General Cycling Discussion - Knee pain after cycling? What to do?

My wife is a utility cyclist, cycling for errands at least 4-5 times per week and up to 3 trips per day, but usually under a few miles per ride. Often she has to carry a heavy load (rides a tandem with trailercycle and two kids and four panniers), bringing the kids to and from school, riding on some hilly streets. So, she rides very short rides but has to pedal very hard for those short intervals. She rarely rides recreationally and never for any distance greater than 5 miles.

She complains of knee pain that she says correlates to bike use. Her knee never hurts when riding, but afterward, when climbing or descending stairs, or just walking. If she takes a week long break from cycling, her knee stops hurting. When she resumes cycling, the pain returns. Again, never while cycling, only when doing other activities.

Is the cycling causing the pain? If so, what can she do (in terms of alternative/supplemental exercises) to decrease the pain? Is it a question of not having enough muscle training? Or is it something else?

In terms of her riding technique, she uses as low a gear as possible when climbing (the tandem has mtb gearing, and her bike has a Shimano 8-speed IGH), so she tries to maximize 'spinning' when she can using low gears, as opposed to mashing in higher gears. The cranks on both bikes are 170mm and she has long legs, riding a 58cm frame. Could shorter cranks be a solution?

I used to have knee pain from cycling. My saddle was too low. I went to my local bike shop to get a fitting done, he fixed it all up, and boom, no more pain, ever.

I highly recommend getting a proper fit done.

"a tandem with trailercycle and two kids and four panniers)"
And on hills, yet. Impressive. That could exacerbate a relatively minor problem. Sounds like her technique is sound.
In addition to improving fit, specific exercises could help. Quad sets, for instance.

If the pain is in the front of the knee, try raising the seat. If the pain is in the back try lowering it a little. Get a good bike fit anyway no matter what happens

If she has arthritis starting, she matches all my arthritis symptoms perfectly. Ride less or reduce the load on the knee during riding. That works for me. Starting a short ride with a high load and no chance to warm up, can stress the joints too. I do a lot better if I warm up first.
History of arthritis in the family? Any other joint issues anywhere?

Check with a doctor it may not be a cycling fit issue.

Shorter cranks make it easier to sping fast. Shorter cranks would probably help, they help me, but try that later if nothing else helps.

It may just be too much of a load on the bike.

Watch her ride the bike, especially under load. Do her knees wobble from side to side? Does her pedal stroke become uneven or jerky? Sometimes, small changes in fit, posture, or technique can make a huge difference in reduced pain and reduced injury.

And be very skeptical of advice from people that do not watch her ride the bike.

"So, she rides very short rides but has to pedal very hard for those short intervals."

Sounds like she needs the bike set up right and gears to help her move those heavy loads.

Thanks for all the advice. I'll watch her riding more closely (in the morning we can each ride one kid to school and share a portion of the route, so I can watch then). I hope it's not the beginnings of arthritis (no real history of it in her family). And maybe a proper fit consultation is in order.

"So, she rides very short rides but has to pedal very hard for those short intervals."

Sounds like she needs the bike set up right and gears to help her move those heavy loads.

Her bike is geared down to <30 gear inches in low gear, and the tandem's lowest gear is <25 gear inches (42/32 gearing with 20" wheels). I suppose we could go even lower with smaller front chainrings, but will shaving off another 5 or so gear inches help much?

Well, for me, my knee pain went away when I significantly increased my overall mileage. It sounds like she is asking her limbs to do intense work without the required endurance base and maybe, an inadequate warm up prior to extreme pedal pressure. The weak link, usually, is the knee joint so that's where the pain of heavy torque application manifests first. Good luck with her "troubleshooting".

Her bike is geared down to <30 gear inches in low gear, and the tandem's lowest gear is <25 gear inches (42/32 gearing with 20" wheels). I suppose we could go even lower with smaller front chainrings, but will shaving off another 5 or so gear inches help much?

