How to avoid knee pain when cycling

Question

I've noticed some knee pain arising recently from cycling. A throbbing around and below the kneecap while I sit at my desk during work. To try and counteract this I've been increasing the height of my seat. This has gotten to the point where my hips slightly rock during cycling.

I know there are a few things I do that do not help.

I ride a fixie: I've tried taking the starts and stops slower in order to minimize tension in my knees. Also I always use the front brake to slow down.

What steps can be taken to eliminate knee pain? It's causing some concern considering my daily cycle is less than 15mins of urban cycling.

Answer 1

I am a physician (not practicing anymore), a biker, and an office worker. And I ride fixie. And I sometimes have knee discomfort. So, my few cents:

• Depending on HOW YOU SIT DURING WORK, specially how you rest your legs/feet, your knee might be twisted for a long time (hours a day). Watch yourself if it is happening or not.
• Take a rest on the fixie. I noticed it is only nice when you are "energized". Sometimes we are a bit tired or "low mood". These are not good times to ride fixed, I think. So, take an abundantly-geared beater or something, until you get better.
• If you don't get the rest, try not to accelerate or decelerate too fast. If you ride in traffic, give up riding faster than motor vehicles, for a while, until your knee gets better. I think speed is not so important (spinning is winning, Stephen said), but bursts of acceleration or deceleration put a stress on the knees.
• Watch yourself while pedalling. If you notice some movements reproduce the pain you feel, change your habit, avoid them as much as you can. But try to keep efficient. If you have to create an anti-natural position so as not to feel pain, things are starting to get ominous!

Other factor: you mentioned your cycle is short, less than 15min (so is mine). I found this to be a problem, because you always ride "cold". Perhaps you could warm-up and stretch, at home (learn how to stretch thigh and calf properly, first), or even take a LONGER way to work, so you can ride lightly for more time, thus pumping some nutrients inside your joints' tissues instead of just hammering'em cold.

At last, seeing a doctor (preferrably specialized in sports medicine) and doing some physical therapy is always something to consider. But don't think that is more important than self-observation, self-knowledge and self-control.

Hope it helps.

Answer 2

Lower your gear ratio. Spinning is winning.

Answer 3

Seek professional medical advice, either a physiotherapist or a sports doctor. Also, have your bike fit checked (see this question).

Cycling in too high a gear, particularly uphill is a pretty good way to hurt your knees, so you may want to get a bike with multiple gears.

Answer 4

Yep, three points:

1. Don't ride a fixie. (Not what you wanted to hear.) The knee is the weakest part of the human body, and riding in too high of a gear puts enormous stress on it. A fixie has you riding in the wrong gear most of the time.
2. Raise your seat. (Though it sounds like you've done this.) Having your seat too low amplifies the stress on the knee. The seat should be as high as reasonably possible without causing you to slip side-to-side as you pedal.
3. Use toe clips. I don't know exactly why, but toe clips help relieve stress on the knee. (And it may be that old-fashioned strap-type clips are better than "clipless", as they don't stress the knee sideways, and don't require knee stress to unclip.)

Visit a orthopedist or at least a medically-qualified physical therapist to find out which variety of knee pain you're experiencing (there are several different knee pain syndromes) and what therapy you should use for it. Very often the right exercises (eg, straight leg lifts) can make a world of difference.

Answer 5

It might also help to work out your leg muscles in the gym. There are many muscles that are useful that aren't easily trained just on the bike. Stabilizer muscles and quads. On the topic of fixed gear, there is a reason the top track guys are all hitting the gym.

Answer 6

I have encountered a few bike fitters who say that a lot of the people who come to them have their saddles too high. Moreover, having your saddle too high is one possible cause of hips rocking when pedaling. Therefore, the OP should have lowered the saddle.

Beyond that, it is not really possible to properly diagnose and treat stuff on the internet, and moreover you will encounter a lot of incorrect opinions. Fortunately, none of the answers here are incorrect. I would generally prefer to see, in roughly this order:

1. A bike fitter who is also able to recognize what exercises or stretches would help you
2. A physical therapist - although they won't generally have bike-specific knowledge. If your bike fitter doesn't give a lot of advice about stretches or exercises, you can find a PT. At least in the US, you can self-refer to a PT without seeing a physician. Health insurance is likely to cover PT visits (note that some insurance arrangements will require a referral from an MD).
3. No offense to physicians, but I would not see a primary care physician. A sports medicine doctor is worth consideration. Physiatrists are MDs who specialize in rehabilitation, and this might also be worth considering. I suspect both these types of MDs will work with PTs a lot.

You can and should ask why you should trust me. The answer is that I have dealt with knee pain before. I started by seeing my primary care doctor, who after x-rays said that fortunately there was no sign of cartilage degeneration, and that I would not need to consider pain medication. On request, he referred me to a PT, but I later discovered that I could have self-referred. Simultaneously, I saw a bike fitter.

That said, I can't address fixie-specific concerns because I've never ridden one.