5 Essential Ways to Prevent Knee Pain Cycling

by Cycling, Dr Charlotte Robinson, Fitness, Physical Therapy

One of the best ways to enjoy the scenic nature of Colorado while getting your exercise points in for the day is cycling. Whether this is road cycling, gravel riding, or mountain biking, cycling of any nature is a very common form of exercise. For this article, we are going to focus on road cycling and gravel riding since we will highlight more of an “in the saddle” position.

Almost every patient I see in my clinic cycles in some manner, many of which complain of knee pain cycling, and I can tell you with all certainty that ALL OF THEM over utilize their quads. Due to the repetitive nature of cycling, overuse injuries, with knee pain (anterior, medial, and lateral) being the most common, happens in a staggering 85% of all cyclists.

This article is going to take a deep dive into how to save your knees, not over utilize your quads, and tap into the muscle that is going to change your cycling for the better; your glutes!

The “Knee Pain Cycle”

Cycling is one movement over and over again, so specific joints are highly predisposed to overuse injuries.

One of the most common overuse injuries is knee pain; this can include patellar/quad tendinitis, iliotibial band pain, pes anserine bursitis, and meniscus irritation just to name a few.

Is quad dominance causing knee pain cycling?

As I mentioned above, most cyclists are very quad dominant in nature. If you are a cyclist, I want you to ask yourself, “When I’m cycling am I concentrating on extending at the knee or at the hip as I pedal?” Now, try to do a step up and then a squat.

What muscle do you feel working? Your quads or your glutes? These three things can often help you determine if you yourself are quad dominant and not utilizing your posterior chain (meaning glutes and hamstrings) while riding.

How is my bike fit affecting my biomechanics?

One of the easiest things you can do to address knee pain with cycling is reassessing your bike fit. Since biking is very geometrical and physics oriented due to joint angles, level arms, and creating torque we can use that to our advantage to predispose certain muscles to fire.

Changing your seat height for example can either increase or decrease your hip and knee angle and determine whether you use your glutes or quads while pedaling. Below are some simple things to assess to make sure we are putting our glutes in a more optimum position to fire and reduce knee pain cycling.

  1. Make sure your seat height isn’t too low. If your seat height is too low you are going to increase your hip and knee flexion angle and activate your quads more which will increase patellar/knee cap compression forces
  2. Make sure your seat isn’t too far forward. At the 3 o’clock position you want your knee to be positioned over the pedal, not your toes. If your seat is too far forward it will be easier to use your quad instead of your glutes.
  3. Make sure your foot isn’t collapsing into pronation as you pedal. If your medial arch collapses, this will cause your knee to dive medially into what we call a valgus position as well and cause knee irritation. To prevent this you can wear insoles in your cycling shoes or use shims to support you medial arch

How does a Bike Fit “fit in” to reducing knee pain cycling?

Tom Robey, a Bike Fit Specialist at Full Cycle in Boulder, CO said that “A cyclist’s ability is made up of 30% bike fit and 70% mobility and biomechanics of the rider. If you are having pain while riding, it’s definitely time to have your bike fit assessed.”

Talking with Tom, his understanding of cycling biomechanics, muscle activation, and bike fit was very evident. If you are looking for a bike fit, I would highly recommend anyone on the team at Full Cycle!

Here is a link to their bike fit page and they are offering a $25 Full Cycle gift card to anyone who books a full priced bike fitting and mentions this article!

Quad dominance and what this means for our glutes

After we’ve addressed any bike fit tweaks that can be made, it’s time to look at our own bodies for areas of improvement. Most of the human population through development, injury, or habit has adopted a quad dominant movement pattern system. This means that they prefer their quads to do all the work for every movement; ie. running uphill/down, cycling, going up/down stairs, squatting.

