Knee Pain Fixes for Cyclists by Andy Levanti, DPT, ATC

Whether you are a mountain biker, road cyclists, or a spin class/Peloton junkie knee pain can keep you off the bike. The easiest way to ease that knee pain can be making sure that you positioned correctly on the bike. You can address this two ways; the first being adjusting your bike to fit your body, the second is by adjusting how you sit on the bike. Below are 3 easy ways to help eliminate knee pain while cycling. 

 Adjust your cleat position

If you are using a “clipless” pedal on your bike it is important that the cleats on the bottom on your shoes are in the correct position. The position of your foot on the pedal will dictate how your knee tracks while pedaling. Most people will have their cleats set in a neutral position with the cleat pointing straight forward on their shoe. However, unless you have a neutral foot and lower leg posture this cleat position may be leading to improper knee mechanics. By adjusting your cleat to compliment your lower leg alignment, knee tracking can be improved. If you naturally have a toe out position (duck footed) then you can try rotating your cleat inward a bit on your shoe. Conversely, if you have a toe in (pigeon toed) position try rotating your cleat outward slightly on your shoe.

Proper seat height

Your seat should be at a height that allows for knee flexion between 25 and 40 degrees when your crank is furthest from your hip (slightly forward of straight down). Ideally we look for knee flexion to be between 30 and 35 degrees. A seat that is too low can lead to pain in the front of the knee and if your seat is too high you can develop pain on the outside of your knee. The easiest way to see if your height is correct at home is while sitting on your seat with your bike supported, put your heel on the pedal and rotate the crank so that your foot is right under your hip. In this position, your heel should just just barely be on the pedal and your leg is straight from your foot up to the hip. If your foot is unable to maintain contact with the pedal then your seat should be lowered, conversely if your knee is bent in this position then your seat should be raised.

Learn to hip hinge 

Now that you have adjusted your bike a fit a bit, the next step is adjusting your position on the bike to make your body more efficient. By learning how to bend at your hips (hip hinge) while seated in the saddle vs bending through the low back, can allow for more efficient pedaling. A hip hinged position on the bike will create a position that allows power generation through your hip and core muscles rather than relying on your quadriceps. This position will not only take some stress off your knees but also off the low back which will prevent low back pain. It is best to learn this movement off the bike first, view our video demonstration on learning to hip hinge for some tips. Once you have mastered the fundamentals then you can progress to drills on the bike and then finally moving it onto the road or the trail. 

Complete Game Physical Therapy works with bikers, athletes, and non-athletes of all ages and activity levels. Contact us to schedule an appointment for all of your PT needs. We are here to help in both our Lowell and Tewksbury locations.