5 Reasons You Could Have Knee Pain While Riding & 3 Exercises to Help Alleviate It

Jun 28, 2019
by Liz Koch  
Knee Pain Photo

The Why


Why do riders get knee pain?! One thing we all can agree on is that it is the pits to have your knee hurt every time your foot goes around the pedal. Also that it is terrible to limp the first couple steps after sitting for a little bit. This post is going to go over knee pain that has come on slowly, not from an injury or crash.

I’m going to go over 5 reasons why your knee can be hurting. This is not an all-inclusive list. I have also included 3 exercises that I would include in programs made for people with knee issues through The Ride Life.


Reason 1: Hip Muscles

So a knee has many things going on, but mostly it acts like a hinge. It likes to move in a bending and straightening way (flexion and extension). It doesn’t like to be kinked, twisted, or rotated and then bent and straightened.

Now imagine you riding your bike… Do you kink or twist your knee as you ride? Can you start to see where an overuse or stress point could be?

Now let me ask the question... Do you know what controls the twisting and potential kinking of the knee?

Your HIPS! Your gluteal muscles more specifically. Glute Max and Med. These muscles control the rotation of your thigh. Therefore, controlling your knee. Another important muscle group that could throw things out of alignment are your groin muscles. If these are overworking, then it will pull your knee inward. Or if they are under working your knees will be pulled outward.

Can you also see how if your hip muscles are not turning on at the right time, you may be twisting your knee as well? Even though your hip muscles are strong. Timing is important.


Reason 2: Core

This reason goes back a bit to reason 1. However, it dives in a bit deeper to why your hips may not be working causing both timing and strength issues. People tend to either use their hip flexors and their lower back to support and control their pelvis or the pattern of abdominal muscles and buttock muscles.

Obviously, you can already guess which one is better. Do you have tight hips and or a tight low back. This might be the sign that you need to work on your core and buttock muscle combination. How you do that is by focusing on core strengthening.


Reason 3: Tightness

Tight hips can be caused from reasons 1 and 2 but might need some extra exercises to reduce and loosen up. If you are too tight in an area in your hip, then you might be pulling your knee off track causing that pinching of the hinge (your knee). Even with activating and using the right muscles you may need to add in a bit of stretching to assist the overall movement.

Reason 4: Quads

Now you are thinking… what about my quadriceps? (The muscles on the front part of your thigh) … what about my hamstrings? (The muscles on the back part of the thigh)
Yes, they are important too, but for knee pain they can be working too much or not be in sync with the hip muscles.

Hamstrings can pull on the back of your knee and need to help your buttock muscles. They are very important, but can be overused if you aren’t using your buttock muscles as well.

The quadriceps are very needed for knee movement and stability. The quad, when it contracts pushes the knee cap into the knee to straighten the lower leg. When it is working too much, this can place excess pressure into the knee. It can also place more tension through the tendons on the front of the knee. If this continues then you can develop tendonitis or other pain on/in the front of the knee.
Hip Muscles

Reason 5: Feet

Everyone knows that having a good base support is important for a house, but it is also important for your body. Your feet are the base support for your knees. If you have a structural issue in your feet, your knees will feel the stress. With flat feet, your knees will be stressed inward. With high arches, your knees will be stressed outward.

This is the same concept that can be and may need to be altered in your biking shoes with insoles or with foot muscle exercises (not shown below, but let me know if you want some).


Now, this isn’t a comprehensive list of reasons why you can have knee pain, but it does cover many global views to decreased repetitive stress on your knee.


Exercises

Exercise 1: Bridge with Knees going out against band

Views: 3,028    Faves: 12    Comments: 0


Objective
- To utilize core with glute engagement

Perform:
- 5x times a week
o Before Riding to warm up for a ride
- Do 20-40 reps 2-3 sets

Things to Note:
- Do not let your back arch
- Push through hips
- Feel in abs and in buttock muscles


Exercise 2: Hands and Knees: Leg Extension

Views: 2,604    Faves: 14    Comments: 0


Objective
- To utilize core with glute engagement along with knee tracking

Perform:
- 5x times a week
- Do 20-40 reps 2-3 sets

Things to Note:
- Do not let your back sag downward – stay strong through core
- Think about how your knee is tracking…not pointing inward or outward
- Feel in abs and in buttock muscles


Exercise 3: Front and Inside of the Hip Stretch

Views: 2,703    Faves: 14    Comments: 0


Objective
- To open up the front and inside of the hip

Perform:
- Daily
o After Riding to recover
- Hold for 15 sec x 6 reps

Things to Note:
- Let your hip relax into the movement
- Be gentle with the stretch
- The wider the stance the more the stretch