At my weight I find it very hard to get up some big hills without my 21" low gear. I'm trying to lower it to 19" on my next bike. I suspect a tandem with two kids is in a similar situation.

Her bike is geared down to <30 gear inches in low gear, and the tandem's lowest gear is <25 gear inches (42/32 gearing with 20" wheels). I suppose we could go even lower with smaller front chainrings, but will shaving off another 5 or so gear inches help much?

Yes it will help. No way to know if it will fix the knee problem.

southpawboston, I suspect there are multiple factors. Dealing with a climb and additional weight when the legs are 'cold', perhaps a fitment issue and maybe just not a low enough low gear for the climbs. I think a visit with a sport's doctor should help to determine what can be done to alleviate the knee pain.

Brad

What type of pedals does she use? I was having knee pain at age 30 that was attributed to arthritis by an MRI and knee specialist. My general doctor, a cyclist, said that was bull. I'd been using toe clips, and he recommended going clipless with float. In my case, with the toe clips, the foot couldn't rotate slightly on the pedal, and that rotation was taking place in my knees. That "prescription" was fun to take and solved the problem. Just couldn't get the insurance company to pay for the new pedals and shoes, however... :-)

This is one of those things that require an experienced coach to actually watch what she does during her rides. Pay for that and you might get to the root of the problem a lot quicker than sticking around here.

A good stretching regime may help.

Otherwise, check the fit and get smaller gears. 30 gear inches is only low for fit, young racers. When you get under 20 gear inches and have knee pain, it's time to get off and walk.

Her bike is geared down to <30 gear inches in low gear, and the tandem's lowest gear is <25 gear inches (42/32 gearing with 20" wheels). I suppose we could go even lower with smaller front chainrings, but will shaving off another 5 or so gear inches help much?

If it hurts at <30 inches then ,hell yes, a lower gear will help!! This poor woman's body is being tasked to do a job that needs more mechanical help from the bike. Now get her some!!!!!!!!

The two most common causes of knee pain on a bike are (1) mashing big gears too much and (2) having a saddle too low. 2manybikes is correct abaout the location of the pain and how to adjust the saddle height - pain in front of knee, move seat up; pain in back of knee, move saddle down. If the pain is on the side of the knee, there is no easy fix I know of, Doesn't mean there isn't one, I just have no idea what it might be.

If you adjust the saddle height, be sure not to do it more than 1cm at a time unless it is crazy-high or crazy-low. One, too much of an adjustment at a time makes it harder to dial in the right position. Two, if the saddle height is in the right neighborhood, too big an adjustment can itself cause pain in the knee, even if only temporarily.

Also, if the pain is in the front of the knee (it feels like it is right under the kneecap), your culprit is more likely to be chondromalachia than arthritis. You can look it up on the Web (warning: some of the lit makes it sound much more dire than it usually is), and ice and anti-inflamatories, along with the saddle adjustment and gear spinning) usually works wonders.

Good luck. Cycling is usually a very knee-friendly endeavor (hence the use of stationary bikes by physical therapists for knee surgery patients), but it is possible to a major number of the knee if something is out of whack (see, e.g., Bernard Hinault, Laurent Fignon, Cyrille Guimard).

I had problems with my knees too; I was riding my 40 pound, 5 gear mixte up a hill for 20 minutes every day. They were sore and started to crack a lot.

LBS guy said it had something to do with muscles getting developed too fast and un-even like, pulling on the kneecap. He also said the same thing happened to his girlfriend and she dislocated her knee because of it. I have never bothered to figure out if it was BS or not, but the solution he suggested worked.

bike with the knees a little closer together than your feet. Now my knees only crack when I'm biking home, uphill, after a few beers and I forget his advice. And they aren't sore anymore.
I hope your wife figures this out.

I agree a good bike fit is important. I also found that taking Glucosamine Chondroitin was a big help for joint pain. There are several different brands available at grocery and drug stores