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Why does my knee hurt when I bike to work?

Stock photo | Thinkstock/Getty Images/Hemera

The question

I've started to bike to work but noticed that I have a dull pain under my right knee cap and what feels like a strained muscle along the outside of my right leg. What do you think is going on? Should I stop biking?

The answer

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The knee is a vulnerable joint and has a high risk of injury and age-related wear and tear because it takes the full weight of the body and is regularly stressed by activities such as walking, running and jumping.

In general, cycling is considered to be less stressful on the knees than other activities because it is a low impact, low load-bearing sport. Knee injuries can occur, however, because of overuse, poor technique or an incorrect fit between the bike and the rider.

The pain you describe could be due to inflammation of the kneecap (patella) or the ligaments and tendons that support the knee, or damage to the joint itself. Specifically, given that you are having pain under the kneecap and the side of the knee, it could be the result of one or a combination of the following conditions:

  • Chondromalacia - irritation and inflammation of the cartilage on the undersurface of the kneecap
  • Patellofemoral syndrome - irritation between the kneecap and femur (long bone of the leg), which can result in wearing out of the cartilage
  • Tendonitis - the patellar and quadriceps tendons run along the side and front of the knee joint and can become inflamed with overuse

Regardless of what may be going on, my first suggestion is that you stop biking for a week or two until your body has a chance to heal. While you are recovering, use the time to figure out what may be causing your pain in the first place and how to prevent it from happening again.

Your pain is likely due to a combination of factors. If your seat is too high or too low, it can result in your knees moving laterally and cause excess stress to the joint and the tendons. If you have accelerated your training too quickly or you aren't allowing your body to rest in between rides, your knees may be vulnerable to damage.

Allow yourself time to recuperate because if you return to biking too quickly, there is risk of further damage to your knee. When your body feels ready, gently increase your distance and training with caution to prevent re-injury.

If you still have pain despite rest, readjusting your position, strengthening your muscles and gradually returning to activity, you should check in with your health-care provider or a professional with training in sports-related injuries, such as physiotherapist or sports medicine doctor who can help you have a safe and healthy ride.

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Send family doctor Sheila Wijayasinghe your questions at She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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