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Best Cyclist Knee Treatment In Delhi NCR.

Cyclist knee treatment at Arunalaya
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What is Cyclist Knee?

The most common site of overuse injury in cyclists of all levels is the knee . This is of no surprise considering the repetitive nature of the sport, with cyclists completing in excess of 10,000 pedal revolutions over a 2 hour ride (at an average cadence of 83rpm). There are various potential causes of cycling related knee pain, making accurate diagnosis and specific early management key to successful outcomes.

Differential Diagnosis
  • Anterior knee pain:
    • Patellofemoral related pain
    • Patella tendinopathy
    • Quadriceps tendinopathy
    • Infrapatellar fat pad impingement
  • Medial knee pain:
    • Pes anserine bursitis
    • Medial patellofemoral ligament (MPFL) strain
    • Medial plica syndrome
    • MCL bursitis
  • Posterior knee pain:
    • Distal hamstring tendinopathy (medially: semimembranosus, laterally: biceps femoris)
    • Strain to posterior knee joint capsule
  • Lateral knee pain:
    • ITB syndrome
    • Here we will take a deeper look into Patellofemoral related pain and ITB syndrome.
  • Patellofemoral Pain (PFP) is a major cause of knee complaints.
    • PFP leads to significant training time loss in professional cyclists.
    • PFP, also known as anterior knee pain, is a general term for pain around or behind the kneecap.
  • Potential sources of pain include:
    • Patella retinaculum
    • Synovial lining and bursa
    • Subchondral bone (most likely implicated)
  • Other factors contributing to knee pain from cycling:
    • Bicycle misalignment
    • Lack of conditioning
    • Inappropriate saddle-to-pedal distance
    • Patellofemoral Pain Syndrome (overuse)
    • Patella malalignment
The pain ranges from mild to moderate

If a cyclist is experiencing pain in the knee, then the cycling activity should be stopped immediately and a break should be taken. “Stretching of muscles around the knee joint should be done and if the pain persists then a physiotherapist should be consulted who will evaluate and prescribe the plan of action for decreasing the knee pain.

Causes
  • Tight Hips/Glutes
    • As the leg goes near top stroke, the knee drifts to the side pulled by a tight hip
  • Tight IT Band/Weak Inner Thigh
    • A tight IT band will pull the knee out to the side as well and many runners have weak inner thighs from only forward movement, so they can’t counteract the pull.
  • Weak Glutes
    • The body will compensate with power from the quads, which again loads the knee.
  • Toe Pedaling (Running on Your Toes)
    • Places the knee in flexion throughout the stroke. While running on your toes will also lead to calf pain that can help you stop, it’s often harder to notice you’re doing it while biking.
  • Seat Position
    • Both too low or too forward will cause issues for the knee {proper bike fitting resolves}. Should be a 25° to 30° flexion in the knee when the pedal is at the bottom-most point
  • Overtraining
    • Much like running, overtraining while cycling can cause knee pain. Remember to gradually increase your cycling mileage to ensure you stay injury-free.
Clinical Presentation
  • Insidious Onset: Gradual development of vague anterior knee pain, around or deep to the kneecap.
  • Aggravating Activities: Activities increasing patellofemoral joint compression exacerbate symptoms.
    • Examples: Decline squats, descending stairs.
  • Pain Progression: May evolve into sharp pain during the down or power phase of the pedal stroke.
  • Typical Findings:
    • Rarely presents with swelling, giving way, or loss of ROM.
    • Possible crepitus (grinding) under the patella during loaded knee movements.
  • Training History: Often preceded by a substantial increase in training volume, including hill climbing.
Biomechanical Factors

A. Patellofemoral Joint (PFJ) Compression Forces

  • Patella’s Role: The patella acts as a pulley, transmitting quadriceps extension forces to the patellar tendon.
  • Force Vector: Results in compressive force, pulling the patella against the femur in the intercondylar groove.
  • Flexion Impact: Compressive force magnitude increases with knee flexion (decreasing angle between quadriceps and patellar tendons).
  • Surface Contact Area:
    • Contact area between femur and patella increases between 30-90 degrees of knee flexion.
    • Improved joint congruency distributes compressive forces over a larger area.
  • Balance of Forces: Increased compression in flexion can be mitigated by increased surface contact, influencing actual PF joint pressures.

B. Frontal Plane Medial Knee Projection (Dynamic Valgus)

  • Mechanism: Medial knee motion during cycling can cause lateralization of the patella, increasing loading on the lateral PF joint.
  • Research Findings: Cyclists with knee pain often exhibit more medial knee positioning compared to uninjured cyclists.
  • Correction Strategy: Adjustments at the foot-pedal interface (cleat/insole wedging) can correct medial knee projection and improve symptoms. (Mechanism explained under bike-fit).

C. Rotational Forces (Torque) at the Knee

  • Fixed Foot Position: Fixing the foot onto the pedal can increase rotational forces at the knee joint.
    • Historical Context: Prior to clipless pedals, the foot could move freely, allowing neutral foot positioning and reduced torque.
    • Clipless Pedal Issues: Fixing the foot in an unnatural position transfers rotation up the kinetic chain to the knee.
    • Floating Pedals Solution:
      • Allow some degree of axial rotation.
      • Studies show reduced moments at the foot-pedal interface (without compromising power transmission).
      • Theoretically reduces torque at the knee joint.
    • Cleat Positioning: Sub-optimal cleat positioning is often the root cause, rather than simply fixing the foot.
    • Practicality: Achieving perfect cleat position can be difficult without a professional bike fit, making floating pedals a popular choice
Management
  • Reduce training volume to allow the irritated fat pad to settle.
  • In mild cases, continue riding at lower intensities, stopping before pain onset.
  • Triathletes: Reduce running volume and avoid running on cambers or downhill.
  • Engage in cross-training activities like swimming during the acute stage.
  • Address causative strength deficits.
  • Icing may provide temporary pain relief but doesn’t address the root cause.

Bike Setup:

  • Reduce saddle height to ensure knee flexion is approximately 40 degrees at maximal knee extension.
  • Position cleats to align feet in their natural position (straight or slightly turned outwards).
  • Consider a medial wedge under the cleat to minimize hip adduction.
  • Adjust Q factor to ensure neutral alignment of hips, knees, and ankles.

Strengthening:

  • Address hip abductor and external rotator weakness with progressive resistance training.
  • Strengthen the entire kinetic chain (quadriceps, calf, and hamstring).

Example Exercises:

  • Early Stage:
    • Side plank top leg abduction
    • Crab walk
    • Standing fire-hydrants
    • Cable hip abduction
  • Mid Stage:
    • Lateral step up (small step)
    • Box step up
    • Star excursion balance
    • Single leg hip thrust
  • Late Stage:
    • Curtsy step up
    • Curtsy lunge
    • Rearfoot elevated squat
Advanced Physiotherapy
  • Myofascial Release
  • IASTM
  • 3D Manual therapy
  • Conventional Therapies
    • TENS
    • IFT
    • Ultrasound
  • LASER
  •  Shockwave therapy
  •  Wireless
  • ART(Active Release Therapy)
  • PRT (Positional Release Therapy)
  • Dry Needling
  • Kinesiology Taping

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