Articles and Race Reports

Knee Pain Part One

KNEE PAIN PART ONE

"There’s an old saying that there are only two types of cyclists: those who started riding because of knee soreness and those whose knees got sore after they started riding."

Author: By Matt Johnson   |  Date Created: 07/07/2008


. It’s unfortunately not that off the mark because while cycling is low impact compared with other sports, there are certain stresses inherent in the cycling action that can easily damage your knees.

By Matt Johnson

Pushing too high a gear, incorrect positioning of your seat or cleats, and over training can all cause knee soreness but because it comes on slow
cyclists tend to ignore it until it becomes debilitating and, by then, too much damage is done to allow a speedy recovery. The key is not getting hurt in the first place so take a look below at what your pain could mean and please see a doctor or physio to help with your recovery. We don’t want you stuck on the couch for too long.

¦ ANTERIOR
The most common location of knee pain in cyclists and can have a number of presentations but most share the same causes. Patellofemoral pain The patella runs up and down in a cartilage covered groove on the front of the femur with each peddle stroke, supposedly protecting the quadriceps tendon from wearing itself against the femur, but generate too much force by pushing too big a gear to often and combine that with poor positioning and you can start the wear the cartilage itself. Patellofemoral pain is usually characterised by pain that is worse when the knee is loaded (eg, descending stairs), that hurts after periods of sitting (known as “Theatre sign”: your knee grabs when you get up to leave after a movie), and that can improve during a ride but ache severely for hours after. Cyclists tend to complain of pain at the centre of their patella while runners tend to point to the medial or lateral side. Patellofemoral pain is an early indication of the cartilage between the patella and femur being damaged so don’t ignore it or you will ultimately need surgery and you can damage the cartilage beyond repair. The condition is typically caused by creating too much shear force between the patella and the femur by pushing too big a gear or with the saddle too low. Situations where the patella is forced to one side of the femoral groove (such as poor cleat position and pronation) can focus the force in that spot and cause inflammation on that side of the patella.
CAUSES:
¦ Pushing too big a gear/cadence too low
¦ Seat too low
¦ Seat too far forward
¦ Pronation
¦ Over-training
¦ Too much hill work
¦ Crank arms too long
¦ Foot too far forward on pedal.

Quadriceps tendinitis
Similar to patellofemoral pain but doesn’t feel as deep, is usually at the top of the patella and hurts when pressed lightly. The pain is where the quadriceps tendon inserts into the patella and can be on the medial or lateral side but is more commonly seen on the lateral side in cyclists. Tends to become established after a bump to the area wasn’t able to fully heal before riding started putting stress on the area.

¦ POSTERIOR
The least common form of knee pain in cycling, most often due to tendinitis ofthe lower hamstrings. The pain typically starts as just an annoyance and without anysignificant event. It is usually worst at the start of a ride, improves during the ride but gets worse with rest. The pain is usually slightly lateral with some point tenderness.where one of the hamstring tendons attaches to the fibular head.
CAUSES:
¦ Seat too high
¦ Seat too far back
¦ Foot too far back on pedal
¦ Excessive internal rotation of the cleats

¦ MEDIAL
Not uncommon especially among cyclists who have previously damaged their medialcartilage. The major predisposing factor is generating too much medial stress on the knee by having your toes rotated outduring the power phase.This can be because of poor cleat positionwith too little float, by moving your knee towards the top tube at the top of the stroke or by pronation of the foot duringthe power stroke forcing the tibia to rotate during the stroke. Can be common among women whose wider hips force a greater angle at the knee.
CAUSES:
¦ Incorrect cleat position - foot held externally
rotated (toes pointed out)
¦ Excessive knee frontal plane motion
¦ Too little pedal float
¦ Excessive pronation: consider orthotics

¦ LATERAL
The ITB is a wide but thin muscle that is composed mostly of tendon and runs from your pelvis above your hips to form a thick tendon on the lateral (outside) of your knee joint. In normal activity it helps adduct the leg and stabilise the knee but in cycling it can become too tight and because the ITB moves posteriorly with flexion and anteriorly with extension, the lower end of the tendon rubs over the lateral condyle of the femur and becomes irritated. Usually responds well to rest and stretching but tends to become pain free before becoming completely resolved and athletes with ITB syndrome tend to return to activity too early. Can occasionally require surgery.
CAUSES:
¦ Incorrect cleat position: holding your foot
internally rotated (toes pointed in)
¦ Too little pedal float
¦ Pushing big gears/cadence too slow
¦ Sprint work with fatigued legs

DON’T GET INJURED! Injuries are generally a problem of overuse, particularly early in a traiining program when enthusiasm is high but your muscles and joints have not yet had time to adapt to the new stresses placed on them. And don’t discount bike position just because it hasn’t caused you problems previously: slight malalignments that your knees could handle when they were strong may cause problems when you return after a break.
AVOID TOO MANY CONSECUTIVE DAYS
A very strong predictor of injury is the number of consecutive days of training. The more consecutive days you have the higher your chances of getting hurt. Too many consecutive days doesn’t allow your muscles and connective tissues a chance to recover and then adapt to the strenuous training. Build 48-hour recovery periods into your riding when you first get back on the bike.
IT’S WEARING IN –NOT OUT – THAT HURTS.
Surprising to some is the inverse relationship between injury risk and the number of years involved in an athletic activity. Basically, relative newcomers to a sport are significantly
more likely to be injured than individuals who have been training for many years because the strength gained from years of training prevents muscles and connective tissues from literally being torn apart by the repetitive forces placed on them during activity. So be careful trying to match the effort of more experienced friends, even if you consider yourself fitter.
HEAL! Only half of sports injuries are actually new trouble areas; the rest are recurrences of previous problems. The fact that injuries tend to re-occur means you may be letting it heal enough to reduce the pain but you’re not correcting the weaknesses that caused the injury in the first place. Go see a physio or sports physician