Cycling knee pain and positioning

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Many common cycling injuries involving the knee are due to poor bike positioning.

Hip and knee pain are the most common cycling injuries. The most common cause of hip and knee pain is iliotibial band (IT band) syndrome. The IT band is a fibrous band of tissue, which extends from the pelvis on the outside of the leg, traverses the lateral hip, and runs down to the outside of the knee. Pain is caused when the band rubs over the greater trochanter of the hip and/or the lateral condyle of the knee. Tight inflexible leg muscles worsen the condition. Pain can also be caused by wrong seat position, saddle position, and cleat alignment.

A simple seat height adjustment may help the knee. If the seat is too low, too much stress is placed on the patellar and quadriceps tendons. If the seat is too high, pain may develop behind the knee because of hamstring insertional stress.

The easiest way to get correct pedal height is to have one pedal drop to the 6 o'clock position and see what the angle of flexion in the knee joint is. There should be a 25-30 degree flexion in the knee when the pedal is at the bottom most point.

If the hips rock when pedaling, that means the seat is too high. Lower your saddle until a smooth pedal stroke results.

Seat and cleat position may also contribute to knee pain. Saddles that are too far back cause the rider to reach too far for the pedal and stretch the IT band with resultant knee pain. There are methods for determining correctness of saddle position.

The term "cadence" means the number of revolutions the pedal goes around in a minute. Cyclists who pedal with a low cadence (less than 80 revolutions/minute) will often have knee problems. One method to try to minimize this problem is to try using a lower gear - shift into an easier gear and pedal faster without changing overall speed. Try to keep the cadence between 90-110rpm.

Cleats that are internally rotated too much may cause stress to the IT band as it traverses the outside of the knee. Cleats should be positioned so that the ball of the foot is directly over the axle of the pedal.

An individual's anatomy may be responsible for knee and hip pain. Riders with leg length differences may develop knee pain since only one side is properly fitted to the bicycle. This causes increased stress on the inside of the knee and hip on the improperly fitted side.

Cyclists with flat feet may have excessive pronation of the leg causing greater stress on the IT band at the knee. Orthotics may correct the alignment of the knee and decrease or prevent medial or lateral rotational stress on the joints.

The knees need to track forward. Many people bike with their feet pointing outward and sometimes inward on the peddles. The feet need to face forward so the knee tracks correctly.

In order to minimize knee and hip pain in the early season, start out slowly. Pedal with low resistance and a cadence of about 80-90rpm to let the body adjust to road riding.

Minimize hard riding or hill work for the first few weeks. Stretching exercises for the lower extremities, especially for the glutes and IT band will help the transition into early season form. Strengthening the quads and stretching the hamstrings will help. Consult a person knowledgeable in cycling mechanics if there are still problems.

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