The 7 Most Common Cycling Knee Pain Causes and How Physiotherapy Can Help
Knee pain is a frequent problem that cyclists run into, whether heading out on long weekend rides, commuting during the week, or training for a sporting event. It’s frustrating because it tends to creep in slowly, and before you know it, every ride becomes a negotiation between your legs and your head. The good news is that most cases of cycling-related knee pain are treatable, and often preventable, with the right approach.
Below are the seven issues we see most often in the clinic when working with cyclists, along with how physiotherapy can help you get back to riding comfortably again.
1. Patellofemoral Pain Syndrome (PFPS)
Often described as a dull ache around or behind the kneecap, PFPS is the classic “cyclist’s knee.” It’s usually linked to how the kneecap tracks when you pedal. If your quads are imbalanced or your saddle height is slightly off, the kneecap can be pulled into a less favourable position, creating irritation over time.
How physiotherapy helps:
A physiotherapist can assess which muscles are underworking (often the glutes or inner quads) and which are working too hard. Strength work and small bike-fit changes usually settle it quickly.
2. Patellar Tendinopathy
Patellar tendinopathy tends to feel like a sharp or localised discomfort just beneath the kneecap, especially when pushing a big gear or climbing out of the saddle. It’s an overload issue, too much intensity too soon, often combined with not enough recovery.
How physiotherapy helps:
Tendon rehab is very specific. A structured loading programme is the gold standard, gradually rebuilding tendon strength and tolerance. It’s not a “rest and hope for the best” situation.
3. IT Band Friction or Lateral Knee Pain
Pain on the outside of the knee is commonly blamed on the IT band, but in cyclists it’s often rooted in hip control and glute function. If the hip drops or rotates during the pedal stroke, it places more strain on the outside of the knee.
How physiotherapy helps:
Strengthening and technique coaching are key. Force-plate assessment can also help identify any left-right imbalances contributing to the irritation.
4. Quadriceps Overload
Cycling naturally favours the quads, but if the glutes aren’t pulling their weight, the quads have to do more than they’re designed for. This can create a heavy, burning sensation around the front of the knee, particularly towards the end of a ride.
How physiotherapy helps:
A physiotherapist will look closely at your pedalling mechanics and overall strength profile. Targeted glute strengthening and cadence adjustments often make a big difference.
5. Poor Bike Fit or Subtle Positioning Issues
A saddle that’s a touch too low, cleats rotated a few degrees off, or bars that are too far away, these small tweaks can create big problems. Many cyclists assume bike fit issues must be obvious or dramatic, but it’s usually the millimetre-level details that cause gradual irritation.
How physiotherapy helps:
A physio-led bike fit blends biomechanics with clinical assessment. It looks not just at the bike, but how your body interacts with it. Sometimes a minor change is all that’s needed.
6. Sudden Increases in Training Load
If you’ve recently started climbing more, pushing harder, or using the turbo trainer more frequently, your knees may simply be struggling with the rapid increase in demand. Indoor training in particular can cause trouble because it removes the natural variations you experience outdoors.
How physiotherapy helps:
A physio can help you adjust your training plan, build a smarter progression, and strengthen the areas struggling to cope with the workload.
7. Muscle Weakness or Imbalances
Cyclists are strong in certain areas and under-developed in others. Weak hip stabilisers, underactive glutes, or reduced core strength can all shift load into the knees. These weaknesses aren’t always obvious until you’re assessed properly.
How physiotherapy helps:
Strength testing, particularly with force plates, allows us to pinpoint imbalances accurately. Rehab can then be specific rather than guesswork.
When to See a Physiotherapist
If your knee pain is stopping you from finishing rides, shows up earlier and earlier in the session, or isn’t improving with simple rest, it’s worth getting assessed. The sooner the underlying cause is identified, the quicker you can get back to riding without thinking about your knees.
Cycling shouldn’t be painful, and with the right guidance it rarely has to be. If you’re struggling with knee pain on the bike, The Injury and Performance Clinic can help you work out what’s driving it and support you through a tailored plan to get it sorted. Feel free to get in touch with our sports physiotherapists, we’d be happy to help you enjoy your cycling again.
