Bicycling is normally a low-impact exercise; however, anterior knee pain and patellofemoral pain syndrome are some of the most common leg injuries seen in cyclists. Dr. Chad Asplund and Dr. Patrick St. Pierre, reporting in The Physician and Sportsmedicine, find that bicyclists' knee problems often stem from overly intense riding and improper alignment of the saddle and pedals. If you experience chronic knee pain that doesn't respond to bike or riding adjustments, see a physician with experience in sports medicine.
Types
Anterior knee pain, on the front of the knee, is frequently caused by improper saddle height or poor cleat positioning on the pedals and feet. Medial knee pain, on the side of the knee facing the other knee, is caused by improper saddle height or cleat positions that rotate the toes outward from the bike and pedals, and it is exacerbated by bad riding regimens or pedaling positions. Lateral knee pain, on the side of the knee facing away from the body, is caused by improper bike fit or anatomical issues, such as leg-length discrepancies or abnormal knee alignment. Pain on the back of the knee is rare in cyclists.
Sitting Position
While pedaling, your leg should bend only slightly at its most extended position, creating an interior angle of 25 to 30 degrees. If your leg is completely extended, lower the saddle. If it is too bent, raise the saddle. Changing the front-to-back position of the saddle more than a centimeter or two alters your legs' angle toward the pedals and may actually be harmful.
Pedal Position
Your natural foot position on a pedal without clips or cleats should be roughly identical to your foot position with clips or cleats. Try pedaling without clips or cleats, and see where your feet naturally sit; then change your pedals to match. Get a professional bike fit at a bike shop if you don't know how to make this or other bike adjustments.
Knee Alignment
Pedaling with your knees out of line with your thighs can cause knee injuries, according to Dr. Michael Sparks of the Dartmouth-Hitchcock Sports Medicine Clinic. Many cyclists pedal with their knees leaning outward or inward, though their foot position may be fine. Watch yourself as you pedal, to train yourself to keep your joints aligned.
Gears
A common cause of knee pain is pedaling in gears that are too high for conditions. If you regularly stand up to pedal on hills, shift your gears down and pedal faster instead. Standing up to pedal puts additional strain on your knees, frequently without actually increasing your speed relative to gearing down.
Training Regimen
A training regimen that ramps up the weekly or daily mileage too quickly can lead to injury. Never increase your total mileage by more than 10 percent from week to week. Drs. Asplund and St. Pierre recommend increasing the length or intensity of rides only if you did not experience pain during or after any rides in the previous week.
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