Cycling Knee Pain: Causes, Fixes, and Prevention Guide

Knee pain affects up to 65% of cyclists at some point. The good news? Most cycling knee pain is caused by bike fit issues that you can fix yourself.

This guide will help you identify what's causing your knee pain based on where it hurts, and show you exactly how to fix it.

Knee Pain Location Matters

The location of your knee pain is a diagnostic clue:

Pain Location	Common Cause
Front of knee (anterior)	Saddle too low, saddle too far forward
Back of knee (posterior)	Saddle too high, saddle too far back
Outside of knee (lateral)	Cleat angle wrong, wide Q-factor issues
Inside of knee (medial)	Cleat angle wrong, narrow Q-factor
Below kneecap	Saddle too low, overuse

Anterior (Front) Knee Pain

What it feels like:

Pain at the front of your knee, often on or around the kneecap. May feel like grinding or aching during climbing or high-effort pedaling.

Primary causes:

1. Saddle Too Low

When your saddle is too low, your knee bends excessively at the top of the pedal stroke. This puts enormous pressure on your patella (kneecap) and the cartilage behind it.

The fix: Raise your saddle in 5mm increments until your knee angle reaches 140-150° at the bottom of the stroke. Use BikeFittr's saddle height analyzer to measure.

2. Saddle Too Far Forward

A saddle that's positioned too far forward shifts your weight onto your quads and increases patella pressure.

The fix: Move your saddle back until your knee is roughly over the pedal spindle when the crank is at 3 o'clock. Check this with BikeFittr's KOPS tool.

3. High Gear Grinding

Pushing big gears at low cadence multiplies the force on your knees.

The fix: Increase your cadence to 80-100 RPM. Use easier gears, especially on climbs.

Posterior (Back) Knee Pain

What it feels like:

Pain behind your knee, often with tightness in the hamstrings. May worsen during the pulling phase of the pedal stroke.

Primary causes:

1. Saddle Too High

When your saddle is too high, you overextend your leg at the bottom of each stroke. This strains your hamstrings and the structures behind your knee.

The fix: Lower your saddle until you eliminate hip rocking and achieve a 25-35° knee bend at the bottom of the stroke.

2. Saddle Too Far Back

A saddle positioned too far back increases hamstring activation and strain.

The fix: Move your saddle forward in 5mm increments.

Lateral (Outside) Knee Pain

What it feels like:

Pain on the outside of your knee, often along the IT band. May be sharp during pedaling and ache afterward.

Primary causes:

1. IT Band Syndrome (ITBS)

The iliotibial band runs along the outside of your thigh and can become irritated where it crosses the knee joint.

The fix:

• Check cleat rotation—toes may need to point slightly outward
• Ensure your cleats allow adequate float
• Stretch and foam roll your IT band
• Gradually increase training volume

2. Cleats Rotated Too Far Inward

If your cleats force your feet to point inward, it twists your knee with every stroke.

The fix: Adjust cleat rotation so your natural foot angle is supported. Most people need 0-5° of outward toe angle.

3. Narrow Pedal Stance (Q-Factor)

If your feet are too close together, it can stress the outside of your knees.

The fix: Use pedals with longer spindles or pedal spacers to widen your stance.

Medial (Inside) Knee Pain

What it feels like:

Pain on the inside of your knee, potentially with clicking or catching sensations.

Primary causes:

1. Cleats Rotated Too Far Outward

This forces your knee to track inward, stressing the medial structures.

The fix: Rotate cleats so your toes point more naturally (usually slightly outward or neutral).

2. Wide Pedal Stance

Feet too far apart can stress the inner knee.

The fix: Narrow your stance if possible, or check cleat fore-aft position.

The Bike Fit Connection

Most knee pain comes down to one of these fit issues:

Saddle Height

• Too low → Front knee pain
• Too high → Back knee pain

Check your saddle height for free →

Saddle Position

• Too far forward → Front knee pain
• Too far back → Back knee pain

Check your saddle position (KOPS) →

Cleat Position

• Rotated wrong → Inside or outside knee pain
• Too far forward → Hot spots and knee strain

Prevention Strategies

1. Get Your Fit Right

The best prevention is proper bike fit. Use BikeFittr's fitting tools to check your position.

2. Build Up Gradually

Sudden increases in volume or intensity cause more knee injuries than anything else. Follow the 10% rule—increase weekly volume by no more than 10%.

3. Spin, Don't Grind

Maintain a cadence of 80-100 RPM. Lower cadence = higher knee forces.

4. Strengthen Off the Bike

Strong quads, hamstrings, and glutes protect your knees:

• Squats
• Lunges
• Single-leg deadlifts
• Step-ups

5. Stretch Regularly

Focus on:

• Quadriceps
• Hamstrings
• IT band
• Hip flexors

6. Listen to Your Body

Pain is a signal. Don't push through it—identify and fix the cause.

When to See a Doctor

Seek professional help if:

• Pain persists despite bike fit adjustments
• You have swelling or warmth around the knee
• The knee locks, catches, or gives way
• Pain is severe or worsening
• You can't bear weight on the leg

Quick Diagnosis Guide

Front knee pain → Check:

1. Saddle height (probably too low)
2. Saddle position (probably too far forward)
3. Cadence (probably too low)

Back knee pain → Check:

1. Saddle height (probably too high)
2. Saddle position (probably too far back)
3. Hamstring flexibility

Side knee pain → Check:

1. Cleat rotation
2. Cleat float
3. Q-factor/stance width

Start Fixing Your Fit Today

Knee pain doesn't have to end your cycling. Most cases resolve quickly once you address the underlying bike fit issue.

Start with the most common cause: Check your saddle height with our free AI tool. It takes just a few minutes and could save you months of pain.

Frequently Asked Questions

Why does my knee hurt when cycling?

Cycling knee pain is usually caused by bike fit issues rather than the cycling itself. The most common causes are incorrect saddle height (too high or too low), poor saddle fore/aft position, and misaligned cleats. The location of your pain indicates the likely cause: front knee pain suggests saddle too low, back knee pain suggests saddle too high.

How do I know if my saddle is causing knee pain?

If your knee pain occurs during or immediately after cycling but improves with rest, your saddle position is a likely culprit. Front knee pain indicates your saddle may be too low or too far forward. Back knee pain suggests it's too high or too far back. Try adjusting in 5mm increments and test ride to see if symptoms improve.

Can cleats cause knee pain?

Yes, improperly positioned cleats are a common cause of knee pain, especially pain on the sides of the knee. If your cleats force your foot into an unnatural angle, your knee will twist with every pedal stroke. Ensure your cleats allow your feet to sit at their natural angle and provide adequate rotational float.

Should I stop cycling if my knee hurts?

Reduce intensity and duration first rather than stopping completely. If the pain is mild and related to a recent fit change, gentle spinning may be fine while you make adjustments. However, if pain is severe, worsening, or accompanied by swelling, stop riding and consult a healthcare professional.

How long does it take for knee pain to improve after adjusting bike fit?

Most cyclists notice improvement within 1-2 weeks of correcting a bike fit issue. Minor adjustments may feel better immediately. However, if you've been riding with poor fit for a long time, your body may need several weeks to adapt to the correct position. Make changes gradually.

What cadence is best for avoiding knee pain?

A cadence of 80-100 RPM is generally recommended to minimize knee stress. Lower cadences (grinding big gears) increase the force through your knees with each pedal stroke. If you're prone to knee pain, focus on spinning in an easier gear rather than pushing hard in a big gear.

Experiencing knee pain? Start with a free saddle height analysis to identify the most common cause.