Bike Fit | Causes of Knee Pain and Solutions 

I have seen so many videos discussing knee pain and saddle height, this is the first I've seen that talks about crank length in that context - which makes a lot of sense.

Out of all the videos I watched you're the only one who addresses the how bent the knee is when the pedal is positioned up. That helped all my problems

At least in my country, I know a lot of people who just buy a bike and start to do long rides. I don’t understand why do everyone underestimate the role of a bike fitter, and why does everyone consider going to the bike fitter only if you are a pro. I believe that everyone who rides a bike, even in daily life should go to a bike fitter. Your health is your priority. Your position on the bike after 10 years will cause you problems that you never imagined. I am very unlucky not to have one in my town. Suffering a lot from the knee pain.

best and most comprehensive video on RU-vid about knee pain. Thanks

This is the first time of hearing about the crank length being an issue. Thank you for the info and for taking the time to post this info.

Best vid on youtube about this. Thankyou.

I've been trying to figure out what I did to my knee for a year now and you just answered it. I can't believe I didn't find this video sooner. Thank you sir!

Thank you very much! I almost thought my cycling career was over. Thanks again!

Gold. Thank you. I have lateral knee pain 6mo after moving to a new larger bike, the pain is accompanied by tighter ITB too so wil try lowering the seat. It's actually taken me off the bike for the last 6mo. Thanks for your vids, been watching for a while and appreciate your efforts

Well explained. I need to know more through Physical Therapist. Bike fitters should consider all of this, truly. 👏🏻 Thanks for the video.

very informative and helpful..thanks .....

Professional. He is really professional bike fitter. No nonsense here. Thank you!

All these videos later and now I'm just convinced I'll never figure it out on my own. Also great tip in the end about muscle imbalances, one of the first videos where that's mentioned :)

finally some one that goes into crank length

My problem was two fold. I have arthritis in my right hip, so in order to ease some of the pain on the up stroke while peddling using the 172.5mm cranks. I had to raise the seat which in turn would cause pain to the back of the knee from being to high. I could never find a happy medium! So for my situation, shorter crank = less rise on the up stroke allowing me to lower seat to correct height, ending back of knee pain! How nice would it be to be able to have a bike made to your body and it's range of motion...CHEAP...heaven! great video btw!

Best video that explained the knee issue

Much clearer than many others vid relevant to this topic, thank you Sir

Best money iv spent on my bike completely cured my knee pain

It's interesting what you say about cadence. I personally noticed that my knee hurts less if I keep cadence 75-80 rather than above those values

Wow ! Glad I found this. Great video and your the first out many I have watched that mentions the bend in the knee. I use the heel on the pedal method to get my seat height but tomorrow I will now be out in my garage checking out my knee angle. Thank you.

Riding 5k a year without ever paying attention to cranklenght. Have a 81 inseam and 90GT and was rocking a 175mm crank -.- i was always the first getting out of the saddle on hills. And very comfortable on low cadence 75-80. Changed my cranks to 165 (allthough im 178 but have short legs) and i can stay in the saddle for longer, my cadence went up drastically 85-90 now and i just feel so much more comfortable. My bikeshop always told me cranklenght doesnt matter you cant tell the difference etc. since i made the change for me it is the single most important measurement after framesize and saddle height.

Really really really good video. Wow! thank you so much for your video!

Excellent stuff. I wish you lived in Scotland so I could visit you for a bike fit.

I’m surprised you did not mention pedal float among the possible solutions for knee pain. Many years ago (age 49) I began to have knee pain and switched to Speedplay pedals, which allow your foot to rotate freely. Thanks to this “float” my knee pain disappeared. It felt natural from the start. Still going strong at age 61. They may not be for everybody, but I believe a lot of people got relief with them. Common sense, or intuition, should tell you that having your feet strapped to a machine in a locked position parallel to the crank is not natural. Something’s gotta give. The ankle has little mobility, so the knee takes over and is subjected to increased torque.

yes! very interesting. I have battled with lower back pain and saddle height , fore aft etc for over 25 years....curiously, a high saddle (lets call it heel +5mm) is painful when riding but great for my back a few days later, whereas a low saddle (backpedal with heels , hips not rocking) gives me a great ride but pain the following days due to some sort of referred pain from tight hip angles. The former saddle height which is not that high, (nowhere near 0.885) gives me that outer side knee pain.... still trhing to get to the bottom of this!! And before you ask, yes I have tried shorter cranks! Thanks!

