"DH" <
[email protected]> wrote in message news:<
[email protected]>...
> I appreciate all the responses, but am really interested in knowing (mechanically/biologically)
> what causes the pain when riding a bit too hard or a bit too long.
>
> I believe the bike fits me well. I have a slight to moderate break in my leg when biking and it
> feels natural.
>
Lawrence Preble, D.C. gave a great analysis on knee pain on this list in the past. Let me
quote it here:
>>Here are a few basic suggestions concerning cycling-related knee
pain which you may find helpful. I posted something similar to this on this NG, some time ago;
however, this might be a good time to review some basics in assessing and preventing knee injuries.
Just a second while I take off my helmet and put on my lab coat...There, that's better. The
following information should not be construed as a diagnosis or prescription for anyone's particular
injury and is meant as informational, only. Also, this information did not originate with me but is
widely available from multiple sources.
The knee is the most commonly injured joint in cycling. As injury is generally a problem of overuse,
it is often seen in the cyclist just beginning a training program or early in the training season
when the temptation is to do too much too fast. The most common causes are:
1.) For a wedgie rider, faulty saddle height or for recumbent rider, faulty seat distance.
2.) Pushing excessively high gears
3.) Slow cadence in cold weather
4.) Too much leg work in the gym. (Yes, some of us cyclists do some cross-training, and some
do way too much. I'm guessing this is not your main problem.)
One way to classify knee pain (and identify possible solutions) is to look at the location
of the pain.
Anterior (i.e., front of knee.) Reasons patellar tendonitis patellofemoral syndrome Causes pushing
BIG gears - cadence too low saddle too low or too far forward foot too far forward on the pedal
crank arms too long leg length discrepancy with seat set for shorter leg Possible solutions ride at
75 rpm or higher raise seat (in small increments of less than 5mm) or move seat back move cleat
forward 1 to 2 mm shorten crank arms by 2.5 cm set seat for longer, not shorter, leg with correction
for the shorter leg
Posterior (back of knee) Reasons hamstring/gastrocnemius neurovascular bundle Causes saddle too high
or recumbent seat too far back too much pedal float leg length discrepancy with no correction for
shorter leg Possible solutions lower seat (in small increments) or move seat forward limit float to
6 - 8 degrees set seat for longer, not shorter, leg with correction for the shorter leg
Medial (inner side) Reasons medial collateral ligament pes anserenus Causes cleat position too wide
- foot held internally rotated excessive knee frontal plane motion too little pedal float Possible
solutions narrow foot position by moving cleat outwards orthotic or wedge to correct foot alignment
pedal float should be 6 - 8 degrees
Lateral (outside of knee) Reasons iliotibial band degenerative lateral meniscus Causes cleat
position too narrow - foot held internally rotated too little pedal float excessive knee frontal
plane motion Possible solutions widen foot position by moving cleat towards the bike pedal float
should be 6 - 8 degrees orthotic or wedge to correct foot alignment
Treatment General Issues
These are usually conditions that develop slowly over a number of days and are not emergencies.
Likewise immediate evaluation by an orthopedic specialist is overkill. Immediate care is always
available at a walk in clinics, but it is more productive to see your primary care physician or a
sports medicine physician as the first step.
Dealing with yourself will be the biggest issue. Competitive athletes and overzealous newbies have a
"fear of rest" - and rest is probably the single most effective treatment. Peer pressure to continue
to ride doesn't help.
First Aid Ice, elevation, and resting the knee are all helpful.
Rehabilitation Take a few days off and then begin a limited riding program - cut back mileage by 20
- 30 % and spin at a high rpm and in a low gear for a week or two. And the same goes for leg work
in the gym. Remember, if you push too hard, you just get to start over again. Mild stretching
before and after the ride keep the muscles loose, and icing the knee after the ride may be
beneficial as well.
Drugs Tylenol or NSAIDs such as motrin are a good start. Motrin can be taken up to 800 mg 3 times a
day for a few days, but then drop back to the recommended dose on the bottle. If you have a history
of ulcer problems or develop GI side effects, either switch to tylenol (it helps pain but is not as
good an antiinflamatory) or see your physician for one of the newer Cox-2 medications (Vioxx,
Celebrex) which are much easier on the stomach.
Prevention
a.. Correct biomechanics - follow suggestions above
b.. Consider a complete bike fit
c.. Choose gears that allow a cadence of at least 75 - 80 RPM
d.. Don't make big changes in your training program - increasing mileage by more than 10% a week
is a risk factor for injury as is over zealous interval training.
e.. Keep your legs covered in cold temperatures
