Cycling - Knowledge

Cycling Injuries: Anterior Knee Pain in Cyclists (The Common Agony!)

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Among the most common of injuries a cyclist has to face, Anterior Knee Pain in cyclists is what tops the charts. Of course, when it comes to cyclists, 41% of the reported injuries are at/around the knee per se. When it comes to the knee joint, the most afflicted areas are the front and on the outside. Facing knee pain isn’t a serious worry worthy problem. In fact, most cyclists tend to ignore the common muscle imbalances that occur as a result of this sport being repetitive in a single plane motion.

Most of these issues can be easily taken care of by proper stretching like knee stretches and strengthening even during offseason. Anterior knee pain in cyclists can be a result of multiple issues though. The VMO or the Vastus Medialis Oblique located in the kneecap or the patella is a cyclist’s biggest weakness. While cycling, often the last 35 degrees of knee extension, which is controlled by the VMO, escapes being completed.

Hence, over a period of time, the muscles of the lateral side of the knee or leg tend to become tighter and stronger than the VMO muscles which are under-engaged. This leads to the patella to improperly track and create irritation to the tissue under it. There are solutions to every issue and we’ve broken down the components involved in anterior knee pain involving pain behind the knee, back of knee pain, inner knee pain, pain in the back of the knee, knee pain cycling top of the knee and the ways to fix them. If you’re a cyclist who’s facing similar problems read on to decipher how to deal with it.

The conclusive reasons for sensing inner knee pain, pain behind the knee or on the front part of the knee is due to Patellar Tendonitis or Patellofemoral Syndrome.

Patellar Tendonitis

Patellar Tendonitis is an injury to the tendon which connects your shinbone to your patella or kneecap, leading to cycling kneecap pain. The patellar tendon is responsible for you being able to run, kick, jump and bike by working alongside the muscles at the front of your thigh enabling you to extend your knee.

Among the first of the symptoms, the pain will make an appearance generally in the area between where the tendon is attached to your tibia or shinbone and your kneecap.

The pain will make its presence known as such:

  • Initially, it will pain only when you start a physical activity or after an intense workout session
  • It will worsen to the point of being an interference in your sport
  • Its worst stages will interfere even in common daily activities such as ascending the stairs or getting up from a chair.

Patellofemoral Syndrome

The cartilage present on the underside of the kneecap is known to be a natural shock absorber but any injury or overuse of the same will lead to a condition called patellofemoral syndrome. This will come up as dull aching pain present in the front part of your knee. The pain can get further aggravated when:

  • Ascending or descending the stairs
  • Squatting and kneeling
  • Walk up or down stairs
  • Sitting with your knee bent for longer time periods
knee pain cycling top of knee
Patellofemoral Joint (Source)

The Causes and the Solutions

Anterior knee pain in cyclists is pain present in the front part of the knee and can be brought on many different factors:

The Position and Height of the Saddle

A bike that has been fit for you, will bend your knee to approximately 30 – 35 degrees at the bottom of the pedal. When setting the saddle height generally the point when the knee is at its straightest is used for reference. However, to eliminate this kind of injury from occurring, optimally the knee shouldn’t be bending excessively when on the top of the pedal which is when maximum force is applied through the quadriceps.

knee pain cycling cleat position
Position and height of the saddle is vital(Source)

Another thing to be careful of is raising your saddle to a height that is comfortable for you and not according to the levels present. To eliminate front knee pain cycling seat height needs to be just right. A too high saddle will remove the pressure from your patellofemoral joints but will distribute it to another part causing a new kind of injury in another area. Along with saddle height how our saddle moves to the front and back will also change the way your knee is angled during load. Look out for the knee is in line with the pedal axle when at the 3 o’clock position.

The Length of your Leg

Of course, with all of this, even the length of your length will matter. Note that a longer leg is prone to bending more. A good solution to this is either you adjust the saddle height to make room for the additional length of your legs or you could always purchase orthotics or external ‘shims’ under your cleats - knee pain cycling cleat position - to accommodate for such a difference.

Workload and Cadence

It’s been noted that when using higher gears or riding uphill the amount of force applied is more thereby the load on the patellofemoral joint are higher. Also, a drop in one’s cadence from 90 rpm to 70 rpm leads to a reported increase in patellofemoral joint forces. Therefore, if you’re facing outside knee pain cycling, or back of knee pain cycling it could be worth the while to increase your levels of cadence, or ride on flatter terrains and easy gears whilst the recovery period.

Read: Bike Cadence-Techniques for improving Cycling

Positioning of the Leg

In the case of cyclists, the position of the knee while riding is known to be among the more common reasons for a back of knee pain, inner knee pain, pain in the back of knee or pain behind the knee, in general - patellofemoral joint pain. You might have seen that some cyclist’s knees tend to move inwards towards the frame whilst pushing down on the pedals or even be guilty of doing it yourself.

While not much research backs up the fact, the link between this type of pattern in movement and anterior knee pain in cyclists can be justified since similar to this has also been identified in runners and also among the general population.

Flat feet, Weak Hips and a Weak Core

The movement pattern that allows for your knee to turn inwards could easily be a result of a poorly set up bike but can be more prominently attributed to the weakness of your hip muscles. Weak hip muscles would affect how fast and for what duration your hip muscles are able to contract. Even weak core muscles can be blamed for contributing to this pedaling action.

A substantial amount of research goes to show that ankle eversion or the amount of roll your feet have when running or walking is what leads to this type of foot posture. The more your feet roll, the more your leg will rotate towards the inner side which will eventually lead to a higher chance of patellofemoral joint pain.

However, to what extent the leg and foot movement is interlinked and to what greater capacity it will be the cause of anterior knee pain is still to be determined by the variants of the research.

Muscle Balance

The muscles that attach to the patella play the crucial role of keeping it in a correct position. Should the muscles that are attached to the outer side of the patella become too tight, it can lead it to be pulled across. So, it is absolutely essential that muscles attached to the inner side of the patella function properly. Sadly those suffering from patellofemoral joint pains show a delay in the contraction of these muscles and are weak leading the patella to get pulled across by the outside muscles.

Additionally, tight quadriceps muscles mean they too will push the patella with more force against the femur when the knee is bent. The leg alignment and position of the foot while walking will also be affected by tightened hamstrings and calf muscles located at the back of the leg.

Training Load

While it might not occur as a factor, the sudden increase in the volume of training, or a sudden change in the style and type of riding like incorporating hill training in the middle will play a fair share in contributing to this overuse injury.

Dealing with the Pain

If any of the above-mentioned issues are what’s bothering you, then it’s time to hit the solutions to see what works for you. As you now know anterior knee pain could have a lot to do with you and your bike. In order to attempt a speedy recovery, you will have to initially self-assess the root cause.

In the beginning, you might want to treat the pain as an overuse injury with some heating and icing the area, popping a painkiller, few knee stretches while recovering and basically resting it out for at least 3 days.

Post that you can isolate one factor a time and target the solution to it for a while to see if it makes a difference. Make your way to the list till you reach your root cause. Be patient. It will take a while before you can pick up from where you left off.

Now that you know about the anterior knee pain in cyclists and the causes and solutions for the same don't hesitate to enjoy your passion for cycling without the fear of injury as we have got you covered with this article. Also feel free to share your tips and comments for the same.

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