Follow my multi-step approach to eliminating outer knee pain while cycling for good!
The majority of cycling-related injuries are overuse injuries. They’re overuse injuries because tissue damage occurs from repetitive stress over time, unlike acute injury resulting from an accident or crash. Studies show that knee-related overuse is most likely to cause professional cyclists to take time out of the saddle.
It explains why I experience pain on the outside of my knee while cycling that comes and goes—directly related to periods of increased training intensity and volume. Recently, when the pain became too much to ride through, I had to get to the bottom of it.
Ask yourself the following questions about outer knee pain while cycling.
- Do you experience sharp pain on the outside of your knee below the joint where the boney bump sticks out when you ride?
- If you press the boney spot while bending your knee back and forth, does it cause the same pain you feel when cycling?
- Does the pain worsen and travel to your thigh or calf the more you ride?
- Do you feel tightness and lack of flexibility on the outside of your thigh and front of your hips?
- Has it been a long time since you had a proper bike fit?
- Did you recently have a sudden increase in mileage or intensity?
- Are you an aggressive pedaler or primarily use a low cadence?
- Do you enjoy other sports that make your knee bend repetitively, like running and hiking?
If you answered “yes” to five or more of these questions, you might be suffering from a cycling-related overuse injury known as Iliotibial Band Friction Syndrome (ITBS). It is called “Runner’s Knee,” but it is almost as common in cyclists, especially this one.
The iliotibial band is the strong connective tissue that runs along your outer thigh. It extends from your pelvis to just below the knee and inserts on that boney bump (the lateral femoral condyle) I mentioned earlier.
Friction occurs in that area as you bend your knee (most significant between 0 and 30 degrees) repetitively and intensely when riding, leading to inflammation and pain. The ITB rubs against the lateral femoral condyle, or vice versa, which causes irritation.
A 2017 systematic review published in the International Journal of Sports Physical Therapy determined ITBS was the most common cause of outer knee pain while cycling. The underlying reasons noted include:
- Tightness of the ITB.
- Toeing in of your foot on the pedals.
- If your saddle position is too high.
- Excessive hip adduction occurs when your foot is too close to the crank.
- A rapid increase in mileage.
For a deeper dive into other possible causes, treatment, and prevention of outer knee pain while cycling, check out the ZOM virtual case study entitled “Pain on the Outside of the Knee While Cycling.“
Here are a few tips, tricks, and suggestions I offer my patients and cycling friends and have used myself for outer knee pain while cycling.
Tip #1 - ITBS Self Test
In my clinic, I sometimes use Noble’s Compression Test to diagnose ITBS. Ideally meant to be performed by a clinician on a patient, but you can do it to yourself to get an idea if ITBS is your problem.
Grab the back of your knee and place your thumb on the boney bump where you experience pain. Apply firm pressure with your thumb as you bend your knee between 0 and 45 degrees. If you feel localized pain (most significant at 30 degrees), snapping, or rubbing, it just may be your ITB.
Tip #2 - Stretch Your ITB and Hip Flexors
Tip #3 - Roll Your ITB and Hip Flexors
There are many benefits of foam rolling, and you can do it yourself at home to prevent and treat outer knee pain while cycling!
Tip #4 - Strengthen Those Glutes
There are many glute strengthening movements you can do at home, like the ones found in The ZOM article entitled “Dead Butt Syndrome—A Real Pain in the Cyclist’s A–.” However, nothing beats getting in the gym to do some squats, lunges, or hitting the leg press.
Tip #5 - Basic Bike Fit and Pedaling Recommendations For Outer Knee Pain While Cycling
A proper bike fit by a certified specialist is always a good idea, but you can give this a try until then.
- Lowering your saddle height (or decreasing crank length) will ease the friction of excessive flexion and give your knee time to heal, but it won’t solve the problem. A proper fit will.
- Adjust your cleat inward to move your foot out on the pedal.
- Avoid toeing in of your foot on the pedal.
- Address any leg length differences with shims.
- Focus on pedaling technique and avoid low cadence and high torque.
Click here for a written description of the things we discussed.
Pain on the outside of your knee is common, but you will see. These tips will help you as much as they did me.
What do you find helps your outer knee pain while cycling?
What tricks do you use to get back in the pedals painlessly? Comment below! Your fellow virtual cyclists want to know.
For more ways to actively treat your cycling-related aches and pains, check out the Virtual Case Studies page of The ZOM!
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Semi-retired as owner and director of his private Orthopedic Physical Therapy practice after over 20 years, Chris is blessed with the freedom to pursue his passion for virtual cycling and writing. On a continual quest to give back to his bike for all the rewarding experiences and relationships it has provided him, he created a non-profit. Chris is committed to helping others with his bike through its work and the pages of his site.
In the summer of 2022, he rode 3,900 miles from San Francisco to New York to support the charity he founded, TheDIRTDadFund. His “Gain Cave” resides on the North Fork of Long Island, where he lives with his beautiful wife and is proud of his two independent children.
You will read him promoting his passion on the pages of Cycling Weekly, Cycling News, road.cc, Zwift Insider, Endurance.biz, and Bicycling. Chris is co-host of The Virtual Velo Podcast, too!
