Why does the back of my knee hurt when I cycle?

How bike setup causes back-of-knee pain

At the bottom of the pedal stroke, the knee should still be slightly bent. If the saddle is set too high, you reach for the pedal by straightening the knee fully and tilting the pelvis, which repeatedly tugs on the hamstring tendons where they cross the back of the knee. A saddle that is too far back, long cranks or cleats placed too far forward on the shoe can add to this.

Pain can also come from a fast increase in riding, such as several spin classes a week or long weekend rides once the weather cools in Qatar, and from tight hamstrings in people who sit for much of the day.

What to try

• Lower the saddle slightly and check for a gentle bend in the knee at the bottom of the stroke
• Bring the saddle forward a little if it is set far back
• Reduce ride time and intensity for a week or two, using an easy cadence
• Add hamstring strengthening off the bike, such as bridges and slow hamstring curls
• Consider a professional bike fit if adjustments do not help

When it may be something else

Pain behind the knee that comes with knee swelling or a feeling of fullness can mean a Baker's cyst, which points to a problem inside the joint. Catching or locking suggests a meniscus tear. A swollen, warm or tender calf needs same-day emergency assessment to rule out a blood clot, especially after a long flight.

Seeing a knee specialist in Doha

If the pain persists after correcting your setup and easing load for four to six weeks, or if any of the signs above appear, book an assessment. Dr. Gelber examines the tendons, the joint and the back of the knee, and arranges ultrasound or MRI if needed. Most cyclists get back on the bike after a period of adjusted training and rehabilitation.