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Five tips to prevent knee pain

Editor’s note: This article was originally published in the May 2013 issue of Velo magazine.

As soon as the snow begins to melt, many of us find ourselves increasing both our intensity and volume on the bike. Knee injuries are so common in the spring that one type of patellar tendinitis has even been nicknamed “spring knee.” Yet unlike running, cycling is very low-impact, so much so that it’s often used for rehabilitation in other sports. Why, then, do we still get knee injuries? The answer lies in the remarkably adaptable nature of the human musculature.

Doing bicep curls would lead you to believe that a single muscle bends each joint, but that’s not the case. In your leg, a surprisingly large number of muscles would have to be removed before you completely lose the ability to extend your knee. Having multiple muscles allows some muscles to do the strength work, such as the rectus femoris, while others provide stability, such as the vastus medialis. If one muscle becomes weak, tight, or neurologically inhibited, the others can take over its job. This versatility allows us to keep functioning.

The problem is that this new recruitment pattern may not be optimal, and at 5,400 pedal revolutions per hour, it adds up, leading to neurological reprogramming, learned muscle imbalance, and, ultimately, injury.

For example, a weak gluteus medius (a muscle that provides stability in single-legged exercises) causes the iliotibial (IT) band to take up more stability work. Over time, the IT band gets tight and forces the patella to track incorrectly, causing tendinitis. The list goes on.

“Your quads being too tight from riding can lead to patellar femoral syndrome, where your patella actually gets ground into your femur,” said massage therapist Nick Cowan, who has traveled with the Garmin and UnitedHealthcare pro teams.

Muscle imbalance due to poor recruitment patterns is at the heart of most cycling knee injuries and is caused by three things: muscle weakness, tightness, or bad position. Surprisingly, it normally starts with unstable hips. The vastus medialis (in your quads) and gluteus medius (in your butt) are the biggest culprits in knee pain.

To keep your knees happy and healthy, here are five things you can do.

Get a good bike fit

A bad position on the bike ensures poor muscle firing patterns and increased strain on joints. The first thing you should do to increase the longevity of your knees is to find a certified fit specialist. Scientifically based fit systems such as BG Fit and Retül can keep your knees working for a long time. The goal is a neutral knee position, according to Boulder Center for Sports Medicine’s biomechanist Charles Van Atta. He finds that improperly tracking knees are often due to poor foot support and a weak gluteus medius.

Stretching and functional work

Just going into the weight room and squatting huge weights won’t necessarily protect your knees or solve imbalances. In some cases, it will only help strengthen muscles that are already being recruited inappropriately. Functional training that focuses on keeping muscles activated, stable, and loose can be more important for injury-free cycling. I recommend athletes spend 10 to 20 percent of their training time doing stretching, activation, and stability work.

Foam rolling and massage

Foam rolling is one of the best things you can do for knee health, according to Cowan. “I’ll guide clients to do some foam rolling on everything — gluteals, hamstrings, quadriceps, and calves,” he said. “Basically to take the tension off the knee and all the muscle insertions that cross the knee.”

Wear leg warmers

“I really encourage people to keep their ligaments warm,” Cowan said. “Anything below 60 degrees, I say leg warmers. 60 to 65 degrees, I say knee warmers.”

Ease in and spin

Ramp up your volume slowly in the base season and spin a higher cadence. Big gear riding can put a large strain on the patella. And remember, climbing is essentially big gear work.

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