What happens when a Cyclist gets Knee Pain?
By Sports Physio, Rob Brown (ex-Physio to Orica Green-Edge Pro Cycling Team & 2019- Gold Coast SUNS AFL Sports Physio)
What do you call a runner with knee pain? A cyclist…
So what happens when a cyclist gets knee pain??????
Anterior (front) knee pain is one of the most common reasons why both professional and amateur cyclists seek Physio & medical care, accounting for 32% – 60% of all overuse injuries in cyclists. It occurs in Road Cyclists, Time Trial-lists, Triathletes & Mountain Bikers.
The force at the foot during cycling is only 17-19% of the vertical force during running, meaning the major contributor to anterior (front) knee pain in cyclists is repetition. The repetitive flexion (bend) and extension (straightening) of the knee during 1000s of revolutions can irritate soft tissues surrounding the knee cap and knee joint, as they slide over the inside aspect of the thighbone (figures 1 &2). Irritation of these soft tissues may also arise secondary to acute trauma, for example landing directly on this area during a crash causing inflammation and scaring.
Cycling related anterior knee pain usually presents with a superficial, dull ache locally in the front inside aspect of the knee. Pain is often accompanied by a snapping or clicking sensation under the knee-cap and/or over the medial aspect of the thigh bone. There may also be palpable thickening and tenderness of these soft tissues over the medial aspect of the thighbone when you flex and extend the knee. There may also be a small amount of swelling/puffiness in the region.
Imaging (MRI, Ultra sound) usually reveals nothing but may be useful in excluding other pathology.
What Treatment is needed?
Initial treatment involves pain relief and reduction of inflammation with icing massage of the quadriceps and limiting aggravating activities helping in the acute stage. Anti-inflammatory medication and/or a cortisone injection may be indicated after consultation with your Sports Doctor (we have one consulting from clinic). Once the acute pain and inflammation has settled (usually 2-3 days) it is time to address the causative factors and initiate a gradual return to cycling.
The next phase of correction usually includes:
1. A BikeFit– A bike position with the seat too low or too far forward may cause an increased knee flexion angle placing overload on the quadricep muscles and increasing tension on the front aspect of the knee. Only a small error in Bike position with lots of repeated revolutions can still become a significant cause of pain. Cleat position is also critical for making sure your thigh and shank track in the correct plane during your pedal stroke to reduce overload at the pivot point in the middle- ie your knee.
2. Off the bike – Improving movement patterns and control of the whole lower limb is essential in managing anterior knee pain. In terms of muscle activation, reliance on the quadriceps to supply power to the pedal will lead to an overload at the knee, and likely pain. Training the hip (gluts) and ankle (calf) to contribute more optimally to the pedal cycle (particularly during the power phase) will contribute to more effective and efficient loading through the entire lower limb, preventing dominance of the quads and knee and eliminating pain.
Some of the best exercises to achieve this are:
– Bridges
– Squats
– Calf raises
– Lunges
– Step-ups.
3. Technique Cues – Reduced lower limb control in muscles may result in your knee coming inwards towards your top tube and/or your thigh rotating inwards (knee tracking towards the frame) and this will place tension on front inside structures of the knee. Movement control exercises which focus on optimal knee positioning as well as specific hip exercises to limit inward rotation of the hip and thigh, along with improving Cycling Technique will reduce overload.
Exercises for this include:
– Single leg squats
– Hip external rotation with band
– Lunges
– Step ups
How I can help you & getting a BikeFit
At Gold Coast Physio & Sports Health, I consult to all Cyclists and can provide a thorough, accurate & experienced pathway for eliminating your knee pain and improving your Cycling Performance, right from Assessment, Diagnosis, Hands-on Treatment, Exercises and Technique Cues. We also have Peter Spencer from GC BikeFit available to come into clinic to provide a thorough assessment of your Bike position. Peter and I will communicate about your needs together to ensure you get the same quality level of care that our Elite Cycling Team Cyclists receive to make sure you are achieving your Cycling Goals.
For Physio appointments, ph 07 5500 6470 or Book Online with me at Ashmore (Runaway Bay) clinic and Book your Bikefits HERE
Happy Cycling!