Kneecap pain is not foreign to cyclists, and it can often be the reason for missed training days if left untreated. Knee pain affects about 48% of cyclists in the UK at some point, a study in 2023 showed. Other studies have shown a yearly prevalence of 25.8% in a group of competitive and non-competitive cyclists, and 23% in a group of professional cyclists.
In this guide, we’ll cover the causes of kneecap pain after cycling and how physiotherapy can help manage these types of injuries when they crop up.
Causes of Kneecap Pain After Cycling
There are many health benefits to cycling – it’s great for improving cardiovascular fitness and can also be an ideal low-impact option for anyone recovering from injury. However, as the mileage adds up, the repetitive nature of cycling can sometimes lead to overuse injuries.
Overuse injuries are also known as gradual onset injuries and are not caused by sudden trauma, but build up gradually over time, often when distance or intensity of training increases too quickly.
The most common overuse injury in cyclists is pain at the kneecap, or patellofemoral pain. This is usually felt as an ache at the front of the knee around the kneecap but can also develop into sharper twinges. It usually worsens with repetitive activity that loads the front of the knee.
This is usually connected to your quads as the four quadriceps muscles attach to the shin via the patella, and when you are putting force into your pedal stroke, these muscles deliver force across the knee. The pain can be attributed to saddle height, saddle fore and aft, and/or crank length. Working with a professional bike fitter can be very useful in addressing this type of knee pain.
Some cyclists will experience pain on the lateral side of the knee joint, which can be attributable to iliotibial band (ITB) pain. ITB pain is an overuse injury that causes compression to the structure at the side of the knee, which can result in inflammation and pain. Symptoms will typically worsen throughout the ride. ITB pain hurts most when the knee is at 20- to 30-degrees of flexion, like when you approach the 6 o’clock position and start to come back up.
Apart from overuse, most cycling-related knee pain can also be attributed to a combination of these factors:
- Individual anatomical or biomechanical factors
- Bike set-up
- Training load errors
Getting advice from a professional bike fitter and physiotherapist can help tackle the root cause of the pain and prevent injury.
5 Ways Physiotherapy Can Help
Physiotherapy is a holistic approach to the prevention and treatment of cycling injuries, as well as the prevention of any injury recurrence. Here are 5 ways that physiotherapy can help relieve and prevent kneecap pain after cycling:
1. Fix muscle imbalance, weakness, and tightness
Muscle imbalance, weakness, and tightness are often key contributors to kneecap pain in cyclists. One common issue is poor activation of the Vastus Medialis Oblique (VMO) – the small teardrop-shaped muscle on the inner thigh, just above the kneecap. If this isn’t firing effectively, or if the outer quadriceps and ITB are too tight or dominant, the kneecap can start to track slightly off course. That increases pressure in certain parts of the joint and leads to pain.
If the glutes are not providing their fair share of power production, either due to weakness or poor recruitment, this will increase demand on the quads and hence stress on the patella, which they attach to.
Muscle imbalance also has a role in ITB-related pain. Weakness in any of the muscle groups around the hip or knee can lead to alterations in pedalling technique when under high load or when fatigued. This is particularly important in regard to the glutes and lateral stabilisers of the hip, which control rotation of the knee. This is also applicable to the muscle that stabilises the core and pelvis, which provides a stable base for the efficient transfer of power to the pedals.
This is where a physiotherapist’s expertise comes in. A physiotherapist can identify any muscle imbalance, weakness, or tightness that is causing pain in your kneecap. They will also be able to provide advice on exercises that can strengthen the muscles to prevent the recurrence of injury.
2. Advice on training load errors
Inappropriate training load or training errors are a factor in many overuse and overload injuries, not just of the knee. This can be described as a training load that is beyond the individual’s capacity and can occur in a range of situations.
Overload is a rapid increase in volume, intensity, or frequency, especially if increased all at once. Adding too much high-intensity training with a lack of base conditioning can also be a factor. Making significant positional or equipment changes can increase stress on tissues, especially if done during a period of high training load, when the body is close to its limit of load tolerance.
Additionally, insufficient recovery, such as inadequate nutrition and sleep, can lead to poor tissue repair and injury.
A physiotherapist can identify and advise on any of these training load errors and help develop a personalised training program that gets you closer to your goals, without the injuries.
3. Set up a rehabilitation plan
With physiotherapy, you can improve your strength and mobility with exercises, stretches, and other treatments. It can be used to manage a variety of conditions such as musculoskeletal injuries, neurological conditions, and cardiovascular and respiratory conditions.
In the beginning stages, a physiotherapist may focus on reducing pain and swelling through different modalities such as the use of heat and ice therapy, electrical stimulation, and massage. These treatments can help to reduce inflammation and improve blood flow to the affected area, which can in turn help to alleviate pain and promote healing.
In the later stages of rehabilitation, physiotherapy may focus on restoring functional abilities and helping you return to your pre-injury level of cycling. This can include balance training and functional exercises.
Let Us Help
Kneecap pain does not need to hamper your cycling performance or goals. With the right physiotherapy expertise, training plan, and rehabilitation, you will be better prepared to take on more challenges and achieve more milestones.
We want to be a part of your cycling journey and be the ones to help you reach your goals. We are True Physio and with 9 clinics around the UK, our physiotherapists are trained and qualified to assess, diagnose, and treat any of your injuries.
Whether it is easing rotator cuff pain or relieving back pain, physiotherapy is highly effective and is a long-term treatment option. We also provide a wide range of treatment options such as massage for stress headache, repetitive strain wrist treatment, podiatry services, mummy MOT, sports therapy, lower back physiotherapy, RSI injury treatment, treatment for joint pain and stiffness, and more.
Let us kickstart your journey to stronger knees today by booking an appointment with us.