Cyclist's knee: why climbing on the Costa del Sol causes knee pain and how a bike fit fixes it
- Flora Muijzer
- Jun 29
- 6 min read
Updated: Jul 6
By Flora | Physiotherapist & Sports Performance Specialist, Riviera & Marbella, Costa del Sol
Reading time: approx. 7 minutes
It starts as a dull ache around the front of your knee, somewhere on the climb up to Mijas Pueblo or along the Ronda road out of Marbella. You ease off, finish the ride, and feel fine again by the time you reach the coast. Then, gradually, the ache shows up earlier in the ride. Soon even walking down stairs feels uncomfortable.
This is cyclist's knee, also known as patellofemoral pain syndrome, and it is one of the most common overuse injuries among cyclists training on the Costa del Sol's famous climbs. The good news is that it responds very well to physiotherapy. In most cases, a few targeted changes get you back on the bike pain-free.
In this guide, you'll find:
The most common causes of cyclist's knee pain
How we diagnose the root cause at Physio Flora
Our physiotherapy treatment options for cyclist's knee
Three physiotherapist-approved exercises to start today
Answers to the questions our patients ask most
What is cyclist's knee and why cycling causes it
Cyclist's knee describes pain around or behind the kneecap, usually triggered by the repetitive pedalling motion. Because cycling involves thousands of pedal strokes per ride, even a small mechanical issue gets repeated often enough to become irritating. As a result, problems that would go unnoticed in daily life become painful after just a few rides.
The Costa del Sol draws cyclists from across Europe for its year-round climbing routes, from the switchbacks above Mijas to the long ascent toward Ojén and Istán. However, this terrain also means local riders accumulate far more climbing volume than most. Climbing demands greater force through the knee with every pedal stroke, especially out of the saddle. Therefore, the same roads that make this region a cycling destination also make patellofemoral pain one of the most common complaints we see in clinic.
Common causes of cyclist's knee pain on the Costa del Sol
Saddle height set too low. This forces extra knee flexion through every pedal stroke, increasing pressure behind the kneecap with each rotation.
Cleat misalignment. Cleats positioned incorrectly change how force travels through the knee, often without the rider noticing until pain develops.
A sudden jump in climbing volume. Riders who increase hill training quickly, often after visiting or relocating to the Costa del Sol, overload the knee before it has adapted.
Weak hip and glute control. When the hip cannot stabilise the leg, the knee drifts inward on each pedal stroke. This subtly increases strain on the kneecap over time.
An ill-fitting bike. A frame, saddle, or crank length that does not suit your body proportions changes your mechanics on every single ride.
Because of this combination of factors, cyclist's knee usually develops gradually rather than from one hard ride. Most riders notice the ache weeks before it becomes consistently limiting.
How we diagnose the root cause at Physio Flora
When you come in with knee pain related to cycling, we start with a thorough assessment rather than jumping straight to treatment. This typically includes:
Patellar tracking and palpation testing to identify exactly which structures are irritated.
Hip and glute strength assessment, since weakness here is one of the most common drivers of patellofemoral pain.
Movement screening, including step-downs and single-leg squats, to see how your knee behaves under load.
A review of your bike fit, covering saddle height, saddle setback, cleat position, and crank length.
A look at your recent training load, particularly climbing volume and any sudden increases.
This assessment matters because Flora holds a certification in Bike Fitting (a special course to understand the cycling biomechanics and prevent injuries), in addition to her physiotherapy training. As a result, we can connect what we find in the clinical assessment directly to what is happening on your bike, rather than treating the knee in isolation.
Our physiotherapy treatment options for cyclist's knee
Treatment at Physio Flora is tailored to how long you have had symptoms and what our assessment uncovers as the underlying driver. In addition, we always look at the bike itself, not just the knee.
Bike fit adjustment. Because Flora is trained in bike fitting specifically for physiotherapy patients, we can correct saddle height, cleat position, and other variables that are quietly overloading your knee with every ride.
Manual therapy and Mulligan mobilisation. As a certified Mulligan therapist, Flora uses mobilisation with movement techniques to address stiffness around the knee and hip that contributes to poor tracking of the kneecap.
Dry needling. Targeted dry needling around the quadriceps and hip muscles helps release tightness that often builds up around an irritated kneecap.
Shockwave therapy. For cases involving patellar tendon irritation that has become chronic, shockwave therapy stimulates the tendon's own healing response. This is often the turning point for riders who have been struggling for several months.
Progressive strength programme. We build a graded hip and quadriceps strengthening plan to restore the control that protects your knee on every climb. This combination of bike fit correction and targeted strength work is why our patients tend to stay pain-free, rather than seeing symptoms return after a few more big rides.
Three physiotherapist-approved exercises to start today
Try these gently, and stop if any exercise sharply increases your pain.
Spanish squat hold. Loop a resistance band around a sturdy post and step into it so it sits behind your knees, then squat down with your shins staying vertical. Hold for 30 to 45 seconds and repeat four times. This builds quadriceps strength while keeping load off the kneecap itself.
Side-lying hip abduction. Lie on your side with your legs stacked and knees straight. Lift your top leg toward the ceiling, keeping your hips still, then lower slowly. Complete three sets of 15 repetitions per side. This strengthens the glute muscles that control knee position while pedalling.
Slow step-down. Stand on a low step and slowly lower your free foot toward the floor, bending the standing knee while keeping it tracking over your toes. Return to standing and repeat 10 times per side. This builds the control needed to keep your knee stable through the pedal stroke.
Answers to the questions our patients ask most
Can I keep cycling while treating cyclist's knee? Often, yes. In many cases, we recommend adjusting your climbing volume and bike fit rather than stopping completely. We will guide you on what is appropriate for your specific stage of recovery.
Is this really a bike fit problem, or is it my body? Usually it is both. A bike fit issue creates the mechanical overload, while weaknesses in the hip and quadriceps determine how well your knee tolerates that overload. We address both together.
How long does cyclist's knee take to heal? Mild cases often settle within four to six weeks once the bike fit and loading are corrected. More chronic cases, especially those present for several months, can take longer and benefit from a structured programme.
Do I need a new bike? Rarely. Most issues come from fit, not from the bike itself. Adjusting saddle height, setback, or cleat position is usually enough to resolve the mechanical problem.
Should I stop hill training altogether? Not necessarily. Climbing is not inherently harmful to the knee. However, climbing volume needs to increase gradually, in the same way running volume does, so the tissues have time to adapt.
Cyclist's knee does not have to mean giving up the climbs you love.
At Physio Flora, we combine thorough clinical assessment with evidence-based treatment and a genuine understanding of the active, outdoor lifestyle that brings people to, and keeps people on, the Costa del Sol. We see patients from Riviera del Sol, Marbella, Fuengirola, Estepona, Benalmádena, Mijas Pueblo, and across the region.
No referral needed. English-language consultations. Appointments available this week.
Website: www.physioflora.es
Phone: +34 711 059 592
Email: hello@physioflora.es
Clinic locations: Riviera del Sol (Urb Balcon del Golf, c/ Topacio 2, local 1-2, 29649, Riviera del Sol, Mijas) Marbella Nueva Andalusia (at The Clubhouse Marbella, c/ Juan Belmonte, Nueva Andalusia)
Your knees carry every climb, so give them a bike fit and a body that can handle it.
Physio Flora · English, Dutch, German and Spanish-speaking physiotherapy on the Costa del Sol · Specialising in cycling injuries and bike fit assessment
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