How to Manage Cycling Knee Pain, According to Physical Therapists

Whether you like to occasionally venture out for a weekend bike ride or swear by your daily spin class, you may notice that your knees occasionally hurt when you cycle.“Cycling knee pain is a common issue and it can happen to anyone, including beginners and people who have been biking for years,” explains Dorian Logan, PT, DPT, a physical therapist at Hinge Health. But just because it’s common doesn’t mean it has to deter you from getting — and staying — in the saddle. In fact, biking can be a highly effective way to prevent and manage knee pain. 

But if knee pain from cycling is an issue for you, know that there’s a lot you can do to address it so you can continue to bike, says Dr. Logan. Here's what Hinge Health physical therapists recommend.

Common Causes of Cycling Knee Pain 

There are a few possible reasons you could have knee pain related to cycling. Fortunately, these issues are often manageable with adjustments to your cycling routine and by incorporating specific strengthening and stretching exercises to prepare your knees for more biking. Here are some common contributors to cycling knee pain. 

• Tight or weak quads or hamstrings. “Both muscles act on your knee, so if one or both are tight or weak, your knee may be impacted and this can contribute to cycling knee pain,” explains Dr. Logan. 

• Going beyond your body’s sweet spot. You may be excited to increase training for an upcoming race or fall in love with your gym’s new spin class. But increasing the frequency or intensity of your cycling workouts too quickly can be an issue. “One thing people don’t often think about is the terrain. For example, if you normally bike a flat route and suddenly take on more hills than you’re used to, your knees may be more sore,” says Dr. Logan. It’s great to have a goal in mind, but ramp up gradually to prevent increased knee pain, she suggests.  

• A tight iliotibial (IT) band. Your IT band is a long tendon that extends along the outside of your leg, going from your hip to just below the outside of your knee, explains Dr. Logan. The motion of bending and straightening your knee repeatedly (like when biking) can cause it to tighten up and contribute to discomfort on the outside of your knee, especially when cycling. 

• Not enough core strength. “A lot of people overlook this in biking, but you need to have a strong core because you use those muscles a lot when you cycle, especially as your arms brace against the handlebars of the bike,” says Dr. Logan. If you’re not using your core muscles effectively when you bike, other muscles may need to work harder, including the muscles around your knee joint.

Cycling Knee Pain: A Hinge Health Perspective

If you experience knee pain when cycling, you may assume that you should stop cycling altogether. But really, you should do the opposite: keep moving. Any type of movement, including biking, helps your body become stronger and more resilient, which will diminish your pain. 

“Whenever you start a new activity, it’s common to have some aches and pains initially as your body adjusts to the new demands on it,” points out Dr. Logan. Biking places more load on the muscles around your knee joint, so it’s not uncommon to have some pain at first. But the best way to address pain is through strengthening and stretching exercises, like the ones listed below. You don’t want to ignore pain, or push through unacceptable levels of pain. But if you keep moving and strengthening your knees, your body will respond positively.

The above exercises recommended by Hinge Health physical therapists help strengthen your quads, hamstrings, hip flexors, glutes, and core — all muscles you need to avoid and manage knee pain related to cycling. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatment Options for Cycling Knee Pain

Is cycling good for knee pain? The answer is absolutely! Over time, regular cycling builds strength, and the movement helps reduce joint pain and stiffness. But what if you have knee pain from cycling right now? Know that there are many ways you can reduce discomfort and build strength in the muscles around your knees — like your hamstrings, quads, and glutes — that will help relieve cycling knee pain. Here’s more on how to treat knee pain from cycling.

• Consider physical therapy. A PT can show you how to perform specific exercises that will help your knee pain. They can also review your bike setup and offer suggestions to help minimize knee pain in the future. “They can analyze your biking and point out things like how to improve the efficiency of your pedal stroke by engaging your core muscles,” explains Dr. Logan. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Adjust your bike seat. Knee pain relief may be as simple as lifting — or lowering — your seat. “You want to make sure that your bike fits you properly,” advises Dr. Logan. You should have a slight, soft bend in your knee when you're sitting on the bike with the pedal pressed down toward the ground. “Knees tend to do better when they’re in a slightly flexed position,” explains Dr. Logan. If you’re not sure what the right seat height is for you, a bike shop can help you.

• Do the right exercises. Focus on strengthening and stretching your quadriceps and hip muscles, since they work together to stabilize your kneecap, says Dr. Logan. Core exercises are also important to strengthen the muscles in your abdomen and lower back. The exercises above are a great place to start.

• Use clipless bike pedals. This term can be confusing, because you do still “clip into” clipless pedals. But they allow you to snap your cycling shoes flat onto the pedal, which is different from pedals that use toe clips or toe cages. “Clipless pedals help distribute load more evenly across your quadriceps and hamstrings, unlike other pedals which have you rely more heavily on your quads,” says Dr. Logan.

• Use ice and heat. Either ice or heat can be helpful for cycling knee pain. If pain is new or accompanied by swelling, try ice for 48-72 hours, advises Dr. Logan. After that, you can switch to heat, which increases blood flow and helps to reduce stiffness. Apply either one as needed for 20 minutes at a time.

How to Prevent Cycling Knee Pain

There are things you can do to prevent sore, achy knees before you even hop on your bike. Here are a few tips that may help you avoid cycling knee pain.

• Warm up. Like any other activity, you want to ease your muscles into it before you go on a hard-core bike ride. The above stretches and exercise are a great place to start before you head out on the roads.

• Build up slowly. You don’t want to push your body past its sweet spot, points out Dr. Logan. Aim to increase how far you go, or how hard you work, gradually. 

• Wear the right shoes. If you have clipless pedals, it’s important that you wear bike shoes. They provide more support and a stiff sole that helps you cycle more efficiently.

• Check your bike. It’s a good idea to check your bike periodically to make sure your seat is still in the right position and your handlebars don’t need to be adjusted. A bike shop can help with this. 

PT Tip: Squeeze in Core Exercises 

Sitting at your desk? Take a break to do a few core exercises every 15 to 30 minutes, if you can. “Simply squeezing your abdominal muscles and glutes while you slowly exhale trains those muscles to engage when you bike,” says Dr. Logan. This, in turn, makes it easier to cycle and prevents extra load from being placed on your knees.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. van der Heijden, R. A., Lankhorst, N. E., van Linschoten, R., Bierma-Zeinstra, S. M., & van Middelkoop, M. (2015). Exercise for treating patellofemoral pain syndrome. Cochrane Database of Systematic Reviews, 1(1). doi:10.1002/14651858.cd010387.pub2

2. Asplund, C., & St Pierre, P. (2004). Knee Pain and Bicycling. The Physician and Sportsmedicine, 32(4), 23–30. doi:10.3810/psm.2004.04.201

3. Piotrowska, S., Majchrzycki, M., Rogala, P., & Mazurek-Sitarz, M. (2017). Lower extremity and spine pain in cyclists. Annals of Agricultural and Environmental Medicine, 24(4), 654–658. doi:10.5604/12321966.1233552

4. Bini, R., & Flores-Bini, A. (2018). Potential factors associated with knee pain in cyclists: a systematic review. Open Access Journal of Sports Medicine, Volume 9, 99–106. https://doi.org/10.2147/oajsm.s136653

5. O’Connor, F. G., & Mulvaney, S. W. (2023, September 27). Patellofemoral pain. UpToDate. Retrieved from https://www.uptodate.com/contents/patellofemoral-pain?search=patellofemoral%20pain&source=search_result&selectedTitle=1%7E56&usage_type=default&display_rank=1