Cycling Knee Pain: What I’ve Learned From 20 Years Coaching Riders (and Fixing Knees Through Bike Fit + Training)
Over the last 20 years coaching cyclists and doing bike fits, knee pain has been one of the most common problems I’ve helped riders solve. It shows up worldwide in every type of cyclist beginners, sportive riders, road racers, gravel riders, mountain bikers, and time triallists.
The frustrating part is that knee pain makes riders feel “broken”, when most of the time it’s simply the body saying:
“Your training load, your position, or your technique has got ahead of your knee’s current tolerance.”
In my experience, knee pain responds best when you stop guessing and follow a clear process:
1. Calm it down (reduce irritation)
2. Use the pain location as your clue
3. Fix obvious bike-fit and technique triggers
4. Rebuild strength and tissue tolerance
5. Return to training in stages (patience wins)
This article is how I explain it to riders: practical, simple, and focused on what works.
Quick note: this is general education, not medical advice. If you have swelling, locking, giving way, severe pain after a crash, or symptoms that worry you, get assessed by a clinician.
Why knee pain is so common in cycling
Cycling is repetitive. A one-hour ride can include thousands of pedal strokes. So if something is slightly off cleat position, saddle height, training load, technique, or strength the knee doesn’t get “one bad rep.” It gets the same stress repeated again and again.
Most cycling knee pain I see comes after one of these changes:
• a jump in training load (more hours, more climbing, more intensity, more turbo time)
• a equipment change (new shoes, new cleats, new saddle, insoles, new bike)
• lots of big gear / low cadence riding (grinding)
• a position that’s “fine” early in the ride but breaks down when fatigue hits
The knee pain location map (what the pain often suggests)
This isn’t a diagnosis but it’s a very useful starting point. When riders can point to the exact spot, it often guides the first fix.
1) Front of knee pain (around/behind the kneecap)
Typical rider story:
“It hurts at the front when I push hard, especially hills, headwinds, or when I’m tired.”
Common contributors I see
• big gear / low cadence efforts (high torque)
• saddle too low (knee stays more bent)
• saddle too far forward (in some riders)
• sudden increase in climbing or intensity
First actions that usually help
• raise cadence and stop grinding for 1–2 weeks
• reduce climbing torque temporarily
• check saddle height + fore/aft carefully (tiny changes only)
2) Outside of knee pain (lateral knee)
Typical rider story:
“Outside of the knee starts burning or tightening, often after 40–90 minutes.”
Common contributors I see
• sudden increase in ride duration (long rides)
• fatigue-driven tracking changes
• stance width / cleat position issues (sometimes)
• weak hip control (knee drifts slightly when tired)
First actions that usually help
• reduce long ride volume briefly
• check cleats/stance (don’t guess measure)
• add hip stability work (it’s often the missing piece)
3) Inside of knee pain (medial knee)
Typical rider story:
“It’s on the inside. Sometimes sharp, sometimes achy.”
Common contributors I see
• cleat rotation forcing the knee inward/outward
• foot angle being forced rather than natural
• fatigue changing knee tracking
First actions that usually help
• stop forcing foot angle (let it sit naturally)
• review cleat rotation and float
• build single-leg control and hip stability
4) Back of knee pain (posterior knee)
Typical rider story:
“Tight behind the knee, especially when I extend the leg or push at the bottom.”
Common contributors I see
• saddle too high (overreaching at the bottom)
• hamstring/popliteus irritation
• sometimes aggressive cleat changes
First actions that usually help
• check saddle height first (small changes)
• reduce big gear work temporarily
• reload hamstrings gradually with controlled strength work
The 3 biggest causes I see (real-world knee pain)
If I had to sum up two decades of knee pain fixes in cycling, it’s usually one of these:
1) Training load spikes (the #1 cause)
Knee pain commonly starts after:
• a sudden jump in weekly hours
• a climbing block
• too many hard days too close together
• long turbo rides stacked in winter
• returning too quickly after time off
Even with a perfect bike fit, tissues still need time to adapt.
2) Torque and technique (grinding vs spinning)
A lot of riders create knee irritation by riding:
• low cadence
• big gear
• heavy force per pedal stroke
Big-gear work has a place but only when planned and progressed carefully.
Technique fix that helps most riders
• increase cadence slightly
• focus on smooth pressure, not stomping
• stand briefly on long climbs to change joint angle
3) Cleats + saddle setup (small changes, big effects)
Cleats are a classic trigger. I see knee pain appear after:
• new shoes
• new cleats
• cleats replaced but not aligned exactly
• insoles added
• moving cleats without a plan
Saddle height and fore/aft matter too but the key is making changes in tiny steps and testing properly.
