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Sports Medicine

Knee pain - cycling



I`ve started having knee pain while cycling ~two weeks ago. Shortly before that I "think" I hyper extended it, but had been without pain or limitations. The knee tightens in the back after riding, and I noticed some clicking and slipping on the outside of the knee. Suggestions?


The best treatment for your symptoms should be based on their cause, which requires the performance of a medical history, physical examination, and possibly imaging studies (if results would influence treatment options).

Clicking and slipping on the outside of the knee could be due to "iliotibial band friction syndrome", but could also result from a patellofemoral problem, biceps femoris tendon subluxation, or a lateral meniscal tear. Tightness in the back of your knee after riding could be due to fluid accumulation within your knee due to inflammation, and/or due to one of the potential causes just mentioned.

General measures which may help include applying ice to your knee when painful - particularly immediately after pain-producing activities such as cycling (but being careful to not use ice for longer than 20 minutes particularly over the outer knee, since the peroneal nerve is located close to the surface and is therefore vulnerable to cold-induced injury), wrapping your knee vs. wearing a knee support such as an elastic knee sleeve, taking an over-the-counter anti-inflammatory medication if not contraindicated, and cutting back to a pain-free level of cycling, if possible, including consideration regarding adjusting (raising?) bicycle seat height, choosing lower gears, minimizing cycling up hills, and otherwise reducing cycling intensity, as well as cycling frequency and/or duration. Finally, cross training - by participating in another form of aerobic activity which does not aggravate your symptoms - is necessary as long as you're not cycling at the level you desire.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University