Dealing With A Painful Knee (Or Any Injury That Keeps You Off The Bike)

There is a certain sinking feeling when a familiar injury returns. The twinge in my left knee as I get off the bike. The tightness above the knee. That feeling of dread as it starts to seize over the course of the afternoon. The jolt of pain as I walk down the stairs in the evening.

Then weeks of ‘is it getting better?’, ‘I’m sure it’s improving’, and ‘damn it, that hurts’.

I’m in that place right now with my knee.

I’ve tried resting it (sort of). I’ve tried light training rides. And, so far, the pain doesn’t seem to be going away.

Now I’m getting worried. I’ve got PLANS for this year. I’ve made some commitments to do rides with people and I don’t want to let them down. I need to get my training started.

What am I going to do?

Too Confident Mont

I’ve done ‘cycle every day’ challenges before (for instance here and here). The more recent one started just after Christmas after a ‘successful’ autumn of de-training. I didn’t pick up an injury then.

This time, after just two sessions on the indoor trainer (one of which was outside), and one outdoor ride (which was also outside), the chronic knee pain, which I thought I’d seen the back of, returns. With a vengeance.

I think part of the problem was that I’d still been carrying a little bit of fitness through autumn and into winter. I thought I was quite fit. I didn’t take care to make sure that my joints and muscles were keeping up with my cardio.

Most of my riding takes place outside (that damn weather-beating Castelli Perfetto jersey!). I’m pretty relaxed on them. I get bored on the turbo trainer and tend to push myself too hard. Even if a turbo session is only half the length of an outdoor ride, I probably spend more time in the seated position driving a really high gear.

And my turbo bike is my trusty Dawes. Which is not ideal for reasons I’ll come onto in a moment.

I’m sure the volume of driving I do on my commute doesn’t help my knee either.

What Causes Knee Pain In Cyclists?

It turns out, with a little Google research, that there are many potential causes of knee pain for cyclists (and for other people). I’m not going to go through them all. I’m sure you all know how to search for questionable medical advice on the Internet.

I’m pretty sure that my pain comes from the patella (the knee cap) not tracking properly. This can be caused by tightness in the quadriceps or of the iliotibial band pulling it out of line as you (I) use the knee.

A range of potential weak muscles or tight tendons, in the area around the knee, and further afield, can all contribute to the problem.

One cause, cited by physiotherapists, is a weak core and weak glutes (bottom muscles). A weak set of glutes causes your quads and hamstrings to have to work too hard and the leg not to track correctly around the pedal stroke. All of which can manifest itself as pain in the knee (and my knee in particular it seems).

The more you look into it, the more complicated it all seems to get.

Bike Fit Body Fit

Knee pain often shows up in cyclists as a result of riding a bike where the saddle has been set too low. This results in too much pressure being placed on the knees (and quadriceps) as you drive down the pedals, rather than spinning them smoothly. I’m pretty sure that this was the case for me the last time that I really struggled (whilst I was training for RideLondon in 2013).

My trusty Dawes (now my ‘indoor trainer bike’) was bought in haste as a commuting bike one Sunday afternoon. We’d actually gone into the shop for a bike for my girlfriend (yes, I married her; no, she doesn’t ride bikes much these days… sad face). I received virtually no advice from the shop assistant. I certainly didn’t get a bike fit. I rode the bike off and on for the next 8 years.

The good thing in 2013 was that, when I bought my Trek Domane, which was properly sized in the first place and then tweaked further following a professional bike fit, my knee issues went away almost instantly.

The pro bike fit on my Trek also involved the fitter doing what he could to whip the Dawes into shape (new handlebars, shorter stem). It’s considerably better than it was but still not as good as the Domane.

Following the Trek purchase, and the realisation that bike fit is so important for avoiding injury (as well as riding more quickly!), I thought I’d solved my knee issue. All of which makes the recurrence of knee pain so worrisome. I’m now riding bikes that fit, but still it’s there…

The Hips Don’t Lie

Poor bike fits alone do not cause knee pain. Many of the studies done on cyclists that carry chronic injuries involve professional riders. We can safely assume that they have correctly sized and fitted bikes.

