An Active Approach to Cycling Injuries: Knee

An Active Approach to Cycling Injuries: Knee

The majority of cycling injuries are overuse injuries which develop gradually over time due to repeated movement patterns.  The most common insidious cycling injuries tend to be knee injuries. In fact, a recent study of 109 professional cyclists revealed that 58% experienced an overuse injury over the previous year, with 23% of the injuries involving knee pain.

Basic Anatomy of the Knee

In simplistic terms, think of the knee joint as a hinge where the quadriceps muscles, which run from the front (anterior) of the thigh to the knee cap, act to pull the knee straight.  The hamstring muscles, found to the rear (posterior) of the thigh, function to bend the knee.  The iliotibial band, which attaches to the glutes and hip flexors, travels down the outside (lateral) of the thigh and inserts to the outside of the knee.  The adductor muscles travel from the pelvis to the inner (medial) aspect of the knee.

Common Knee Pain Complaints and Injuries

  • Anterior: patellofemoral pain syndrome, quadriceps tendinosis, and patellar tendinosis
  • Lateral: iliotibial band syndrome
  • Medial: pes anserine bursitis and mediopatellar plica syndrome
  • Posterior: hamstring tendinosis

Immediate First Aid for Acute Injuries

The PRICE principle, an acronym which stands for Protection, Rest, Ice, Compression, and Elevation, is the standard for the treatment of sports injuries during their initial phase of discomfort.  It should be applied as soon as possible for 24-72 hours.

Basic Bike Fit Recommendations

Simple bike fit recommendations can be made based on the location of your knee pain:

  • Anterior: Increase saddle height and/or move cleat forward
  • Posterior: Decrease saddle height, move saddle forward, and/or limit internal cleat rotation
  • Lateral: Move cleat inward 
  • Medial: Move cleat outward

Active Treatment Plan For Knee Pain

What follows will be the foundation of a solid cycling injury active treatment and prevention plan, beginning with the basics of flexibility, strength, and recovery with a focus on the knee joint. 

By completing all elements of the program, and building upon it with each installment of the series, you will be equipped to withstand the physical stress of cycling with less pain and greater enjoyment in addition to having a resource to refer to when symptoms necessitate.

Flexibility Exercise of the Knee

Find the Zwift Insider Knee Flexibility Program complete with exercise descriptions >

Static Stretching Tips

  • Go to point of stretch and hold for 15-30 seconds
  • 3 repetitions per exercise
  • Don’t bounce!

Strengthening Exercise of the Knee

Find the Zwift Insider Knee Strengthening Program complete with exercise descriptions >

Strength Training Tips

  • Perform 3 sets of 15 repetitions to start
  • Don’t perform if experiencing severe sharp pain (PRICE)
  • Increase intensity by adding weight or increasing repetitions
  • Strict form is essential!

Foam Roll Recovery Techniques

Find the Zwift Insider Thigh Foam Roller Program >

Foam Rolling Benefits and Technique

  • Improves circulation to enhance muscle recovery
  • Relieves muscle tension to improve flexibility
  • Roll slowly and when you find a tender spot, focus in on it by rolling back and forth until you feel it soften or release

The Follow-Up Appointment

Stay tuned, as in the next edition of this series I will address cycling pathology of the hip, including hip bursitis, hip flexor tendinitis, piriformis syndrome, gluteal tendinopathy, and other disorders.  We will examine active intervention measures to keep you riding, training, and racing at your best!

What do you think?

Would you like to take a more extensive look at advanced strength and flexibility exercise to add to your knee program?  If yes, let me know and I will examine this topic further in upcoming installments. 

About The Author

Christopher Schwenker

Chris is a semi-retired physical therapist who, following more than 25 years in solo private practice, considers himself blessed to combine a passion for cycling and creative writing in pursuit of his next life goal. He lives on the North Fork of Long Island with his beautiful wife and two university student children.

Subscribe
Notify of
guest
39 Comments
oldest
newest most voted
Inline Feedbacks
View all comments
Andrew
Andrew
9 months ago

Definitely time to get the foam roller out after doing my first ever 100km ride!

Lewis Jones
Lewis Jones
9 months ago
Reply to  Andrew

The foam roller is great for getting into those hard to reach areas but i would be careful if using it on my ITB like in the photo above. There’s a lot of adverse advice to rolling your IT Band. It’s not a muscle and it can really damage it. Stretching it is a better way to treat it.