Bit the bullet a few months back and switched my cranks from 172.5 to 165 mm... Amazing, what a difference.

Great video. I've been getting some knee pain recently and now got a good idea where that is coming from. My pelvis is pulled up on the right side according to my Physiotherapists. Thanks for posting!

Really helpful to learn and adjust little things from my bike fit

Happy holidays J and thanks🙏

Cranks typically run from 170 to 175mm. I don't think 5mm is going to do much for maximum knee bend. For my height, I'm supposed to use either 172.5 or 175, so that's a 2.5mm margin, which will have even less impact on your theory. Saddle height is by far the most important fitting motive for knee pain, not crank length.

Omg the back of my knee was starting to hurt. Put my seat down the pain is go.Thank you

My right hip is lower and my right leg is shorter. Only thing that stopped knee pain in the past was using a 165mm crankarm on the right and 170mm on the left side. Bought a new crankset in March, both are 170mm, and my right knee is back at creating pain! So I have to buy a whole new crankset so I can have a shorter right crankarm.

crank length， this is quite a useful information

Thanks for demoing on a bike that is actually affordable!

It seems like a shorter crank length would be the safer option to avoid knee pain. I'm guessing there's a tradeoff in power or something. As someone who's trying to get past some knee pain I would definitely like to go with the safer option.

Just found you, Have watched a bunch of your videos and you do a good informative job.

I am trying to solve the knee pain mystery. I rode my trainer all winter then took my bike off the trainer onto the road and developed medial pain in my first 2 rides in the bottom of my Vastus Medialis very close to the Patella. One interesting clue is that the pain starts at around the 1.5 hour mark in my ride. I go from feeling no pain to significant pain after a few minutes at around the 1.5 hour mark then I can barely ride. Both of these rides had significant climbing and a lower cadence than my winter cadence on the trainer so at first I thought I had strained a muscle but it does not bother me off the bike or after the ride. I have a 100k in 7 days and am racing to figure it out.

It's really helpful in a professional way. Thank you. But I have a big problem, I mean as you can see from my text, my english is very poor (specially when I listen). So could you help me how can I get this video with subtitles. I know you are laughing now but when you t inish laughing, please write me back something. Thank you.

Thanks man! Greatly appreciate you sharing your knowledge and expertise and the time to explain this! 👊🏽

probably the best bike fit video on youtube

yes thanks very nice video and great splanations

Good information Thank you so much Very interesting subject

Great video!

amazing video on this. love to see someone who really knows what they are talking about! Would love your thoughts on my predicament. my gf and I have just begun our cycle from Alaska to Argentina, but only made it 2 days before I had to stop with a knee injury. we didn't do any training as we only got the bikes a few days before we left....bad idea i know. We then left anchorage on our hard tail mountain bikes with panniers and frame bags and way too much weight. we cycled 70km the first day and 60km on the second. half way through the second day my knee became extremely painful on the interior top part of my patella and the inside of the tendon joining the patella to the quad. We didn't do a bike fit at all and I'm sure it was due to the massive increase in volume and weight to an extent but I think mostly the riding position. We've rested for 5 days now and are keen to get going but it's still a bit painful when I cycle. we've had a bike shop take a quick look at a fitting but there aren't many places here that specialise in fitting. what would you recommend we do? do you think spds would help as now I just have flat mountain bike pedals? apologies for the super long message, but wanted to give the full picture Thanks George

Thank you

I keep trialling to resolve pain in calf, only outside of calf

Hey i just watched your video to try and fix an issue I have. I have pain on my inner knee when i only ride one of my bikes. Maybe you can give me some ideas on how i could adjust my cleats because i think its a cleat issue.

Excellent video!

Amazing video

Thank you for this advice

Great explanation!

thumbs up! i'd love to see something on how fit affects anterior hip pain (impingement)

GREAT VID!! can you address cycling cleats, necessary or not?

Very helpful

Great content. I have a salsa Fargo that has been giving me IT band issues. I tried different seat heights and moving fore/aft. I also recently just switched from 175mm to 170mm and still IT flair up. I have 2 other bikes, giant tcx and revolt that cause me no IT band issues. Both have 172.5mm. Very frustrated because I have actually stopped riding the Fargo because it causes me discomfort and not sure how to which way to go to eliminate IT flair up. Thank you!