The more fundamental cause of knee pain for me is (self diagnosis alert!) poor core strength, weak stabilising muscles around my hip (if I squat down, my hip goes outwards and my problem knee moves inwards rather than staying in one place as it bends) and flat feet. My hamstrings are too tight. I have poor flexibility.

I am falling apart.

It’s time to work on the root cause of the problem.

So What Am I Doing?

Which is not at all a question I ask myself every day.

What I’m not doing right now is going on the indoor trainer.

I’ve tried to the rest the knee. It’s hard though. Using one’s knee is a pretty fundamental aspect of life. Simply not using it isn’t an option.

Sleeping. Or trying to. It’s not just rest in the sense of not riding a bike that’s important when you have a physical injury. Sleep is required to give your body the down time to fix the problem.

More than that though, more sleep (or better quality sleep, which might include an element of getting more) is really important to replace the psychological benefits that exercising on the bike gave me.

The Mental Aspects of Dealing With An Injury

I’ve actually found it quite hard stopping myself from getting back on the bike. Whilst I think that riding the bike (in the right way) should form part of my recovery, I do want to give the inflammation that is presumably causing the pain an opportunity to settle down.

I guess I should take it as a positive that my riding habits are so ingrained now that I’m not using this as an excuse to pack up the bike until… whenever. That said, I do want to make sure I don’t lose the desire and habit to start riding again.

It’s all too easy to put on a bit of weight, lose some cardio ability, forget the joys of cycling, and suddenly find that the bike has lain dormant for months.

It’s not like I’m targeting a place on the Tour de France but having an injury does cause the occasional worrying thought:

  • Will I ever be free of it?
  • Will it always be there as a limiter of what I can achieve on the bike?
  • Does this mean I can’t even think about planning a multi day ride in the Alps (if the other demands on my time ever allowed it)?

This is particularly the case when it’s a recurrence of an old injury, which felt like it took a long time to sort last time round.

Thinking Outside The Bike Box

This episode has reinforced in my mind the importance of a bike that fits well.

When I had issues in 2013, it was buying my new bike and having a professional bike fit that solved the problem (at least on the face of it), almost overnight.

As I write that out, it is clear now that my knee is telling me that I need to buy a new bike.

Oh, and my knee is also saying that you should get a bike fit.

The Real Solution

Whilst ‘I should buy a new bike’ is the answer to most problems, I think in this case that resolving the issue might involve a little more work.

Whilst I’ve paid lip service to my body being a complex interconnected system (it is!), I haven’t being paying enough attention to treating it as such.

I have been feeling knee pain, but I’ve also been experiencing tightness in my hip (I think) as I mount the bike (cocking the leg, as it were). I’ve also had a few sharp twinges in my lower back.

I’ve ignored the unsexy bits of improving cycling fitness for too long.

There’s a concept in business productivity of activities being either important or unimportant, and urgent or non-urgent. Generally people prioritise the urgent important things (and often the urgent unimportant things).

But it’s the non-urgent important things that are often most vital to business success (or any success).

In the case of cycling, the non-urgent important things are fundamental to building a solid foundation of fitness and, whisper it, allow us to ride regularly and strongly as we get older.

The ‘off season’ (assuming I have an ‘on’ one) is when I should be focusing on strength and conditioning. Fixing some of the underlying issues with my body (although there’s only so many hours in the day).

Whilst there is absolutely no way I give off any impressions other than of youthful vigour, I probably should recognise that I will be 39 in a few months.

And then 40 after that (I think I’ve got the maths right there).

Suddenly the ‘Fast After 50’ book, which I like to think that I reviewed as an act of generosity for others a few years ago, is starting to look a personal instruction manual (and very good it is too).

I’ve been researching exercises to help me stretch my quads and IT band, to strengthen my ass muscles and to improve my core in general. I’ll write more about what I’m doing in future posts (recognising that I am not a physiotherapist nor a doctor).