About the Author:

Liz Koch, PT, DPT is a physical therapist that knows exactly what it is like to have pain. She has been to many PTs over her life, which directed her to becoming one. She has been a mountain biker since she was a kid and has recently opened up her own clinic in Western North Carolina, Blue Ridge BioMechanics that treats mainly mtn bikers. She wants to share the knowledge that you don’t have to be in pain when riding and you don’t have to stop riding to get out of pain. She has focused this mission to Rad Mountain Biking Ladies on Facebook and through her online business, The Ride Life.

Let her know if you have questions.
*If you have pain please consult with a doctor or physical therapist for further evaluation, Liz Koch and companies are without liability if you injure yourself while performing these exercises*


MENTIONS: @theridelife



87 Comments

  • + 60
 I only have knee pain when I’m begging my wife to buy new stuff for my bike.
  • + 22
 @Monkeyass: Neither method seems to work.
  • - 1
 is there a new comment policy with some officious monkey deleting comments that might not please a few individuals? Why does a bagging comment get deleted?
  • - 1
 My gluteus is maximus!
  • + 1
 @Monkeyass: Apparently. Now this entire thread makes no sense.
  • + 0
 @chriskneeland: i guess the world has moved on
  • + 0
 Beg her for your balls back while you're at it.
  • + 9
 I think is called being old
  • + 4
 I concur, at 53 everything hurts, mind you it hurts if I ride or not Smile
  • + 3
 Yep, after the 50s if you wake up in the morning and nothing hurts, is because you are dead Smile
  • + 2
 It might be also because of 4 knee surgeries (3 ACLs), but I started with patellar pain when I was training for some long distances, 60-100 mile rides/ races. I found that going to flat pedals has helped me ride without knee pain anymore. Also, I think it’s the combo of a steeper SA and a more forward foot position with the flat pedals that has helped.

If my IT band gets tight, I get some meniscus pain. Massage and foam rollers help with that a ton.

Additionally, I’ve seen some research showing longer cranks, may hurt the knees more. Shorter cranks keep the knees more extended and less stress while deeply flexed. I’m going to try some 170s to see if that helps going back to clipless on certain days.
  • + 1
 Yes def having a dif seat tube angle can make a big difference and yes a shorter crank is another option. (I didn't want to open that pandora's box in this post) Smile
  • + 1
 You might have to size down on your chainring when using smaller cranks to reduce needed torque aka knee stress.
  • + 2
 @colincolin: so far have been using the same gears. Feels like it’s just quicker through the dead part of the stroke before you get back on the power. Just a couple rides in so far on the shorter cranks, so not a long term test or enough time to fully adapt. Also, less rock strikes while climbing, so that’s nice with current bikes low geometry.
  • + 2
 For seated pedalling pain I found this helpful; knee pain at the front, seat too high. Knee pain at the rear, seat too low.
I get occaisional pain in the front of my left knee. The cause for me I believe is driving, using the clutch pedal with my seat set too far back for many years. I now drive an auto, and in a manual I set my seat further forward than I used too. I usually have no pain nowadays.

I support the hip stretches too, it's a great feeling when you loosen tight hips.
  • + 3
 That’s interesting... I have the same thing, only the other way (too low hurts in the front). Bodies are weird.
  • + 6
 @tbmaddux: i think Braindrain has it reversed...I always heard front knee pain was seat too low.

I don’t claim to know anything, however.
  • + 2
 Last monday I went to see a doctor because of knee pain. He told me that the problema was quadriceps contracture, at first it was too strange to believe it. Now, after some stretching exercises the knee feels much better. Excelent article, 4 days later for me, haha
  • + 5
 Did the hipstretch in the office. People were confused. I felt better after. Thanks a lot for this!!
  • + 1
 yea it looks kinda odd but I really like that stretch... doesn't stress the back and stretches the right spots
  • + 1
 I misread that as "concussed". Take it easy with that stretch!
  • + 2
 I rarely if ever have knee pain when riding bikes. But I do sometimes have knee pain when running. Especially on hard terrain and/or when I have not been running for a while. I run on those Vibram Fivefinger things. Would the same exercises help or is it a different mechanism? Advice I got in the past was to take it easy, but not to do any particular excercise. I've got to say most of the time I'm fine and painless. It is just occasionally when on hard terrain and/or when I've not been running for a while.
  • + 1
 I think you are answering your own question. Ditch those shoes and run on soft ground. I had issues with my feet, while running. I run mainly off-road now wit Hoka one one shoes. Cushy as hell, but no more leg issues. At least mix up your running in those vibram shoes and use them only once in a while.
  • - 1
 I don't run only because I get IT band syndrome right away. It got better after I improved my technique and started landing midfoot but, then my feet tend to give up. Running + biking is no fun, especially if you didn't run much in the past.
  • + 12
 Don't make me run, I'm full of chocolate.
  • + 2
 I rarely post, but I'll go out of my way for this one. Stay away from the Vibram Fivefingers! I hardly ever trained in them when I was in my best physical shape, but I did because my dad thought they'd be a cure for my bunions.