When we adopt a quad dominant movement pattern, our body learns how to move without even having to recruit or activate our glutes. Over time our glutes learn that they aren’t needed and will shut down and become inhibited, meaning that they will have a hard time activating and firing. Bodies always follow the path of least resistance. Once your body has learned it can get away with using your quads for everything and not activating your glutes, you subconsciously adopt bad movement patterns that drive this now negative feedback loop.

This cycle is very hard to break because certain compensations happen that make it hard to reverse; ie. tightness in the hamstrings, overactivity and tightness in the quads, limitations in ankle mobility, etc. So if we are quad dominant, how do we start down the path of learning to activate and use our glutes during daily tasks and more specifically cycling?

70% mobility and biomechanics

When I have the discussion with my cyclists that they should be driving the down stroke or propulsion phase of pedaling with their glutes, I often get a bewildered look and a lot of resistance to the idea. If this is your current mindset, let’s explore this a bit more below. If I can teach this concept to a cyclist who’s been cycling for 50 years and was having knee pain cycling who told me I was crazy when I introduced this concept, there’s hope for you as well!

Above is a fantastic visual of what muscle activation should look like while pedaling. The fact that this is NOT the muscle activation that is happening for most cyclists is why knee pain cycling is so common.

You can see that the gluteus maximus should be firing for most of the downstroke phase, and actually initiates this motion. The glute max is most engaged at the 3 o’clock position. This is because in the 3 o’clock position, you should be driving through your heel and actively extending through your hip to drive the crank down and around. By generating enough power through combined hip extension via the glutes and knee extension via the quad, the upstroke phase should be fairly passive. This is because while one side is on an upstroke, you’re generating force on the opposite side during a downstroke.

From a power perspective, if I’m only using my knee extensors for cycling, I’m leaving a lot of muscular real estate on the table. The glute max is one of, if not the most, powerful muscles in our body. If I’m not able to engage and recruit this muscle while pedaling I’m not only increasing forces on my knee but over using  my quads, but I’m being less efficient and powerful as well. If you want to save your knees AND improve your cycling efficiency and power, wake up your glutes!

Combating “Dead Glute Syndrome

So now that you understand how important the glutes are during cycling, what can you do to promote their firing while riding and prevent knee pain cycling?

  1. Optimize ankle mobility
  2. Be able to activate and isolate your glutes
  3. Strengthen your glutes

How ankle mobility effects knee pain cycling

As we discussed above, during the 3 o’clock phase your glute max is working it’s hardest to extend the hip and drive the crank down. During this position, we should AT LEAST have a neutral foot position meaning that our heel and our toes are in line. If your toes are relatively below your heel in the 3 o’clock position it’s going to be easier for your quads to fire and to not utilize your glutes. If you focus on dropping down through your heel and driving with your hip extensors, this is going to help you activate your glutes and decrease knee pain cycling. 

The more you can drop your heel past your toes in the 3 o’clock position, the more success you will have with glute driven downstroke or propulsion phase. So, we need to make sure we have appropriate ankle mobility to do so.

Here are my favorite exercises for promoting ankle dorsiflexion, which is the motion needed to let your heel drop down while pedaling

Forward lunge ankle mobility

Lateral lunge ankle mobility

Glute activation

Most people have trouble with just activating and isolating their glutes, so this is a great place to start for most of us. With a quad dominant movement pattern, our glutes are essentially sleeping and need to be woken up and taught how to do their job. Below are some exercises to promote your glutes waking up and firing!

After doing these exercises a few times, think about these concepts while on the bike. Focus on driving through your heel and extending at the hip to generate power and downstroke. When you bring all of these concept together you will be on your way to decreasing knee pain cycling!

Bridge for low back pain

Curtsey step up

While most people will get a lot of helpful information from this article alone, this is just a brief overview of preventing knee pain cycling. Depending on how long you’ve been suffering with knee pain cycling, you may require a more holistic look at the issue concerning your body.

If you’ve been suffering for a while, you might need a little extra help! Click here to book a FREE Discovery Visit with one of our expert Doctors of Physical Therapy today to discuss how we can get you back to pain free and living your life.

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