Paul Griffiths
Paul Griffiths
9 months ago

I found by moving my cleats back instead of forward it instantly relieved my anterior knee pain by placing the foot further infront of the knee, relieving knee stress when pushing hard on the pedals.

Erik
Erik
9 months ago

Would love to see a similar article on Achilles’ tendon injury, any ill effects from cycling to look out for there, and good plans for recovery and avoidance.

Ben Moose
Ben Moose
9 months ago

Thanks so much for sharing, I was looking for Cycling centric exercises for flexibility, strength and recovery and everything is in here! Can’t wait for the other exercices!

Ben Moose
Ben Moose
9 months ago

How about a poster with all the exercises on? that would be terrific in a pain cave, and I am sure that lots of people would go for it! And a good way to encourage ZwiftInsider team as well!

Diogo
Diogo
9 months ago

Thanks for this!
Could you please focus on future topics on cyclist’s back?
Rounded shoulder
Bottom back pain
Shoulder blade pain

Regards from Portugal!
Diogo

Mathieu Hould
Mathieu Hould
9 months ago

Thanks a lot !

MarkE
MarkE
9 months ago

A professional bike fit made a world of difference for me last year. I used to be able to ride about 2.5 hours outside or an hour inside before knee pain forced me to stop. With a properly fitting bike and itb stretches I was able to do my first imperial century this year.

Jeffrey Roger
Jeffrey Roger (@buy5)
9 months ago

As I suspected this is an awesome addition to the ZI format. Thank you Chris for offering your expertise to us all. Looking forward to the discussion on gluteus medius syndrome, et al.

Jeffrey

Ingólfur Már Ingólfsson
Ingólfur Már Ingólfsson
9 months ago

Theragun ,,(massage gun) was the best thing I discovered

edmund espinola
edmund espinola
9 months ago

very well written, this could be the handbook for all aged bike riders. So many people spend big money on a road bike, and don’t realize the bike is setup wrong. Ad in the ” i know it all” factor this is a injury just waiting to happen. I am very happy to know you have had a successful career, and are beginning another

Debra Parker
Debra Parker (@debparker07)
9 months ago

Love this as I experience knee pain from a synovial cyst in the knee; lots of the strength moves noted above are what my physiotherapist has me do along with isometric walls squats which have provided the most benefit for my personal rehabilitation. Which I do 3 sets of 60s with 25# in each hand so quite heavy.

Christina Holum
9 months ago

How cool to see this. Today was day one on my Peleton!

Mick Such
Mick Such
9 months ago

Due to having bad knees from too much running in boots in the Army. I found cycling to be great exercise but still had a bit of knee pain…. I then found Speedplay pedals and they solved my issues along with a bike fit.
Best pedals out there in my opinion. 😁

Monica Schlange
Monica Schlange (@mmisc)
9 months ago

I look forward to your upcoming info about the hip as that’s my problem area at the moment!

Jo Agin
Jo Agin
9 months ago

Great article, thank you!! I have been experiencing inner knee pain so I will adjust my cleats outward a tiny bit and see if that helps. Please continue with this topic and more

RaoulT
RaoulT
9 months ago

I practice foam rolling every morning on all my body, including my feet. It keeps me really “flexible”, as much as doing streching exercices. And it takes me about 20 minutes, so not a very long time.

There’s a better movement to strech the quadriceps, in order to preserve meniscus injury (due to compression) :
comment image&f=1&nofb=1

just remember you have to stand your back straight. If it doesn’t strech enough, just drive away the foot on the floor.
If you keep the back foot on the floor, drive away the front one and you’ll get your ischio (translation ?) stretched.

Onno
Onno
9 months ago
  • Anterior: Increase saddle height and/or move cleat forward”

Not sure I understand this. When you move your cleat forward, your foot moves backward, so your foot gets closer to your saddle, which is pretty much the opposite of increasing your saddle height.

Harriet
Harriet
9 months ago

Following

Simon F
Simon F
8 months ago

great article thank you . will be trying these out and interested in any follow up articles

David Forti
David Forti
7 months ago

Enjoyed riding with you. I’ll start doing these stretches after my rides.

Free Zwift Trial

Newsletter Subscription

39
0
Would love your thoughts, please comment.x
()
x