Knee pain in cycling
Knee joint pain is a fairly common occurrence in cycling. Although the knees when riding a bike are not so much burdened by body weight and impacts as, for example, when running, there are still relatively large force moments and there is a movement in the range of about 5-120 degrees.
The place of pain of the musculoskeletal system usually does not correspond to the place of the cause of the pain. And so it is with the knee. The function of this most complex joint of the body should be seen in a broader context. The function of the knee joint is directly influenced by the position and function of the joints of the foot, hip joint, pelvic position and spine.Knee pain can have a cause in itself, as is the case with injuries (e.g. meniscus or ligaments). However, this issue is not common in cycling, so we will leave it aside. Knee pain can also have a cause in remote areas, most often they are caused by a disorder of muscle coordination.
Why do knees hurt not only cyclists? The key to understanding the problem is the work of the muscles in harmony.
In general, the most common cause of pain in the musculoskeletal system are so-called functional disorders. These are disorders of muscle coordination, that is, the work of muscles in mutual interplay. With optimal muscle coordination, the articular surfaces are in maximum contact and the load is therefore distributed over the largest possible area. If some muscles or parts of the muscles are in predominance and others in attenuation, the mutual position of the articular surfaces changes and some parts are loaded more, others less.Thus, premature degeneration of the cartilage of the joint occurs. Muscles, or parts of them that are in increased tension, are themselves a source of pain. They can also hurt their tendons, behind which the muscles chronically pull. Another source of pain can be overloaded parts of the articular surfaces. Impaired muscle coordination can occur due to various influences, for example, as a result of an injury, unilateral overstrain, or this coordination did not develop well in early childhood.
The quality of muscle coordination plays a significant role in the load on the knee joint, as well as in cycling. We can say that the worse the quality of muscle coordination, the more wear and tear occurs. By the load and its escalation, with non-ideal coordination, this risk is multiplied.
We provide physio consultations for cyclists, come on your bike or have your style analyzed on a wattbike. We will detect and correct deviations, teach you exercise and compensation.
Resolution of knee joint pain
In cycling, it can be tendon pain, caused by both muscle imbalance and excessive load, or both. Some of these difficulties can have a cause very distant from the very place of pain.
Pain on the inside below the knee
is caused by increased tension of the muscles that clamp here. These muscles are in hypertone in hip joint disorders or blockages of the joints of the spine.
Pain at the upper or lower pole of the patella
is due to the increased tension, especially of the straight head of the quadriceps muscle. This can occur both as a result of excessive loads and, above all, a disorder of muscle interplay affecting the position of the pelvis and blockages in the lumbar spine. The pelvis in this case is in anteversion, that is, tilted forward. We usually carry this position with us from the first months of life, when the abdominal muscles were not properly engaged.
Pain on the outer side below the knee
occurs with blockade of the head of the calf bone at the site of articulation with the tibia bone. This blockade occurs with increased tension of the two-headed thigh muscle. But this is again due to the position of the pelvis, suboptimal involvement of the abdominal muscles and blockages in the lumbar spine.
Knee pain from the front.
Probably the most widespread problem in cycling is the so-called femoropatellar pain syndrome, sometimes also called chondromalacia patella. The patella, or patella, actually has the function of a pulley for the quadriceps muscle of the thigh. It is inserted into the tendon of this muscle and makes its work more efficient. With contraction of the quadriceps, there is a compression of the patella into the joint. Cycling, mainly uphill, but also, for example, walking on stairs, requires a fairly strong contraction of the quadriceps. Thus, there are great pressures on the patella and on the cartilage under it. As already mentioned, the quality of muscle coordination is essential for the distribution of the load on the joint. Likewise for the patella. In order to distribute the force on the joint as much as possible, the patella must be stabilized as best as possible. For an ideally stabilized patella, a balanced function of the outer and inner head of the quadriceps muscle of the thigh is needed.And it is this interplay that is often broken. In this case, the patella is pulled, or even tilted externally. This is due to the functional attenuation of the inner head and the predominance of the outer head, which pulls the patella to its side. Thus, there is an excessive load on the outer part of the articular facet, its pain and gradual degenerative changes in the cartilage of this part of the joint.
Several factors are involved in the failure of this interplay. These are both biomechanical factors, where the so-called Q angle is increased. Q angle is the angle that the axis of thrust of the quadriceps with the axis of the femur. This angle is increased when the knee is positioned in X, which is associated with tilting the pelvis forward and flattening the longitudinal arch. This erroneous position in the knee therefore arises as a result of poor muscle interplay in the pelvic and torso area, or in the leg area. The Q angle also increases the wide pelvis.In these cases, the patella travels externally, and this position causes the outer head of the quadriceps to be in a more advantageous position than the inner head. Women, because they have a wider pelvis and more often knees to X, are more predisposed to these problems.
However, there may also be a malfunction of muscle coordination itself, even if you do not have a biomechanical disposition. The inner head of the quadriceps is extremely vulnerable and tends to fall out of function. This can happen, for example, as a result of an injury (e.g. rupture or just stretching of ligaments, damage to the meniscus, etc.), but also by one-sided load and physical impoverishment.
How to help yourself with knee pain?
As you can see, knee pain is often a complex problem of the musculoskeletal system. To eliminate the cause of the problem, targeted physiotherapy is necessary, that is, the activation of the correct muscle interplay not only in the knee area, but also in the leg, hip and pelvis. Exercise for knee pain will definitely not revolve around the knee itself.
What can you do yourself? Stretching of the muscles is a matter of course, which will make it easier for her tendons. It is necessary to stretch all muscle groups of the lower limbs, but especially the straight head of the quadriceps. It is also advisable to combine cycling with another sport, because the variety of movements improves body image and muscle coordination.
When riding a bike, it is necessary to create suitable biomechanical conditions for the knee joint. It is mainly about adjusting the saddle in terms of horizontal displacement, relative to the pedals. When you have the pedals in a horizontal position and your foot clicked into the pedal, the perpendicular lowered from the knee should intersect the center of the pedal axis. If the knee is in front of the center of the pedal, this position will be biomechanically disadvantageous and, most importantly, there will be excessive pressure on the patella.
It is also a technique of cycling, especially the position in the hip. If the knees are directed inward, it means that there are internal rotations in the hips. This position is both disadvantageous for the hip and also disadvantaged in the function of the inner head of the quadriceps and the external one will be more involved. Furthermore, the internal rotators in the hip will be overloaded, so the muscles of the inner side of the thighs, the so-called short adductors, will be in increased tension. Ideal for the hip joint is if the external rotation increases with increasing flexion. Therefore, the more we bend the leg in the hip, the more the knee should go to the side. This bend ensures maximum contact of the articular surfaces. For cycling, it follows that at the moment when the knee goes up, we should dial it even slightly externally. A racing driver will probably not use this pull-up, it would put more air resistance, but I highly recommend it to others even at the cost of a slight deceleration. After all, we only have one joint!