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Overview
On weekend mornings or weekday evenings across Singapore, it is common to see groups of cyclists cruising along
East Coast Park, Seletar, and many other cycling trails. For many, cycling is more than a form of exercise. It
is a social activity, a stress reliever, and a way to explore the island.
Yet, even though cycling is considered gentle on the joints compared to running, many recreational riders
eventually experience discomfort in their knees or hips.
By learning how cycling injuries develop and how to avoid sports injuries like these, recreational cyclists can
ride safely and keep enjoying their hobby well into the future.
By Arete Orthopaedic Centre
Medically Reviewed by Dr Wang Lushun
Why Do Knee and Hip Pain Happen in Cyclists?
Cycling is a repetitive activity that involves continuous circular motion of the legs. Each pedal stroke engages
the quadriceps, hamstrings, glutes, and hip flexors in a consistent rhythm. Because the movement pattern is so
repetitive, even small issues in posture, alignment, or technique can lead to strain on the joints over time,
resulting in knee pain and hip pain.
Several common factors contribute to overuse injuries among cyclists:
Improper bike fit: A saddle that is too high or too low changes the angles of one’s hips and knees, altering how the muscles engage and increasing pressure on the joints.
Muscle imbalances: Many riders develop strong quadriceps but weaker glutes and hamstrings. This affects how force is distributed through the legs and can pull the knee slightly out of alignment.
Training load: Increasing mileage or intensity too quickly prevents the body from adapting, leading to smaller injuries that build up over time.
Riding technique: Poor technique, such as pedalling with one’s knees turned out or pushing heavy gears at a slow pace, can strain the knees and lead to overuse injuries.
Biomechanical issues: Flat feet, leg length discrepancies, or previous injuries can alter natural movement patterns and make some joints work harder.
Common Knee Injuries from Cycling
1. Patellofemoral Pain Syndrome
Patellofemoral pain syndrome is one of the most common overuse injuries in the sport. It causes a dull ache
around or behind the kneecap, especially after climbing hills, riding long distances, or sitting for extended
periods. The pain occurs when the kneecap does not glide smoothly along the groove of the thigh bone. Tight
quadriceps, weak glutes, and incorrect saddle height often play a role.
Prevention tip: Adjust your saddle so that your knee maintains a slight bend when the pedal is
at its lowest point. Strengthen the hip muscles to improve knee tracking during pedalling.
2. Iliotibial (IT) Band Syndrome
The IT band is a strong, fibrous tissue that runs from the hip to the outer knee. When it becomes tight or irritated from repetitive bending and straightening, cyclists may feel sharp or burning pain along the outside of the knee. Poor alignment or sudden increases in training volume are common triggers.
Prevention tip: Stretch the hips regularly to relieve tension. Ensure that your cleats are aligned correctly so that your foot is not rotated too far inward or outward.
3. Tendinopathy in the Quadriceps or Hamstrings
Tendinopathy refers to irritation of the tendons where the muscles attach around the knee. Cyclists who push high gears at a low pace often develop this type of pain, as the increased resistance can overload the tendons.
Prevention tip: Incorporate recovery rides and vary your pace. Include off-bike strength exercises that target both the front and back of the thighs to balance muscle load.
Common Hip Injuries from Cycling
1. Hip Flexor Tightness or Strain
Cyclists spend long periods in a seated position with hips flexed, which keeps the hip flexor muscles in a
shortened state. Over time, this can lead to tightness, discomfort in the front of the hip, and reduced range of
motion.
Prevention tip: Stretch the hip flexors daily and balance your routine with activities that
extend the hips, such as yoga or mobility drills. Strengthen the glutes to counteract the tightness that
develops from prolonged sitting.
2. Gluteal Tendinopathy
Weak or underactive glutes can cause pain on the outer side of the hip that may radiate down the thigh. This
problem is often linked to sitting for long periods at work, followed by long rides that further fatigue the
muscles without proper activation.
Prevention tip: Incorporate strength exercises like clamshells, step-ups, and single-leg
bridges into your weekly routine. Engaging the glutes before rides with activation drills can also improve
stability and reduce strain.
How Bike Fit Influences Injury Risk
Many cycling injuries can actually be traced to bike setup. A properly done setup takes into account your body
proportions, flexibility, and riding style to ensure the most efficient and comfortable position. Proper saddle
height, handlebar reach, and cleat alignment all play a role in keeping your joints moving smoothly.
Ideally, you should be able to maintain a relaxed upper body, a smooth pedal stroke, and even pressure through
both legs. Even small adjustments can make a noticeable difference in comfort and performance.
Building Strength and Stability Off the Bike
Cycling strengthens certain muscle groups but neglects others. Without cross-training, imbalances can form
between the front and back of the legs, or between the left and right sides of the body. A simple off-bike
routine that includes squats, lunges, and core exercises helps create a more balanced foundation for riding.
Core work improves posture and reduces back and hip strain during long rides.
Glute activation enhances stability and power output.
Mobility training keeps joints flexible and prevents stiffness, especially in the hips and lower back.
Recognising When to Seek Medical Advice
Minor soreness after a long ride is normal, but pain that persists for more than a few days or worsens with each
ride should not be ignored. Early intervention can prevent a small issue from developing into a long-term
injury.
If you experience swelling, sharp pain, or discomfort that interferes with daily movement, visit an orthopaedic
specialist clinic. A physical examination and other imaging tests can identify the underlying cause, which in
turn allows for proper treatment planning and a safe return to the sport.
Dr Wang Lushun is a Senior Consultant Orthopaedic Surgeon with over 20 years of experience. Formerly heading
the Hip and Knee Division at Ng Teng Fong Hospital, Dr Wang is skilled in sports surgery, complex hip and
knee replacements, and minimally invasive surgery, including advanced robotic surgery. Trained in the UK and
France, Dr Wang is dedicated to providing comprehensive and effective orthopaedic care to all his patients.
Trusted
Leadership on Orthopaedic Advisory Boards
Skilful
Double Fellowships at Centres of Excellence
Experienced
Senior Consultant with Over 20 Years of Experience