Fantastic job on the video. I have inner knee pain (facing the frame) on the right side. Saddle was bit too high. Plus my right foot naturally is pointing to the right which could be adding strain on the knee I am guessing. Anyone else with this problem? Solution?

Hey john, I’ve getting back on the bike after a 4-5 mo. Hiatus. I was riding some fairly easy miles and increasing the climbing from day to day I developed a bit of pain on my quad tendon as you put it. The tendon right above knee cap. I did slide my seat forward a bit. That seemed to not help so I slid it back. That seemed to help a little. I still feel it every now and then after some longer climbs, Where as before it never bothered me. My sit bones and the tissue around them are a bit sore on climbs longer 20mins. Also kind of new sensation. Did I really get that soft in those few months. Like your channel!

Thanks for posting this video bike fit advisor!!! I started feeling pain at the bottom of my quad tendons the last few weeks from my saddle being too low. I hope it's not permanent! I am curious if I should do anything special in my mechanics or bike set up for being flat footed too. I ride an mtb btw

It would have been good if this video canvassed knee pain that arises from *cleat mis-alignment* . When I recently made the transition from flat pedals (plus good ol' velcro straps) to SPDs+cleats, a whole *bunch* of things had to change - partly because of a bunch of small geometry changes, but *mostly* because a fixed foot position is a lot less forgiving on the knee (unless you're lucky and you hit upon the perfect cleat position first time). Under the "old" configuration, my pedal straps held my foot on the flat pedals just fine (especially since I do 99% of my riding indoors on a KickR), but looking back it was kinda like having a huge amount of cleat "float": my feet could twist however they needed to in order to prevent any stress on my knees. Now with SPDs (at a default float - i.e., some wiggle room) and cleats positioned as good as I can get 'em, I finish a 30-minute ride with significant tenderness at the top front of my right knee... indicating that something about the cleat setup is askew (basically: my right knee has to take a path that puts it under unnatural tension at some point in the pedal stroke... *but I have no idea which* point). Anyhow... long story short, I will continue to tamper with my cleat angle over the next few days: it has to be something to do with the position and angle of my right foot, as opposed to seat height or seat fore-aft adjustment. Left side is perfect.

Someone adjusted my seat, they claimed they knew everything about bikes. Apparently he adjusted it too low for me. I developed a painful Bakers Cyst back in April of this year and my knee hasn't been the same since. The doctor doesn't even know what exactly caused it but told me definitely having the seat too low is a problem. Every time I ride I worry if it's going to pop again. Although the cyst is gone, I am having discomfort virtually every time I get on a bike. I used to ride 40 miles, I'm down to 7,8. 9 or none at all. I will look into a different crank size. But honestly. Feeling so discouraged. I do have toe clips on my bike. I really am not comfortable going clipless. I have been using those clips for years with no problem. But since the cyst, I notice my right foot (the leg that had the cyst) likes to flail outward. Supinate I think it means. I do try to keep my foot straight in the clip but wonder if it's better to let it naturally drift to the side? The left leg stays fairly straight in the clip. My doctor says the toe clips shouldn't be a problem judging from my chart. When I bike I can only seem to tolerate up to around 9 miles and then I either feel tight where the cyst was (back of the knee) or sore at the top of the knee with it wanting to pop again. I did get adjustments to this bike with a professional bike fitter but that was back in April right before the Doc diagnosed me. My seat was raised and some adjustments were made but he never mentioned the crank length as a possible culprit. I am not even sure what my crank length is. I am 5'3.. It really sucks not knowing what exactly caused this cyst and now subsequent pain. I have been doing squats and lunges, Pilates, using leg weights doing hamstring and quad and glute exercises and I do run also. But I've gone weeks without cycling just to avoid the pain or the possibility of pain and that's not the future I want to have as a cyclist. I miss my confidence which this has robbed me of. I don't have any friends who cycle so I feel pretty isolated and no one understands the pain and frustration I've been through so I feel pretty alone :( Anyone out there with advice would mean so much.,

I have inside knee pain , what s that ? Cleats miss alignment?

Eplained very well!!

Thank you!

