Cycling related Knee Joint Injury

Hello, I have been cycling 4miles to work place, and another 4miles back. After almost 4 months of cycling, both of my knee joints started to feel painful and sore. It is not sharpening pain, but it is indeed a "sour" pain on my knee joints.

I have stopped cycling and decided to take the public transport for 2 weeks now. Although the pain is subside now, but the dull sour pain is still there to stay and once in awhile a popping sounds can be heard if i stretch my legs. I am wondering whether any kind of physio movement I can do to fasten the healing?

Thank you very much.

Dear Neotheone,

Well, your note does not specify the area of knee pain, movts that precipitate or relieve the pain etc.

Anyway taking your history of regular long distance cycling into consideration I wish to let you know that one of the commonest cause of knee pain among cyclists is Iliotibial (IT) band syndrome.

I know you must be wondering what is iliotibial band. Well, the IT band is a thick fibrous band of tissue, which runs on the outside of the leg from the hip to the knee. Pain is caused when the band becomes tight and rubs over the bony prominences of the knee (lateral epicondyle) and/or the hip (greater trochanter).

As far as a cyclist is concerned the reason for band tightening may be because of inappropriate seat height, saddle position, cleat alignment, or by individual cyclist anatomy.

Well, I wish to discuss some of the salient points with you. In case you need further help/advice feel free to contact me.

Regarding seat height, there are several different ways to determine proper seat height. The easiest way to do this is to allow one pedal to drop to the 6 o'clock position and observe the angle of flexion (bend) in the knee joint. There should be a 25-30 degree flexion in the knee when the pedal is at the bottom most point.
Another method is to measure your inseam (in centimeters) and multiply this measurement by 0.883. This should be your distance from the top of the seat to the center of the bottom bracket. Your hips should not rock back and forth when you pedal - that means your legs have to stretch to far to reach the bottom of the pedal stroke. If your hips rock when pedaling, lower your saddle until you achieve a smooth pedal stroke.

Next is saddle position, saddles that are too far back cause the cyclist to reach for the pedal and stretch the IT band with resultant knee pain. Saddle position can be evaluated with the "plumb bob technique". Seated with the pedal in the 3 o'clock position, a "plumb" hung from the most forward portion of the knee, should intersect the ball of the foot and the axle of the pedal.

Cleats that are too far internally rotated may cause increased stress to the IT band as it crosses the outside of the knee. Cleats should be positioned so that the ball of your foot is directly over the axle of the pedal. Make sure they are aligned to allow the knee and hip to travel a neutral path when pedaling (not turned out or in).

Finally, by cyclist anatomy what I really mean is individual factors like leg length discrepancies, flat feet which can cause excessive pronation of the lower extremity causing greater stress on the IT band at the knee, etc.

With respect to what you asked as what to do now... my personal advice is to take it easy as your pain score is declining with time. You may try icing (cryotherapy) around the outer side of your knee. Once you start to feel better start biking with low resistance and a cadence of 80-90rpm allowing your body to adjust again. Also, try to minimize or avoid hard riding or hill work.

You may also start general stretching exercises of your lower extremities, especially the gluteus and the IT band which will help transition you into early season form. I know I have been kind of too technical with you, so I would rather advice you to fix an appointment with your local sports physiotherapist.

Take care & all the best.

Cheers,

Thomas

hi
i want to add some more
we are now relating the knee pain to cycling.i think there is a need to ask about the type of job he does.what i mean is whether he is suppose to sit for prolong periods.the attitude of the leg he places there.
his extra carricular activities
current history of pain elsewhere ,mainly low back
previous history of muscle aches

as you suggested he should undergo a detailed assessment by a physiotherapist

Hi,
As I work with a lot of cyclists (about 60-70% of my patient load) I thought I'd add my two cents...

Firstly, I agree with the previous two posts - you need a proper assessment by a physio or sports medicine practitioner. If we are to be able to provide some intelligent advice on this forum however, we need a little more information about your knee pain, for example where (exactly) in the knee it is, is there any specific tender points to touch or is the pain only when you are loading the joint, are there any other movements that bring on the pain etc.

Thomas Bibu provided a thorough answer if it is one specific problem, although in my experience if you have only been cycling for four months it would not be the first thing I would suspect. If I was a gambling man I would put money on a more generalised patellofemoral joint synovitis, or perhaps an inflamed fat pad.

As for the bike set-up reccomendations for ITB friction syndrome I agree with almost everything Thomas suggested except the knee angle at the bottom of the stroke. Whilst 25-30 degrees is an acceptable angle for a fit (and flexible) competitive cyclist, it is not unusual for even the highest level professionals to be around 40. ITB friction syndrome patients most often get pain around 30 degrees of knee flection - the so-called "impingement zone." Lowering the saddle so that maximum knee extension is around 40 degrees often avoids this zone.

BMC

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