The first 7–14 days: how I calm it down (without losing fitness)
When a rider messages me with knee pain, my goal is to stop it becoming a long-term issue.
What I usually prescribe
• keep riding easy (Zone 1–2) if pain allows
• shorten ride duration temporarily
• raise cadence (avoid grinding)
• avoid sprints and hard climbing for 1–2 weeks
• keep frequency, reduce load (if it doesn’t flare)
What I usually pause
• low cadence strength intervals
• hard group rides (surges are knee killers)
• back-to-back intensity days
Rule: if it hurts more during the ride and it’s worse the next day, you did too much.
Bike fit fixes that often solve knee pain quickly (ONE change at a time)
This is where experience matters. Riders often change five things at once, then never know what helped.
Step 1: Check saddle height
• too low often links to front-of-knee pain
• too high often links to back-of-knee pain
Adjust in tiny steps (2–3mm), then test for 2–3 rides.
Step 2: Check saddle fore-aft
A small shift can change knee loading patterns again, tiny changes only.
Step 3: Check cleat position (fore-aft)
Moving cleats slightly back can reduce peak load for some riders. Don’t overdo it small changes, then test.
Step 4: Check cleat rotation + float
Feet have a natural angle. Forcing toe-in or toe-out can irritate the knee.
In bike fits, I’m looking for the knee to track naturally without forcing it.
Strength & conditioning: knee rehab and injury prevention (what I use with riders)
Knees don’t just need rest they need capacity. In my experience, the best bang-for-buck strength work targets hips, quads, and calves.
Pillar 1: Hip control (stops knee drift under fatigue)
• side plank variations
• step-downs (slow control)
• band walks (done properly)
Pillar 2: Quad and tendon capacity (gradual loading)
• split squats
• controlled squat holds (if tolerated)
• slow tempo work (quality reps)
Pillar 3: Calves (often forgotten)
Calves influence ankle control, which influences knee tracking.
• slow calf raises (straight and bent knee)
The simple 12-minute routine (2–3x/week)
Do 2 rounds:
Round A
• Step-down: 6 reps/side (slow)
• Split squat: 6–8 reps/side (short range first)
• Side plank: 20–40 sec/side
Round B
• Glute bridge: 10 reps (2-sec pause)
• Calf raises: 10 reps (slow)
• Wall sit: 30–45 sec (pain-free only)
Progress slowly. Knee pain usually improves over weeks, not overnight.
Winter rides + café stops: a sneaky knee pain trigger I see a lot
This one catches riders out, especially on weekend rides with mates.
The classic story:
“Jon, I was fine… we stopped at the café… then when we set off again my knees felt stiff and sore.”
Why it happens
In cold weather, when you stop pedalling:
• your muscles cool down quickly
• tissues feel stiffer
• and then you often restart in a big gear because the group rolls off briskly
Warm + moving → cold + static → straight back into load. If you’re already near your tolerance, that restart can spark knee pain.
Best practice if you need a café stop
1) If possible, put the café at the end
The simplest fix is finishing at the café. It removes the “cold restart” problem.
2) Keep heat in during the stop
• jacket/gilet on immediately
• keep knee warmers/leg warmers on
• don’t let the knees chill — that’s often the turning point
3) Restart properly: spin first
• first 10–15 minutes: easy gear, higher cadence
• avoid standing starts and stomping
• let the group roll away if needed protect the knees first, ego second
4) Do a 60-second warm-up before clipping in
• 10 easy bodyweight squats
• 10 calf raises
• 10 gentle leg swings each side
Return-to-riding plan (the order that prevents relapse)
I keep this boring because it works.
Week 1
• short, easy rides
• higher cadence
• flat routes
Week 2
• extend one ride gradually
• still mostly easy
• keep strength routine consistent
Week 3+
• add intensity only if pain is stable
• add climbing later
• add sprinting last
• return to hard group rides last
Best order: duration → frequency → intensity.
When to get it checked
If you have:
• swelling that doesn’t settle
• locking or catching
• knee giving way
• sharp pain that isn’t improving
• pain after a crash
• worsening symptoms despite sensible changes
…get assessed.
FAQs
What is the most common cause of cycling knee pain?
In my experience it’s a training load spike (hours/climbing/intensity) combined with higher torque riding.
Is cycling knee pain usually a bike fit issue?
Sometimes especially after cleat/shoe/saddle changes but many cases are mostly load and tissue tolerance. You often need to address both.
How long does cycling knee pain take to fix?
Mild flare-ups often settle in 1–3 weeks with smart changes. Stubborn cases take longer, especially if you keep triggering it with surges, climbing, and low cadence.