Warmer weather has finally reached us and it is time to hit the road or trail pedaling! Biking is a great way to get outside and enjoy our Wisconsin summer. Unfortunately, it can also bring new aches and pains, such as knee pain. Almost half of all recreational riders experience knee pain at some point. Cyclists commonly experience anterior knee pain due to patellofemoral stress syndrome (PFSS).
Patellofemoral stress syndrome is a fancy name for kneecap pain. The patella (kneecap) is like a train riding on a track created by a groove in the femur (thigh bone). If the train starts to ride catawampus in the track, excess loads (stress) can cause symptoms including a deep ache around the front of the knee, noticeable with activity and prolonged sitting. These symptoms are often associated with several common underlying factors, referred to as a syndrome.
Common Causes of PFSS
There may be one or several contributing factors that may be attributed to musculoskeletal inefficiency of the body or mechanical malalignment of the bike. Common musculoskeletal causes include: soft tissue inefficiency as a result of poor flexibility, strength deficits and imbalance, or patellofemoral joint degeneration. Common bike mechanical causes include: improper seat height, cleat position, or crank length.
From the body side of things, inflexibility of quads, hamstrings or iliotibial band in isolation or combination are common culprits for PFSS. Stretching and foam rolling are good places to begin. While it is rare for a cyclist to have weak quadriceps, it is fairly typical to have weakness of the hip muscles, which can ultimately result in poor tracking of the kneecap. A comprehensive biomechanical assessment by your PT may reveal a functional leg length discrepancy as a result of pelvic alignment issues, or faulty foot mechanics, which can wreak havoc with the angle between your thigh and shin bones, resulting in an unhappy kneecap.
A comprehensive program to address muscle imbalances and mechanics are one piece of the puzzle. PFSS might also be the result of faulty mechanics of your bike fit. Worn out cleats are by far and away the most common source of knee pain. One can only hope for such a simple and inexpensive solution! A seat that is too low or too forward, or crank arm lengths that are too long (shorter stature women mountain bikers beware) may need to be modified. Finally, even a cyclist with optimal bike and body fit can suffer from PFSS if training volume increases more than 10% per week. Gear ratios and climbing technique should also be evaluated, especially in novice riders who seek the thrill of altitude.
Quick Suggestions To Keep You Rolling
1) Improve your muscle flexibility –
- Stretch quads, hamstrings, IT Bands, hip rotators and low back
- Use a foam roller
- Do yoga
2) Manage your soft tissue –
- Regular massage or manual therapy
3) Be good to your feet
- Carbon fiber inserts or custom orthotics in your bike shoes
4) Move in another plane
- Cycling involves motion of the lower extremities in the sagittal plane, but little to none in the frontal or transverse
- This is one reason for muscle imbalances, which can be eliminated with a bit of thoughtful cross training
Professional Help. Fit Your Body. Fit Your Bike. Fit Both.
1) Consult a physical therapist to –
- Assess your posture and symmetry
- Measure your strength and flexibility
- Make recommendations based on your specific needs
2) Make sure your bike is properly fit –
- Check the wear and position of your cleats
- Use over the counter or custom orthotics in your bike shoes for better foot support
- Optimize seat height: too high or two low can result in different stresses on the knee
- Change position of seat fore or aft
- Check crank length
- When riding, spin at greater than 80 rpm to reduce compressive forces
- This is tough to do without a professional bike fit
Have fun out there! Contact us at Cronometro and Crono PT to keep you rolling pain free.
Fit the Body. Fit the Bike. Fit Both.
Clinic appointments are available Tuesday through Friday. Online scheduling for Stacey (Tue and Thur) and Heather (Wed and Fri) is on the Crono PT page. For appointments on other days and times, please email the PT.
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