Save Your Knees This Cycling Season


The knee is particularly vulnerable to all the RPMs (revolutions per minute) riders rack up. Use these tips to protect it -  and to deal with injury if it occurs.

The sport of cycling is booming at all levels and for all ages. Whether you are new to road biking or a seasoned cyclist, keep in mind that without adequate care and preparation, all of those RPMs could add up to injury and a short-lived season.

Repetitive strain injuries (RSIs) occur when tissue is loaded repeatedly in a single direction – a prime characteristic of the actions involved in cycling. Due to its mechanical action in the pedal stroke, the cyclist’s knee is particularly susceptible to repetitive loading. The resulting pain can occur anywhere in the stroke but is most commonly experienced in the downward phase of the stroke, when the quadricep muscles are exerting strong forces around the kneecap.

Along with inappropriate training errors (doing too much too soon), many other factors may contribute to knee pain in cyclists. Muscle imbalances anywhere along the lower kinetic chain can lead to improper tissue mobility, which can in turn can lead to altered oxygenation and result in tissue breakdown and pain.

An overdeveloped outer quadricep muscle often overpowers the inner head of the muscle, which can cause patello-femoral pain syndrome.  Patellar tendonitis is also a common syndrome, where the pain is felt below the kneecap where the tendon of the quadricep muscle attaches to the lower leg.  The crouched posture assumed by cyclists can cause the hip flexor (the psoas and iliacus muscles) to shorten, which may also increase quadriceps tension and be responsible for knee pain.

There are many therapeutic options available to help deal with these injuries. A biomechanical assessment by a qualified health care professional such as a sports medicine physician, chiropractor or physiotherapist with sports injury training is a good place to start.

Advanced soft tissue treatments such as the Graston Technique and Active Release Technique are commonly used to address adhesions and fascial restrictions in soft tissue and allow proper tissue mobility and oxygenation. Many kinesiological taping techniques can help cyclists maintain mechanical efficiency and neurological control of muscles and soft tissue. When applied by a professional, these taping techniques provide a way to continue training and minimize the risk of injury. A consistent stretching program focused on the lower body is also an important preventive measure that will keep muscles pliable and loose. Using a foam roller can also assist in preventing muscle tightness and cramping.

Proper set-up of your bike is critical, especially when distances start to grow longer as the training season progresses. Proper seat height and pedal position are key to achieving a full revolution with optimal power transfer and minimal tissue loading. This also applies to pedal clip positioning. Although it will mean spending a few dollars, a proper bike fit by a certified provider is well worth the investment as it can maximize power and performance and optimize mechanical efficiency, thereby reducing the risk of RSIs.

If you are dealing with sports-related knee pain, don’t delay having an assessment done by a qualified health care provider. Seek out a sports medicine physician or a chiropractor who deals with sports injuries on a regular basis and understands the nuances of your sport. Remember, the longer you wait, the longer it can take to heal!

Here’s wishing you a healthy and injury-free cycling season!

Agostino Di Paolo, DC, is a Chiropractor at Cleveland Clinic Canada in Toronto