This article was originally written for Wings of Steel – a blog created and maintained by Karley Cunningham, a cycling woman of steel!

Did you know that knee pain (or patello-femoral pain) accounts for one quarter of all cycling problems?

While cycling can provide an amazing workout without the repetitive high-impact forces (like those associated with running), it is in fact associated with a great number of overuse injuries. Patello-femoral syndrome, which is the most common cycling injury, accounts for around 25% of all cycling related complaints.

Biomechanical irregularity of the knee joint, along with demanding training, are believed to be responsible for most cases of chronic knee pain in cyclists. These irregularities are believed to put excessive pressure on the cartilage within the knee during the constant knee flexion and extension associated with cycling.

This produces degeneration of the knee cartilage and other structures. As the cartilage degenerates, more stress is put on the bones as they compress, producing pain and inflammation.

Why do people develop biomechanical problems with their knees? Explanations abound, including weak quadriceps (most notably the vastus medialis oblique), over-pronating arches, poor flexibility, genetic structural problems, improper bike set-up or poor equipment.

Training aspects that could aggravate the knees include excessive hill training, riding slowly in high gear and a sudden increase in training volume. Interestingly, research has shown that most cyclists with knee pain have too much side-to-side swinging of their knees during the down-stroke of their pedal cycle.

Usually, people will feel pain in the front and inside of the knee, which is hard to pinpoint. Often people will say it is inside the knee, or under the kneecap. Activities that can worsen the pain include walking up and down stairs, sitting for prolonged periods of time, squatting and of course riding.

If you’re a cyclist who develops knee pain, your first line of defense should be the familiar RICE – rest, ice, compression and elevation. Most cyclists with knee pain will find that this relieves the symptoms quite quickly.

It is important to note that this self-therapy will only serve to reduce the symptoms, but will not resolve the biomechanical problem that is causing the pain. Therefore, the pain will return when you go back to your regular training.

Your ultimate goal is to improve your joint motion, flexibility and strength. The quadriceps muscles need to be strengthened, abnormal biomechanics of the lower limb need to be identified and corrected, and training errors need to be rectified.

When introducing hill training or when increasing your training volume, be sure to do so in a gradual and measured manner. You may also add in some spinning, or cycling at low gears in order to maintain volume while minimizing stress on the knees.

If you are unsure of the source of your knee pain, or are unable to manage the condition on your own, consult your Comox Valley Chiropractor. A chiropractic doctor can diagnose a specific cause of your pain, provide treatment to manage the condition, and prescribe sport specific and injury specific rehabilitation exercises.