Knee and Back Pain for Cyclists and How to Prevent It

Knee and Back Pain for Cyclists and How to Prevent It

I have had the pleasure of treating many cyclists over the years, and two of the most common complaints I've seen are knee and lower back pain. These are problems that affect a significant portion of all cyclists, and if you’ve experienced one or both for yourself, you’ll know how much impact they can have. In many patients I have worked with it has resulted in time off the bike or god forbid stopping riding. The good news is that there is often a simple solution. These conditions are highly treatable, and we’ll provide you with a few ways you can address them yourself in the sections below.

What causes knee and lower back pain in cycling?
There are multiple possible causes for knee pain in cycling and pain is often an indicator of an underlying problem rather than the primary source, that is to say, that it is often the symptom, not the source. The underlying sources of this pain can vary from a bike that isn’t set up correctly or ergonomic for your anatomy, to muscle weakness, to a lack of mobility, the causes of pain often vary from cyclist to cyclist.

In general, however, pain in your knees and lower back should be a call to action, not a thing to grit and endure. Meaningfully addressing pain can mean both identifying and addressing these underlying symptoms sources.

Exercises for Preventing Cycling Pain
Often a good place to start is to improve your strength and mobility. Knee pain in cycling is often triggered by imbalances or deficiencies in lower body muscle strength or inadequate mobility. The development of pain in the lateral knee or iliotibial band syndrome, or as it is sometimes called iliotibial band friction syndrome, is a good example of a muscular imbalance in cycling. This condition, while felt in the knee can often be caused in part by tightness or imbalance between the tensor of fascia latte (TFL), a muscle at the front of the hip, and the glutes. Excessive tightness of the hamstrings, or a lack of mobility about the hips, can result in athletes struggling to achieve optimal postural alignment, placing increased stress on the lower back which can result in lower back pain.

There are a number of great resources out there for cyclists these days with simple prepacked strength and mobility programs that in many cases will assist cyclists in staying pain-free. I have personally used some cycling yoga videos from Abi Carver at as a simple starting point when I want to turn the brain off and follow a set routine. The same is true for lower back pain, and while the muscles differ, the principal remains the same, with greater strength and optimized mobility the chances of riding pain-free increase.

Bike-Specific Considerations
Another principal consideration is your form or position on the bike. Without getting into a full dialogue about cycling positon and bike setup, saddle design, saddle height, handlebar and stem size, cleat position and bike frame geometry can all have marked effects impacts on how power is generated on the bike, which muscles are used, thus which systems are stressed. Again there are some great resources available to help establish a basic setup which in many instances is all that is needed, one of the best early options is to have a friend take a video of you on your bike (play safe here). This simple feedback can often highlight the difference in our perception of how we are set up and reality.

There are also professional services, one of the best professional services is and there is some great information on their website about the principles of bike setup.

It is important to remember that addressing knee and back pain on the bike is about getting the best intersection between the user and the equipment, the strongest and most mobile athlete may still get pain if they are using equipment that is not well set up or is simply inappropriate for the user. Most standard bike fits, and off the shelf programs assume that there is "normal" underlying anatomy. In many athletes, especially "masters" ones such as myself, there are often a number of underlying joint changes, old injures, and beer guts, that require a more nuanced solution to balance "optimal" and "achievable".

If you have tried the suggestions above and not been able to address your issue, or have any other concerns, contact us at Form + Function Physiotherapy - we are always happy to talk bikes. Our cycling physiotherapist has all the skills and expertise needed to manage your knee and back pain once and for all. As always our aim is to not only treat your condition but also provide you with the knowledge to prevent it from occurring again.

Our physiotherapy facilities are located in Richmond, Victoria, and our doors are open Friday and Saturdays during COVID. Get in touch with us today if you’d like to book an appointment.