Keep them spinning!
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Knee pain is the most common reason for sportsmen and -women to consult medical professionals and although cycling has a well-deserved reputation for being kind on the knees, anterior knee pain (pain over the front of the knee) remains the most common complaint among cyclists, accounting for a quarter of all cycling-related injuries. There are many causes of anterior knee pain, including wear and tear of the patella surface. Unfortunately, there is no cure for this wear and tear once it has developed, but there is plenty you can do to minimise pain, any further deterioration in wear and tear, and continue enjoying your sport.
Be one with your bike!
The knee relies on four ligaments for it's stability, so there is a fair degree of instability inherent in it's design. Optimising your biomechanics will help reduce the stress your knees are put through while you are cycling.
So what can you do?
Correct saddle height
If your saddle height is too low then your knees will have to bend more and will be put through much more stress. So what height is right? A rough guide is to put your heel on the pedal on the downstroke, and if your leg is straight with no bend at the knee then it's about right. There are also lots of different formulas out there for calculating your optimal saddle height, the majority taken from professional male road cyclists altering their saddle position to achieve their best power output. These constitute a good guide to your saddle height but will not give every individual the perfect answer. And if you're really serious, you can go to a professional bike fitter. Remember, any change in your bike set up will take approximately 2 weeks for your body to adjust to.
Pedal and cleat interface
In the early days of clipless pedal systems, knee pain became more troublesome to cyclists. This was soon recognised and the R&D boffins came up with clipless pedal designs with integrated float. Float is the amount of free movement the pedal system allows your foot to move while pedalling without unclipping. As there is natural side-to-side movement of the foot while pedalling, if this is restricted extra strain is put on other structures, particularly the knee. To avoid this, check you have a system with plenty of float. If you want to get really fancy, you can have the cleat positions checked and, if necessary, small wedges (such as LeWedge) fitted under the cleats to make sure they are set up to fit your biomechanics.
Pedalling technique
There are three factors related to pedalling that have been shown to predispose cyclists to anterior knee pain: low cadence, hill climbing, and a sudden increase in mileage. Avoid these factors and you'll minimise your chances of aggravating your knees.
Pedalling at a higher cadence will mean you can put less force through each crank revolution to maintain the same overall power output. For example, if you're pushing out 250W on a killer climb and you're grinding at 50rpm you are pushing out 5W per crank revolution, whereas if you're spinning at 100rpm you only need to put 2.5W out per crank revolution for the same overall power output! Apart from the efficiency you will gain, there is much less force through your knees!
Remember, you are most likely to drop your cadence when you are climbing. So make sure you use your gears and allow yourself to spin up hills. If you ride lots of hills on the road you might want to consider fitting a compact or triple chainset to give you more options when things get steep.
Becoming a smooth and efficient cyclist comes down to practice. The more second nature it becomes the less you will have to think about it. And there's no better time to start practising than in the middle of winter, when you're stuck inside. Turbo trainers are a great time to concentrate on circular pedalling and cadence. Alternatively, pop down to your local spinning class!
Eccentric training!
There's more than one way to train a muscle! Concentric muscle contraction is when the muscle shortens, whereas eccentric contraction is when the muscle lengthens. Eccentric muscle training is a very efficient way of improving muscle strength and has been shown to improve anterior knee pain by allowing forces to be spread more evenly through the knee.
Step-downs and decline squats are good exercises that can be included in your training programme, which can initially be part of your rehabilitation to get you back to fighting fitness and then can be incorporated into your regular training to maintain these benefits. Remember, as with all new training exercises, start slowly and progress at your own rate. You should not do these exercises with a view to “pushing through the pain barrier”! You should expect to do the exercises for 2 to 4 weeks before progressing to the next stage.
Decline Squat Progressions
Stage Exercise
1 2 legs, 90 degree squat, no slope
2 2 legs, 90 degree squat, on 45 degree slope
3 1 leg for squat phase, 2 legs for return phase, on slope
4 10kg weight, 1 leg for squat phase, 2 legs for return phase, on slope
5 1 leg squat, on slope
Just a spoonful of sugar
Finally, over recent years, glucosamine has been researched as a potential treatment for osteoarthritis. Glucosamine is a naturally occurring sugar, thought to promote the formation and repair of cartilage, and as such it is generally classified as a health supplement. Many studies have shown glucosamine is beneficial to patients with osteoarthritis, mainly in reducing pain, but there remains uncertainty about it's actual effect on joint surface cartilage. It is safe, with no reported side effects, certainly not on the sports banned substances list and is available from any health food shops. However, if you are going to see if it works for you, make sure you take an adequate dose (1500mg) and shop around to get discounts because buying it at full price can get expensive.
Top Tips
- 1. Optimise your bike set up
- 2. Smooth spinning rather than gear grinding
- 3. Include regular eccentric loading exercises in your training
- 4. Minimise high impact training
- 5. Try glucosamine
Most importantly, take a slowly, slowly, catchy monkey approach to improving your knee's training tolerance. Slow steady gains through regular small chunks of training are more sustainable and prevent you breaking down with knee pain and ending up back at square one.
DISCLAIMER: Advice and information is provided via SheCycles.com Clinic on a free of charge basis as a supportive service to women in sport. It should not replace the use of your General Practitioner for medical problems.
Vicky Ware
