Sports Tours International | blog | Stop knee pain from ruining your cycling

Causes and factors to be corrected

Causes and factors to be corrected


Patellofemoral pain syndrome is related to a combination of factors involving malalignment of the knee extensor mechanism.

Patients generally report that anterior knee pain is worse when the knee is loaded (e.g., when climbing or descending stairs, during prolonged sitting or squatting). Patellofemoral joint problems frequently differ between cyclists and runners – many cyclists will point to the centre of their patella and describe the pain as being directly under the patella, rather than on the medial or lateral side. The pain, sometimes severe, often initially occurs after cycling, rather than during the ride but as this progresses eventually overflows into the next ride or when under extreme racing loads occurs more severely than ever as seen on the dreaded Mortirolo.

When evaluating a cyclist who has anterior knee pain, the physiotherapist must first inspect the bicycle fit. The saddle may be too low, too far forward, or both, causing excessive patellofemoral loading throughout the pedal cycle. When the saddle is low, the knee functions in hyper flexion, increasing compression of the patella on the femur.

Improper shoe cleat position or float may force the rider to pedal with poor biomechanics, increasing patellar forces. Float is the motion of the cleat on the body of the pedal and is usually measured in degrees of internal or external angulation (i.e., 9° of float means that the foot may rotate 9° inward or outward relative to the pedal body). Cleats with excessive internal or external rotation may cause exaggerated tibial rotation, placing more stress on the anterior knee

Training errors are leading causes of overuse knee injuries. Holmes et al showed that heavy training loads and high mileage contribute substantially to knee injuries. Likewise, a rapid increase in training distance or intensity, seen in the early cycling season, also leads to overuse injuries.

When evaluating knee pain and cycling-related overuse injuries, important considerations include bicycle fit, training distance and intensity, and anatomic factors such as leg-length discrepancy, muscle imbalance, and inflexibility.

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