Ok. So i had pain in the upper front of my knees, it definitely was the quadriceps tendon. I was riding 32km, 5 times a week, low cadence, flat feet angle, hard gear ratio and low saddle. I changed my gear ratio to make it easier to pedal so now the force i have to apply to the pedals is lower. But after watching this video i can now notice that at the top of my pedal stroke my knee angle might be too bent and my feet tend to be flat at the bottom. So i'll play with increasing saddle hight and pointing the toes down at an angle and see how i do. I havent experience pain in the back of my knee luckly. Thanks for the tips.

Too bad you're not in the NYC area, I really need a good bike fit. I'm having too much knee pain on my bike.

Very informative...

What about inner part of the knee ?

Very interesting video! I love your channel for finding the cause of pain in biking! Helped me with numbness in my hand! Though this video didn't quite help me with my type of knee pain... I have knee pain on my right knee on the outside of it, near the top. I haven't found anything talking about that type of pain. It doesn't happen all the time, but often enough for me to notice it especially when I'm climbing or putting down a lot of power. Do you have any insight to this problem?

Excellent video! I see why I have some lateral discomfort. Do most have issues with both knees or are they one sided like me?

What about the inside of the knee

how to change gear during race

Could a bike fit fix my knee problems ( I have chondromalacia ) ? I ride a track bike on the streets, sometimes I have to grind on steeper bits. So I can't really set my cadences.

very informative and so I'm having the most tricky one, a lateral pain... it comes when I'm getting 80km ride, then just becomes worst... after 1st time it came, I didn't ride this long, only for my daily transport which is 20km for more than 1 month then after maybe 2 months that last long ride (not sooo long I think!) I did 110km and again, it was hurting in the same way 😥😓

Thanks for the tips. I have front of knee pain my the height has been correct. I will look at crank length and try to do higher RPM instead of more power. See if that help. Thanks!

Yo! Here's a question. Do you factor in sag?

great vid.. also leg length can have a big part of pelvis rocking. i ended up with 5mm of packing under the left cleat so my left leg isnt reaching for the pedal.

Great stuff!

nice man i shared twice

How do I know if my knee flexion is not excessive? I am asking because sometimes I have top front knee pain. From your description it seems more the quad tendon connection to the knee. It is obviously exacerbated when I go too hard too early (from a period of inactivity). This only happens on my left knee. My left leg is visibly stronger than my right one, and my left foot is one size larger than the right one. This is the only discomfort I have on my current set up. How do you suggest I start investigating? I just found your channel, great videos, thanks!!

What about pain right below the head of fibula (outer lower leg) on the peroneus longus. Does it have to do more with saddle height, cleat angle or pronation vs. supination? Thank you in advance, your help is much appreciated.

Hi John, I agree that crank arm length could cause knee flexion problems. How mch difference would a 5mm longer crank length make?

Hi. Interesting. But there is different thing involved in that motions. For 30 years I ride bike in completely different way. My knee bend to the frame in upper position. And only then I have not problem with my knee. And that happens only when have larger Q-Factor on pedal. For 30 years that saves me from pain. When I try to change that "bad" thing, for the first time my knee start hurt. Most important is ankle position and natural rotation of ankle on pedal stroke. I have knee close each other when I walking. There is people they are opposite. So, do not force knee to unnatural movement. Just adapt Q-Factor to follow that movement. Larger Q for closer knee, and smaller Q for wider knee. Generally, saddle position will be that you bend knee slightly in 6 position. I thing that is wrong. You have to follow movement with ankle and push it down. Look at professional. They newer reach that 6 position. If you bend knee, and your foot is horizontal, you push pedal to wall. And loose power to nothing. Pedal stroke must be constant. Before 12 and after 6 o'clock. That can be key factor for lower back pain. I'm 6'' tall. On newer bike have cranks 172,5. Can't ride that in any position, with any Q and saddle high. It is impossible for me. Lower back kills me. On older bike are 175 cranks. That is much better. But I have proper riding technique of riding. When you have proper technique on different terain and situation and apply that for riding, longer crank gives you benefit for longer ride (slightly shorter crank is for sprint on flat). Proper technique and proper bike fit will solve any problem. Not shorter crank. It solves problem with numbness and you can ride faster and longer for free. With same power. I'm not pro rider or pro bike fit expert. I'm just gay with 30 years of experience and several 100000 in my ass. I can't swallow all that expert recommendation for extremely shorter crank and knee in line. It is wrong for most of the people. And it is dangerous.

