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Causes of Knee Pain in Cycling

Causes of knee pain in cycling
Here we’ve put down some factors and the possible results in italics.


Leg-length discrepancy
ITB stretch on shorter leg, lat tracking patella
Wide pelvis
Lateral knee stress
Pes planus and/or pronation
Medial knee pain
Internal tibial rotation
Patellar malalignment
Muscle weakness of quadriceps, hamstrings, hip flexors, gluteus Fatigue-induced alterations in pedalling technique that transfer stress to other parts of the kinetic chain.

Bike Fit

Saddle too high
Knee extension that irritates the ITB, patellofemoral loading, hips stressed by rocking while pedalling
Saddle too low
Stress on patellar and quadriceps tendons
Saddle too far forward
Stress on anterior knee from pedalling in hyperflexed position
Saddle too far back
ITB stretch from excessive forward reach for pedal
Crank arms too long
Increased forces on the entire knee; patellar tendon and quadriceps tendon are most affected
Internally rotated cleats
Patellar tendinosis, tibial rotation stress on anterior knee


Rapid increase in distance or intensity
Muscle tightness, microtrauma
Excessive hill work (on bike)
Cartilaginous breakdown, chondromalacia
Pushing high gear ratio
Medial knee stress
Hill running (on foot)
Medial knee stress (uphill), tight quadriceps (downhill)
Deep leg squats
Increased stress on entire knee

ITB = iliotibial band

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