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Cycling Knee Pain

When riding a bike at an average cadence, each knee will bend and extend around 5000 times per hour. So it is easy to understand why knee pain can develop from bike riding due to even a marginal impairment. Problems can occur due to training load errors, biomechanical imbalance or sub optimal bike fit.

The 3 most common overuse knee complaints from cycling are:

1/ Patellofemoral Syndrome

This refers to pain deep to, or around the kneecap (patella) and is often related to a poorly adjusted bike, a sudden increase in cycling activity, muscle imbalance in the lower limb or abnormal cycling mechanics.

There is research evidence that patellofemoral pain is more likely when a cyclist allows their knees to drift inwards as they push down on the pedals, so restoring optimal pedalling technique is paramount.

Other treatments which are likely to be successful are taping strategies to control the kneecap movement, inserts in your footwear and cycling shoes, and particularly exercise therapy building strength of the hip and knee muscles.

2/ Iliotibial Band Syndrome

The iliotibial band runs from the outside of the hip (ilium) to the outside of the knee (tibia) and is a very strong and in some cases an overtight band of fascial tissue. ITB syndrome is often linked to poor biomechanical control of the lower limb, resulting in rubbing and friction of the band on the outer bony protuberance of the knee, or from compression of the fat pad just above this bony bump.

ITB pain can often be relieved by foam rolling and stretching the band, however long-term relief usually requires a broader investigation of the reasons behind the tightness and restoring optimal strength and flexibility in the leg, pelvis and trunk.

3/ Patellar Tendinopathy

Pain which can be pinpointed to the Patella Tendon is much more common in jumping and landing sports than in cycling, as it is understood to be related to the function of the tendon as a spring. However, if the cyclist has a background in jumping sports, then some of the long-standing wear within the tendon can become symptomatic later in life. Also, if the cyclist:

  • Rides frequently in the hills
  • Prefers out of the saddle efforts
  • Accelerates very quickly from stoppages

Then this problem can surface more readily.

Other than the very initial presentation of tendon pain, it is usually a degenerative issue, not an inflammatory problem.  The long-term solution for tendon pain is to develop the capacity of the quadriceps muscle and tendon to produce force and absorb load. In other words, strengthening is the cornerstone of tendon rehab.

Knee Extension machine

In the short term, avoiding hills, less time out of the saddle and slower accelerations from traffic lights may be required.

Tendon rehabilitation protocols are quite specific to the stage of the injury and need to be progressed accordingly. A long term (lifetime?) commitment to a maintenance program might be required to keep tendon pain from recurring.

Here is a blog post on Patellar Tendon problems in cyclists.

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