Hi John. Thx for this fine video. Here is a relevant problem: when pedalling, I feel that my right foot does not fit well in the shoe; I feel that it is "in the air" inside the shoe and that it would need to go "forward" in the shoe to feel "right" and better step on the pedal. To solve this I tried adjusting the shoe cleat, the saddle and also the straps on the shoe, but the feeling of the foot " in the air" stiill remains. This does not happen with the left foot. Is this a cause of the shoe size? the cleat/saddle position? my position on the saddle!? the muscles of the right leg being less strong than those of the left leg? or my anatomy (right leg slightly shorter than left leg)? Would I need to add an insole in the shoe or a wedge between the cleat and the shoe? Or to strengthen the muscles of right leg so that they become as strong as those ofcthe left leg? Please advise. Thx, Laz.

I just discovered your channel and this video is great. My knees are causing me lots of pain but it's more in the front towards the inside area of my quads. The left is worse than the right and this possibly because my one leg is supposedly slighty shorter, though it may be more due to contracted quadratus lumbarus back muscles (as shown on an MRI scan) pulling my hips out of alignment. I'm going to try shorter cranks to see if that helps.

This helped alot

My saddle height is not too high still I feel ITB pain?

I have experienced pain at the back of my knee (hamstring) and I belive it was too much cycling caused the issue (overload). I teach Spin 3X a week and cycle outdoor 3 days a week. So, could this be true?

I'm always getting lateral pain during long rides. How can I avoid it? I hope you could help!

Is there road bikes for overweight people?

Is there a kind of thumb rule to set the correct toe down ? Often, after pedaling over 80km under a strong pace, my IT band hurts but it feels better if I tilt down my feet. However, I don´t know if I shall do it all the time. I use to set the saddle height to the upper limit to mitigate fatigue.

Echoing so many other comments already, but great video as always. I'm trying to find just the right fix for my RT Lateral Hamstring tendon pain. The pain starts within the first miles of a ride and is pretty consistently annoying. Not enough to make me stop, but always there while riding. I pull up quite hard on the pedals when I sprint or dig for power, and I'm wondering if that might be causing some issues. It is only on the right side, but as you said in this video, everyone sits a little differently (and rarely squarely) on the saddle.

I bought a new pair of riding shoes, cleetless pedals, and my hamstrings and gastric cramped on me so bad. I hurt for two days afterwords. My old shoes didn;t casue this to happen. I do have knee problems when not on the bike. Chonamalica and calification of the meniscus. How do I adjust the cleet to take care of this problem?

Thank you for the video. Off late , I am experiencing pain in my right leg shin especially when I am doing 50 km plus rides. I had adjusted my right shoe cleat to make it align with the centre line. Both my cleats are attached far back on my shoe. Could you offer any remedy. Warm regards

I don't really understand the relationship between fore aft and back angle. Why does further forward or back require a lesser or greater bar height? Thank you for the videos!

Sir can a knee osteoarthritis patient do cycling ? please guide me

Thank you for the video, I have a question. I started cycling on a road bike last year. I cycled about 1000km with clipless pedals and road shoes (also had a bike fitting done at a local bike shop, nothing pro though) and my back of the knee hurt. It hurt when I bent the foot at the top of the pedal stroke. After few months of pause, I put normal pedals and cycled about 6 months (2000km) with normal shoes with no pain. This was until end of May this year. Start of June I bought new shoes (cause last didn't fit too well) and after a good month (and a bit more than 500km) the same thing happened. Pain in the back of the knee (only on left leg). I'm 164cm and my inseam length is 74cm. My crank length is 170mm, frame size is XS. What do you reckon could be a cause to this problem? Thank you.

Awesome!

I have knee pain on the inside (not front or back) of my left knee while riding and I have had a bike fit from my LBS. What may be the cause?

Hello, You were demonstrating an internal rotation of the tibia when the foot is inverted, could this be a mistake? I thought the tibia did an external rotation when inverting the foot? If I'm right, this still might have an important influence on the ITB I guess, but maybe not by stretch? Gr, Miel (graduating student physical therapy dreaming of a job like yours)

how sure are you about the tibia rotating that way? (when you talk about it at around 6:20 time) thanks for the video! regards, M