How To Prevent And Treat Bicycle Touring Knee Pain


How to Prevent and Treat Bicycle Touring Knee PainOne of the most common problems encountered during a bicycle tour – especially an extended one – is knee pain. The most common cause is patellar tendonitis, which causes anterior knee pain. If this condition is not taken seriously, it can lead to serious life-long damage and/or might require knee surgery.

Causes & Risk Factors

  • Poor muscle mass. If you lack cycling experience, chances are that your muscle mass is not sufficient, so much more stress is put on the tendon
  • Heavy load. Too much weight on the bike = Too much stress on your knees
  • RPM (cadence) is too low. In other words, you are pushing too hard on the pedal
  • Cold weather. This causes vasoconstriction, so fluids and blood flow to the knee are reduced
  • Dehydration. The body needs fluids to lubricate the mechanics of the tendon
  • Lack of rest and/or day off
  • Bad saddle position. In this case, it is usually too low or too close to the handlebar
  • Crank arm is too long
  • Anatomy discrepancy (one leg shorter than the other)
  • Bad foot position on the pedal and/or crooked pedal

Treatment & Prevention

  • STOP. This is the #1 rule! AS SOON AS it starts hurting: STOP BIKING! It doesn’t matter where you are – stop, go see a doctor, and rest for a few days. The more you bike on a painful knee, the longer you’ll need to wait for the tendon to recover. For each day biked on a painful knee, you may need one week of rest. Biking several days with a painful knee may cause irreversible damage.
  • Training. Train before leaving or at least take it easy when you start. Every sport uses a specific set of muscles. It doesn’t matter if you’re in great shape; if you are not used to biking, it is guaranteed that you don’t have the proper muscle mass and your tendons will suffer no matter what.
  • Rest. Force yourself to rest, especially during wintertime and even more so if you are not trained. For the first few months, it is usually recommended to take a day off every two days of biking so your tendons have time to rest. Remember that it is continuous overuse that causes tendinitis.
  • Weight. A good rule of thumb is to carry no more than half of your own weight on your bike.
  • Gear. Don’t be afraid to use a small (easier) gear. You should ride at 70 – 75 rpm or higher.
  • Knee brace. Wear a knee brace or knee warmer in order to increase circulation to the knee area. This works better as a preventive measure. It won’t actually cure the tendinitis.
  • Warmth. Wear warm and breathable clothes in cold weather. Merino wool (ie. Icebreaker) is an excellent material (the best in my opinion). Gore-Tex or eVent on top of a warm layer (ie. Merino) are seriously recommended, especially if it is raining or snowing. I personally wear the knee brace in addition to those layers when it is really cold (below freezing).
  • Clips & Straps. It is best to keep the foot in its ideal position (once you have found that position). Clips are the most efficient. Straps are a lot better than nothing at all, but not ideal. An excellent compromise – and my personal preference – is to use Power Grips.  They are very close to the efficiency  of clips without the hassle of having to carry bike shoes.
  • Stretching. Do your basic stretching exercises before and after the ride.
  • Adjustments. The best thing to do first is to see a bike specialist. If you are doing adjustments on your bike, do them one at a time and wait for about a week to see if there are any improvements. That way, you’ll be able to tell what helps and what doesn’t.
  • Saddle. Make sure your saddle height is correct. If it is, try to raise your saddle anyway 1/2 inch at a time and see if there is any improvement.
  • Anatomy. If you know that you have one leg considerably shorter than the other, you might want to consider getting professional advice and to invest in a custom-made bike.
  • Water. Be sure to drink plenty of water, as in any sport.
  • Anti-inflammatory. Pain killers while biking are not recommended, as they simply mask the pain and the damages on the tendon will simply get worse. Anti-inflammatory creams and medication should be used ONLY while resting to ease the pain. But do not use them without seeing a doctor first and DO NOT use them simply to be able to keep biking. YOU NEED TO REST!
  • Wait until the pain is completely gone and then wait a few extra days before hitting the road again.

Additional Information

About Stephane Marchiori

Owner of
Bike touring since 2003, including:
a 5-Year Bicycle Journey Around The World!

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