Will a Bike Fit Fix My Knee or Back Pain on the Bicycle?

A good bike fit lets you deliver maximum power from your current fitness and lets you ride for hours without generating new injuries. It lets you comfortably use all the hand positions your bike offers If your bike fits correctly, muscles that don’t power the bike are mostly relaxed; your bike supports you but you don’t need to engage much muscle to support yourself; you don’t need to remind yourself to hold a good position because your bike meets and supports you where you are. You feel draped across your properly fitted bike, 

Even with a perfect bike fit you can still get sore from an unusually long or hard workout, or from the effort of a climbing race or a time trial, but routine riding should not hurt. If something hurts when you ride, a bike fitting will generally help. Common areas for bike-fit correctible pains include: knees, hands, neck, shoulders, lower back, Achilles tendons and feet. This doesn’t mean that a bike fit is needed if you were kicked in the knee playing soccer and then it hurts on the bike, but it does mean that if you have a pain triggered by riding without another obvious cause, a bike adjustment is worth considering.

Here’s a simple, three-part test to tell if a bike or cleat fitting is likely to eliminate your pain: 

1. The pain starts or gets worse while or shortly after riding,
2.  The pain subsides when you take time off the bike AND
3.  The pain doesn’t return or grow worse until you ride again.

If the pain remains even when you don’t ride for several weeks, a bike fit alone probably won’t fix it.

Knee or back pain that doesn’t clear up when you don’t ride or do other activities that stress those areas indicates a medical or anatomical problem and requires longer rest and possibly intervention by doctor, chiropractor or physical therapist.

Medical professionals often prescribe rest, anti-inflammatory medication and possibly massage or physical therapy for overuse injuries, and these can help in the short term, but pain that happens only when you ride and clears up when you rest is NOT going to be fixed permanently by rest, physical therapy or meds alone. When you ride again, you’ll irritate the same area again. You will require a change in bike fit, cleat adjustment, cadence, training volume or intensity, or training consistency. In some cases a consistent stretching routine can make a positive difference as well. 

If you have pains that clear up repeatedly when you don’t ride and return when you do, then rest and meds alone are not going to correct them. If you keep triggering pains, they eventually become chronic injuries that will need medical intervention or a very long break from cycling.

You may hear that certain changes to your form, the way you ride, will help with a particular problem. Generally, relaxing is well advised, as is standing or changing hand positions from time to time. A higher cadence that makes pedaling feel easy is often better for knees. However, if your bike fits well, your form will naturally become better. When the seat height is right, the legs move smoothly and higher cadences come naturally. When the bars are in a good spot on a road bike, you enjoy riding the drops, and on either a road or MTB, your elbows naturally bend. You may get a diagnosis that your pain is caused by overreliance on one muscle group to the exclusion of another. That may be true, but a good fit will usually cue you to use the muscles in a more appropriate, balanced way. 

Note that getting a bike fit may not automatically correct all the problems that can be fixed by a bike fitting. The fitter has to be competent, experienced and committed to getting you a fitting that works for you. If you have an asymmetry or other unusual anatomy, peculiarly tight muscles or history of injury that leaves you uncomfortable or inefficient in a position that might work well for most other riders, a less experienced or committed fitter might not be able to help you. In other words, it doesn’t matter how much you pay for a fitting. If the position leaves you uncomfortable, it’s not a good position.

Modern dynamic fittings are done by watching the rider and questioning what aspects of the position are working and which are causing problems and correcting in ways that work for that individual rider. Dynamic fits usually start with adjustments to the cleats, including shimming and wedging if needed, because the foot-shoe-pedal connection is the foundation on which all other aspects of the fit will stand, and because poorly adjusted cleats cause a significant percentage of knee problems. 

If you are wondering if you might benefit from a fitting, contact a fitter for a consultation. An experienced professional fitter will be willing to talk to you about how a bike fit may or may not be able to help in your current situation. 

Head Coach Scott Saifer, M.S. has been doing bike fittings and helping people with bike-related pains and overuse injuries for over 30 years. He can do bike fits over video when necessary.  Contact him for a fit!