Member Case Study: Knee Pain While Cycling

author : AMSSM
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This month I upped my bike time a lot but at relatively low intensity and I started experiencing pain on the outside lower part of my knee. It did not affect anything other than cycling.

Question from pigpen35
I have a question that is probably common. This month I upped my bike time a lot but at relatively low intensity and I started experiencing pain on the outside lower part of my knee. It did not affect anything other than cycling and I was fine to run but every time I got on the bike it would start to hurt after 30 -45 minutes. It seems to be taking longer to start now but I am curious why only one knee and why only during cycling. I hope this makes sense.

Answer
Outside lower knee pain is usually suggestive of iliotibial (IT) band syndrome. This is common in cyclists and runners, who may be increasing the volume or intensity of workouts. The IT band runs along the outside (lateral) part of the lower extremity, starting at the hip and runs all the way to just past the knee. When it is tight, the band can rub against the bone on the side of the knee. That begs the question, “Is the knee pain the culprit or the victim?” That is, the IT band may be tight because the tensor fascia lata muscle is tight or it may be rubbing because the muscles in the pelvis are tight or weak or the pelvis may be rotated, putting the IT band at a mechanical disadvantage. The knee pain could also be the victim of improper bike fit (i.e.; placement of the foot on the pedal, seat height, or position).

Why the pain has come on only in cycling, as opposed to during running, may be related to your bike positioning or bike fit. Your seat may be too high or too far back. You can have your leg length evaluated and corrected with cleat shims, if necessary, for the shorter side. Before you add shims, make sure your pelvis is not rotated causing a functional leg length discrepancy. You can also be observed from behind while riding on a trainer to see if your hips are symmetric, whether or not you are dipping more to one side, or rocking your hips; suggesting your seat is too high. Your cleats may need to be shifted more forward or rearward in the shoe.

You will benefit, long-term, from exercises to strengthen your gluteus medius (hip abductor) muscles. These exercises will improve your lower extremities’ endurance as you increase your mileage in biking and running. For short-term/immediate relief, try some IT band stretches as well as stretches for your piriformis (a small muscle in your buttocks) and hip flexors. Icing the area that hurts and a short course of anti-inflammatory medications can be helpful too. Back off a bit on your mileage until your body can adjust to the new load. If these suggestions do not work, see your sports medicine physician.

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date: May 1, 2006

AMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

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