Knee Pain

Around this time of year, many cyclists start to experience knee pain which becomes a nagging problem during long rides, training sessions and competition. Often, this pain will begin as a subtle, post-ride ache which turns into a problem that doesn't seem to go away on its own. While there are many reasons for knee pain (injury, surgery, immobilization), pain that gradually creeps into your daily rides is normally due to overuse, poor bike fit, poor body mechanics or a combination of these. Overuse injuries can occur when an athlete performs a repetitive task that taxes a specific set of muscles and sustains that activity beyond the muscles' current capacity. In cycling, that task is pedaling, which requires the athlete to use most of the muscles of the lower extremities. In order to increase strength in any muscle it must be challenged to its capacity regularly. When a muscle's capacity is regularly exceeded for extended periods you may not only experience muscle soreness but also joint soreness. This can lead to altered mechanics at that joint (in order to avoid pain) which may intensify the problem.

One commonly diagnosed cause of knee pain is patellofemoral syndrome. In normal cycling, every time a cyclist pushes down on the pedal the quadricep muscles (the big muscles at the front of the thigh) contract causing the patella to move up and down in that groove. Patellofemoral syndrome occurs when the patella (knee cap) is "tracking" improperly in the groove at the lower end of the femur (thigh bone); i.e, the patella repetitively rubs the femur and eventually results in pain. Improper "tracking" may be caused by a structural anomaly or muscle imbalance that can often be traced to bike fit or riding technique.

Proper bike fit and riding technique are essential preventive measures for knee pain. Quality bicycle retailers will have personnel trained to observe your riding position and then recommend appropriate adjustments to stem height, as well as seat and cleat positioning. Less experienced riders should spend some time with a skilled rider who can observe their riding technique, including gear selection and pedaling cadence. Most beginners tend to use fewer of their gears and pedal at far too low a cadence. Low pedalling cadences require riders to strain too hard with each pedal revolution. Higher pedalling cadences spread the effort out over many revolutions. Casual cyclists should strive for 70 to 80 rpm. Competitive cyclists should strive for 80-120 rpm. There is a reason (besides marketing) for those 21 gears on new bikes these days - use them! Treatment: If there is no obvious swelling in the knee, but pain and stiffness are present, there is at least trace swelling. The use of ice packs over the knee for 15-20 minutes at a time, on a regular basis, can greatly decrease discomfort. Ice numbs the area and serves as an anti-inflammatory. The use of ice 2-3 times per day, especially directly following bouts of activity, will decrease and prevent swelling.

A painful knee usually progresses to become a "tighter" and weaker knee. The natural tendency is to rely more heavily on the healthy knee in an attempt to rest the knee that hurts. This leads to a gradual decrease in quadriceps strength. Gentle stretching of both the quadriceps and hamstring muscle should become a daily routine in order to maintain good knee joint flexibility. Stretches should be done gradually (without bouncing) and sustained for at least 30 seconds. A gentle pulling sensation is expected but stretching should not be painful. Quadriceps strengthening should also be undertaken, but again, all strengthening activities should be painfree. Slow straight leg raises, quarter wall slides (see above diagram) or quarter squats may serve as strengthening tools. Seated knee extension machines should be avoided (especially end range knee extensions) as they are extremely stressful for the knee joint. Deep squats or activities that require extreme knee flexion should also be avoided.

Finally, knee pain incurred secondary to trauma or severe knee pain should be evaluated by a physician in order to determine that the structural integrity of the knee has not been affected and that continued use of the knee will not lead to further damage.

The knee is crucial to vigorous cycling. Take care of even the mildest twinge of pain at the outset, before it becomes a chronic problem.