By Amy Schlinger
While it’s incredible if you’ve been able to ramp up your riding by taking to indoor cycling over the past year, that can also mean more stress on your knees. If you’re experiencing some knee pain on the bike, use these expert tips to help manage and eventually get rid of it for good.
Many people took their workouts inside over the past year, and for those who love to ride, it meant moving from outdoor cycling to indoor cycling, or from indoor studio cycling, to into-your-living-room cycling. Whatever the case, cycling of all kinds has exploded since the pandemic, and it doesn’t appear to be losing any popularity as things open back up and the world gets back to normal.
For many of us, our time in the saddle and on the bike has increased as well. Whether you wanted to make the most out of your expensive indoor bike purchase or you found some indoor classes and instructors you really love, chances are you’re riding more than ever before. This increase in exercise and time on the bike also means extra stress on the body. Knee pain is something that cyclists often deal with, and it's significantly more common for those who start riding a lot more frequently in a short amount of time.
“Constant repetitive stress within the exact same range of motion on each pedal stroke adds up and can lead to overuse,” explains Cameron Yuen, DPT, a physical therapist at Bespoke Treatments Physical Therapy in New York, NY. “At a minimum, make sure you periodically change cadence, resistance, and come out of the seat.”
If your knees are starting to bother you on your indoor rides, don’t ignore it. Here are some ways to help keep your knees healthy while indoor cycling.
1. Make sure the bike is set up to fit you properly.
One of the most important factors for preventing knee pain when riding indoors is proper bike setup. While this is important no matter who you are, it's especially important to keep in mind if the bike you're riding is shared amongst you and other family members or roommates. Everyone will have their own personal fit, and you have to be sure you set the bike to fit you each time you get on it.
“When it comes to seat height, the following typically holds true— line up the seat height with the top of your hip bone to start,” says Ryan Waldman, DPT, a physical therapist at the James J Peters VA Medical Center in New York, NY. “Ideally, there should be a slight bend of the knee at the bottom of each pedal rotation, forming around a 20- to 30-degree angle at the ankle. If your knee is fully straight at the bottom of the rotation, you will be overextending the knee and eventually develop pain in the back of the knee.”
Having the seat too low isn’t ideal on the knees either. “If your seat is too low, you might experience pain in the front of the knee as this increases the demand through the quadriceps,” says Waldman.
And don’t forget about seat setback, too.
This refers to how far forward or backward your saddle is positioned over the crank. “The sweet spot for seat depth [setback] would be a position that allows your knee to be centered over your foot when you’re looking down at your feet and they’re both at equal height on either side,” says Waldman. “If you notice that your knee is tracking slightly more over the back of the ankle, this could increase stress to the posterior structures of the knee. And vice versa—if you are positioned too far forward and your knee is going over the toes, this can increase the stress to the anterior structures of the knee.”
In general, if you are experiencing pain in the front of the knee, check to make sure you’re not positioned too far forward. If you are experiencing pain in the back of the knee, check to make sure you’re not too far back. You may need to get off the bike and adjust the seat mid-ride until you’re comfortable with the setup—and even then, sometimes, you may still need to get off to make micro-adjustments.
2. Check your cleat positioning
If you don’t know much about cleat positioning, it’s not unusual to have just attached the cleats to your shoes the way you think they’re supposed to be, put your shoes on, started riding, and never looked back. But cleat positioning on a shoe is important.
“This can be very tricky and gets a lot more in-depth, but to scratch the surface, if you are using cycling shoes, especially for the first time, you will need to install cleats on your shoes,” explains Waldman. “Make sure that the cleat is installed straight without any turn in or out as this can stress the knee during cycling.”
You also want to ensure that the cleat is installed in the center of the shoes using the marks provided, Waldman adds. “If you are suffering from pain on the inside or outside of the knee, cleat position could be one of the contributing factors,” he says.
Most cleats have a little margin for error when it comes to movement, also known as "rotational float." If you find that the initial neutral mount position is bothering your knees, you'll have a little wiggle room, or you can try making some minor adjustments to the cleat placement.
"Figure out whether you feel you're inhibited moving your heel inwards towards the bike or away from the bike, and then adjust the cleat slightly in the opposite direction," says Chris Jacobson, North American brand manager for bikefitting.com and PRO Bike Gear. “Try just one adjustment to start, and if that doesn't work, you may want to consider asking a bike fitter for help."
3. Add variety into your programming
If you purchased an indoor bike, you probably spent a good amount on it. Or maybe you recently bought a trainer over the last year to allow you to ride your road bike indoors. Whatever the case may be, if you're indoor cycling a lot, you're getting the most out of your investment, plus you're probably enjoying the rides as well. But, you shouldn’t let indoor cycling become your only form of exercise. It’s still important to switch things up from time to time and have some variety in your program.
“To keep your knees the healthiest, you’ll want to include lower body strength training and walking or running,” explains Yuen. “Both resistance training and walking or running stress and strengthen the knees in complementary ways that will keep your knees both strong and healthy,” he says. So, consider trading one of your indoor cycling days with a strength training session or a long walk—your knees will thank you.
4. Befriend your foam roller
If you already have a foam roller, it’s time to make this tool a part of your routine—and if you don’t have a roller, it’s time for you to get one.
“Biking builds leg strength, but it can also cause loss of flexibility,” explains Jordan D. Metzl, MD, sports medicine physician at the Hospital for Special Surgery in New York, NY, and author of The Exercise Cure. “The best way to fix this is a daily session on your foam roller, emphasizing myofascial release, also known as a self-deep tissue massage.”
Dr. Metzl adds that you want to make sure to include your lower back in the massage session, which can also ache with more time spent in the saddle.
5. Take a break
If your knees are acting up and nothing else seems to be helping, you may need to take a couple of days off from the bike. "The body is capable of significant adaptation and change, but progress is rarely completely linear,” explains Yuen. “As you train, you accumulate fatigue. When you rest between training sessions, your body should super compensate and allow you to come back even stronger. As you get further along in your training, however, you eventually reach a point where the body only adapts slightly and requires even more rest. This is where trainees often develop overuse pain as they are trying to get more and more out of their training sessions without enough recovery.”
If you think you may fall into this category, this is a good time to shift your focus to rest and recovery a little more than you may have been doing previously. “The body often requires more recovery time as you get fitter and are able to express more power or endurance,” explains Yuen. “So don't feel bad about taking some time to de-load—you may come back stronger!”