I'm a longtime runner who has never, I mean NEVER, had any running-related injury before.

About 2 1/2 months ago, I started bicycling to my new job, about 5 very up-and-down, stop-and-go urban miles each way, a significant increase over my previous job where it was 1 mile each way, flat, and no traffic lights. I took a couple of weeks off of running to let my body adjust to the increased bicycling and then started up again.

Now, I've started having such bad knee pain that I can't run more than a mile. It only hurts when I run, and starts about 5-10 minutes into the run - it is a painful stiffness on the outside of my right knee. When I stop running or do other exercise, the pain goes away. I talked to my brother (who at one point studied to become a PT) and he said it sounds like runner's knee. So I got a foam roller and started rolling out my IT band 2-3 times a day, and it doesn't seem to be making much of a difference.

So here's my question: it seems like this is related to my new bicycling routine, since that's the only lifestyle change I've made. I am eager to hear if anyone else has dealt with a situation like this and how they were able to start running again. I do wonder if it could be related to my bicycle technique, or just in general the fact that my ride is so hilly and traffic-y. Or anything else that I haven't thought of.

People who don't bicycle just don't get this one - so I'd really love to know if anyone has some thoughts on this. I'm supposed to be running a marathon in March!

  • 5
    I'd say that it probably isn't the route. More likely it is your bike fit (and your bike has to fit correctly in order to pedal correctly.) Have you read any information on correct fit and posture? (Read this too: bicycles.stackexchange.com/questions/5739/…)
    – WTHarper
    Nov 14, 2013 at 19:57
  • Thanks for the link. I am 90% confident on the bike fit being correct... it's the right amount of knee bend etc. Do you think standing up on the bike on steep hills could affect it though?
    – src
    Nov 14, 2013 at 20:04
  • Unless you're riding the entire way standing up with a backpack on... Have you injured yourself before? Have you had any back injuries? Also note that most people don't fit into any bike fit model perfectly...you may need to peruse our questions and resources pertaining to bike fit. There are literally volumes written on bike fit and 2.5 months may not be enough time to have worked out the kinks. Don't lose heart (also don't injure yourself!)
    – WTHarper
    Nov 14, 2013 at 21:06
  • 2
    To reinforce what @WTHarper says, a bad fit is a sure-fire way to damage your knees. That would be my first stop. After that, it might be worth booking a session with a physiotherapist - I lived with knee problems for a while before doing this, but was very impressed when she was able to pinpoint the likely cause (believe it or not one of my legs is 1cm longer than the other) and also suggest some remedial exercises which seem to work. Remember that on here we're pretty good as regards anecdotes, but we're not health professionals.
    – PeteH
    Nov 14, 2013 at 22:44
  • 2
    I'm not sure about your specific problem, but you can create a knee problem or aggravate an existing one by cycling with the seat too low and/or using too difficult a gear. And I can confirm that doing the right knee exercises can rather quickly bring a knee problem under control in many cases. Nov 14, 2013 at 23:07

4 Answers 4


The Wikipedia entry for Iliotibial band syndrome suggests that some of possible causes may be

  • Inadequate warm-up or cool-down
  • Excessive up-hill and down-hill running
  • Positioning the feet "toed-in" to an excessive angle when cycling

This IT Band Pain Stretches, Treatment And Prevention article suggests "Having a properly fitted bike can help triathletes who suffer from ITB impingement while riding", and gives other advice.

Edit: This old answer may be useful also.

I suspect

  • because it's such a short ride, maybe you are not warming up enough before you start.
  • the bike fit, despite your confidence that it's ok.
  • gearing: if you have to stand on the hills for long periods, then you need lower gears.

I recommend

  • stop riding now while you find the cause and find the correct treatment.
  • go to a specialist bike shop and get you, your bike, and your position (including foot position) checked, so that the fit is confirmed to be good.
  • get lower gears.
  • get medical advice. I like to see a physiotherapist for this kind of thing. Find one who is really into sports injuries.
  • depending on the medical advice, do some strength work.
  • when you resume riding, make sure you warm up thoroughly.
  • when riding hills, use the lower gears so that you spin more.

Edit: and I should add I am not a medically trained person.

  • I saw the "toed-in" thing on Wikipedia, too... I've been trying to be pretty mindful of my foot positioning ever since this knee thing started. And yeah, unfortunately I have had to greatly reduce my amount of riding. I know that I will need medical advice if this continues much longer, but sports injuries aren't well covered by my insurance so I'm waiting until I have a bit more $$ saved up. It seems like everyone agrees that I need to use lower gears, so I am eager to try that out and see how it feels.
    – src
    Nov 15, 2013 at 16:15

If your commute is as up and down / stop and go as you say then I would suspect your knee problems are similar to mine. I've found through practice, and a few quick minute of research just now, that keeping your cadence (crank rotations per minute) high will help you keep from straining your knees on your ride; especially where you are making many stops, and always heading up hills, you should try to be conscious of how fast you are pedaling.

