Saturday, May 16, 2009

Knee Pain and Cycling

You ride your bike and and expect your knees to hold up - until they don't.

Knee pain for cyclists, previous injury notwithstanding, is usually not an isolated event; it is a process. We lose our health, knee joint included, one sand at a time until the point where we begin to notice it and do something to try and change the downward trajectory. Knee pain has truncated training rides, spoiled centuries and even ended cycling careers. But it doesn't have to - learn how to diagnose and prevent knee pain to keep cycling a part of your life for years to come.

What types of knee pain are common to cyclists?
Anterior knee pain which includes patellofemoral (also known as chondromalacia) is the most frequent type. Patellofemoral stress syndrome is an overuse injury that involves cartilage breakdown underneath the kneecap. Have you ever wondered why your knee makes crunching or popping noises going up or down steps? Often times this is a symptom of patellofemoral stress syndrome, because of an imbalance occurring above or below the knee. Some of this imbalance is caused by posture on the bike. Cycling positioning involves hunching forward and flexing your hips while in the saddle for long periods. If you are not fit to the bike properly this can exacerbate the problem. Other factors are muscle development distribution or a muscle strength deficit which can throw things off.

What causes knee pain in cyclists?
The knee can be affected by weakness of the gluteal external rotators which can lead to increased internal rotation of the leg and increase patellofemoral stress due to altered bony alignment. Cyclists typically have more developed calf and quadricep muscles than the average person. The vastus medialis is the tear drop shaped muscle that bulges out just above the inside of the knee and is usually well developed in cyclists, but if you have let riding go for a while or are new to the sport you can strengthen it with straight leg raises, lunges and dips or step downs with one leg going lower than the other while the other leg is on a block or stair. Other problems include muscle imbalances, excess motion in one or more joints, and leg length discrepancies. As we age a phenomena called cross linking occurs. This results in our tendons and ligaments being less flexible making them more susceptible to injury. Massage yoga and proper stretching can help minimize this. The body has a memory regarding injuries and sometimes it takes only a little more stress to setup for another injury episode.

Solution 1: Cycling Orthotics
A cycling orthotic can be made to compensate for problems that stem from too much motion occurring at the foot pedal junction.Not only can an orthotic decrease injuries but it can improve performance. This is accomplished by filling the dead space between your arch and the insole of your shoe so that energy is transferred directly to your pedal and not lost inside the cleat. An example of an imbalance which may be corrected is building lift on one side of an orthotic if there is leg length discrepancy. As a general rule, I usually compensate for half the difference of the discrepancy. Larger differences have to be adjusted in the crank arms or with shims. Another problem that can be addressed is excess motion, which can cause knee or arch pain. By placing a cant into a prescription for an orthotic, this force can be decreased. In cases where there are only minor issues over the counter insoles can sometimes be used.

Solution 2: Professional Bike Fitting
Bike fit issues and pedal selection may be the primary source or exacerbate existing knee problems. A saddle that is too high can lead to stress on the ITB, and patellofemoral loading can occur. If it is too low stress on the patella or quadriceps tendon can occur. If the seat is pitched too far forward stress on the anterior knee occurs because of too much flexion. If the saddle is too far back the ITB can be stretched because of the increased length. If the inside of your knee is bothering you and your clipless pedals have too little or no float, consider changing to a pedal with more float. If initial measures do not solve your problem a professional bike fit is in order. With this many moving - and connected - pieces, getting a professional opinion can not only increase your comfort and power, but also help ensure you can hammer for years to come.

Solution 3: Avoid the need for a Solution in the first place
Finally, try to control what you can. Keeping the knee warm in cooler weather is critical if you have any knee stiffness. Consider joining a yoga class or check out some yoga DVD's. Some people swear by glucosamine supplements to mininmize cartillage breakdown. Make sure you have no allergies to any of the components before you try glucosamine. If you have chronic swelling after exercise this may be a sign of more specific damage such as a meniscus defect or tear or internal ligament damage and a visit with your friendly neighborhood orthopedist is advised.

Remember that knee health is a process, not an event. Maintain your body more care than you put into your bike, because you probably use it more frequently and replacement parts aren't as easy to come by.

