Uncovering a Hidden Cause of Knee Pain: Why Cyclists Need to Work on Their Feet

cycling and knee pain

Clients often share that they started cycling because they either got injured running or their doctor suggested a lower impact sport to relieve foot or knee pain. Unfortunately, these problems don’t just go away once you’re clipped into a bike pedal. If you’re experiencing pain on the bike, especially knee, calf, hip or hamstring pain, there’s a good chance your foot is involved.

Recently, a client came in with a bunion on her right foot. She had hamstring and back pain as she cycled. As I watched her walk, I could see her right foot collapsing inward along with her knee. When the foot cannot properly move between pronation and supination, the body feels these effects at a global level. I’ve seen bunions cause neck and shoulder pain.

If one part of the body is not moving correctly, something else will step in to do its job. The key is to figure out where the mobility issue is coming from and correct that. Try to resist heading straight to the site of pain and only treating that. Unless you’ve had an impact to the knee itself, the root cause of the pain is usually stemming from somewhere else. Looking at the foot is a great place to start. 

After some assessment, we discovered that this client’s back and hamstring pain were merely symptoms of the foot, so that’s where I started the treatment. She learned foot drills (a few examples are posted below) to unlock the underworking muscles and begin to mobilize the joints of the feet. She also learned how to begin to pronate and supinate properly. We also worked on strengthening her hips because strong hips actually produce an arch in the foot.

Cycling neglects hip movements in several planes of motion, so it was vital that we taught her hips how to move well and get stronger to support her activities on and off the bike. This not only increased hip strength (which, in turn, boosted her cycling performance) but also caused the low back and hamstring pain to subside. Why? Because both muscle groups were busy bracing and trying to stabilize a weak pelvis.

The Importance of the Feet

Our feet play a very important role in alerting us to the environment we’re in so that the brain can respond appropriately in order to keep us safe. Little intrinsic foot muscles are responsible for controlling the forces produced through movement, contributing to balance and relaying information about the surfaces we’re walking on. Cushy shoes prevent our brain from getting a true picture of the terrain we’re trying to navigate and lead to inactive intrinsic foot muscles. This combination can lead to rolled ankles and sprains, plantar fasciitis and a host of other problems in other areas of the body as well. 

The big toe has a direct connection to the hip and pelvic floor. If your pelvic floor doesn’t feel safe and supported, it’s game over. Think about it: this is where your body’s prized reproductive organs are. If the brain senses a lack of safety here, you sure aren’t going to be vying for sprint points anytime soon. Proper big toe engagement makes it possible to engage the pelvic floor and recruit the muscles needed to perform well while decreasing the risk of injury. This another reason to go barefoot as much as possible and try to get your toes moving independently. 

The stiffness of cycling shoes and the position of the pedal on the foot makes it very difficult for cyclists to properly engage their feet. But that doesn’t mean all hope is lost. You simply must make a concerted effort to give your feet some love when you’re out of the saddle.

Essential Foot Exercises for Cyclists:

cycling and knee pain
Healthy toes must be able to spread in the same way our fingers do. Toe separators (Yoga Toes) can help counteract the narrow fit of cycling shoes

1. Roll out of your feet and go barefoot whenever possible

Rolling a ball on the bottom of your feet will not only help you discover sore, tight areas, but will also prime your brain to begin to recruit these muscles in more movements. Walking barefoot will help engage these foot muscles as well. These muscles are like tiny messengers that are constantly relaying vital information to the brain.

Wearing a big, cushy shoe essentially muffles the signal between them and gives your foot muscles the green light to chill out and not do much work. If your brain doesn’t have a movement strategy because the muscles aren’t engaging as they should, this leaves the door open for a greater risk of injury.

2. Practice short foot

If you’ve had plantar fasciitis, achilles pain or flat feet this is a fantastic exercise to incorporate into your program. The idea is to actively engage your toes, especially the big toe, to form a dome in your arch, which causes the foot to shorten and an arch to form. Once you can actively engage the short foot, try to incorporate it by rooting your toes into the ground as you squat or do other exercises.

3. Open up the foot tripod

In order for our structure to maintain alignment as we move, we must first engage the foot tripod, which consists of the three major contact points our feet have with the ground. They are:

  • The calcaneus (your heel)
  • The first MTP joint (base of the big toe)
  • The 5th MTP joint (base of pinky toe)

If one point cannot engage (as was the case with the client with the bunion), then the alignment of the structure above the feet will be compromised and you’ll likely compensate for the lack of foot mobility somewhere up the chain, such as at the knee, hip or opposite shoulder.

You can practice this by bending your knees slightly and lifting your toes. Do you feel the weight evenly distributed? Or do you tend to shift to one side? The exercises in this video will give you an idea of the movements required to begin to unlock healthy movement in your feet and ankles.

This video shows you how a few different foot movements can act as levers to help mobilize the cuboid and navicular and to help open up eversion/inversion through the calcaneus.  Foot exercises start about 2:40 into the video.

If you feel like you’re chasing painful symptoms around your body, the feet are an excellent place to begin by exploring different kinds of movement. Just because your feet are clipped into pedals or you use fancy insoles or shims, doesn’t mean your lack of foot mobility isn’t affecting your cycling.

If in doubt, seek out a movement professional to help uncover and treat your specific issue.

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