Knee motion with Cycling

[2LeftCleats]

I have anterior knee pain (patellofemoral syndrome) from a non-cycling injury. After much frustration I got evaluated by sports med and now sports PT. Interesting experience in that when others analyze my strength and movement, it results in a totally different perspective. Anyway, I'm doing certain strength and balance exercises which have been humbling in their difficulty. I'm paying more attention to leg motion. I'll get a fitting/adjustment this week from the PT guy who's a cyclist, but I thought I'd throw this out to the Forum. There is more medial-lateral motion during the pedal stroke than is probably good. Internet search suggests that the less motion, the better for the knee and for power transfer, but how much is too much? I'm sure that cleat position, seat position, hip and ankle flexibility/strength all are variables, but how much motion do the better riders and/or those free of knee pain tolerate?

Thanks.

[gone]

I'm sure that cleat position, seat position, hip and ankle flexibility/strength all are variables, but how much motion do the better riders and/or those free of knee pain tolerate?

Thanks.
I don't know the answer to this but I do know someone whose knees swing way out away from the bike on the upstroke then back in as they reach the top. He's ridden more than 300k lifetime miles and has done numerous brevets up to and including PBP, all without knee injury or pain.

Don't ask me to explain it, he looks like an RSI waiting to happen but it obviously works.

[etu]

i started having knee pain early in my cycling experience. i tried to treat it through rest and stretching, but i never got past short and slow rides as anything more would result in gnawing pain a day or to after the ride.

after a couple years of this along with visit to PT, orthopedist, podiatrist, i just got frustrated and decided to push through with the use of Mobic (NSAID - longer acting version of ibuprofen) and ignore the post ride pain which in retrospect wasn't too bad. within a few months, the pain disappeared! anti-inflammatory meds along with appropriate strengthening of the medial quads took care of my problems.

caveat of course is that it's one person's experience and that i am an MD, but not a sports medicine one or a PT. key lesson for me was that these nagging chronic problems cannot be dealt just with rest, but with strengthening the supporting structures and that this process may require going through a period where the mild comfort may be involved. good luck.

[11.4]

Your experience is typical. Ask five people and get six opinions. In the end you need to evaluate your own situation and figure out simply what works for you. You aren't breaking any rules -- just find what works.

The solution usually lies in something other than the usual metrics that fitters and, above all, typical PTs and orthopedic surgeons, try to impose. Everyone wants to presume a straight line movement for a limb that is very complicated and has forces running in every direction except straight. Further, it's all driven by your hip sockets -- if they aren't letting the rest of your leg extend in a straight line, you can count on your knees and feet wobbling. Part of straightening out your problem (pardon the pun) is getting the flexibility in your lower back, hips, and thighs so you can get the right hip rotation which then lets your hip ball joints rotate in something closer to a straighter line. And most fitters, PTs, and docs try to fit you to a straight line first, without thinking about the whole picture.

Remember that the human body wasn't made to do everything in a straight line anyway. Weightlifters work with knees wide spread. If you're bench presses, you aren't pushing with your upper and lower arms all in a straight line. Again, don't feel you have to obey some magic rule. Especially when you have a non-cycling-induced injury, don't blame your position yet.

You do want to solve the pain. Positioning is always the mantra of fitters and others, but frankly, the single most effective thing you can usually do to solve pain is to strengthen your legs. Get with a really good weights coach (preferably someone who's party to the Rippetoe school -- see www.startingstrength.com for much more of this), and start building leg strength. Cycling alone will rarely give you the strength your knee needs, but weights can give you remarkable improvement. Don't listen to the BS about how weights destroy your knees -- that's people who lift ridiculous weights with poor form. Do free weights, just do back squats to start, and you'll find you'll build a lot of strength that helps keep your joints safer.

Obviously we don't know what your specific prior injuries were, or what your joints look like now, or whether you have complications other than your knees. The three points I'd make are simply that you will really have to figure out your issues yourself in the end, that you don't have to fit some magical formula for straight-line knee movement or whatever if it simply doesn't work for you, and that you can get great improvement and have more to work with if you strengthen your legs (hip to ankle) with some judicious weight work.

[2LeftCleats]

Thanks for the advice.

[jlwdm]

Add saddle choice and custom orthotics to your list.

Jeff

[dekindy]

Further, it's all driven by your hip sockets -- if they aren't letting the rest of your leg extend in a straight line, you can count on your knees and feet wobbling. Part of straightening out your problem (pardon the pun) is getting the flexibility in your lower back, hips, and thighs so you can get the right hip rotation which then lets your hip ball joints rotate in something closer to a straighter line. And most fitters, PTs, and docs try to fit you to a straight line first, without thinking about the whole picture.


Agree with this with but with a caveat. I have limited lower back and hip flexor flexibility so my Serotta trained fitter tried to make the best of my natural position without making drastic changes. I rode 4 seasons with zero problems using that philosophy. Now I am seriously working on my flexibility both to improve my cycling but also with an eye toward the future in that for my first 53-years lack of flexibility has been limiting annoying but may be a cause major problems as I age. For second fitting went to the head of the biomechanics lab at a local university who also has several cycling fitting certificates including SICI. Physical evaluation quantified my lack of flexibility and now have to proper knowledge and exercises and am working hard to improve. You can get a lot of information but there is no substitute for a knowledgeable hands on evaluation and that should be where you place your trust or seek a second opinion but again hands on and not over the Internet.

[Alan]

I had similar problems and ended up getting over it thru PT and meds. As others have said it is a very complex problem. I think that light cycling can help but your PT should ck your quad muscle balance as inner and outer quads can be out of balance due to cycling. I do very short range knee extensions to strengthen my inner quad muscles so they are balanced vs the outer quad muscles. This aids correct knee tracking. Certainly the better your knees track the better during cycling and a good fitter can help a lot w that but it is not a perfect science as we all know.

One tip is to try using concentrated tart cherry juice as an antiinflamatory. My wife has been using and feels like it is effective and there have been studies that show it is effective. I get concerned about taking NASIDs.

Good luck.

Alan