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TRIA Orthopaedic Center Your Cycling Blog

Ask the TRIA Orthopaedic Surgeon

June 4, 2010

Most of the pain in cycling is located on the upper body. Wrists, hands, neck and back are the main culprits for bike-related pain, but the lower extremities are no strangers to pain, either. Knees are a touchy subject, as any slight biomechanical imperfection can cause major pain, as well as the four words that anger cyclists the most: stay off your bike. Michelle Gorman McNerney, M.D., CAQ Sports Medicine is going to address this week’s question: What should I do if the pain while cycling is behind my knees:

While cycling is a great exercise for cardiovascular fitness and large muscle strengthening, there are certain muscles that get neglected when we’re pounding out the hilly terrain. Cyclists, and triathletes for that matter, tend to target their straight ahead muscles, the hamstrings and the quadriceps, with their exercise programs. Many of the stabilizing muscles like the gluteus muscles get neglected with this training. That tends to limit the control you have in the thigh bone when you’re up out of the saddle and the knee cap tends to shift around (like a train off its tracks), causing pain and stiffness.

Pain and stiffness behind the knee can be noted during activities like cycling and running, but the activity can be pain-free with some athletes only noting symptoms after a ride. Interestingly, some of this pain may be detected even with day to day activities and on days where you didn’t even work out or are just sitting at your desk. It is actually common to have pain when sitting for a prolonged period of time with the knee in flexion. It is also common to note this with going up or down stairs.

A cyclist will always want to make sure they are having no swelling in or around the knee. The knee should not be catching or locking into place or feeling unstable (like giving way with walking). If none of those symptoms are occurring, it is safe to try and strengthen some of the stability muscles in the belly, back, and butt to help take some of the stress off your knees when you ride. Some target muscles to think about strengthening are the gluteus maximus and gluteus medius. Also, regularly using the transversus abdominis (not the beach muscles), a core stabilizer of the torso, will contribute to more stable lower extremities. Hip adductors are also a very important and often overlooked muscle group. A few visits with a good (sports) physical therapist is helpful to get on the right track and make sure you are activating the correct muscles and not wasting your time. It may be also worth a visit to your friendly sports physician to make sure there is nothing more significant going on!


Ask the TRIA Orthopaedic Surgeon

May 14, 2010

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.