Most cyclists at some stage experience pain at the knee. This can be at the front of the knee (Anterior knee pain) or at the back of the knee (Posterior knee pain) or at the sides of the knees (Medial and Lateral knee pain).
Anterior knee pain or pain at the front of the knee, in and around the patella or knee-cap is caused by overuse due to an increase in cycling activity. Let’s say a Sunday C group cyclist moving up to the A group where there is a sudden change in intensity and length of spin. The average C spin would be 50 kilometres at 23kph whereas the A spin would be 100k at 28kph. The large quadricep muscles attaches to the shin bone via the patella, so the forces of pedalling are transmitted across the patello-femoral joint whenever the knee is bent, thus squashing it back against the thigh bone. The part of the tendon attaching the patella to the bony part beneath the knee cap becomes inflamed. This should respond to ice or physiotherapy.
There is also another problem which can cause great pain when off the bike and ride - stopping agony when on it. It is known as “Patella Compression Syndrome”. During the push phase of pedalling many riders do not complete the last 35 degree of knee extension. The result of this is that the muscles down the outside of the thigh become much stronger and tighter than the less used medial muscles. The patella is pulled thus causing pain around the knee cap.
To treat such pain at the knee you should:
Try to keep your leg out straight
Correct a saddle that is too low or too far forward, avoid cycling in big gears
Spend a couple of weeks doing exercise that strengthens the less used medial muscles
Posterior Knee Pain
Pain behind the knee is mostly caused by extending the knee. The remedy is to lower the saddle or bring it slightly forward
Medial and Lateral Knee Pain
This is usually caused by incorrect fitting cleats on your shoes. It will often surface when you get new shoes or change your cleats. Badly placed cleats can cause excessive rotation of the knee joints which stresses one or other of the collaterals. When these ligaments are damaged they should be rested to heal and then you can rectify the cleats and commence easy cycling to build up strength in legs again