Knee injuries are a very common problem for cyclists.
This blog approaches cyclists knee injuries from a coaches and Chartered physiotherapists perspective.
I have written on what I have observed as a coach to cyclists and other athletes for over 40 years.
I also had a number of years as a cycling masseur and have some knowledge of injuries.
Doctors and Physios
However, I learned from an early stage that the best people to deal with injuries are the Physiotherapists and sports doctors.
So it’s great to get excellent advice and tips from Chartered Physiotherapist Aiden Woods of Pearse Street Physiotherapy Clinic.
Aiden has huge experience as an athlete and physiotherapist to sportspeople.
Mind your tendons
As the training hours and or intensity is ramped up the possibility of developing knee pain increases.
The particular pain I am looking at here is the Patella tendon
What is it
It’s the tendon that is just below your kneecap. It’s attached to the little bump on your shinbone / Tibia. Photo
What does it do?
It straightens your lower leg as the force of the four quadriceps muscles are applied to the tendon through the patella / kneecap.
Try straightening your leg from a 90 degree angle while touching the tendon and you will feel it being activated.
Why does it get injured?
Overuse is a common cause of patella injury.
9,000 to 1,000 Pedal revs
During a two hour cycle the patellar tendon will be activated 9/ 10,000 times if the cyclist has a pedalling cadence of around 80 rpm.
That’s a lot of revs and 10,000 opportunities for injury if not done correctly
Likely Causes – coaches perspective
- Ramping up training volume and or intensity too quickly
- Using too high a gear for training, too soon
- A combination of increasing gears volume and intensity together
- Very cold weather
- Lack of warmup
- Poor Bike fit.
Likely Causes Physiotherapists perspective
- Poor lower back or leg biomechanics. We are all built differently. How you are built I would describe as your individual biomechanics (or body mechanics or body posture).
- Very few people are built perfectly symetrically or have perfect posture. It is normal to have one leg slightly longer than the other, one foot slightly turned out, or one leg slightly bigger than the other.
- While it is important to be aware of these subtleties in your body, most of them can be addressed with a good bike fit. This is one of the reasons why having a good bike fit is very important.
- For a very small percentage of people there will be a significant issue in their biomechanics which could predispose them to injuries of the patellar tendon.
- One practical example of this would be someone who has grown up with a difference in their leg lengths of 4cm.
- For something like this in addition to getting a good bike fit I would recommend liasing with a good Physiotherapist for advice
- Past history of previous injuries is another common cause of pateller tendon injuries. A practical example of this would be a an old football injury which tore the cartilage and ligaments in the knee, or a dodgy ankle from old sprains, or a dodgy leg from having broken it in the past, or a history of poorly managed lower back pain.
- Previous injuries often have a tendency to leave that leg a little weaker. As Paddy has said above if you are using your patellar tendon 5000 times an hour in a cycle and there is an underlying old weakness then I believe you are at a higher risk of getting a patellar tendon injury.
- Yes I believe some people are more likely to get injured than others, we are all different. On the other side of this there are some really annoying people who are bullet proof and can flog themselves in training and never get injured.
- If you are one of the unlucky ones and are prone to getting injured then having a good cycling coach, working closely with them and following their advice is essential.
Poor recovery strategies
- is another very common cause of injury. If you are training hard ideally you would be getting a good nights sleep, eating healthily and staying properly hydrated. Stress can quite often affect your ability to sleep. If you are under stress for example having a sick child at home or being very busy at work this can have a negative impact on your sleep and leave you more vulnerable to getting injured.
Prevention Coach perspective
- Follow sound principles of training
- Be progressive with increase of training and gears
- Keep your knees warm during cold / wet weather
- Have your bike position set up correctly
Prevention -Physiotherapists (Aiden) perspective
- Listen to your body, liase regularly with your coach and modify training if both of you are in agreement
- Get a good bike fit that is appropriate for you as an individual
- If needed address old injuries/poor body mechanics. This can be done with in a variety of ways, most commonly with a rehabilitation programe from a good Physiotherapist.
- I generally encourage my patients to work hard over the winter months and then to back off rehabilitation programes once racing season comes around.
Diagnosis is king
Pain is the first sign of the problem The pain occurs between the bottom of the patella/ kneecap and where the tendon is attached to the tibia. When pain occurs Reduce or stop the activity immediately.
Continuing to train when the tendon is sore will most likely make things worse and increase recovery time.
Get professional advice if it persists. Correct diagnosis and rehab is important to avoid recurrence or other injuries developing. For example, the quad muscles are inclined to deteriorate very quickly when your knees get injured.
This can lead to another/ different knee injury (chondromalacia) when cycling is resumed because of a muscular imbalance.
Top Tips from Aiden Woods
Don’t get injured.
Try to avoid injury by
- Having a good cycling coach and follow the training programe they recommend.
- Having good recovery strategies.
- Having your bicycle properly fitted
- Modify your training if you are tired, sick, stressed etc
- Be careful if you are making any changes in your bike set up or clothing eg new shoes, new cleats etc
- Spend the winter months working on your strengthening your biomechanical weaknesses or weaknesses you may have from old injuries
Aiden Woods has been a Chartered Physiotherapist for nearly 25 years, he has worked with international athletes since 2001 most recently at the Rio Olympics with the Irish team. In a previous life he was competitive cyclist and duathlon champion, and now cycles for fun with his family.
Paddy Doran High performance cycling coach and Tutor at PEC Coaching