Everything you need to know about Cyclist’s Knee

Cycling is a great low-impact aerobic activity. Cyclists are usually more efficient on both hills and flat terrain when they pedal quickly (at about 80-85 rpm) rather than at slower cadences. Although cycling is considered a knee-sparing exercise because it does not require impact with the ground, the repetitive motion of pedalling can lead to a variety of overuse knee injuries. The majority of cycling injuries are indeed caused by overuse, which leads to cumulative tissue microtrauma and consequent symptoms. In overuse injuries the problem is often not acute tissue inflammation, but chronic degeneration.

Cycling is obviously very repetitive: during one hour of cycling a rider may average up to 5000 pedal revolutions. But which cyclists sustain overuse knee injuries? Basically, cyclists of every ability level are at risk: riding too hard, too soon and too far is the usual recipe for numerous knee problems.

It’s important to remember that the knee is effectively a hinge between the hip and the ankle. It’s very rare that the problem is actually with the knee itself.

Anterior knee pain: pain at the front of the knee

Pain at the front of the knee is very common, and its proper name is ‘anterior knee pain’. Usually, it’s caused by tightness in the quads or the fibrous tissue that runs alongside the outer leg –the 
Iliotibial band– pulling on the patella (knee cap). This can be down to bike fit, or tightness as a result of a lack of maintenance or overuse.

The main thing to look at is the patella [knee cap]. Everyone talks about patella tracking, or malfunction of the patella, basically the way the knee cap glides over the joint. Often people will say the patella gets ‘stuck’, feels like it clicks or gives way.

Cyclists use the quads most in the downward stroke, so that’s a lot of pressure on the knee. Tight quads affect the pedalling action, and can be seen visually in advanced cases in a pattern we could refer to as ‘Kermit the Frog Syndrome’.

Treated early, pain can be reduced very quickly. However, if left alone, it can cause longer term damage. Pain at the front of the knee can come from damage to the meniscus or cartilage – often that comes from trauma, but can also be from repetitive movement. If the knee is held in wrong position for a long time it can really irritate the tendons where the quads attach at the front, just below the knee cap – you can get quite severe pain there where the tendon gets inflamed, and this can spread around the knee.

How to fix anterior knee pain

So what can we do about pain at the front of the knee? First – it’s a good idea to check your bike fit. Pain at the front of the knee often arises from the saddle being too low and too far forward. Often racers feel they get more power down that way, with their teeth on the bars – but that means they’re sitting on top of the knee and pushing a lot of force through it.

Cranks that are loo long can also create a similar incorrect angle, and overly tight cleats can cause strain from repeated unclipping.

When it comes to treating the tightness – be it a result of improper bike fit or simply originating from heavy mileage – it’s all about foam rolling and stretching. Stretch the muscle that is the issue, loosen off the buttocks with massage and that will release some of the tension, then foam roll – gently.

Foam roll the quads, the inside of the thigh and IT band. All rolling needs to be done slowly. Sometimes people go up and down like it’s a rolling pin – but that just flushes over the fibres, and doesn’t get into it – this needs to be one long smooth and progressive push through the fibres to add a bit of length into the muscle.

Kinesio tape supports, enables, or restricts soft tissue and its movement. By stretching and recoiling, it augments tissue function and distributes loads away from inflamed or damaged muscles and tendons, thereby protecting tissues from further injury

The tape help puts the knee cap back into the right position if displaced or unstable – what you need is for the tight muscles to relax so that it naturally goes into the right position. Taping is a really quick fix, but doesn’t work long term.

If you’re sufering from issues related to cycling, our physios at PCA can help and the PCA Independence Store has a wide range of equipment to ease your symtpoms and give the necessary support for your body.

Check out our website or call on 0813 028 0496!