"Ravi Raman" <
[email protected]> wrote in message
news:[email protected]...
> I developed a pain around the top-inside of the knee ...
I am fairly frequently contacted by cyclists with knee pain. Frequently enough that I have composed
the note below as a response.
--
Mike Murray MD
About the only knee problems seen with any frequency in cyclists are Patello-Femoral syndromes, i.e.
things related to the knee cap mechanism and the joint between the knee cap and the femur. There are
several different entities which can cause this; patellar or quadriceps tendonitis, chondromalacia,
patellar instability, etc. The tendonitis problems are caused by strain and subsequent inflammation
on the attachment between the tendon and the bone. Chondromalacia is a problem with developing
irregularities under the knee cap in the patello-femoral joint. Pretty common problem for bike
riders. Patients often notice a clicking or catching when extending the knee from a flexed position.
For all these problems the pain is in the anterior portion of the knee, around the knee cap. They
will all get worse if there is increased force applied by the quadriceps, particularly if this
occurs while the knee is in a more flexed position. Climbing stairs or ladders causes more problem,
as does riding up hill or in higher gears.
In general for all anterior knee pain problems and cycling the approach is the same; heat before and
ice after riding, NSAIDs (ibuprofen, et. al.), keeping knees warm while riding, lower gears,
standing occasionally rather than sitting and grinding. For positioning you want to raise the saddle
and put it further back. It can also help to use a shorter crank. These positions make it so there
is less flex in the knee at the top of the stroke (during max quadriceps contraction) and therefore
less force against the patello-femoral mechanism. Avoiding hills and using lower gears is also a
good idea. Standing, rather than sitting and grinding, on hills is probably better. This decreases
the force across the patello-femoral mechanism.
Stretching the opposing (hamstring) muscles may decreased force a bit. Use of a knee sleeve or
infra-patellar strap may limit the excursion of the patella or move forces away from the
attachment of the tendon to the patella and help somewhat. Exercises are often recommended but I
suspect that they are probably more useful in the non-athletic population and/or those with
patellar instability issues.
Beyond this there really isn't much info. Unfortunately there are not many orthopedists that have
much experience with problems seen in cyclists, in part because the number of injured cyclists is
pretty small.
There is a reasonable article at:
http://www.aafp.org/afp/991101ap/2012.html
Posterior knee pain is usually a sign of inflammation inside the joint and possibly a development of
a Baker's cyst (an extension of the knee joint capsule into the "knee pit"). The other alternative
is tendonitis of the hamstrings, which is fairly uncommon. Hamstrings tendonitis should be treated
by lowering the saddle, using lower gears, keeping the legs warm, etc. Baker's cysts need to be
addressed by looking at the underlying problem, often a cartilage tear obtained in another sport.
