Cycling Knee Pain: 3 Hidden Causes and Physio-Approved Solutions
That sudden knee pain mid-ride - the one that makes you question your cycling future - rarely comes out of nowhere. As a Physiotherapist, I've seen countless cyclists mystified by knee pain that seems to appear randomly, when in reality, the warning signs have been building for months.
The truth is, knee pain while cycling is rarely about the knee itself. It's typically the result of something else. The "last straw". A consequence of hidden restrictions or weakness elsewhere in your body that's been forcing your knee to work overtime.
Key Insight: The "Last Straw" Principle
When your knee first begins to hurt on the bike, don't think of it as the start of something new. Instead, look at it as the last straw—the moment your body stopped tolerating the covert dysfunction it's been buffering for months beforehand.
The 3 Hidden Handbrakes Causing Your Cycling Knee Pain
These three areas of restriction are the most common culprits I find clinically. Address them systematically, and you may not only eliminate pain but also unlock stronger, more efficient riding.
1. Stiff Ankles: The Silent Knee Killer
Your ankle is the foundation of your pedal stroke. Modern life in heeled shoes and restrictive footwear gradually robs our ankles of the mobility cycling demands.
How it causes knee pain: A stiff ankle can't properly dorsiflex (flex upward) during the power phase of your pedal stroke. Your body compensates by shifting the knee inward or outward to find clearance, altering the entire mechanical loading of the joint. This repetitive compensation overloads structures like the patella, meniscus, and IT band.
Quick test: In your cycling shoes, try doing a squat. If your heels lift off the ground or your knees cave inward, you likely have ankle mobility restrictions contributing to your knee pain.
Fix: Banded Ankle Mobilisations
Protocol: Perform for 2-3 minutes per ankle before riding and as part of your daily mobility routine.
2. Tight Hips: The Pedal Stroke Saboteur
The modern sedentary lifestyle creates chronically tight hip flexors that directly impact your cycling biomechanics and knee health.
How it causes knee pain: Tight hip flexors (particularly the psoas and rectus femoris) can create excessive anterior pelvic tilt and pull the femur forward, altering the knee's tracking pattern. Tightness through the front of the thigh can also increase the resting tension through the knee. This increases stress on the patellofemoral joint and quadriceps tendon, common sites of cycling knee pain.
Quick test: Lie on your back and hug one knee to your chest with your hips on the edge of a bed. Let the other leg fall off the edge and see if it dips below horizontal. If it doesn't, or it feels extremely tight, then you may need to address this. The repetitive nature of cycling (up to 5,000 revolutions per hour) magnifies even subtle biomechanical inefficiencies.
Fix: The Couch Stretch
Protocol: Hold for 2-3 minutes per side daily, focusing on deep breathing to facilitate release.
3. Stiff Lower Back: The Core Connection
Your lower back acts as the transmission between your powerful glutes and your legs. When it's stiff, this power transfer becomes inefficient, forcing your knees to pick up the slack.
How it causes knee pain: Thoracolumbar stiffness can inhibit glute activation and create compensatory tightness in quadriceps and hamstrings. Similarly, increased neural tension that starts from the spine can affect how things function lower down the chain. These issues can alter patellar loading and increase stress across the knee joint during cycling.
Clinical insight: I consistently find that cyclists with chronic knee pain have significant thoracic and lumbar stiffness. Freeing up the spine often provides immediate improvements to stubborn knee issues.
Fix: Thoracic Extension Mobilisation
Protocol: Perform 10-15 repetitions before riding and throughout the day if you have a desk job.
Beyond Stiffness: Other Cycling Knee Pain Considerations
While the three areas above are the most common hidden culprits, also consider these factors if your pain persists:
Bike Fit Fundamentals
- Saddle height: Too high can cause posterior knee pain; too low may cause anterior pain
- Cleat position: Improper alignment may create rotational stress
- Saddle fore/aft: Affects knee angle at the top of the pedal stroke
Training Load Management
- Sudden mileage increases (the "too much too soon" principle)
- Inadequate recovery between intense sessions
- Poor gear selection (mashing big gears vs. spinning)
7-Day Knee Pain Resolution Protocol
- Days 1-2: Reduce cycling volume by 50%. Perform all three mobility exercises before riding.
- Days 3-4: Maintain reduced volume. Add the exercises to your morning routine.
- Days 5-7: Gradually return to normal volume if pain-free. Continue daily mobility work.
If pain persists beyond this protocol, consult a sports physiotherapist for individual assessment.
When to Seek Professional Help
While these solutions help most cyclists, seek professional assessment if you experience:
- Swelling, redness or warmth around the knee
- Pain that wakes you at night
- Locking or catching of the knee joint
- Numbness or tingling down your leg
- Pain that persists despite 2 weeks of consistent mobility work
Conclusion: Ride Stronger, Pain-Free
Your knee pain isn't a life sentence—it's a message about hidden dysfunction elsewhere in your body. By systematically addressing ankle, hip, and back mobility, you're not just treating symptoms; you're looking to solve the root cause.
The best part? Improving these areas won't just eliminate pain—it will make you a stronger, more efficient cyclist. Your body deserves to ride at its full potential, free from limitations that proper mobility work can resolve.
Need Personalised Guidance?
If you'd like help trying to uncover the underlying cause of your pain or dysfunction, consider booking an online Telehealth consultation with Grant here!
