Cycling has a unique relationship with knee health - it can both cause and relieve knee pain depending on circumstances. As a low-impact exercise, cycling is often recommended by physiotherapists for people with joint problems. The smooth, circular motion puts less stress on knees than running or walking. However, incorrect bike setup, poor technique, or overuse can create problems. Whether you're an experienced cyclist developing pain, or someone looking to use cycling as rehabilitation for existing knee issues, understanding this relationship is key. This guide covers both sides - when cycling causes problems and when it's beneficial.

Bike fit problems are the most common culprit: saddle too high causes overextension, too low creates excessive bending, wrong fore/aft position shifts load incorrectly, and misaligned cleats twist the knee unnaturally. Overuse injuries occur when increasing mileage too quickly. Gear selection matters - grinding in high gears strains knees more than spinning in lower gears. Specific conditions include: patellofemoral pain (front of knee, often from saddle position), IT band syndrome (outer knee pain, often from cleat alignment), and patellar tendinitis. Pre-existing conditions can be aggravated - those with osteoarthritis may need specific adjustments. Muscle imbalances, particularly weak glutes and hips, can also contribute to cycling knee pain.

For many knee conditions, cycling is therapeutic rather than harmful. It's low-impact - putting far less stress on joints than running or even walking. The controlled, circular motion strengthens the muscles supporting the knee without jarring impact. Cycling is frequently recommended for osteoarthritis management, helping maintain mobility while building protective muscle. It promotes flexibility and range of motion. The cardiovascular benefits support weight management, which reduces knee stress. Indoor cycling on a turbo trainer or stationary bike offers an especially controlled environment for rehabilitation, allowing you to stop immediately if pain occurs. Many people recovering from knee injuries or surgery use cycling as part of their rehabilitation programme.

Professional bike fit is the best investment for preventing knee pain. Key adjustments: saddle height should allow a slight bend at the bottom of the pedal stroke (around 25-30 degree knee angle). Saddle fore/aft position affects knee tracking. If using clipless pedals, get cleats professionally fitted - small rotational adjustments make a big difference. Gear selection: spin in lower gears at higher cadence (80-90 rpm) rather than grinding slowly in high gears. Build mileage gradually - no more than 10% increase per week. Warm up before hard efforts with easy spinning. Strengthen supporting muscles off the bike - focus on glutes, quads, and core. Stretch after rides, particularly quads and IT band. Consider flat pedals if cleat position remains problematic.

Certain symptoms warrant stopping and getting professional assessment: Sharp pain during cycling that doesn't ease when you stop. Pain that worsens with each ride rather than improving. Swelling around the knee after cycling. Pain that continues at rest or disturbs your sleep at night. Knee giving way or locking during or after cycling. Pain persisting for more than two weeks despite rest and adjustments. Pain that affects activities beyond cycling - walking, stairs, daily life. Don't push through these warning signs as you may worsen the underlying problem.

Self-Pay Health helps you find sports medicine specialists, physiotherapists, and orthopaedic consultants quickly. Proper diagnosis is important because cycling knee pain has many possible causes requiring different treatments. You may need imaging if a structural problem is suspected. Treatment options include physiotherapy, bike fit adjustments, orthotics, and addressing muscle imbalances. For those with severe arthritis affecting cycling, surgical options including knee replacement may be worth discussing. Private appointments mean you can get back in the saddle safely, sooner.