Eliminating Knee Pain During Recreational Cycling

Eliminating Knee Pain During Recreational Cycling

Meet Laura

Laura is a healthy and active 55-year-old woman who recently transitioned into cycling from her repertoire of outdoor activities, including running and touch football. With a previous injury to her right knee that was causing her ongoing niggling pain, Laura wanted to focus on cycling to give her knees a break, let them recover, and help prevent her injury from continuing to cause her pain – or new injuries developing.

Fact: Did you know that activities like running and jumping place a tremendous force on your knees compared with walking and cycling? Up to twenty times your bodyweight.




Laura was going for 1 – 2 rides per week for 20 – 32 km each time. Unfortunately, Laura’s pain in her right knee was creeping back during her cycling, and she thought that it may be the uphill cycling that was aggravating her knee. This is when she came in to see our team at The Podiatrist after hearing that cycling assessments are one of our specialities!

Laura’s Assessment Found:

We started Laura with a standard biomechanical assessment, which revealed that:

  • Her ankle couldn’t move as much as we like to see, with her being unable to point her toes upwards past a certain point
  • She had quite tight calf muscles, which explained the ankle restriction above. The right foot was worse than the left
  • Tight hamstrings on both legs
  • Her right foot tended to roll in (pronate) and internally rotate at the knee much more than her left

We got Laura on our assessment bike in the clinic and found that:

  • Her left cleat was positioned 5mm out of alignment, whereas her right cleat was slightly rotated inwards
  • The pronation and internal rotation of her right knee was tracking towards the top bar at the bottom of every stroke
  • We also measured her saddle height (5mm below the height of the greater trochanter of her hip), knee over pedal axle position, pelvic angle and foot/ ankle positioning so we had a full picture of what was happening with every stroke

This was Laura’s positioning before her adjustment:

stationary bike treatment

Laura’s Bike Adjustment

Our assessments immediately identified discrepancies between how Laura was positioned on her bike, and optimal positioning to optimise her posture, alignment and the movement of her joints and muscles through every stroke. Based on these findings, we:

  • Moved Laura’s saddle up 5mm to 840mm
  • Moved the saddle backwards 5mm, to bring the pedal axle to the centre of the bottom of the pedal spindle (with regards to her knee position)
  • Reduced Laura’s pelvic angle to 55-60 degrees from 60-65 degrees
  • Taught her a new glute cue for the right leg to assist in straightening the right knee as it tracks up/down through each stroke
  • Added a specific arch pad to her right foot to encourage the right knee to rotate outwards, instead of continuing to rotate inwards

It often takes a few weeks for people to be able to notice the long-term changes, as well as for any pains or injuries to recover, so we booked Laura back in to check on her progress in three weeks’ time.

proper angle treatment

Laura’s Three-Week Review

At Laura’s three-week review, she reported that she had no troubles adapting to the new bike position and had been practising her right glute cue. Better yet, her right knee was feeling significantly better.

We got her back on the bike and found that:

Her right knee was tracking better, though there was still some internal rotation towards the topbar

Her pelvic angle was now at 60 degrees – a comfortable recreation angle

Her pedal angle was now in line with the pedal spindle with regards to her knee

Three months later

We checked in with Laura three months later, after instructing her to continue practising her glue cue for another 4 weeks minimum, and that we’d expect her to continue to improve and feel better on her bike.

Laura is now able to ride 60km without pain, and is planning on increasing her distance even further.

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