I’m also thinking again about habit building and how I execute successfully a plan in order to get results over time. I’ve already mentioned how complicated it all seems. There are an infinite combination of exercises I could undertake (or not). A basic plan that gets executed will be far more effective than one that looks amazing on paper but stays resolutely there (on the paper).

The sorts of exercises involved in building core strength and hip-stabilising muscles, say, do not have immediately obvious results. The process will need to have other ways of providing feedback (I’m thinking crosses on a calendar and a commitment not to break the chain).

I will definitely be writing more about instilling basic habits and how we can use them to achieve better-than-basic results. That’s my jam.

It’s Your Turn

Have you suffered from a persistent injury that has kept you off the bike (or stopped you from doing other exercise)?

Have you suffered from knee pain – are you suffering right now?

Is there anything I’ve missed in thinking about rehabilitating my knee or coming back from injury in general?

Let me know in the comments below.


Credit: Owl photo by Paul M on Unsplash

20 thoughts on “Dealing With A Painful Knee (Or Any Injury That Keeps You Off The Bike)

  1. Three right knee, one left knee, both hip replacements give me some insight into knee pain. In my case there were two root causes – an athletic early life and a labor intensive work regimen. That resulted in damaged and dead soft tissue in my knees compounded by arthritis.

    See your doctor as soon as you can would be my advice. Chronic pain anywhere knocks the crap out of you. The damage to your body was probably in place before your recent problems and just surfaced with your current workout regimen.

    For what it’s worth my knee pain is still present, but now I just compartmentalize it in a back drawer and push through it. I’m almost 67 y.o. and cycle almost daily. I hate a trainer and use a recumbent exercise bike when I can’t get out and ride.

    Also try to stay away from any drugs (painkillers) that may mask the problems. Good luck.

  2. I feel your pain – literally! Same knee issue has me worried about the upcoming season. It’s difficult to tell if the exercises and stretches that I should be doing daily are actually helping my knee to recover (plus, they are so boring and repetitive to do!). I look forward to reading more about your efforts, including the mental side as motivation, worry, and frustration are closely tied to the physical knee discomfort.

    • Avoid the ‘frog-kick’ associated with breast stroke, if you can; it causes too much non-linear movement in the knee & hip, resulting in a grinding type effect on the internal gubbins.

  3. Got a nagging little pain in the back of my thigh just above the knee while training for the Whistler Granfondo last August. It didn’t show up in the first 3 months of progressively longer and harder training rides. My training schedule had me doing a long ride 20 km farther than the 122 km Granfondo one month before the big day.

    My left knee twinge didn’t appear until around kilometre 125. It didn’t seem particularly bad, and I thought little of it until I rode again a couple of days later. The twinge came on within 10 km.

    A friend who has been a endurance runner advised me to see a physiotherapist immediately. I took his advice and went to a specialist in cycling. She did a full work up on my body position, symmetry, strength and alignment. It turned out that I had tight and iliotibial band in the left leg, a quirk at the top of my left pedal stroke, and restricted movement in the left knee. She prescribed exercises and stretching and told me to stay off the bike for five days.

    I followed her instructions, did my stretching and exercises, and returned for a follow up. I had gained a little flexibility and the problem hadn’t reappeared. So I resumed riding, avoiding longer rides for two weeks, and trying not to over stress.

    When the big day arrived, I was not at my peak, but certainly good enough to do the ride with a respectable time and without re-injury.

    This winter I am working on flexibility and overall strengthening, and the problem has not recurred on my rides, which have been limited to around 50 km or so.

  4. Surprised Andrew that you have not mentioned the importance of properly aligned cleats and footwear in overcoming knee pain. The float given by using Speedplay are a definite help in avoiding knee issues.

  5. I had the same issue last year when I did a couple of sportives at home after a week’s training in Mallorca and the knee pain kicked in after the 40 mile mark. I rested the knee for several weeks and then did the King of the Downs sportive when my knee flared up again but I managed to complete it but in a much slower time.

