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Knee Pain & Cycling

One of the most common complaints we see clinically is pain in the knee. In fact, many athletes turned to ride a bicycle as a way to relieve the pain derived from sports such as running. Since cycling is a low impact sports, why do some cyclists knees still hurt?

In principle, the knee is a simple joint. It consists of a bilaterally curved upper section (The femoral condyles) and relatively flat lower section (The tibial plateau) which operates as a hinge. There are multiple support structures that are relatively inflexible that hold it in place. These include the cartilage pads also known as the menisci, and the four major ligaments that stabilize the knee. In addition, there is an extension of the quadriceps muscle called the patellofemoral complex. This large tendon structure runs over the front surface of the knee and attaches into the lower leg and allows you to extend your lower leg forward. Most people do not realize that the thickest cartilage in the body actually sits beneath the kneecap, or the patella, and provides decreased friction for the front knee during motion. The posterior muscles of the thigh, also known as the hamstrings, attached on both sides of the knee to allow it to flex. Add all of these factors together and the so-called simple joint becomes extremely complicated with many spots of vulnerability for injury.

Certain types of exercise predispose for certain types of injuries. For instance, many runners develop what is known as IT band syndrome, in which extreme tightness and pain is noted over the lateral portion of the knee, especially when running. While the circular motion of cycling requires very little consistent pressure on a particular point on the knee, the same circular repetitive motion can exacerbate the problems almost anywhere.

In general, there are three things any cyclist needs to look for one thinking about knee pain:

1) First is any structural imbalance between the left and right side of the body. Many people are not equal on both sides and one side is frequently stronger than the other. Leg length differences, previous injuries on one side the other, etc., all can have an effect and create pain.

2) The second most common cause is acute overuse. Increasing your training cycle significantly over a short period of time can create problems not related to structural abnormalities.

3) Lastly, but certainly not least, is improper bicycle fit. There is no other sport where the marriage between machine and body is more important. Many of the old guidelines for proper fit, like so many other primitive approaches, have been replaced with more direct measurement tools that are unique to your own structure and physiology. No two persons have exactly the same bike fit. When competing in cycling, or just riding for fun with the bicycle club a few days a week, proper fitting makes a difference between pain and injury and an enjoyable ride. Proper fitting can accommodate structural abnormalities and weaknesses unique to your particular body and help you avoid the problems associated with them. Just like you wouldn’t trust your surgery To someone unqualified, you should trust your bike fitting to someone with the highest level of experience and techniques.

By using good common sense as listed above, knee pain can be reduced or avoided in our sport of cycling.