Anyways, I got a stress fracture in my foot after about two weeks to a month of training in them and my family physician was sure it was the Vibrams. He's an avid marathon runner and absolutely despises them. If you want to walk, and do some lifting in the Vibrams, that's probably fine, but I was advised to never run in them from a doctor/avid runner.

Running is great for your cardiovascular system and overall health (especially for offsetting the stiffness and mobility issues that sitting and biking will cause), but really not that good for your joints & ligaments (hence Waki's IT band comment). Running shoes are designed to alleviate the constant and repeated impact, use them!
  • + 2
 Thanks all for your feedback on this one. I only started to use the Vibram Fivefingers last summer. Living in The Netherlands, they never really bothered me. But I also used them in the mountains of Croatia and South Tirol (northern Italy) and they definitely put more strain on my calves and feet when descending. But I thought I just needed to learn to be more subtle and become stronger. And obviously running over sharp rocks hurts my feet too, no easy way around that. However, they've been relatively easy on the knees, which is what I got them for. I feel that the wide platform of shoes janks the whole foot along if you run on uneven terrain (which you feel at the knee) whereas the Fivefingers leave that up to the foot to solve. The knee injuries definitely didn't start from using the Fivefingers. I almost always run on soft terrain (at least over here) but sometimes your foot jams in a hole or something you just didn't see in the high grass and twists the knees. Things like that happened a few times in my teens and pop up when I start running again after a while of not doing that. Or when I try to run on the road. My girlfriend once suggested I run some local 10 mile race here so that's what I trained for but only on soft terrain. Then I raced it on tarmac. You can go incredibly fast on tarmac but after 10km I was destroyed. Still finished it (75 minutes or so) and even though my knees are fully healed up they are still mad at me.
  • + 1
 @vinay: I know a few seasoned marathon runners and triathletes and they say everything that @Freerideguy14 has said and more about the barefoot “shoes” and barefoot running in general. If you do it, do it on really soft ground, loam/ sand especially if you ride bikes, mountain bike in particular at the same time. I had my share of running related knee pain, including falling off the stairs and don’t want it again. Bear in mind that most running enthusiasts don’t ride bikes, their cardio is crap when they start and it limits their ability to run long in the beginning which allows the body to adapt. When I started running few years ago, being an avid cyclist, I did 12 km in hilly terrain 2 weeks. And could do
20km If Fox 36 at 50% off was at the end of the run. Regular person will barely do 5 in that time.
  • + 1
 I don't know anything about running but I'd guess that when using vibrams you have to change the way you run : Stop landing on the heel and instead land on the mid/front part of the foot (that's how we did it when we were still hunter/gatherer), and make smaller strides as if you were about to fall forward. You have to start slowly, a bit at a time, as your legs aren't used to this running technic.
  • + 1
 I have flat feet so pedal heels in, and broke my left leg and ankle a few years back but the ankle was never set properly so the problem is even worse on that side. I didnt realize but on flats I would have my foot positioned half way off the pedal, otherwise ankles would be knocking on the cranks. When going to clips I found I physically couldnt pedal the bike with my foot in the correct position. Started using 20mm pedal spacers (knee savers?) and that solved the problem completely. Have since ditched the clips (thankfully) but still use the spacers, they have survived multiple hucks to flat, one bent crank arm, 1 broken one, various other damaged bike components but have had absolutely no problems with the spacers themselves.
  • + 5
 Reason #6 - 77 degree sta.
  • + 2
 lmfao
  • + 1
 @therifelife: you reckon muscle imbalance: weakness of the VMO and overdeveloped of the VL --> lateral tracking of patella in pedaling and compression of patella when in the attack position (knee flexion ~80*) as well as poor coordination of these muscles? just curious your thoughts. cheers.
  • + 5
 Reason #6: you’re on a singlespeed
  • + 1
 hahaha
  • + 1
 This is a great reminder to not be a slacker and not do my core exercises, leg and back stretches. I should have my PT just call me every two weeks and remind me to do my exercises because riding the bike is sooooo much better when everything is working correctly.
  • + 4
 Right?! I send email reminders and check ins to my patients every couple of weeks-month. I think it helps them a lot. Or at least I have good feedback from it.
  • + 1
 One of the reasons for me, and probably more common than you think, is that one leg is a little longer than the other. I had a bike fit done and they figured it out. Put a shim between the cleat and the sole on the shorter leg and things got better. I just need to figure out a way to do this with my mountain bike shoes.
  • + 2
 There are many people that have a leg length discrepancy. More than most think. Just an idea...You could run two different pedals... one thicker than the other... I haven't seen it done before, but with a thinner flat and a thicker flat you might be able to offset just enough.
  • + 1
 @theridelife: I have them on my Speedplay cleats. I just need to measure them and then make a set of shims. The moment I shimmed, it was immediately noticeable. I was racing road and had no pain, regardless of how hard I went and whether I was tucked in for TT or riding sitting up.

