Knee pain and cycling, where to start

The most common site of pain we see at RevoPT is the anterior knee. The knee is comprised of three bony structures, the femur that creates the top section of the knee, the tibia that creates the bottom section and the patella or knee cap acts as a lever on the front of the knee for the quad muscle. Obviously the knee is doing quite a bit of movement while cycling. Small movement faults can turn into major pains quickly.       

orthoinfo.aaos.org

Assessing your own movement is a great place to start tracking down the cause of your pain. We like to start with a squat or a lunge. This movement gives us lots of information about your default movement strategies and how your load the lower extremity.  In the case of anterior knee pain we want to pay special attention to how you are loading the knee joint as you move into knee flexion. The movement we associate most with anterior knee pain is termed dynamic valgus. This is characterized by a medial collapse at the knee as you move into deeper flexion.  

Notice the internal rotation required to allow this motion.  Glute max creates hip external rotation, abduction and extension...maybe that will fix this problem???  Knee is positioned inside the ankle.  No good!

Notice the internal rotation required to allow this motion.  Glute max creates hip external rotation, abduction and extension...maybe that will fix this problem???  Knee is positioned inside the ankle.  No good!

The knee valgus seen above in a split squat/lunge will usually show itself on the bike as well. If you find yourself knocking your top tube with your knee or collapsing medially at the bottom of the pedal stroke odds are you are stressing the front of your knee excessively. As your femur internally rotates the condyles at the top of the knee also rotate.  This changes the contact patch between the patella and the groove of the femur.  Less surface area equals a spike in pressure.  Do that 10,000 times a ride and you're going to have some pain at the front of your knee. 

Ideally we will see the knee stacked directly above the ankle on and off the bike.   

Knee stacked over ankle/pedal.  Nice!

Knee stacked over ankle/pedal.  Nice!

Knee stacked over ankle/pedal.  Nice!

Knee stacked over ankle/pedal.  Nice!

So you did a lunge in the mirror and your knee is collapsing inward.  What happens next?

When the knee is collapsing inward we know the external rotators/abductors of the hip are not doing their job.  Turn them on!  Below are two videos showing you a fire hydrant and a skate to activate your glute max and glute med. Start with 30 second holds followed immediately by 30 repetitions.  If you feel a small fire on the back of your hip you are doing it right! You should also give this a try right before you get on the bike to "prime" your glute and ensure it is ready to work.

Riding bikes should be fun, not painful! Ask us more questions to be answered on the blog at inforevopt@gmail.com