Knee pain is a common symptom with cycling. It's an activity and sport that depends on the knees performing countless movement repetitions and as the primary link in the legs for balancing on the pedals. Additionally, the bike posture is unique in that it assumes a foot stance width that is more narrow then we often assume to stand or sit for long periods. The bike posture is also bendy. Often more bendy at the ankles, knees and hips then our familiar seated postures (like a computer chair). So, what knee pain is "normal" and what warrants bike position assessment?
Common Knee Pain Symptoms Related to Poor Bike Position Include:
Front of the knee pain
Saddle too low in height
Saddle too far forward
Saddle nose down (the thigh muscles have to work extra hard to keep you on the saddle in addition to pedaling!)
Behind the knee pain
Saddle too high >> is the knee actually going from straight to straighter?!
Saddle too far posterior (which creates a longer reach to the pedals)
Foot position considerations
Foot too far forward or behind on the pedal - this puts the knee (and ankle/foot) at a biomechanical disadvantage for performing a pedal stroke
Feet too narrow or wide in relation to knee - If it feels too narrow or wider then your naturally assume when standing, bike positioning can help with making the bike pedal stance width more consistent with your natural standing alignment.
Cleats?!
Are they symmetric?
Should be initially installed by a bike position professional to optimize foot and overall alignment
Shoes?
Running shoes - are made for running and are often too wide to reasonably get the foot on a bike platform pedal
Flexible shoes - will not provide support to the foot meaning there is extra ankle bend and therefore extra knee compensation with every pedal stroke
Rider Considerations
Rider flexibility (or lack there of)
How well can you bend forward?
How well can you perform a squat (keeping your whole foot touching the ground through the entire movement)?
How well can you sit with your knees, shins and ankles touching for a narrow stance?
How flexible are your ankles? Stiff ankles often means the knee has to compensate in pedaling.
Rider experience
New to cycling?
History of endurance sport activities?
Significant increase in average mileage? elevation? speed?
Indoor trainer vs outdoor riding?
Pattern related to knee pain symptoms
Is knee pain consistent no matter where you ride? (Flat vs. Hilly)
Knee pain with riding uphill? downhill?
Knee pain with "powering through" pedals? Pushing a harder gear
Do you know your pedaling cadence?
Are you able to vary your pedaling cadence regardless of the terrain?
Knee pain does not have to be consistent to warrant professional bike positioning. Knee pain with cycling is often due to a combination of bike position and rider consideration variables. Working with a professional bike position specialist can help address and correct the positional contributions to optimize the knee position and ergonomics with cycling. A physical therapist who knows and understands the unique demands of cycling can help a rider to progress their cycling tolerance and goals.