Why Do My Knees Hurt?
It’s common for people who love bike riding to suffer from knee pain. Does this sound like you? Walking up and down stairs or inclines hurts? Sitting for a long time starts to stiffen joints? Does this pain in and around your knees cause the bike to go unused for a while?
You might be suffering from PFPS, patellofemoral pain syndrome, which is one of the most common injuries in cyclists. PFPS is known to keep even elite cyclists off their bikes for extended periods of time. In fact, over 45% of overuse injuries in cyclists are to the knee, and when you think about it—it makes sense. The repetitive motion of pedalling time after time wears down the body, especially the knees.
PFPS affects the cartilage underneath the kneecaps as well as the supporting structures around it. When you bend or straighten your legs, all these moving parts help to move the kneecaps up and down over your femur, which is the large bone of your thigh. Overuse causes PFPS, which results in tight muscles around the knee joint. If the injury is old, it could even cause quadricep wasting. When these thigh muscles atrophy, they become shrunken and weak. This is why it’s so important for you to address knee pain sooner rather than later.
You might be wondering: what causes PFPS and knee pain, and how can you prevent it?
Poor alignment and improper form are major culprits of knee problems. When your legs are not in line with your hips, you put pressure on your knees from the sides rather than from above. Our knees are engineered to withstand the pressure of our upright moving bodies, so when we exercise improperly, we can exert abnormal and destructive forces on our knees.
Keeping in mind that the knee is meant to bend a certain way, unusual bending could cause patellar mal-tracking. This occurs when the kneecap doesn’t sit nicely in the position where it should in what’s called the trochlear groove of the femur. This causes chronic stimulation of the surrounding nerves which results in knee pain.
Other factors that increase patellar mal-tracking include the way that we exercise; excessive high-intensity cycling, a sudden increase in mileage, and riding uninterrupted for long periods can all aggravate knee pain. Our equipment can also negatively impact us. A seat that sits too low and shoes that angle the feet inwards worsen the misalignment.
The body is deeply interconnected, and we can think of the knees as hinges between our hips and ankles. Problems in these areas can also contribute to patellar mal-tracking and resulting knee pain. For example, weakness and low flexibility in the hips, hamstrings, and quadriceps have all proven to make knee pain worse.
What Should I Do Now?
It might be difficult for you to break your routine but resting is the best path to healing and treating PFPS. Consider cutting back on the length and intensity of your sessions or even taking a complete break from cycling for a short period while your health professional works out what the best treatment and training strategy is, to get you back on your bike pain-free.
Using a combination of ice and taping can be a useful short term “alignment tool”. By manually keeping the kneecap in the right place, you can reduce irritation and pain. Finding methods to manage pain in your daily life is essential for recovery, but it is not all you need for full rehabilitation.
The best solution to chronic knee pain is joint mobilisation and physical rehabilitation therapy. Your physiotherapist or chiropractor will be able to assess your needs and create a custom plan for mobilising the joints and soft tissue structures healthily and progressively. They will also help you to gradually reintroduce training to avoid further injury.
Some cross-training options a physical therapist might recommend include inclined treadmill walking, elliptical training, and swimming, which can strengthen your leg muscles without putting pressure on your knees.
How Can I Prevent Knee Pain in the Future?
Educating yourself on body conditioning and taking precautions is a great way to reduce your risk for PFPS and ensure healthy, happy knees. Remember that knee pain is not just a knee problem. All the parts of our bodies work together. Strong legs and core are essential for preventing knee pain.
Professional cyclists often have huge quadriceps and calves—these are key muscle groups for cycling. But professionals and beginners alike should take special care not to neglect their lower back, abdominals, or glutes.
Strong hip abductors and gluteus muscles support healthy knee movement and can reduce PFPS pain. Strengthen your hips and butt with these exercises:
- Squats
- Lunges
- Crab walk
- Bridges
Improving flexibility in the legs and hips, especially the hip flexors, is an important strategy to prevent PFPS. For this, try:
- Gentle stretching
- Using a foam roller
- Getting regular massages
How Should I Set Up My Bike?
You can also set yourself up for success by setting up your bike the right way. To relieve some of the pressure on your knees and prevent injuries, you’ll want to:
- Set the pedal cadence to 90-120 revolutions per minute
- Raise the seat
- Push the seat backwards
- Stabilise your feet with inserts
Raising the seat will distribute the force to your glutes and hamstrings, taking pressure off vital knee supports—the quadriceps and patellar tendon. It will also reduce knee strain by decreasing your range of movement when cycling.
If your body weight is right above your knees, lots of force goes through them—moving the seat backwards reduces pressure.
Rocking feet also add strain to the knees and inserts beneath your heels will fix that.
Do I Really Need Physical Therapy?
The best thing you can do for your body is to listen to it. Knee pain from PFPS only gets worse with continued use, so you should never continue to work through the pain. It will not make you stronger.
There are specific ways to build up strength, flexibility, and endurance over time safely. This often includes exercises you wouldn’t consider or might think wouldn’t help. Both Physiotherapists or Chiropractors have extensive knowledge of the body and can help you target specific muscle groups to rehabilitate yourself from injury.
Educating yourself online is a great first step into learning about your body, but getting an expert opinion is necessary when your health is on the line. Even if you don’t think you need physical therapy, being assessed by a licensed health professional will help you on your way to achieving your health and fitness goals, whether you are injured or not.
Want a personalised rehab program with free access using Physitrack? (library of 3500+ exercise videos accessed/monitored from your smartphone). Contact us!