I had the opposite issues previously as well. I had a utility bicycle with three relatively high(ie. easy) speeds. I am not one to coast along, so on that bicycle I found I would be pedaling faster and faster. Going down hills I'd be spinning my legs so fast that I would hurt my knees, so there is that to consider as well. If you have anything to measure your cadence then I'd recommend trying to stay between 75-90rpms. If not then just be mindful, and make sure you aren't on a gear that you need to pedal hard opposed to fast; try and balance the two.

Edit: I should note that I do not run, I only cycle. If I walk for maybe an hour or so with a load on my back, I tend to get some pain in my knee. Also if I ride for more than 50km I tend to also get the same sort of pain. The longer I go the worse it gets.

I had spoken with my Doctor about it, he told me to cycle more often and for just slightly shorter periods. To work up the strength of the tendon that was causing pain.

As Andy mentioned however, you should definitely speak with your own Doctor about the matter.

  • +1, helpful answer, and welcome to the community. As regards your own problems, I can only say that I lived with my knee problem for quite a while, thinking I was just "getting older". I only visited a physio on the offchance and she gave me some exercises that were really useful. My knee rarely plays up these days. I guess I'm just making the point that just because you have pain you don't necessarily need to accept the situation.
    – PeteH
    Nov 15, 2013 at 0:02
  • @PeteH thanks! I was on stack overflow a bunch today, and I realized there were a whole bunch of "stackexchange" communities. Yea I should probably do some knee exercises or just do like my doctor said. I take a month long break, then I go for a 40km ride; I blame myself.
    – Josh C
    Nov 15, 2013 at 3:28
  • Thanks for sharing your experience. If I walk for a long time & with a load on my back, I also have a little knee discomfort (though not exactly the same as this running pain). I think that getting a higher rpms is definitely something worth trying, given that it helped you.
    – src
    Nov 15, 2013 at 16:13

A couple of thoughts:

Firstly, ITB problems can sometimes come from too much of an increase in weekly distance. A 5-10% increase per week seems to be the usual rule of thumb. It may be that adding your commute to your usual running was too much of an increase, and cutting back, and then gradually increasing could help.

Secondly, you mentioned in comments that you're using clipless pedals, so it's important to get the angles right. You should be able to adjust the cleat left/right to get closer to or further away from the frame. And also the angle of your foot on the pedal. When I first got mine, I loosened the clips until I had a lot of float, rode for a bit, then stopped pedalling and made a note of where my feet naturally angled themselves. Do this at various positions through the pedal stroke, and repeat, reducing the float as you do. Some people will be happy reducing the float to zero, others will still need some as the angle of their foot changes through the stroke. You'll need to work out which one you are.

  • Oops! I got myself mixed up because of the misnomer. I am using flat pedals, not clipless one. But I am planning to switch eventually so I will keep this in mind.
    – src
    Nov 25, 2013 at 17:02

Similar case from my personal experience- I hope it is helpful.

Your post didn't mention what type of pedals and shoes you wear while cycling, but I found that if I used platform pedals and running shoes while I road, I ended up having a runner's knee condition with one knee. When I switched to wearing cycling shoes and SPD cleats the problem went away.

My theory was that the running shoes and platform pedals combination prevented the minute rotation of my foot through the pedal. Wearing bike shoes on clipless pedals, my heels can swing a degree or two as I pedal, thus sparing my knees from the torsion.

  • 1
    I think it's more that the clips make it easier to keep the feet on the pedals, so you don't contort the legs as much doing that. I know my knee condition improved when I started using old-fashioned toe clips, vs open pedals. Nov 25, 2013 at 2:25
  • Also important that if you move to using cleats, that you ensure that the cleats are positioned correctly for you. Unfortunately the only way I know to do this is through trial and error!
    – tdc
    Nov 25, 2013 at 11:05
  • That's really interesting. My pain is only in one knee as well and I have been doing the same running shoe/platform pedals combo. I've been planning to change anyway since the wear on my running shoes caused by biking is uneven and affecting my comfort when running (in addition to the knee hurting).
    – src
    Nov 25, 2013 at 17:04
  • @src I messed up my knee two summers ago. I commute eight miles each way, rain sleet ice whatever. I also take longer weekend rides. I use SPD system on all my bikes. No pain, ever, for years. One day I rode about 25 miles in new shoes. The next day my knee was in bad shape. For a week or more I had pain. I started rolling the ITB and switched the commuter bikes to a townie (a 100% change of riding position). I did this for almost THREE MONTHS. When I went back to the old bikes I raised all my saddles and pushed the cleat back on my shoe - moving my foot forward on the pedals. No pain anymore.
    – jqning
    Jun 7, 2015 at 13:02
  • @src my point to that long story is that once you are injured many things that DID NOT cause the injury are going to hurt and make the injury worse.
    – jqning
    Jun 7, 2015 at 13:04

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