Knee, hip and back pain are common complaints among cyclists. They are certainly my weak points, with a gait that is often more akin to an old woman, rather than a relatively fit thirty-one year old.
I am not a physio and have no training in sports massage, personal training or anything similar. Over the last few years, I have simply spent a lot of time trying to sort out my joint problems, seeing physios and sports masseurs and reading around the topic. I now know enough that when the symptoms flare up, I can usually do something about them myself.
What follows is a summary of what I have learnt.
Knees
Regular cycling, particularly on a single speed, often leaves my knees feeling like tennis balls. All over the front of the knee cap feels swollen, with walking up stairs aggravating the problem further.
Some things worth trying include:
1) Adjust your seat height
Raise it as high as you can while still being able to touch the floor with your tip toes when you sit on the saddle. If your hips wiggle up and down when you pedal, it’s too high.
Be aware that your saddle is likely to slip down over time and will need readjusting. Mark the right height with some gaffer tape on the seat post, so you can always adjust it quickly.
I find that my knees are much more sensitive to a low saddle on flatter terrain. If I’m doing lots of hill climbing, a lower saddle is fine. I wonder if adjusting saddle height for different gradients would work, to compensate for the different postures you have going uphill and cycling on the flat. I’m too lazy to do this but if anyone else does, let me know how it works.
2) Use your gears properly and check your cadence
Pedalling in a gear which is too high is a killer on the knees, particularly when setting off from stationary. Think low gears, high cadence. When you are slowing down to stop, get into the habit of shifting into a low gear, ready for when you set off again. This advice was a real gem when I was commuting through London, stopping and starting at traffic lights every few minutes.
3) Check your cleats
If the pain is on one side of the knee, it may be that your cleats are wonky (if you use them). Play around until you find the right fit – or just use normal shoes.
4) Check your alignment
We’ve all seen a cyclist who looks bow-legged, pedalling along with their knees turned out every time they hit the top of their pedal stroke. This may result from a seat that is too low, but it could also be poor technique. Everything should be in a straight line, with knees and toes both facing forward as your feet rotate – no turning your knees outwards.
I’ve also been told that your front knee should be over your ankle when your feet are at the ‘quarter past nine’ position. In other words, when your feet on the pedals are level with each other, your front leg should make a right angle, with your knee over your foot. Get an expert in a bike shop to check your position out if in doubt.
Lower backs
A stiff lower back from cycling can have many causes, so it is worth seeing a professional to find out where your problems lie. Ensuring you ride a bike which is the correct size is crucial, as is having it adjusted to fit your particular measurements. The best, but potentially most expensive solution, would be to have a bike custom built for you. In the meantime, some suggestions include:
1) Avoid being too upright
On a long day ride or cycle tour, avoid a riding position that is too upright. Sitting upright puts all the weight through your lower back and bottom. On racing and touring bikes, the rider leans forwards, sharing some weight through the upper body and arms and relieving pressure on the back and bum (as well as being more aerodynamic, but that’s hardly relevant on most tours). Compare the cycling posture of someone sat on a Dutch city bicycle to someone on a touring bike to see what I mean.
However, you need to find a balance. Too much weight on the arms can lead to wrist and neck problems as you are constantly craning your neck upwards.
2) Avoid overstretching
There are two things to consider here: your seat position and your stem.
You may need to play around with moving your seat forwards or backwards. If the seat is too far back, you risk overstretching as you reach for the handlebars, straining your back. Too far forward, you will be hunched over the bars and your knees may suffer.
The stem is the bit that connects the handle bars to the rest of the bike. On every bike I’ve owned, I’ve switched the factory stem for a shorter one and it has instantly helped with back issues. I apparently have very short arms but according to the fantastic Sheldon Brown website, this is fairly common among women.
3) Stretching
My three favourite back stretches are very simple ones.
Firstly is the roll down. Beloved of yoga and Pilates practitioners, it simply involves standing straight up and then slowly bending over to touch the floor (or as far as you can get), with straight legs. Begin with bending the neck, then curling the shoulders, then proceed vertebrae by vertebrae until you are hanging upside down (try not to hinge from the hips). Reverse the ‘peeling’ motion to return to standing, and then repeat. This is brilliant for releasing tension is your back and neck.
You could also try the cat stretch. On all fours, alternate between arching your back while looking up to the ceiling and rounding your back while looking to your navel and pulling your tummy in.
My favourite lower back/hip stretch is the cross body stretch. Lying on your back, pull your right knee up to your chest while the other leg stays straight out on the floor. Slowly roll over your left side, keeping your right shoulder on the floor. Aim to get your right knee to touch the floor on your left. After a minute or so, switch sides. There are plenty of variations on this stretch.
If you happen to have a yoga block or similar, lying on the floor with it between your shoulders blades is a brilliant way of releasing upper back tension. This is particularly useful for people who do a lot of front crawl swimming.
General advice
1) Stretching the hip flexors, strengthen the bum
All my physio visits taught me one crucial thing – that most of my knee and back problems stem from tight hip flexors and weak gluteal (bum) muscles. If the big muscles in your bum aren’t working properly, undue force is placed on other things, including muscles and tendons around the knee and your hip flexors.
To strengthen the bum, try squats (double or single leg). I do a particular kind of exercise my physio described as a ‘sprinter’s squat’ – it involves standing a metre or so in front of a chair or bed with your back to it, putting one leg up behind you on the chair or bed and then squatting down, being careful of your knees. You can do these with weights once you’re strong enough – at my most keen, I did 3 sets of 12 reps of the sprinter’s squat holding 6kg weights, 3 times a week.
For the hip flexors, my favourite is a lunge. With one foot back and my hands on my hips, I dip down and press my hips forward. The heel on my back foot is up and my front foot is flat on the floor. I do this stood over my bike at traffic lights (and pretty hot I look too).
Most mornings, I also do a figure of four stretch and a pigeon stretch on each side before I get out of bed. This targets first the front of the hips and then the back of the hips and the glutes.
It is very difficult to describe stretches in prose and I’m not Davina McCall, so am not about the demonstrate them. I would strongly recommend seeing a professional and/or trying a few yoga or Pilates classes.
I can’t emphasise enough what a difference stretching my hips makes to my cycling life.
2) Warm up
It takes a bit of time for the bigger muscles to warm up, so if it’s a cold day, either start slowly or do some gentle exercise before you head outside, to make sure the right muscles are switched on.
3) Foam rolling
This is useful if you can’t get to a physio or a sports massage. It can be particularly useful for releasing tension in the hips and the IT band (which runs from your knee to your hip). If your muscles are tight, it will feel horrendous at first – be warned.
If you don’t have much space, try a physio ball. This is a small rubber ball which you can either roll over on the floor or hold in your hand to work into your muscles.
4) Medication
I have taken both glucosamine and cod liver oil on the advice of various doctors, but not really noticed much difference. In my case, stretching and bike adjustments were more noticeable solutions.
Of course, what works for me may not work for you and I strongly urge you to seek advice from a professional if you’re suffering. It took me a little while to find a physio I was totally comfortable with, but eventually I met someone who understood that I wasn’t about to just stop and rest, so designed exercises to fit around my daily dose of exercise (mainly commuting by bike, running and swimming). The only thing I stopped was high intensity exercise classes and yoga, which I replaced with Pilates on the advice of my physio.
I’d be interested to know what works for others, so please add your thoughts below.
