Solving Cycling Knee Pain - Bike Fit Basics and Rules

The knee can be a particularly abused joint.  With our feet placed firmly on our pedals and our hips resting solidly on the saddle the knee becomes a slaves since it has to go where the foot and hip direct it to.All of us have seen the cyclist with the knee that swings wildly out to the side, or one that nearly hits the top tube on every pedal stroke; these movements generally aren’t coming from some issue in the knee, they’re from something above or below at the hip or foot.Because the knee has a lot of external influences on it, knee pain on the bike can be tough to track down a culprit for.https://vimeo.com/257815891/ff22069887

The Simple Rule for knee pain

The two main areas -- the front and back of the knee -- do have some simple correlations that many have heard about.  Namely if the pain is in the front of the knee (quad tendon/patellar tendon/patella) then the saddle is too low, and that if the pain is is at the back of the knee (hamstrings), the saddle is too high.  To a certain extent these generalizations are true.  Except when they’re not:What I mean by that is that it’s not that cut and dried because often times knee pain, in the front or back of the knee, isn’t coming from saddle height at all, but rather has a root cause somewhere else.Which brings me to a cardinal rule of bike fitting that needs to be addressed before we go any further:Because we’re connected to the bike at our feet, hands and rear end there is more push-pull with our mechanics on the bike than just about any other activity we do.  In PT we call it regional interdependence and it basically boils down to the idea that a posture or movement change in one area can have a significant impact on another distant area.  An aberrant movement at the feet can cause a problem at our hands or shoulders and vice versa. This phenomenon is especially pronounced on the bike.This is where the true difficulty of bike fitting lies -- being able to ferret out these distant and complex mechanical relationships and then understanding what changes will solve the problem.  Of course knowing what the cause of the problem is will be the most important step.  In this module we will address some of these complex relationships to increase the likelihood of solving more problems.

Some fundamentals of the process when making bike fit changes

    1. Do not expect the pain to disappear quickly.  Most of these injuries take time to develop and so even if we perfectly fix the root cause, it’s likely to take (often significant) time for it to resolve.
    1. Be cognizant of riding on terrain that increases the symptoms -- for instance if hill climbing makes your knee pain worse then you should moderate the amount of time you spend doing this, but you shouldn’t completely avoid it either.
    1. Make changes -- raise the saddle around 5 mm -- and then complete at least a couple rides that include the sort of terrain that tended to exacerbate the symptoms.  Don’t make any decisions about whether a change was “good” or “bad” after a single ride.
  1. You can judge the change after a few rides based on a change in one or more of the following parameters:  frequency, intensity, or duration.
      1. Frequency: Does the pain occur less or more often?  It could be that it hurts on every ride still, but it no longer hurts after every ride like it did.  This is a positive change in frequency.
      1. Intensity: Is the pain less intense?  Maybe it hurts the same amount at the beginning and end of the ride but now there’s a period in the middle where it feels better.  This is another positive sign.
    1. Duration: Does it not hurt for as long?

As we change saddle height we need to carefully track all of these.  Any improvement in any of these areas is considered a positive sign that the changes were beneficial.If after 2-4 rides the symptoms are exactly the same, then we can assume the change was either not enough or not the right change to begin with.If the pain increases consistently* then we need to move backwards and undo it.*Consistent pain increase means that it didn’t just hurt more on one ride, but on more than one and then pain never dipped below its baseline level.  This is where things can get very messy since there is always a lot of gray area with tissue healing.  It is entirely possible that a change might cause a significant increase of pain on one or more rides, but still provide relief on a different ride -- these cases can be difficult to read, but should usually be tested further.Patience is the key here.To start, we need to understand the tissues that can be involved in our discomfort. Location of the pain, nature of the pain, and the sensations associated with it will be important to better understanding what is causing the problem and how we can best fix it.So in the next section we're going to look into the area or location of the pain and how we might use this to narrow down to the involved tissue.Next Up: Tissues involved - where is your pain?

Contents

IntroductionBike Fitting's Basic RulesTissues InvolvedBike Fit FixesReal World Example Bike Fit #1Real World Example Bike Fit #2Real World Example Bike Fit #3

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