How to avoid spring knee pain when cycling

Before you’re lured by spring sunshine into ramping up your training, consider the possible consequences for your knees, writes Graham Theobald

As the improved weather and longer days entice us to ride further and more frequently, many of us end up sidelined by the dreaded ‘spring knee’.

The commonest cause of this early-season knee pain is overload and overuse of the knee joint after a decrease in cycling activity over the winter.

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This overloading often takes the form of ‘mashing’ up hills or through hard efforts using a big gear in a bid to get fit after easing up over winter.

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A simple solution is to avoid using your outer chainring when you first increase your mileage in spring. Stay on the inner chainring as much as possible to keep cadence high and resistance low.

This in turn will reduce the forces and stress put through the articular structures of the knee. You can also use easier gearing on the rear cassette, though this does not remove the temptation to change up into the big ring at the front.

The essentials

  • Never ignore knee pain — it’s a sign something is wrong
  • Modify your riding; use smaller gears
  • Reduce/manage the training load
  • Progressively increase load as pain lessens

The main goal when you experience knee pain is to modify your cycling to reduce the loading and stress on the knee joint.

Once the pain has settled and you are managing the load, you can consider gradually and progressively increasing the load until normal training is back on track.

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Classifying the cause of knee pain is crucial to its resolution and although there are many causes of knee pain, if you have not made any major changes to bike set-up or sustained any other related injury, overload and/or overuse is likely to be the prime candidate.

The modification/loading model can be used to effectively manage knee pain in a controlled and reasoned manner.

If pain does not improve, the best course of action is to seek help from a specialist physiotherapist or sports doctor who has experience treating cycling-related knee pain.

Saddle height: it’s essential you get it right

Dr Graham Theobald ( is a specialist physio with a doctorate in cycling-related knee pain

Key points

Do: build up training volume slowly, progressively and carefully. This ensures that the structures in the knee do not become overloaded and painful. If you are prone to knee pain, it is crucial to get this right.

Do: ensure that your set-up — saddle height, pedals, cleats, etc — has not changed, as each of these can cause knee pain. If you dismantle your bike over the winter, take careful note of measurements.

Do:  keep the cadence higher than normal to reduce the resistance on the knee. This can be done with a combination of gearing, terrain, pacing and sensible training loads.

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Do: be prepared to rest and treat the knee if it becomes overloaded. If it is hot and swollen then consider Rest, Ice, Compression and Elevation. Also consider seeking professional help and medical advice.

Look after your neck, too

Don’t: apply changes in position or set-up without testing in isolation whether they have adverse effects on the knee. Small changes can have big effects.

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Don’t: use massive gears (e.g. 53x11t) — consider a smaller front outer chainring. Huge gears increase the loading on the articular cartilage in the knee joint and can cause inflammation and possible long-term damage.

Don’t: listen to ‘old-school’ advice. As much as it’s tempting to trust experienced riders, when advice is not based on current evidence, it can be misleading and cause further problems.