Cycling and Knee Pain
Cycling and knee pain
As a keen cyclist and as a chiropractor in Islington I have had to deal with more than just my knee pain, I have had to treat plenty of cyclists with knee pain.
Knee pain is a common cycling injury and I am sure that a few of the cyclists on this years Tour de France and Vuelta will have sore knees when they finish. Knee pain is sometimes given the non-specific label of patellofemoral pain. This is not a specific 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 patello-femoral pain
Causes are often multifactorial and it is a condition that needs to be addressed by a chiropractor 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.
Factors that can cause patello-femoral 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 chiropractor to assess.
Flat feet can internally rotate the tibia and change the tracking of the kneecap.)
Also, 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 patello-femoral 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?
As the chiropractor in Islington l will make a diagnosis your knee pain from the history and from your symptoms followed by an examination of the knee. Will also look at your feet and ankle to assess their function. We can refer you privately for and X-ray or an MRI scan or we can contact your NHS GP with our findings and he can refer you.
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 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.
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.
As the chiropractor in Islington I am very aware that keeping fit and active is important, not just for your body but also for your mind. Don’t suffer with any aches or pains as they can progress further and take a lot longer to treat!