As we all get enthused with cycling during the Tour de France, there will inevitably be a few knee injuries along the way. Here we take a look at some of the areas of knee pain.
Anterior knee pain is the pain you get at the front of the knee, on and around the knee-cap, and is the most common of cycling injuries. The large quadriceps muscles attach to the shin bone via the knee-cap, so the forces of pedalling are transmitted across the joint whenever we bend our knees, essentially squashing it back against the thigh bone.
It is the part of the tendon attaching the knee-cap to the bony prominence below the knee-cap can become inflamed, known as patellar tendonitis. If this area is persistently sore to the touch it’s definitely worth seeking a medical opinion. It should respond to ice, anti-inflammatories and physiotherapy, with or without strapping.
Another form of anterior knee pains is patellar compression syndrome, causing pain when off the saddle and agony when on it. During the push phase of pedalling, we seldom complete the last 35° of knee extension, meaning that over a long period of time the muscles down the outside of the thigh become much stronger and tighter than these less-used medial muscles.
The key to treating these conditions is to loosen off the lateral structures before attempting to redress the balance and concentrating on building medial muscle bulk.
It’s also worth pointing out that cycling isn’t the only time we bend our knees. Crouching down to pick something up and walking up the stairs are more obvious activities, but sitting at a desk with feet underneath the chair (or in a cinema seat) for prolonged periods will produce the same effect.
Posterior knee pain is the pain behind the knee and is far less common and much more straightforward and is almost always due to over-extending the knee. Make sure your saddle is at the right height to avoid this.
Persistent pain behind the knee should be looked at medically to exclude a Baker’s Cyst, a harmless bulging of synovial fluid into the space behind the knee. Your doctor can discuss treatment options with you.
Medial and lateral knee pain is the pain at the sides of the knees and is fairly common. The cause is usually the feet and the pain is often noticed during or after the first ride with new cycling shoes known as cleats. Ensuring your cleat is in the correct position before and during push off and cycling will help avoid such pain.
Finally there is the pain that is known as iliotibial band syndrome. The iliotibial band is a thick strap of tissue that runs all the way down the lateral thigh, from the pelvis to just below the knee. It can tighten up over time and pulls the knee-cap off centre if the muscles aren’t strong enough to counteract. It is an unpleasant condition thought to be exacerbated by weakness of the gluteus medius muscle, another essential core muscle that gets neglected by cycling, and also by wearing cleats that point the toes too far inwards.
The treatment is the same as any for an inflammatory condition: rest, ice and regular anti-inflammatory medications. Rehabilitation focuses on building up the gluteus medius muscle. Stretching should precede any strengthening exercises. A return to normal activities should be phased in gradually, being guided by the easing pain.
If you have any niggling knee injuries from cycling or any other sport please contact one of the Orthopaedic Consultants at North Downs Hospital in Surrey. Please call 01883 348 981 to make an appointment. Appointments are available daily.