22 comments:

6p00d83451612b69e2 said...

I would start with a different assumption: humans were not meant to ride bikes. It doesn't surprise me that many cyclists have knee pain, because the knee was not designed for this movement throughout evolution.

BAS said...

I disagree with 6p00d83451612b69e2.

Humans may not have been meant to do a lot of things, but I don't think knee problems are that much of a problem from evolutionary deficiencies.

A lot of people start off with bad habits or knee problems from years of damage from other things.

doc for jocks said...

I'm in your camp BAS.

Michael said...

I've been riding for some time (some rides longer than others). I recently went on a 60+ mile ride and followed it up the next day with a easy 5K run. I felt good after both events. The following morning I left for work commuting by bike. Half way through I began experiencing localized pain at the patella tendon. It hurt to just barely touch it. The weird thing is was that nothing else would cause the irritation except biking. Lunges, stairs (up or down), light jogging, etc would all be pain free. Its still tender to the touch and painful to bike, but nothing else. The only thing that's changed is I recently put on some different clipless pedals, but I wouldn't think that something that minor would cause something so painful. Can't figure it out.

Christopher said...

Thanks for the tips, Doc! I was standing up on my bike the entire time because of that other nagging issue with men and bicycle seats. Apparently trying to prevent one problem gives rise to another. The inside edge of my right knee hurt midway through a very light 2 hour ride on the greenway with my wife. That knee has had ACL reconstruction and since I stopped running about 5 years ago, I just can't seem to get back to doing anything now. I tried running last year: Got a coach to get the basics right. Started really slow, and still it started hurting after a couple of months. Had to stop. Jump rope? Nothing doing. Bought a bike this spring. Starting very slowly --- still have knee pain at the slightest effort. Am I really consigned to senior citizens water aerobics at age 40? I'm so frustrated.

doc for jocks said...

Keep plugging away, Chris_
Time is the ultimate healer.

Sudhindra said...

Hi Doc,

I am from India, I read your article when I was browsing through some knee pain articles, now I had a patellar tendonitis earlier due to low saddle went for a few soft tissue sessions and also a couple of strength training sessions (back in Dec 09). Now six months later i was doing a long ride with the end of the route being a hill section, on my way back due to intense pain had to stop. So went back to the doc another few soft tissue sessions and a few strength training sessions, but now i wear knee braces and ride till i feel my knee has heeled but its been two months the condition is better but once i remove the knee brace after the ride the pain comes back and then its an on off affair. Please suggest

Average Joe Cyclist said...

Humans evolved from apes, and therefore one might suppose that we are well designed to swing from trees. However, the average person cannot actually do that without dislocating a shoulder! Forget evolution - let's look at what we are NOW. We are amazingly physically talented creatures who can do all kinds of things. We can cycle; we can also run. Running causes more pain because it's higher impact than cycling. However, cycling also sometimes causes pain for cyclists, especially cyclists who are no longer 20-something. I happen to have a simple, cheap but amazingly effective remedy (I’m not selling anything – I just want to share the relief with you – this is something you probably have in your home already, or else can pick up from the drug store for $5) – see my post at http://averagejoecyclist.com/?p=1188

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Dan said...

I'm scheduled to ride both Ride Like Crazy and the TDU BUPA Challenge over the next couple of weeks. I'm desperate to take part but the tendon in the back of my right knee is sore. Its fine until I ride but then is a niggle during. If I pull a big chain I can def feel it....

Any tips on how to manage it??

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David Brooks said...

@Dan: First of all I would suggest check your shoes whether your shoes are comfortable enough for you or not? Then my advice is to consult with the best physician in your area and tell the physician about your condition and then follow the instructions of your physician.

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REBECCA jones said...

Thanks for explaining types and causes of knee pain. My sister fell while jogging and injured her ankle. Tried different drugs and treatments but didn’t get relief. Then one of my friends suggested me to take her to reputed Mississauga chiropractors. Will visit them soon!

Luke Forsyth said...

Most athletes experienced knee pain due to their practice or their live games.

Octavio Campo said...
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