[FAQ] How to Fix Knee Injuries for Cyclists (Knee Pain)

Contrary to what you might think this isn’t usually the best option, unless the pain is so acute that you cannot function. Inflammation is part of the healing process and may actually be detrimental to recovery. However, it’s hard to say what the issue is so take this with a grain of salt and follow your PT’s advice.

The Detrimental Effects of Systemic Ibuprofen Delivery on Tendon Healing Are Time-Dependent - PMC.

I am as well. I suffer from perpetually “tight” quads, specifically the VMO and the rectus femoris (and TFL) despite doing mobility every day. It sucks. That said, performing hinge pattern movements that focus on the posterior chain has really helped me recruit those muscles during the pedal stroke.

That’s really interesting and I’ve heard it said before. It does seem to ease the pain though.

My Deadlift is like, 45-50kg 1rm, and my back squat is like 75kg 5rm. My hamstring curl vs Leg extension is even worse % strength so the lack of posterior chain makes sense. I also have a desk job though I do try and avoid sitting if poss.

I had an appointment with the Physio last night. He’s diagnosed me with patella tendinopathy, and has given me a rehab program consisting of single leg heavy leg extension holds with a slow decline, single leg heavy leg press decline + holds at ~75% ROM, along with my usual gym routine of squats/split squats and RDL’s etc.

I will also continue my Hip/glute work as I think this is very important. hopefully these two combine will have me back on the bike and training hard.

Had the same condition, although my symptoms weren’t classical plica symptoms. no snapping or something like that. also the pain was more spread around the kneejoint. I also underwent arthroscopic surgery and was back on the back on day 5 after surgery, which is crazy! of course, with some pain and discomfort but I think it did resolve my knee issue. I am in the gym now doing rehab (week 4) and no flareups at all for now. before I got flareups so easily.

Hello folks. Currently dealing with an irritated prepatella bursa issue in my left knee caused by cycling up a mountain on a bike with 175mm cranks (I’ve been using 165mm cranks for 8 years). Very irritating.

I’ve been following a very good physio’s advice, using ice/heat and massage around the area, which helps a bit, but it’s now a chronic issue (injury occured on Feb 20th) and I am looking at getting a guided cortisone injection. Cycling exacerbates the issue, as does walking more than 10 minutes, and any strengthening exercises involving more than 30 degrees of flexion. Physio advised me to carry on with the glute stregthening and gentle cycling, though the latter feels uncomfortable, even at baby watts.

Initially following the injury I worked on strengthening my glutes, core, etc, watched a 100 youtube videos on strengthening the knees…just seems to be doing nothing long-term as the issue arises as soon as I’m back in the saddle.

FTP is down 35 watts in a month. Desperate to get back on the bike, as it helps to keep me sane and reduces symptoms of ankylosing spondylitis (spinal arthritis).

Anyone else dealing with this type of thing?


After dealing with Pattelofemoral pain (runners knee) every spring - I seemed to have avoided it this year with the “glute doping protocol” highlighted above and stair step downs during the off-season.

Specific to Charles question, last year an ortho commented to me about getting one of those knee straps placed below your knee cap. $15 strap. That thing worked wonders for me during flare-ups off the bike, but on the bike as well. Odd that no one mentioned it for 3 years in prior visits. You’ll know if it works, as the pain/pressure relief is immediate.

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For anyone who’s interested: Saw a physio for a cortisone injection, who did an ultrasound of both knees first, which revealed quad/patellar tendinopathy and calcification on top of the knees, thereby negating the need for steroid injections, as that would not fix the issue and in fact might potentially damage the tendons. He recommended targeted shockwave therapy instead, and specific exercises. Currently doing Shockwave therapy - 4 sessions over 10 days or so - and already feeling the benefits. Has to be done in conjection with specific exercises to have long-term effect. Without strengthening and mobility exercises, the impact of the therapy will wear off after a few months and the issue will return. Am sticking to zone 2 mostly while I do the therapy, but occasional (foolish) forays into Z4 and 5 have not resulted in pain, so something has definitely changed!

Just was diagnosed with the same, doing shockwave and getting some sportvis injections (not a steroid) but its used on things like tennis elbow.

In terms of bike fit changes, are there any tweaks that help reduce strain on the quad tendon?

You’d have to consult a bike fitter tbh mate. Opening up the hip angle via shorter cranks has helped my quads a bit, as has lots of foam rolling - my shockwave guy has prescribed a lot of rolling/massage in combo with strengthening exercises. Can share here if helpful but obviously the regime is specific to my issues.

By far the most common answer you will get is to raise your seat height.

But my advice is to do that with caution without consulting an experienced fitter first. In my case raising the saddle resulted in an imbalance which made things worse, not better.

Have any of you got MRI images/results of your knee issues?
I’ve got an MRI scanner in my lab but I don’t do joints/bone stuff.

Wait….you just happen to have MR in your lab?? Like…wow I’d be scanning stuff like crazy.


It’s only an old 1.5 T scanner. I use it for brain activation cognitive psychology stuff but it still has all the clinical scanner protocols on it from when it used to be in a hospital. It’s just a tool and without clinical knowledge is very limited in actually diagnosing small injuries.

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Just for some morale to those in the strugglebus of knee trouble.

I spent 2 seasons out unable to train.

I am now back. I am not sure what the golden bullet was. I have been stretching my Psoas, and doing a bit of pre ride hip openers and banded joint mobilisation.

I started with 15-20km rides last june, and grew from that, and just a few weeks ago finished top 60 at Traka 200Km gravel race, and have been podiuming criteriums and track racing.

I am as fit as I have ever been in my 20 years of cycling.

There is light at the end of the tunnel!