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Ask A Trainer: Why Does the Front of My Knee Hurt on the Bike?

Pain in the front of the knee, or anterior knee pain, is a common injury affecting both recreational and seasoned triathletes.

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Pain in the front of the knee, or anterior knee pain, is a common injury affecting both recreational and seasoned triathletes. Anterior knee pain is often referred to as patellofemoral syndrome or patellar tendonitis. The source of the pain in cyclists is typically inflammation caused by excessive compression from faulty repetitive movement, rather than damage caused by trauma.

Triathletes are at greater risk of developing anterior knee pain due to their oftentimes aggressive time trial bike position. If you are suffering from anterior knee pain, it could be due to one of these four causes:

Training

A rapid increase in training volume either through mileage or low cadence sessions (hill or big gear work) can increase the strain on the tissues crossing the front of the knee.

Solution: Temporarily reduce mileage, and focus on higher cadence (>80 RPM). This One-Hour Workout is a great way to train yourself to spin at a higher cadence.

Saddle position

A seat too low and/or too forward will put significant load on the quadriceps and patellar tendon. In a tri or TT bike position, the saddle is often slid forward on the rails trying to get “over” the pedals, but at the cost of your tissues.

Solution: Adjust your saddle, or better yet, invest in a proper bike fit. This particularly important if you’ve bought a new bike recently, as new bikes have a different geometry (and therefore different fit considerations) than past designs.

RELATED: Critique My Fit

Crank length

In effort to gain leverage during the pedal stroke, athletes often use longer crank arms which can cause excessive knee flexion.

Solution: Decrease to appropriate length.

RELATED: At Arm’s Length: The Great Crank Arm Length Debate

Tissue tightness

Lack of flexibility can cause the patella to track improperly in the groove of the femur creating compression and pain. Tight quads and/or tight iliotibial bands are the culprits.
Solution: Begin a regular routine of stretching, massage, and foam rolling. The following links will be particularly helpful for dealing with tissue tightness:

The bottom line

Remember that ignoring pain and trying to train through it will lead to more significant injuries and greater loss of quality training time. Catching and treating repetitive trauma injuries early can get you back on the road sooner.

Casey Maguire is a Los Angeles-based orthopedic physical therapist who has treated professional triathletes, cyclists, and multiple athletes in the NBA, NHL, NFL, and USTA. His focus is on functional biomechanics.