    Like you, I thought this would curtail my riding. However, I traced the problem to the new pedals I had installed after Mallorca. The tension on my clipless pedals were a lot looser and more flexible than my previous clipless pedals. So it was a matter of readjusting the tension on them and making them a bit tighter so keeping my knee alignment more or less fixed throughout the ride.

    It may be something as simple as that or the angle of your cleats. And do you use the same pedals on your turbo trainer as on your bike? If not, then the difference between the two may cause extra stress on your knee.

    I also had the same issue with my knee when I was running several years ago and a change of trainers with more cushioning (which flies in the face of conventional wisdom) did the trick. Being flat footed is a contributory factor!

    It’s about the alignment of the hip to the foot as this affects the health of your knees.

    The following link might be of some help:

    https://fitnesspainfree.com/knee-pain-fixing-the-foot-part-2/

  6. I’ve had a few cases of knee pain over the past couple of years, and I sympathise with you! It’s incredibly frustrating.

    Over and above what you’ve said already, I would say that a bike fit should be thought of as a process rather than a one-time thing. I now go once a year to fine-tune things and work through any niggles that develop.

    One important factor is cleat placement. Your saddle height might be bang on, but if you’ve changed your cleats or they’ve slipped, that could explain some of the knee issue.

    I’ve also found that a spikey ball (instead of a foam roller) has worked wonders at getting the more specific trigger points for muscles that tend to pull on the knee. They’re cheap and easily available from amazon. 15-30 mins every day while watching the TV helped my knee pain to disappear over a few weeks.

    In the meantime, I found a combination of Voltarol gel and biofreeze were good at reducing any pain or inflammation I had.

    Hope you heal up and get back to achieving your goals!

  7. I suffered from what I feared to be serious knee pain (patella) and weird noises a few years ago in my mid 40’s. It took my Doctor just seconds to determine that it wasn’t serious. Mine was cured through rest, a minor refit (moved 2cm) aft, looser cleats, glucosamine, hydration and retraining weak areas. Your back tweaks should be a clue that you have core work to do. Sounds like you need better hip flexibility as well, all issues that contributed to my knee and back problems. Check out Kym Non Stop on youtube for core training for cyclists. She’s fun and pretty badass. My pain has thankfully disappeared since I climbed that 6-week bump in my training to become a stronger athlete on my bike. Walking is also a great complimentary excercise to cycling.

  8. Monty, one item you seem to have missed is seeing a doctor. You have tried the usual self help ideas. At least for peace of mind, consider getting the knee worked up by an orthopedist. I went several years able to reach a certain level of “fitness” but trying to push harder made my knee pain unbearable. I’m about half again as old as you, but it turned out to be I was several years overdue for a new knee. As you correctly point out, everything is connected. That meant favoring the bum knee threw my back out. My back issues made recovery from a knee replacement more difficult than usual (perhaps made worse by my efforts to completely wear out the knee before surgery, including a ride 3 days before), but I look back on the year since and it was very worthwhile. Hopefully your knee problem can be fixed with therapy or relatively minor surgery.

  9. Monty, something seems to have happened to your blog so that I can’t see the comments any more — it tells me that there are 8 comments, but I can’t see them. Poor me. Anyway, I suffer knee pain intermittently; in my case it’s usually from overuse (ramping up miles or amount of climbing too quickly), or from doing things I shouldn’t (e.g. riding my rain bike, which doesn’t fit me, or running, which I don’t seem to be suited for). Rest helps, especially if the pain is bad, but it also has the effect of causing the muscles to tighten up, which puts further strain on any injury, and I believe this is why moderate exercise is indicated if it can be done without pain. Also good to work on the various leg muscles with a foam roller or baseball. Core exercises probably help (I like Tom Danielson’s “Core Advantage”, which gives various exercise programs of varying difficulty) although I tend to get bored with them. Other things I’ve done while waiting out injuries include one-legged cycling (just be careful not to injure that other knee!) and learning how to track-stand (highly recommended, and great fun to do at traffic lights). Anyway, good luck with your knee, and please let us know how you get on and what works best for you. And see you on Strava, hopefully soon!