I also foam roll the piss out of my IT band
  • + 2
 @theridelife: Yup', I have a 15mm difference, which is starting to be quite a bit. A physio figured it out but it's on the femur so it's trickier to solve and he wasn't sure how to do.
I sort of simulated it on a 3D software and to keep similar movement angles I ended up using 2 different cranks (one 170mm and one 175mm) and 2 different pedals (XPedo detox 20mm thinck and XPedo Spry 11mm thick).
Small crank and thick pedal on the shorter leg, longer crank and thinner pedal on the long leg.
So the overall difference compensation goes from 0mm to 10mm depending on where the foot is.
It hasn't hurt ever since, though I still feel a difference depending on which foot I put forward.
  • + 1
 @Will-narayan: Length differences are a real thing and a thing that a lot of people do not always think about checking out. It really can change so many things. our pelvis will naturally shift and tilt to make up for it as well so you can get knee and back problems.

I had a full Retul fit done so I could find the right TT bike and while checking flexibility, the guy found it.
  • + 3
 Hi, would love a similar article on foot pain, I wonder if my pedals are too wide and could give pain at the ball of the foot. One actually swells. Happy riding, Ved
  • - 1
 What is your fore/aft foot position on the pedal? Ball/midfoot? What sort of shoes are you using?
  • + 1
 Sweet! I will do one soon. Thanks for the feedback!

One thing that could be happening so you can help things now is that you need support for the transverse arch (the ball of your foot) or that you are trying to compensate for weak hips with your feet. Also making sure your ankle movement is good and equal on both sides is key.
  • + 1
 @theridelife: what if my ankle movement is shit...
  • + 2
 @laxguy: yup that can cause issues in the knee and in the forefoot
  • + 1
 @theridelife: what can i do to strengthen my ankles? if thats even a thing..
  • + 1
 Clipless for me. Can't get the clip far enough back on the shoe so I'm on my tip toes. Toasts my calf's and knees so bad. The curse of stumpy toes and wide feet. Thank God for 5.10s and free riders
  • + 2
 do some research, slamming those cleats is doing damage, hence why shoe manufacturers place them around the ball of your foot
  • + 1
 That's the problem If you read what I said properly.
They weren't on my balls they were in front. Hence on my toes like a ballerina.
I used to hack shoes up so I could get my cleats / feet on the balls. But that's expensive way to ruin brand new shoes and have something that then leaks like a bastard and falls apart.
Apart from 5.10 no one makes wide shoes that aren't to long. Especially clipless shoes.
Glad I gave up clipless anyway. Bad habits, bad riding technique, pain in the arse. Not like I needed to pull up on a power stroke like a roady gimp anyway.
  • + 1
 @bagballz: it’s the other way around. You want the axle of the pedal quite mid foot, no matter if you are on flats or clip in. Attaching yourself to the bike with cleat at the ball of your foot is definitely more harmful for your knees than midfoot as you increase the leverage on a 3d joint that is ankle, leaving the 2d joint: knee, having more stabilizing work to do.

