4 Ways to Fix Anterior Knee Pain from Cycling

Written by
Marc Lindsay
It's not uncommon for athletes to be drawn to cycling from another sport because of the perceived notion that it is a low-impact activity. Because of this, more and more people give up sports like running or tennis in favor of cycling to save their ailing joints.

While there is some validity to the belief that cycling does less damage to the cartilage in the knee because of the low level of impact involved, it doesn't mean that the sport doesn't present an opportunity for knee injuries.

Patellofemoral syndrome and patellar tendonitis are two common cycling-related injuries caused by overuse, weak muscles and improper bike fit. Both can make cycling nearly impossible.

Use these four tips to fix knee pain and make your cycling more enjoyable.
Patellofemoral Pain Syndrome
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The kneecap, or patella, is a floating bone that lies on the underside of the patella tendon. During movement, the patella tracks along a groove in the femur. When the undersurface of the kneecap tracks incorrectly, the cartilage on the patella and the femur can be worn away, causing pain.

The cause of incorrect tracking of the kneecap is likely due to one of the following two factors: weakness in the VMO and overuse.
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Weakness in the VMO
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The VMO, or vastus medialis oblique, is the teardrop quadriceps muscle that runs along the inside of the thigh down towards the knee. In cycling, the vastus lateralis (quadriceps muscle on the outside of the thigh) often becomes overdeveloped, resulting in a muscular imbalance. The overpowering of the vastus lateralis can make the kneecap track too much towards the outside of the femur during pedaling, which in turn wears away the cartilage and causes pain.

The Fix: Stretch the lateral side of the leg with IT band and quadriceps stretches. Once you have gained flexibility, strengthen the VMO. Step-downs and short arc quadriceps exercises are two favorites.
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Step Down
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Stand backwards on a step. With one foot balancing on the step, lower your other leg toward the ground until your toe or heel taps. Make sure to keep your hips level (concentrate on not dipping the hip on the lowering side, bending only at the knee) and your back straight. Start off with 10 repetitions on each leg and increase repetitions as your strength improves.
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Short Arc Quad
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Lying on your back, place a foam roller under your knee. Contract the quad so that your foot rises, making the leg straight. To isolate the VMO even more, rotate the foot slightly so that the toes point outward. Hold the contraction for 10 seconds and repeat 10 times. Once this exercise becomes easier, add ankle weights or hold the contraction for longer durations.
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Overuse
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The patella can also begin to track incorrectly because of overuse. When fatigue sets in, the body compensates however it must to do what's being asked. Aside from training more than your body is used to, pushing big gears can be a culprit.

The Fix: Increase your cadence to pedal over 80 revolutions per minute (rpm). Spinning in an easier gear puts less stress on knee joint. It will also keep the quads from becoming fatigued, which will help to keep the kneecap tracking correctly.

Be sure to practice pedaling in circles, too. Many cyclists tend to push down and mash the pedals rather than pedaling in smooth circles. By avoiding the mashing technique, you'll use your hamstrings and gluteus muscles more, which will also take stress off of the often-overworked quadriceps muscles.
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Patellar Tendonitis
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Patellar tendonitis is caused by inflammation of the tendon that supports the kneecap. Increasing your mileage too quickly and poor bike fit are your two most likely causes. An anti-inflammatory such as Ibuprofen and ice should be used to help reduce the inflammation.
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Bike Fit
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Saddle position and cleat adjustment are the two primary areas of concern when treating knee pain from cycling.

The Fix: The most common cause of patellar tendonitis is a seat that is too low. Raising the seat so that your leg is near full extension (about 15 to 30 degrees of knee flexion is ideal) at the bottom of your pedal stroke will relieve pressure on the patellar tendon.

A seat that is too far forward could also be the culprit. The aggressive angle of the knee in relation to the pedal can put undue stress on the knee joint. By sliding your saddle back, you change this angle. Small adjustments can make a world of difference.

Lastly, the position of shoe cleats plays a significant role in the stress placed on the patellar tendon. Much like the fore/aft adjustment of your seat, the cleat's fore/aft position must be properly aligned.

It's a general rule that the pedal axle should be directly underneath the ball of the foot (large bone in forefoot on big toe side). If you are experiencing pain, start with the cleat in this position. From here you can move the cleat slightly forward towards the toe, which will help to put the knee angle in a more favorable position.
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Mileage
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If inflammation has been caused by overuse, rest is a key requirement. As long as you are irritating your injury through the repetitive motion of cycling, you aren't likely to get better.

The Fix: When you do start feeling better, increase your mileage slowly. The 10-percent rule is a good one to follow. Also keep in mind that training on hills forces you to put out more power and usually forces cyclists to pedal at lower cadences (depending on the grade). Stay away from long, steep climbs until you've built yourself back up to your normal mileage. Once you're there, increase your miles by no more than 10 percent per week.
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