Cycling and Knee Pain

This article was written by the physiotherapist in Islington from the Angel Sports injury and physiotherapy clinic. The article will cover:

• Anatomy of the knee
• Causes of knee pain
• Symptoms of knee pain
• Diagnosis of knee pain
• Treatment of knee pain

Knee pain is a common cycling problem and I am sure that a few of the cyclists on this years Tour de France will have sore knees at the end of the event. Knee pain is sometimes given the non-specific label of patellofemoral pain. This is not a diagnosis but a general description of where the pain is. The patella is the kneecap and the femur is the thighbone and this sits behind the kneecap.

The kneecap has smooth cartilage on the back to allow it to slid up and down a groove in the tibia (the bone that is in the bottom half of the leg) called the patella femoral groove. Simple really!

The quadriceps muscles straighten the leg and to do this the quadriceps wraps round the patella and inserts into the top of the tibia. The kneecap acts as a fulcrum to increase the force of the quadriceps muscle to straighten the leg.

Causes of Patellofemoral Pain

Causes are often multifactorial and it is a condition that needs to be addressed by a physiotherapist if you are a keen cyclist and suffering from knee pain. The ligaments and muscles and tendons around the knee can cause pain as can the bursa or synovial sac under the bottom of the knee. This can become inflamed and painful and is know as ‘house maids knee’! The meniscus inside the knee joint is also an area that can become damaged and painful.

Specific Factors that can Cause Patellofemoral pain

• Overuse of the knee: particularly at times of increased training or increased activity/distance

• Problems with knee alignment or ‘tracking’ of the kneecap in the femoral groove. It may be due to the way the knee has developed. Or, it may be due to an imbalance in the muscles around the knee - for example, the large quadriceps muscle above the knee. If one side of the quadriceps muscles pulls harder than the other side, then the patella may not glide 'true' and may rub on one side and this needs a physiotherapist to assess.

• Flat feet can internally rotate the tibia and change the tracking of the kneecap

• Shoes where the soles are hard rather than springy put more strain on the knee

• Injury to the knee - including history of repeated small injuries or stresses due to sports

• Reduced muscle strength in the leg can contribute, as the leg muscles will be less able to absorb stresses on the knee. Most knee pain can be improved by increasing muscle tone around the knee

Symptoms of patellofemoral pain

• Pain and/or swelling around the knee. The pain is felt at the front of the knee, around or behind the kneecap. Often, the exact site of the pain cannot be pinpointed but is felt vaguely at the front of the knee

• The pain comes and goes. It is typically worse when going up or down stairs or running downhill. Also, sitting still for long periods may bring it on. For example, after going to the cinema or a long drive

• There may be a grating or grinding feeling or noise when the knee moves. This is called 'crepitus'.

How is patellofemoral pain diagnosed?

The physiotherapist at the Angel Sports Injury and Physiotherapy clinic will diagnosis your knee pain from the history and from your symptoms followed by an examination of the knee. Our physiotherapist will also look at your feet and ankle to assess their function. X-rays can be useful and the clinic has its own x-ray facilities or the physiotherapist can refer you out for an MRI scan.

What is the treatment for patellofemoral pain?

In the acute phase

• Rest the knee until the pain eases and most of the pain should disappear if the knee is  not over used

• Reduce the inflammation with neurofen or other anti-inflammatory medicine. Icing may be the safest and quickest way to reduce the inflammation

• Improve the strength of the muscles around the knee will ease the stress on the knee. Also, specific exercises and stretching may help correct problems of the tracking of the patella. For example, you may strengthen the inner side of the quadriceps muscle to balance out the lateral quadriceps

• Footwear - arch supports if you have 'flat feet' and getting yourself assessed for some decent running shoes that help to correct the pronation

• Massage to the quadriceps

• Taping of the patella may help reduce pain by changing its tracking. A special brace is another option, which may help reduce pain

• Surgery is not often used for patellofemoral pain. However, it may be helpful in certain situations but a referral to a specialist and having an MRI scan would be recommended.

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If you are having knee pain and wish to see a physiotherapist in Islington contact the Angel Sports Injury and Physiotherapy Clinic. We are offering FREE KNEE ASSESSMENT for July. If you want to make an appointment with our physiotherapist or sports massage therapist click below.



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