Kneecap pain…how to avoid it

Six Physio

Pain under or around the kneecap (patella) is a common cycling injury that can significantly hamper progress on the bike. It’s often diagnosed as ‘patellofemoral pain’, when the cartilage or underside of the kneecap becomes inflamed, or there is excessive friction as the patella moves up and down the femur.

Just think… if your average cadence is 90rpm, you can expect to complete 5400 revolutions per hour – this repetitive motion of the knee combined with surrounding muscle imbalances can easily lead to pain.

A good physio will determine the root of the problem but often it’s because the lateral structures of the thigh are stronger than the medial structures, so any imbalance can cause the patella to tilt/rotate, which can lead to dysfunction.

Cyclists are characteristically stronger in their quads which will try and do all the work so the weaker gluteals will need some encouragement to become active. The lateral stiffness in the ITB will often make it harder to activate the inner quad muscles (VMO muscle) and the gluteals. To prevent knee pain these biomechanical asymmetries need to be addressed.

The lunge is an essential exercise for cyclists for strengthening leg muscles whilst ensuring good stability with muscles surrounding the hips and pelvis. The narrow stance of the lunge can highlight any asymmetries in pelvic stability and allow you to work towards better balance so you are equally strong and stable on both sides. This will also help you avoid any problems that can result from a favoured or dominant side.

Foam roller mobilisation is highly recommended for cyclists to avoid knee pain. The ITB and lateral quads are a big contributor to stiffness around the lateral patella.

Exercises should also address your cycling biomechanics while incorporating elements of your bike position. This squat shows good focus on knee alignment in relation to the rest of the body to avoid any imbalances that may lead to dysfunction at the patella.

If you already experience patellofemoral pain then book a bike fit with Stephen Garvey at Parsons Green

Article by Helen Cooke, rehab physio

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