Common knee injuries in cycling, their causes and what to do about them

 In Exercise and Health

knee injuries

With participation in cycling on the rise, so too are the chronic injuries that can come with the sport. These are caused by training errors including rapid increases in training volume and/or increased hill training, incorrect use of gearing, incorrect bike frame size, incorrect bike saddle height or position, incorrect cleat positioning, or abnormalities of the rider(1).

Anterior Knee Pain

Causes of anterior knee pain include patellofemoral pain syndrome, chondromalacia, quadriceps tendinosis, and patellar tendinosis (2). These injuries are most commonly caused by the saddle being too low, too far forward, or both. This causes excessive patellofemoral loading throughout the pedal stroke. When the saddle is low, the knee functions in hyperflexion, increasing compression of the patella on the femur (2).

Medial Knee Pain

Medial knee includes pes anserine bursitis or mediopatellar plica syndrome. Medial knee pain results from increases in internal tibial rotation. This can be caused from improper saddle height, or an externally roated cleat position that points the toes too far outward (2). Avoiding training errors, such as riding in gears that are too high, or excessive hill climbing, will also help prevent the stresses that may cause and exacerbate medial knee conditions (2).

Lateral Knee Pain

Including ITB syndrome. This is caused from excess internal tibial rotation which places stress on the itb as it crosses the lateral femoral epicondyle. This comes from either the biomechanics of the cyclist or from the bike fit. A saddle that is too high resulting in a knee extension greater than 150*, or a saddle that is too far back can both irritate the distal ITB. Additionally, cleats that are internally rotated too far may increase stress on the ITB as it crosses the outside of the knee.

Posterior Knee Pain

Biceps tendinosis or medial hamstring tendinosis, usually caused by a saddle position that is too high or too far back, stressing the biceps tendon. Excessive internal rotation of the cleats will also increase stress.

Now what!

A simple saddle height adjustment may ease the forces placed on the knee. The easiest way is to allow one pedal to drop to the 6-o’ clock position and observe the angle of flexion in the knee joint. There should be a 25* to 30° flexion in the knee when the pedal is at the bottom-most point (2). Most ideal however would be for the cyclist to get a professional bike fit. This will ensure the rider remains injury free, as well as enhancing performance. In conjunction with a bike fit, consult with a physiotherapist (I recommend POGO physio therapists!) to address any muscular weaknesses or imbalances by starting on an individually tailored strength program to prevent further injuries.


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  1. Schwellnuss. M, Derman. E (2005) Common injuries in cycling: Prevention, diagnosis and management
  2. Asplund. C, St Pierre. P (2004). Knee Pain and Bicycling. The Physician and Sportsmedicine


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