    • I fixed it! (The blog comments not the knee). Only a full site redesign in about 20 minutes. Been meaning to give it a bit of a freshen up – will try to polish it over time. I get you about the boring core exercises- I’m thinking of ways to mitigate this. Will look into the Danielson book. Pretty sure he’s (whisper it) a postal rider (or at least discovery channel), no?

  10. Interesting Andrew, thanks. Interesting to me because I have been off the bike for months due to patellar tendonitis and have lost a considerable degree of CV fitness. Bugger.

    Also, if anyone out there is considering a bike fit but thinks that it’s a lot of money for someone to make minor adjustments to your bike, as I did: it’s a bargain if it gives you pain-free cycling. It worked for both the author and I.

    Your comments on the glutes are spot-on, too. Specifically, in my case at least, the gluteus medius which is a difficult muscle to effectively target. There are exercises out there; Google, browse and choose wisely.

    Excellent article, thanks!

  11. In addition to seeing a Dr or sports thetapist you might Try Pilates to improve core strength and rebalance stressed and underused muscles. This may help with your ITB and glutes. You’ll be assessed by the teacher who can tailor workouts to assist ease on going mobility problems. It’s extremely low impact and very envigorating. I’ve been off my bike for nearly 1 year as i have completely lost my drive to cycle and have been using the last 4 months to strengthen my weak core. Hopefully, when I return to riding I’ll be able to be more efficient as a result of this strengthening. I must be getting closer to returning as I’m taking an interest in cycling issues.
    You might also check your driving position, which pocket you put your wallet in as these can impact on lower back, hips etc. Good luck and a speedy recovery.

  12. Hi Monty,,
    Here’s piece of advice number 11,356.
    I had the same problem. Went to ‘proper’ Sports Physio who correctly diagnosed very tight right quads built up by, er, cycling.
    Fixed me up with a Roller ( high density foam….not the car) and exercises to loosen the quads.
    You have to do the exercises frequently in 5-10 minute sessions and it’s a bit painful but, for me, it worked.
    Combined with other advice here, you’ll soon be back on the bike.

  13. I started cycling after tendonitis stopped me running. I now have the triathlon bug, but the knee problems came back with a vengeance. Following physio advice, I did a lot of work to get the glutes firing again (desk job) and strength training plus pilates. I then had a multi camera bike fit, which showed my hips were rocking due to a mechanical issue in my left foot making my pedal strokes unequal length. Previous bike fits (turning the cleats out) had just masked the problem. The new fit involved wedges and inserts to get both feet pedalling the same. This prompted me to have a session on a treadmill with a podiatrist and physio, who prescribed wedges for my shoes and running shoes, along with exercises to get the muscles working correctly in my feet. Progress so far is that the knee tendonitis has all but gone, but my left IT band is now suffering instead and is what I’m working to solve next.

    As others have said, getting professional advice is important, as is getting progress checked regularly too – I’m hoping that the need for corrective orthotics will reduce as I work on fixing the root causes. As an aside, I get less back and hamstring pain now than any time in the last 25 years!

    • Its great to hear that other people have gone through whats been plaguing me for the last two years. Thanks a lot for sharing your story, it sounds very in line with what I’ve been experiencing. Working with podiatrist/ortho/physio to no avail. Cortisone shots/yoga/stretching all seem to help a little, but not fixing the actual problem.

      I am nervous to use clip in cleats again because I rode for years in just sneakers with no problems, and then after two rides with cleats it seems I’ve done some damage to my knee (though MRI shows no structural damage).

      Would you all recommend going back to the cleats for my fitting or stay with just sneakers and cages for the time being?

      Some days are such a struggle mentally when all you can think about is cycling and your body wont let you.
      Thank you all again for sharing your stories, it gives me some hope again.

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