Medial knee pain cycling is pain on the inner side of the knee and can be caused by improper cleat position or individual anatomical problems such as different leg lengths or even poor technique.
Reasons For Medial Knee Pain Cycling
Pes Anserinus
The pes anserinus is an area on the front and inside of the shin bone where three tendons join the tibia. The tendons can get inflamed and sore from overuse or misuse, and pain and swelling may follow.
Treat Pes Anserinus by addressing the causes listed below coupled with icing, resting and stretching. In extreme cases treatment options can include surgery.
- Ice the inflamed or sore area.
- Stretch – specifically focus on your hamstrings, calves and quads.
- Put a pillow between your legs when sleeping on your side
Medial collateral ligament (MCL)
The MCL is a ligament that goes from the inside surface of the upper shin bone and attaches to the inner surface of the bottom thigh bone and is responsible for keeping the inside of the knee joint stable.
Treat the MCL just as you would treat the Pes Anserinus.
Causes for Medial Knee Pain Cycling
Cleat positioning
Cause: Cleats that are positioned too wide can cause the foot to be externally rotated (toes point out).
Solution: Narrow foot position by moving cleat inwards.
Cleat Float
Cause: Little, to no float in the cleat.
Solution: Increase pedal float to a minimum of 6 degrees. Different cleat styles allow for more or less float in addition to the settings on the pedals themselves. First try and loosen the float on the pedals, but it may require a new set of cleats.
How do you know if it is a cleat problem?
Self assessment can be done by taking a rest for 3 days. While taking a rest, make sure to speed up the recovery process by icing and heating your knee to stimulate blood flow to the area and potentially taking anti-inflammatories. After the three days is up, get back on the bike but stay in the small ring, also wear normal running shoes, and cut your training down to 25% of what it previously was.
Over a week, build back up to 50% of previous training load. If you notice improvements or the pain is no longer as severe, then it may be your cleat position. If the pain did not improve then it is likely an overuse injury and you will need to take a longer rest. It could be 4 to 6 weeks, but it may be time to include a medical professional for a second opinion.
Leg Length Discrepancy
Cause: Excessive impact (running), muscle tightness or imbalance or perhaps just a shorter leg.
Solution: Sometimes you are able to correct the leg length discrepancy through physio, stretching and strengthening. If this is possible then this is the best approach; however, some people have one leg shorter than the other and the only fix is to purchase an orthotic or put a wedge in the cleat.
How do you know if it is leg length discrepancy?
A quick test is it to lie on floor and make a 90 degree angle with your knees while your feet are flat against the wall. If one knee sticks out more (away from the wall) then that tibia is longer. If one knee is higher up the wall (further from the ground) then the femur of the respective leg is longer. This is a quick test and is a starting point to investigate further. X-rays would be more reliable.
Poor Technique, Tightness, Muscle Imbalance, Injury
Poor technique such as riding with your knees too far apart can cause medial knee pain. Tightness, muscle imbalance or an old injury can throw alignment off and cause your knee to track poorly and instead of moving in a perfect linear circle it can move laterally as well, opening you up to potential inner knee pain.
If your knee is moving side to side while pedaling, it will likely just be a matter of time before you start to feel a twinge. Try spinning rather than mashing. Really focus on your pedaling technique, and making sure that you are stretching properly (more specifically your IT band).
Medial Knee Pain Is Not Caused By…
Medial knee pain cycling is generally not caused by saddle height or an improper fore-aft saddle position as that will affect the posterior knee (back of knee) or anterior knee (front of knee). You are looking for a lateral issue and not a linear one.
Assessment
Assessing what is the root cause of the medial knee pain can be quite difficult, but will be one of the most important tasks. Make sure to change one variable at a time. Resting and cutting your training volume down by 50% will address overtraining, then look at leg length discrepancy and cleat position independently of each other. If you change more than one variable at a time how are you going to figure out what the issue is?
Last Words of Advice
Take extra care to warm up and cool down the ligaments that are now inflamed and sore, as ligaments do not receive as much blood flow as muscles and therefore take longer to warm up. Take particular care to dress properly in the cold to protect from further injury.
Take the recovery and assessment seriously. Most cyclists will tend to want to rush the recovery process further setting them back. Don’t be that person.
Knee Rehab Program for Cyclists
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