Sports Performance – Cycling
A Pain in the Knee?
While cycling can provide an amazing workout without the repetitive high-impact forces (like those associated with running), it is in fact associated with a great number of overuse injuries, with Knee pain (or patello-femoral pain) accounting for a quarter of all cycling related complaints.
Biomechanical irregularity of the knee joint, is believed to be responsible for most cases of chronic knee pain in cyclists. These irregularities are believed to put excessive pressure on the cartilage within the knee during the constant knee flexion and extension associated with cycling. This produces degeneration of the knee cartilage and other structures. As the cartilage degenerates, more stress is put on the bones as they compress, producing pain and inflammation.
Why do people develop biomechanical problems with their knees? Explanations include weak quadriceps (most notably the VMO), riding slowly in high gear, excessive hill riding, over-pronating arches, poor flexibility, improper bike set-up or poor equipment. However, research has shown that most cyclists with knee pain have too much side-to-side swinging of their knees during the down-stroke of their pedal cycle.
Usually, people will feel pain in the front and inside of the knee, which is hard to pinpoint. Often people will say it is inside the knee, or under the kneecap. Activities that can worsen the pain include walking up and down stairs, sitting for prolonged periods of time, squatting and of course riding.
If you’re a cyclist who develops knee pain, your first line of defence should be the familiar RICE – rest, ice, compression and elevation. Most cyclists with knee pain will find that this relieves the symptoms quite quickly.
It is important to note that this self-therapy will only serve to reduce the symptoms, but will not resolve the biomechanical problem that is causing the pain. Therefore, the pain will return when you go back to your regular training.
Your ultimate goal is to improve your joint motion, flexibility and strength. The quadriceps muscles need to be strengthened, abnormal biomechanics of the lower limb need to be identified and corrected, and training errors need to be rectified.
An often overlooked, but fairly common cycling injury is something called “handlebar palsy”. Also known as “ulnar neuropathy”, it is irritation and inflammation of your ulnar nerve, which runs from your armpit, through your inside elbow, to your hand. This nerve serves to give you strength in various forearm and hand muscles, and provides feeling to a portion of the arm and hand.
The mechanics involved in cycling can easily inflame this nerve, both at the elbow and at the wrist. Your arms absorb a lot of shock that is transmitted through your handlebars. In addition, the nerve is easily irritated when you hold your wrists and arms in a fixed position for too long. A combination of both can generally be overwhelming for the nerve.
The bumpy roads and trails involved in off road riding are a main culprit of this problem. However, it can also be linked to improper set-up or the rider’s own body type and build. For example, if your handlebars are too low compared to your seat, or if the seat is tilted too far forward, it puts too much weight and pressure on your hands and wrists. Another common problem is riding on a frame that is too big for your body.
Symptoms of this injury include pain, numbness or tingling along the outside of your hand or forearm, and can even progress to the fingers. Often in the early stages it will simply feel like pins and needles, which can be relieved by switching hand positions. However, if left unchecked, it can progress to numbness and intense pain that is present even when not riding. Prolonged irritation of the nerve can even lead to loss of strength and co-ordination of the hand.
If you have the early stages of handlebar palsy, or occasionally feel pins and needles when you ride, you are still at the point where you can manage the condition yourself. This is primarily an overuse injury, and so you should focus on the factors you can control in your riding environment.
Firstly, get your bike set-up and riding posture checked by a professional to ensure you are not shifting your weight too far forward. Secondly, padded gloves are recommended to decrease the amount of shock transmitted to your arms.
Thirdly, be sure to change around your hand positioning while riding and don’t spend too much time in positions you know are more stressful. Lastly, preventative stretching and strengthening will help to increase your arm’s tolerance to riding.
It is important to stretch both the front and back of the wrist. Stretching should be done 3 times daily while symptoms are present, and after each ride preventatively. As well, strengthening the wrist and forearm muscles will also help to build tolerance.
Pudendal Nerve Entrapment Syndrome
PNE is common in high mileage bicyclists who do not stop cycling when pelvic pain starts. It’s so common in this group it’s nicknamed Cyclist’s Syndrome. The prolonged sitting pressure, the continual nerve rubbing and stretching from pedal pumping, and the extremely high seat pressure on the ischial spine and perineum all combine to form the ideal conditions for PNE. Similarly susceptible groups are those using rowing machines or doing lots of sit-ups. The human body was simply not designed for these behaviours.
There are different sources of pain for people since there are so many ligament, muscles and nerves in the area. Sometimes women do pelvic floor exercises for compression after childbirth. However, there have been cases where the wrong stretches make the constant pain worse. Some people need to strengthen the muscles, others should stretch, while for some people it is purely neurological. There have been cases where doing stretches have helped bicyclists. A helpful includes bringing your knee to your chest on the compressed side while laying on your back. One helpful stretch for bicyclists include sitting in the lotus position and moving your head to the ground supporting yourself with your hands and keeping your buttocks up. Stretches should not be held long (about 10 seconds) and be spread out through the day. Chiropractic adjustments to the lower back have been shown to help most patients experiencing with pudendal nerve issues.