Cycling and Knee Pain?

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There’s a lot to love about cycling – the fresh air, the freedom, the fitness and the friends. Cycling is a fantastic low-impact form of exercise that boosts cardiovascular fitness, muscle strength and improves your mental wellbeing too.

There’s just one part of your body that doesn’t always love cycling. That’s your knees.

‘Cyclist’s knee’ as it’s been dubbed is one of the most common cycling-related injuries, thought to affect 30-60% of cyclists, depending on the study.

Cycling relies heavily on your quadriceps, gluteals and hamstrings to pedal through potentially thousands upon thousands of revolutions per week, depending on how far you cycle.

A lot of that load goes through your kneecaps. Eventually, they complain.

Injuries happen when your tissues can’t manage the load placed upon them. That can happen during a one off incident of high loading or through repeated low-medium loading that eventually triggers an injury.

Your knee is a complex structure involving a hinge joint, bones, cartilage, ligaments, tendons and other tissues.

Symptoms of cycling-related knee pain can include:

  • Aches, pains and crackling at the front of your knee and/or under your kneecap (patella), both when you’re cycling and/or when participating in day-to-day activities (patellofemoral pain syndrome)
  • Pain at the side of your knee could be (ITB syndrome), which would need to be ruled out as a possible source of your symptoms.

Clinical Examination

Your physiotherapist will ask you about how often you train, whether you’ve changed your routine recently or altered your bike setup, when you first noticed symptoms and where in your knee you feel pain.

Then we’ll examine you carefully, paying attention to aspects such as your soft tissue length, your glute strength (since your glutes help your quads) and your iliotibial band (ITB)/quadriceps muscle tone.

Treating Symptoms

To ease your symptoms and improve your tissues’ resilience to loading, we may recommend treatments such as:

  • Quadriceps muscle stretches
  • Gluteal muscle strengthening exercises
  • Patellar taping
  • Massage and foam rolling of the quadriceps muscles and ITB (this seems to improve pain although we’re still learning how!). There is controversy over whether such a thick, strong tissue as the ITB can be stretched but your quadriceps muscle lies underneath it, so rolling may help reduce the resting tone of the muscle
  • Reducing your cycling load temporarily to allow for tissue recovery, then gradually increasing this load again to achieve your fitness and sporting goals

Recovery and rest are very important for tissue repair and remodelling but rest alone won’t improve a tissue’s resilience. Too much rest actually results in weakening of the tissues, making them less able to withstand loading once you return to your activity.

Rehabilitating injuries requires regular re-assessment and program modifications to ensure the tissues are being exercised in an appropriate fashion that progressively increases their tolerance to loading. That’s why you need a skilled physiotherapist!

Assess and address underlying risk factors

So far, so good. Hopefully your knee is responding to treatment and feeling better.
Now, we want to examine any underlying vulnerabilities to reduce the likelihood of reinjury.

That may involve:


Orthotics to correct any biomechanical misalignment of your knee


Assessing your bike setup – is your seat too low?

Load management – as a general rule, don’t increase your load by more than 10% per week

Ongoing exercises to help you maintain your strength and flexibility.

The last point is particularly important for riders in their 30s and above. As we age, we usually have to put more work into staying injury-free since our bodies doesn’t bounce back as easily as they did in our teens and 20’s.

How can we help?

At Milton Village Physiotherapy, we have a special interest in helping cyclists recover from knee pain. Our physiotherapist Nicky Rolls has a high-level cycling and triathlon background giving her excellent insight into the demands of managing injuries and rehabilitation whilst continuing to train and race.

We know that many different factors influence your experience of injury and recovery. That’s why there is no single ‘recipe’ for physiotherapy treatment. Effective treatment relies on a physiotherapist using their clinical judgement to tailor evidence-based treatments to each particular client’s unique presentation.