I learned to ride midfoot and discovered it’s pros only because I started riding on OneUp pedal with a big bearing by the crank arm, colliding with the base of the big toe. It forced me to move my foot more forward so that she/foot no longer conflicts with the bearing. Suddenly bunnyhopping, manualing, dirt jumoing became much easier. We can all expect clipless shoes in the future to have cleat ports moved further to the midfoot area. Vast majority of pros in all disciplines from road, XC to DH run their cleats furthest back.
  • + 1
 Yea man, Went to flats, no more sore knees, and man like going from an Auto to manual car, way more fun!
  • + 1
 @markbowden: in all fairness I seriously doubt flats/clips have too much to do with knee pain unless you run cleats quite forward under the shoe. You may have knee pain from clipping out on shimano/HT mechanism if you set the spring hard. Maybe also from cleat hitting the float limit. BUT (!) if you would run Crank Bros or times with lots of float and cleat as far as possible towards the midfoot, it will be better than flats. A grippy flat pedal with a grippy shoe will keep your foot planted for standing riding more than any clipless system out there and thus put side loads on knees. I get knee pain when riding flats when cornering and leaning hard. Same with dirt and landing sideways from whips. Jumping my AM bike with Cbros last week was super smooth. So I don't really agree with James Wilson as if flats were sweet butter for the knees. Do some parking lot S-turns with hard lean angles and you'll see.
  • + 1
 Right on time. Just started getting Knee pain. How'd you know? Thank you!
For me it's below the kneecap, top of Tib on the outside/ front at about 10:00 and in back/ outside at about 8:00. Will give these a try. Thank you!
  • + 1
 A problem I have is different leg length. My right leg is slightly longer, so I just need an extra spacer on my left cleat. Without it, my right knee hurts from a too low saddle position, and my bike leans towards the left.
  • + 1
 Leg length discrepancies can make you move differently for sure
  • + 1
 Reason 2 sounds like a recipe for anterior pelvic tilt, in which case knee pain whilst biking won't likely be your only problem.
  • + 2
 Yup! but you can have a more mild form of this and just develop weak or not working glut muscles.
  • + 1
 Hip and core seems to be the key to so much pain and/or relief.
Both in terms of strenght as well as flexibility.
Especially if you have Desktop job.
  • + 1
 YES! It is by far the most common things that I treat!
  • + 1
 Incorrect crank length can also be a cause of knee pain. I'm short and had 175mm cranks for years. Just moved to 170mm and have much less knee pain.
  • + 2
 Changing bike fit and crank length can make a big difference on the bike. for sure
  • + 3
 6. Knee pain after being featured in Friday fails.
  • + 2
 hahaha
  • + 3
 Reason #6 You rode a fixed gear some time in the last ten years
  • + 1
 This
  • + 2
 For me it is simply that I'm to lazy to train my muscles. Esp. as I'm older than 50... :/ I'm just riding.
  • + 2
 I'm guilty of this as well
  • + 2
 Reason #5, too many years of Motocross, the ultimate knee destroyer.
  • + 2
 Thanks for posting this, will try it out!
  • + 2
 Great article. thanks so much
  • + 1
 Thanks for reading Smile
  • + 1
 If you're riding a bike that doesn't fit, no amount of exercise in the world will make your knee stop hurting.
  • + 1
 #3 so right, this is what happens to me. Don't forget pressure point treatment to help with muscle tightness.
  • + 1
 thanks for all of this advices !!! I will try the last one later. I've got permanent knee pains dur to ACL surgeries.
  • + 1
 That sucks! ACL tears make people move so much differently after them and can actually put more stress on the knees. Being able to move through your hips is so key
  • + 1
 hey theridelife, where can I find some biking women? I'm tired of this sausage fest.
  • + 1
 you know she's a rider when she talks about 'sagging' into it.
  • + 1
 haha... I didn't even think about that. Just what I thought was the best word for it. haha.
  • + 1
 Reason 4, torn meniscus ????????
  • + 1
 the mri i got recently confirmed that as my reason
  • + 1
 @captaindingus: and @Jamesgoulding These are actually good places to start for a tear in the meniscus. The research states that people who get surgery and those who just work on strengthening and mobility do just as good. Still have some problems here and there but no locking up of the knee.

Sucks to have a torn Meniscus Frown
  • + 1
 @theridelife: @captaindingus yeah I had an mri about 2.5 years ago, spoke to surgeon and he said because I can still use it fine, like I can ride all day and run and walk on it there no need for surgery, just advised to hit gym and build up muscles around it.
2.5 years on it feels as strong as ever, doesn’t lock up, can ride just as hard.
  • + 1
 yaaaaaaaaaaaaaaaaaaaaaaasss
  • + 1
 #6 you're old

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