By: Matt Johnson

In a typical hour of cycling a rider can average up to 5000 pedal revolutions and, as we dealt with last issue, the smallest degree of malalignment or poor positioning can stress somewhere in the joint, leading to increased wear and that eventually causes pain. A study of more than 500 recreational cyclists found that almost 42 per cent experienced overuse knee pain. But because knee pain in cycling is caused by overuse rather than major trauma, it’s not unusual for cyclists to continue riding “through the pain” in the hope it will get better. Don’t! Take our four stage plan for managing knee pain and start getting better – rather than worse – now.

Stage 1
¦ RECOGNITION
Cycling is not without any discomfort but serious knee pain from riding is insidious: it generally develops slowly over days or weeks. Do your knees hurt at the start of every ride? Does it hurt to stand up when you’ve been sitting for a long period (“Theatre knee”)? Is your knee swollen? Does it hurt to walk down stairs? If you answered yes to one you probably answered yes to many. It’s time you recognised the problem and dealt with it before you can’t ride at all.

Stage 2
¦ REST
Dealing with yourself may be the biggest issue: athletes have a “fear of rest” but rest is probably the single most effective treatment. Try to avoid the temptation to ride – it won’t be easy but it will be worth it. Damaged tissue releases inflammatory substances that are meant to assist the healing process but in the long term these substances can weaken the joint structure and exacerbate the damage. Breaking this inflammation cycle is vital if the joint is going to heal properly and rest is the only way to start.

Stage 3
¦ REHABILITATION
Now that you’ve taken a few days off it’s time to begin a limited riding program. Cut back your pre-rest mileage by at least 30 per cent, avoid any hills and spin at a cadence of at least 90 for a week or two. Remember, if you push too hard too soon, you just get to start over again. If you took one week off you should aim to do a week of very easy rides and feel no pain. If it hurts, you haven’t rested long enough. Stop, rest for longer and start again. Have the ice ready for a 20-minute session at the end of every ride: either at home or at the café, but don’t miss your ice session, it will help reduce inflammation re-establishing in the joint. Non-steroidal anti-inflammatory drugs (NSAIDs) such a ibuprofen (Nurofen, Advil, etc) can help break the inflammatory process but they can also mask the pain of continuing injury. You should be able to ride without pain, without using NSAIDS, when you start your rehab. When you’re resting you can start with up to 800mg three times a day for the first day or two but beware, this class of drugs can be rough on the GI tract. Seeking the help of a professional can also cut days or weeks of your rehab and reduce the chances of it recurring.

Stage 4
¦ PREVENTION
Now you’re feeling better let’s not have it happen again. Ask yourself, “Why did the pain develop in the first place?” Overuse – too many miles, too big a gear, too soon – is the most common cause but before you get back to full training consider getting your bike and riding position checked. You should also remember that not all leg pain is from “where it hurts”: your lower back, feet and shoes can all play a part in stressing your knees. And promise that you’ll never again increase your mileage by more than 20 per cent in a week.