee flexion, but they do aid in ankle flexion. When these become too tight ankle flexion is compromised which can lead to outside knee pain. How can you fix this? Typically this is a result of your cleats providing too little float which can cause you to be locked into a position that has too narrow a stance width and give the rider a more “toed in” cleat positioning.

Pain in the back of the knee (Posterior):

This pain location is not as common among cyclists, but can still occur due to hyperextension of the leg. This can be a result of having a seat too high where you are constantly reaching throughout the pedal stroke. This type of action can put stress on your hamstrings as well as your popliteus muscle. This muscle is located on the posterior side of the kneecap and attaches to the tibia and the popliteus tendon which connects to the lateral side of your femur.

Getting to the bottom of your pain as quickly as possible is the best way to avoid any long-term irritation for your joints.

If you recognize that many of your issues are stemming from a cleat issue, then perhaps it is time to look into other cleat options on the market. One of the most common issues professional bike fitters see is riders with little or no float in the cleat/pedal interface. This could be because of the choice of pedal or a worn-out/dirty cleat and pedal interface. Either way, this can become a major problem. Even though you pedal in a linear motion there is rotation that occurs through the chain between the foot, ankle, knee, and hip. There needs to be a tolerance for this motion. Especially because the knee is a hinge joint and can not tolerate much rotation. 

While many cleats on the market will offer a small range of float options, Speedplay cleats take the crown when it comes to float and adjustability. Speedplay cleats provide riders with 3-axis adjustability (fore-aft, left-right, and float.) This float can be adjusted anywhere from 0-15 degrees. This gives the greatest amount of customization for riders when aligning their shoe/cleat for optimized biomechanics. This type of freedom for your joints is huge, especially if you have experienced limitations in other cleat models. Many pedal systems on the market pivot around the front of the cleat/pedal, and have a spring in the pedal that tends to force the foot back to the centerline of the pedal, limiting the free range of motion. Speedplay pedal systems allow for a greater range of motion to optimize biomechanics for the rider. This in turn increases comfort, reduces the risk of injury, and can enhance your pedaling efficiency.

What does this all mean for you? More riding, more often, with less pain.