By Theresa Delvo, Physical Therapist
Director of Therapy, Midwest Rehab at OCI
The snow has melted, the temperatures are rising and many of us are ready to get on our bikes and go for a long ride. Whether you’re an experienced cyclist, or just going out for a leisurely ride, below are a few hints in preventing injuries while riding.
- Keep a controlled but relaxed grip of the handlebars.
- Change your hand position on the handlebars frequently for upper body comfort.
- When pedaling, your knee should be slightly bent at the bottom of the pedal stroke.
- Avoid rocking your hips while pedaling
Patellofemoral pain syndrome (PFPS)
One of the most common types of injuries particularly among athletes, active teenagers, and older adults is Patellofemoral pain syndrome (PFPS), which refers to pain at the front of the knee, in and around the kneecap or patella. It often occurs in people who are physically active or who have suddenly increased their level of activity, especially when that activity involves repeated knee motion– running, stair climbing, squatting, and cycling.
Patellofemoral pain affects more women than men and accounts for 20%-25% of all reported knee pain. Current research indicates the PFPS is an “overuse syndrome,” which means that it may result from repetitive or excessive use of the knee. Other contributing causes may include weakness, tightness, or stiffness in the muscles around the knee and/or an abnormality in the way the lower leg lines up with the hip, knee, and foot.
These conditions can interfere with the ability of the patella to glide smoothly on the femur (the bone that connects the knee to the hip) during movement. The friction between the under-surface of the patella and the femur causes the pain and irritation commonly seen in PFPS. Usually, patellofemoral pain is worse when you walk up or down hills or stairs and on uneven surfaces. This pain tends to increase with activity and improve with rest.
Anterior (Front) Knee Pain: Possible causes are having a seat or saddle that is too low, pedaling at a low cadence (speed), using your quadriceps muscles too much in pedaling, misaligned bicycle cleat for those who use clipless pedals, and muscle imbalance in your legs (strong quadriceps and weak hamstrings).
- Neck Pain: Possible causes include poor handlebar or saddle position. A poorly placed handlebar might be too low, at too great a reach, or at too short a reach. A saddle with excessive downward tilt can be a source of neck pain.
- Lower Back Pain: Possible causes include inflexible hamstrings, low cadence, using your quadriceps muscles too much in pedaling, poor back strength, and too-long or too-low handlebars.
- Hamstring Tendinitis: Possible causes are inflexible hamstrings, high saddle, misaligned bicycle cleat, and poor hamstring strength.
- Hand Numbness or Pain: Possible causes are short-reach handlebars, poorly placed brake levers, and a downward tilt of the saddle.
- Foot Numbness or Pain: Possible causes are using quadriceps muscles too much in pedaling, low cadence, faulty foot mechanics, and misaligned bicycle cleat.
- Iliotibial Band Syndrome (ITBS): Possible causes are too-high saddle, leg length difference, and misaligned bicycle cleat for those who use clipless pedals.
How a Physical Therapist Can Help
Your physical therapist will perform a series of tests to evaluate the knee, check flexibility of the muscles in your leg, observe the alignment of your feet, analyze your walking patterns and test the strength of your hip, thigh and core muscles to find out if there is a weakness or imbalance that might be contributing to your pain. After performing a series of tests to evaluate the knee, your PT will analyze, and prescribe an exercise program just for you.
Your individual program may include:
- Strengthening exercises targeted at the hip (specifically, the abductor and rotator muscles of the buttock and thigh), the knee (specifically, the quadriceps femoris muscle, which is located on the front of your thigh and straightens your knee), the ankle and core.
- Stretching exercises for the muscles of the hip, knee, and ankle.
- Taping of the patella to reduce pain and retrain muscles to work efficiently.
- Exercises for improving your performance of activities that have become difficult for you.
- If the alignment and position of your foot and arch appear to be contributing to your knee pain, they may suggest a special shoe insert called an orthosis. The orthosis can decrease the stress to your knee caused by excessive rotation or impact during walking and running.
- Recommend that you apply ice or heat for relief
Your physical therapist will work with you to help you stay active and maintain your fitness level. You may need to modify your activity level or change your training activities until you recover; your therapist will show you how to do activities and exercises that will not increase your pain. Most importantly, your therapist can make recommendations to help prevent PFPS from returning.
If you have any questions about the information in this article or would like to talk with a therapist about your exercise routine, we can help. Call Midwest Rehab today to set up a consultation: (217) 547-9108.