Cycling is often favoured as a way of improving fitness and leg strength without unduly loading the body, particularly the joints of the lower limb. It is an excellent way of maintaining and improving knee function and range of movement but despite this, knee injuries are the most commonly encountered pain presentation among cyclists.
Aside from trauma, almost all knee pain relates to intrinsic and extrinsic biomechanical factors and overuse issues. Causes of symptoms are usually multi-factoral but generally related to sub-optimal ergonomics and changes in training loads, and the effects are often cumulative. For example, a cyclist riding for one hour at a pedalling cadence of 70rpm will complete 4,800 knee flexion-extension movements. Many recreational riders will spend 4 hours or more on weekend rides equating to over 16,800 revolutions!
Here are Michael Crebbin's, a Senior Musculoskeletal Physiotherapist at the ISEH with a clinical interest in the management of cycling related conditions 5 top tips for reducing knee pain in cyclists:
Improve hip muscle function and lumbopelvic control
A tailored programme of strengthening and rehabilitation will help to increase hip abduction and external rotation control and reduce your ‘Q-angle’ which relates to the alignment of the lower limb and the direction of loading through the knee. This is a great way to optimise patellofemoral loading. Many cyclists worry that resistance training will result in weight gain and a loss of cycling performance, but there is a growing body of evidence that resistance training programmes can actually improve endurance sports performance. It is also an excellent way of improving the strength of cycling-dominant muscles like the gluteals and quadriceps to improve dynamic control and give you that extra power on climbs and sprints.
Use a foam roller
Love them or hate them, using foam rollers and reducing tissue tightness in the legs and particularly the ITB is a great way of reducing lateral knee pain, which is often the result of iliotibial friction. Rollers are also a great way of reducing muscle soreness and mobilising the tissues before exercise.
Train wisely
Many riders present to clinic after increasing their training loads. This could be increasing mileage, frequency or riding in higher gear-ratios and ‘grinding’ along. Knees are very adaptable but loading needs to be gradual and sensible to prevent failure, and it is important to allow sufficient recovery and seek advice from a qualified professional as soon as issues arise.
Check your footwear
To reduce unwanted foot movement and loss of power, it is important to ensure that cycling-specific footwear is appropriately fitted and stiff enough to control the foot whilst pedalling. Many riders use cleated shoes which ‘lock-in’ the foot, and it is vital that their set-up is correct as this is a common cause of knee pain because the foot-pedal interface will dictate tibial rotation and the direction of knee-tracking.
Undergo a Bikefit
Whether a DIY attempt or with one of the many commercial systems available, this is time well spent optimising the extrinsic factors; those relating to the bicycle set-up and the position of the five contact points at the saddle, pedals and handlebars. This will allow you to optimise ankle, knee and hip joint angles whilst also correcting factors like stance width, leg-length differences and lower limb rotation.