Does knee pain affect your cycling? If so, you’re not alone. It’s right up there as one of the most common problems that cyclists (both elite and leisure) experience, but fortunately there are a few things that may help. Read on.
What is it about the knee that makes this a problem area for cyclists? Broadly speaking, there are two factors to consider.
Firstly, if you think about sitting on a bike, it is the only joint in the lower limb that is unsupported: the hips are fixed to the saddle, and the feet are fixed to the pedals. The way those contact points are set up will therefore have a direct influence on the way the knee is loaded. Given that cycling is a repetitive action, loading the knee inappropriately over time as a result of a flawed bike set up, will cause injury or pain. So bike set up is of utmost importance, not just for the elite cyclist, but also for the weekend family outing cyclist.
Secondly, the knee is also largely responsible for transferring the power from the pelvis and thigh to the feet on the pedals. If there is a biomechanical issue, in other words your body is not functioning optimally, the uneven loads placed thus on the unsupported knee will over time (remember cycling is a very repetitive action) also cause pain or injury.
Let’s look at a few of the biomechanical issues that you can address yourself:
Problem 1: Quadriceps tightness, in particular Rectus Femoris.
This muscle crosses both the hip and knee joint, (flexing the hip and extending the knee) and is important in controlling the power of the quadriceps group, being largely responsible for driving the pedal around.
Unfortunately, this important hard working muscle is most likely to be tight as a result of the closed hip sitting position in the saddle. This tightness will then result in restricting the smooth gliding of the patella (knee cap), which in turn will cause knee pain in various places under or near the patella.
What can you do?
Use a foam roller. demo
Don’t have a foam roller at home, or not agile enough? No problem! Use a rolling pin (yes, the one from the kitchen drawer) on your thigh while you sit and watch telly.
See your physio or massage therapist
Problem 2: ITB (Iliotibial band) tightness
This is a structure stretching (broadly speaking) from a muscle on the side of the hip area to just below the outside of the knee. There are a few things that could cause this: incorrect bike fit, tight quadriceps / hip flexors, and weak gluts (Maximus and/or Medius). The pain will usually be felt to the outside of the knee.
What can you do?
Have your bike set up checked. Remember that your body shape, strength and position changes over time, so last year’s set up may no longer be appropriate.
Use a foam roller to reduce quadriceps / hip flexor tightness as for Problem 1. Foam rolling the ITB requires some consideration. There exists a debate as to whether this has any effect, and indeed whether it might be detrimental. The “anti” camp believes, as a non-tensile structure, it cannot be “loosened” by foam rolling and is therefore a waste of time. They also argue that the inflammation at the knee tends to be because of friction pressure between the ITB and the femur, and as such they question the wisdom of applying more pressure with a foam roller.
That's not to say you are off the foam rolling hook! Deep foam rolling of the Tensor Fascia Lata muscle (TFL), Gluts, the outer Quadriceps (Vastus Lateralis muscle) and outer hamstring (Biceps Femoris) will, because of their proximity to the ITB, reduce tension on the ITB, which in turn will ultimately help with the knee pain.
Get your Gluts working. A weak muscle becomes a tight muscle and vice versa. There is a plethora of exercises out there, but the single leg Gluts bridge is one of my favourites. Take note: this may not be the exercise best suited to you. It is always best to see a physio who will assess you and prescribe the right exercise.
See your physio.
Problem 3: Incorrect foot position
The knee is connected to the shin, which is connected to the ankle and the foot. If the foot is not aligned correctly it will apply a rotational force on the shin, which in turn will load the knee inappropriately, leading to knee pain.
What can you do?
Check your shoes. If you use cleats, are they positioned correctly? Remember that the right and left feet are not true mirror images, so fit each one individually. If you are unsure of the position, get professional help.
If you’re a weekend leisure family cyclist and wear flip flops or fashion trainers, chances are the joints in your feet are being allowed to move too much as you apply pressure on the pedal, affecting the foot position and ultimately affecting the knee. The solution may be as simple as investing in a pair of cycling shoes or at least make sure you wear a shoe with a very rigid, stiff sole.
Most of you will have heard of over pronation of the foot in relation to running; it is equally valid for cycling. This can be corrected with simple orthotics (inserts) in the shoe, or possibly also by using cleat wedges.
And again ……. see your physio.
There are other issues that could cause knee pain, as indeed there are many other solutions. This is simply a snapshot that might help some of you with the problem, now. The take home from this is that bike fit is vitally important, there are most likely exercises that can be done to alleviate and improve the symptoms, and good footwear is as important for mum and dad and the kids out on a joyride as it is for the elite cyclist.