Knee injuries: how to tackle the problem

The knees are the most active joint when it comes to this gruelling sport. This part of the body takes on the most stress, especially during hard pedalling and climbing.



Injuries usually occur when the load becomes too much for the joint to take. While the exact causes of knee pain may involve many factors, the majority of cyclists that present themselves in clinics often reported these signs leading up to their problem.

#1 Training load: Abrupt increase in mileage

#2 Terrain: Change in terrain that includes more hilly areas or repeated climbs

#3 Lack of conditioning exercises to improve the strength of the lower limbs

#4 Preference of using gears that are too heavy for themselves

#5 Change of bike/poor bike fit



  • The pain felt at the front or outer sides of the knee.
  • Pain can affect activities of daily living such as going up and down the stairs and squatting.
  • Cyclists can complain of pain during cycling especially when executing the down strokes.
  • Injuries often occur on the weaker leg.
  • Painful ‘clicking’ of the kneecap especially during cycling.


Common Knee Injuries

Patella tendinopathy/tendinitis

The patella tendon is the thick band that is located right below the knee cap, and it stretches a few inches down to the prominent protuberance at the shin bone.

Patients usually complain of pain in this area when they climb stairs or when getting up from a seat. Direct pressure to this area will also elicit pain in more severe cases.


Patellofemoral Pain Syndrome (PFPS)

The cause of PFPS is in the maltracking of the kneecap. Anatomically speaking, the kneecap sits in a groove on the thigh bone (femur) and moves up and down like a train on a train track whenever we bend or straighten the knee.

Pain can arise when there is a misalignment which causes the kneecap to move in a tilted/altered manner.

This usually happens when cyclists do not stretch their Iliotibial Band (ITB) or lateral quadriceps enough, causing muscle imbalances which in turn ‘shift’ the kneecap out of alignment.

Patients will commonly complain of pain in and around the knee cap area during activities like running, cycling and climbing stairs.


Quadriceps Strain

The Quadriceps muscles are located on the front of the thigh. Cyclists usually strain this muscle when they are tried to attack uphill or try to accelerate suddenly with heavy gears.

The pain can be felt right in the middle of the muscle belly or right above the kneecap. In severe cases, bruising occurs, and walking can be painful as well.


ITB Friction Syndrome

The ITB is a thick fibrous band that starts from the side of the thigh near the hip and extends all the way down to the outer side of the shin bone. The ITB can get very tight due to excessive climbing and long rides.

When the ITB becomes too tight, it can rub on the outside of the shin bone causing pain. The pain is more intense, especially when climbing.


What can I do?

The common cause of all the above injuries is over-training and over-straining the knee before they are ready to take on the load.

The first thing you can do is to relook at your training mileage and see if you can reduce it. Try to also cut down on the climbs during the rides.

Lower your gears to increase your cadence to reduce the workload on your knee joint. You may not be climbing as fast, but at least you can still enjoy your ride.

Stretch your Quadriceps and ITB. Most cyclists I come across in the clinic tend to have tightness in these areas.

If you can spend some time before and after the rides to stretch out these muscles, you will certainly see some improvements in the symptoms.

Many cyclists do not know that having a shorter leg on one side can seriously affect how you load it during cycling. Consider having customized insoles done to correct this discrepancy.

This will ensure equal force transmission from your muscles to the crank to improve the efficiency of your strokes.

Get a proper bike setup/bike fit. Remember that a good setup should always allow you to revisit to make slight adjustments if you feel uncomfortable after the first bike fit.

If the problem persists, it is the time to consult a sports physiotherapist to get a proper assessment done.

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