TRIA Orthopaedic Center Your Cycling Blog

Depending on the stability of our joints, and the ligaments and cartilage enveloping said joints, noises might occur during a variety of exercises. Relatively impact-free, cycling can elicit some clicking or popping in the knee joints when harder efforts (read: gears) are performed, as well as when the knees are fully extended in the pedal stroke when standing up and out of the saddle to climb or bridge a gap. The real question is: should we be worried about that sound or sensation?

For the answer, we asked asked Dr. Fernando Pena, M.D., an orthopaedic surgeon with the TRIA Orthopaedic Center, whose specialties include foot and ankle issues, reconstruction, and sports medicine. Here’s what he thinks about the uncommon sounds and feelings of harder efforts or climbing out of the saddle:

For the most part, clicks, clonks and pops of any joint, as long as they are pain free, should not be a reason for concern. If the noises are associated with some pain or locking, then you should be evaluated by a physician or physical therapist. When it comes to the knee, you could have a torn meniscus (internal cartilage of the joint) that is getting caught or pinched when you bend the knee.  The definitive solution/answer to a problem like this would be to have an arthroscopic (small incisions and looking inside the joint with a little camera and instruments) intervention of the knee.

The only painful noises not to be concerned about are the ones coming from the front of the knee under the kneecap. Cycling, by design, is one of the healthiest sports for the knee cap joint. Appropriate seat height adjustment is critical to help eliminate knee noises and mild discomfort of the front of the knee.

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During our rides, the heat tends to get to us. Sometimes, it’s an environmental issue. Other times, it’s the bottom of our feet that get hot, but it may or may not be due to the ambient temperature. It could be another issue altogether.

For this answer, we asked again asked Dr. Fernando Pena, M.D., an orthopaedic surgeon with the TRIA Orthopaedic Center, whose specialties include foot and ankle issues, reconstruction, and sports medicine. Here’s what he thinks about the cycling “hot spots:”

The commonly known “hot spots” are foot blisters or at a minimum, early stages of a blister. The reason why a blister takes place is because of the separation between the different layers of the skin. The separation creates damage to the skin and fluid leaks into it by loosing the ability to contain or seal the water inside our body.

The reasons to create that type of damage are many but for the most part all of them follow the same principle; having the skin moving back and forth against the shoe instead of being static. The skin on our feet is very mobile. You can put your finger on it and move the skin almost on any direction while your finger is on it. If from previous injuries or surgeries a scar is developed, the skin will be scarred down to the bone and therefore the ability of the skin to move back and forth is more limited.

Given proper time and a well planned progressive increase in activities, a blister will transform into a callus and remain as such until the activity is stopped. Calluses don’t represent any increased damage to the skin by themselves, but they may still be painful.

A good fitting shoe is mandatory to prevent this type of injuries. If the same spot continues being a problem, try to protect the painful spot by applying some protection to the area (foam or felt donuts) that you can hold in place with athletic tape.

If the “hot spots” are over the bottom of the foot, likely you will need some type of shoe insert to make the pressure over the ball of your foot more even and decrease the increased stress over that portion of the skin.

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Today, we have another hot-button issue for our TRIA surgeons and sports medicine specialists to chew on: to clip in or not to clip in.

We all tried out the toe-strap and gym shoe combination when we first began cycling.

They were easy and you could wear your normal gym shoes. It made riding and commuting a breeze!

If you’re one of the lucky (and coordinated) few who went straight to the clip-less pedal option, then you more than likely fell at many an intersection or stop sign before you mastered the art of rotating your heels in the opposite direction to free yourself from the binding below.

Why the options? Is one more efficient than the other? It’s an obvious technological advancement, but can it aid both biomechanically and physiologically? For this answer, we asked Dr. Fernando Pena, M.D., an orthopaedic surgeon, whose specialties include foot and ankle issues, reconstruction, and sports medicine. Here’s what he thinks about toe clips and clip-less pedals:

The recreational rider will do well with pedal cages and gym shoes. There will be very little benefit to the financial investment of going to clip-on pedals and shoes. Just make sure they both (shoes and cages) fit you well. A comfortable shoe to go walking may not feel that comfortable after a while of pedaling, as the forces across the ball of your foot are higher. If the shoe is not wide enough, you may experience some numbness of the foot. Be careful with not taking chances for an accident. In case of a need for a rapid dismount, the cages may keep you from separating from the bicycle quick enough and you may suffer more injuries than you anticipated based on the speed at the time of the crash.

If you are planning to move it one level up, clips are always beneficial. The most obvious one is that they allow you to use your hamstrings, back of your thigh muscles, to carry up the pedal, so you fire your quads on the way down and your hamstrings on the way up for that pedal. Another added benefit is to keep your feet straight instead of pointing in or out. That will decrease the chances for any knee cap problems (pain, swelling, tendinitis) once the mileage is increased. The only clear down side is the financial investment. If you use orthotics (shoe inserts) make sure you will be able to fit them into your riding shoes. You may even need to go for an specific pair just for your riding shoes, given their unique width. Similarly, dismounting from a bike with clips, takes time and practice to do it safely and quickly. Be careful those few first times out…

We hope you enjoyed Dr. Pena’s response! It took us all a while to figure out how to clip in and out and still stay upright, so don’t fret! All it takes is an empty parking lot, some spare time, and a lot of patience!

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