Looking through fitness magazines and websites, there is certainly no shortage of information for the runners out there when it comes to performance and injury prevention, however, our other love at Asia Physio; Cycling, seems to be getting ignored, even though the rate of cyclists (and cycling related injuries) are growing almost as quickly as that of runners.
I’ve delved in to what research is out there, and even though some of it was older than myself, consistently over the years knee pain continues to be a persistent area of issue, accounting for roughly 20-30% of non-traumatic related complaints by cyclists. These issues are usually chalked up as a result of the knee not staying in a straight line when we look at the cyclist from the front, AKA knee mal-tracking, but after optimizing saddle height and cleat position, the general consensus is then to look at ‘correcting’ the knee alignment with wedges and shims. Well as physiotherapists and bike fitters, we believe in fixing the underlying issues before compensating for them, and here is an aspect to consider if you have knee pain whilst cycling that you wont find elsewhere…
One common misconception, is that the knee is what we call a ‘hinge’ joint, and its widely described as simply only moving in one direction (flexion and extension), however, the knee joint is also designed to rotate significantly as it moves between straightening and bending. During a normal pedal stroke, the knee on average only has to be able to bend around 110 degree, and there are very few people out there that can’t get to this range comfortably, but knee rotation on the other hand is a very common restricted movement in people and in my opinion is overlooked in assessing a cyclist.
Cyclists in general like to position their cleats in a neutral to a slight toe out position, but depending on float setting, to allow the knee to move in the ideal alignment, the knee will be required to internally rotate significantly. When we have reduced range of movement in to internal rotation the body will often get some help by turning the hip in and as a result the knee will dip inwards, from the front there will then be a noticeable side to side movement in the knee during the pedal stroke. Excessive movement from side to side can lead to a range of problems, but most commonly in cyclists this will manifest in pain around or underneath the knee cap (patello-femoral pain syndrome) or pain on the outside of the knee (ITB syndrome).
Luckily, this is something that can be easily assessed by yourself, and if you find its restricted, there are some excellent exercises to help…
To assess, sit with your feet flat on the floor ideally with your knees bent at 90 degrees. Without letting the knee move to the side, turn in the lower leg as much as possible whilst keeping the foot flat, ideally you’re looking for at least 15-20 degrees. If you don’t get much movement and you’re currently getting knee pain whilst cycling then working on this would likely help, you can see one of my favorite exercises to help this on this youtube clip… https://www.youtube.com/watch?v=iKH8FgONbVw
As always, this is just one possible underlying issue that could be causing knee pain, but is one of the areas we assess during our ‘Clinical Bike Fitting’ service. Whilst compensations such as wedging could possibly give some relief in this case, for long-term pain free riding, working on yourself is just as important as the bike. That’s why our bike fits come with a thorough physical assessment and a bespoke exercise program specific to you, boosting performance and keeping you injury free!