Ask a Pro — Diane Stibbard
– Coach, Personal Trainer, and Two-Time Canadian Duathlete of the Year
This question comes up quite often. In fact, knee pain is a very common issue with many athletes, including runners, basketball players, golfers, tennis players. At this point in the cycling season most cyclists are putting in three to four, and sometimes as many as five rides per week. Typically, one ride per week is a long ride and can range from 100 to 120 km. Higher mileage sometimes leads to aches and pains. These may be the result of general body fatigue, however any pain that persists requires further investigation.
Knee pain felt after a long ride can stem from a variety of causes. When a client complains of this kind of pain, I go through a step by step process to determine what the cause may be. I always start with the easiest, most basic, possibilities and work up to the worst case scenario, which may require additional professional help, tests, and therapy. Below is a list of possible causes for knee pain with suggestions for how to deal with each. Address steps 1 to 3 first. If those don’t fix the problem, go to step 4.
1. STEP 1/CAUSE 1: Check for tightness of the upper leg muscles and hips and hamstrings (back of thighs) and IT Band.
Tightness of the quadriceps (thighs), Iliopsoas (hip flexors) hamstrings (back of the thigh) and the IT Band—a ligament that runs down the side of the leg—can create a huge amount of tension at the knee due to where the quadriceps attach to the patella (knee). Without getting too technical, all of these muscles and ligaments attach to the knee at various locations and will affect its movement and function. High mileage, coupled with insufficient stretching, can result in tight muscles, thus causing knee pain.
Suggestion/Remedy: Implement a rigorous stretching plan of all the various muscles that affect the knee, and see if that alleviates the problem. Include the following stretches:
1. Quadriceps stretch – Stand on one foot, and hold the other foot, gently pulling the foot back. As you do this, resist by pushing the thigh forward to create the stretch on the thigh. This stretch can also be done lying down on your side. Bend one knee and pull the foot of that leg back. Resist by pressing the thigh forward — again to create the stretch on the thigh.
2. Hip flexor stretch – Place a mat on the ground, or lay a towel on the grass after a ride. Kneel on one knee with the other leg bent to form a 90-degree angle. Gently press the hip of the leg you are kneeling on toward the ground. When you have gone as far into the stretch as possible, raise the arm on the same side as that leg straight up to increase the stretch to the front of the hips.
3. IT band stretch – Stand next to a post or railing. Cross your inside leg over your outside leg. Holding onto the post, lean out and away from the post you are holding. Once you are leaning out as far as you can go, move your arm up and over your head to increase the stretch.
4. Hamstring stretch – Rest your foot on a bench and keep the leg as straight as possible. Think of the hips as a hinge. Keeping the back straight, lean forward without rounding the shoulders and upper back. Another way of stretching the hamstrings is to lie on the ground with a towel or flexible tube wrapped around the middle of the foot. Keeping the leg straight, gently pull the leg towards you with the towel/tube until you feel the stretch down the back of the leg.
Do 2 to 3 sets of each stretch, and hold for 20 to 30 seconds.
Try this stretching routine consistently for a few weeks, then reassess your knee pain. If the problem isn’t resolved, go to step 2.
2. STEP 2/CAUSE 2: Check for correct seat height and position. And check the cleat position on your cycling shoes.
Seat height determines how far you need to push the pedal to reach the bottom of the pedal stroke. This not only affects how much your leg works but how much of an angle your knee is at during the pedal stroke. If the angle isn’t right, you may end up with knee pain during or after your ride. A proper seat height allows you to cycle more efficiently, which allows you to generate more power, and ride faster.
If your seat is set too far forward your knee will extend over your foot, resulting in too much pressure being applied to your knee. This can also lead to knee pain during and/or after a ride.
Suggestion/Remedy: Take your bike and shoes into a reputable bike store, or to a professional bike fitter to have your saddle height and position, and cleat position assessed. This doesn’t cost much, and is probably the most important step to take before putting any serious miles on your bike. After the adjustments have been made it will take two to four weeks for your body to adjust to the new position. Take this time to assess how the changes feel before taking your investigations to step 3.
3. STEP 3/CAUSE 3: Check your cadence. If you don’t already have a bike computer or meter on your bike, which monitors cadence (revolutions per minute, or more commonly known as rpm’s) purchase one and install it on your bike to check your pedal speed.
Some cyclists use a lower cadence, pushing a hard gear, which results in grinding, or mashing, the pedals. This pedal technique can work for some very large and powerful riders, but for a lot of cyclists a lower cadence can spell trouble, resulting in a lot of tension and strain on the knees.
Suggestion/Remedy: Using your bike computer, make sure you can see the rpms and begin to adjust your pedal speed to 5 to 10 rpms higher than what you usually do. To do this you’ll have to put the bike into an easier gear. If you consistently see 75 to 80 rpms, work on increasing that to 90 to 95 rpms, and see how your knees feel after about one month.
4. STEP 4/CAUSE 4: If none of the above steps have eliminated your knee pain you may need to seek professional help with a sports medicine doctor.
Knee pain can also be the result of wear and tear on the cartilage in the knee. This degeneration is typically seen in older and more seasoned riders. Cartilage is the tissue that covers the ends of your bones at a joint. Healthy cartilage helps you move by allowing your bones to glide over each other, and it protects bones by preventing them from rubbing against each other. The knee contains four bones: the large femur bone (thigh bone), the round-ball bone of the knee called the patella, and the lower leg bones, the tibia and fibula. Over time, the cartilage over these bones can wear down and lose its ability to protect the bones from grinding against each other, causing inflammation and knee pain as a result.
This is the time to see a professional. A sports medicine doctor will order an MRI (magnetic resonance image) to see if there’s any degeneration of the cartilage. If there is, quite often the pain can be lessened by adapting a combination of the above remedies. Rarely will you have to stop cycling. Instead, with some minor adjustments to your training protocol, such as doing more active recovery rides (easy, low-intensity rides), and getting adequate rest after hard and long rides, you can continue to ride.
If you’re experiencing knee pain, follow the protocol above to see if any of these steps help to alleviate the issue. Ride strong but ride smart!
Diane provides training programs for recreational and competitive cyclists, duathletes and triathletes, including nutritional counseling and personal training. Does your company need a fitness consultant? Get in touch with Diane to discuss fitness seminars for corporations
Check out Diane’s e-programs: Keeping Fit in the Off-Season and Training For a Two-Day Charity Event For the Time-Starved Cyclist.