Knee injury prevention in cycling

Getting hurt is just silly.  We should do that less.

Cyclists are a bit prone to a couple of common injuries, but for this entry we are going to chat about knees.  Us cyclists, and our knees, are predisposed to a few things getting too tight as well as one thing that is usually a bit weak.  Let’s break that down…

The weak stuff:

Weakness in your hip flexors is not only embarrassing at party’s, it also predisposes you to overusing another pesky muscle group call your quads.  Too much quads = knee pain.  Lovely as they may be to look at, excessive and imbalanced quad use causes your knee cap to get smooshed quite aggressively into the bones below.

From that picture, the kneecap is the circular bone in the middle.  See that stringy stuff above and below it?  That’s your quadriceps tendon.  When the knee is bent, and the quads pull, the kneecap gets pulled over the angle of the knee and into the surface below.  Do that for 100 miles and your knee will be telling you things – rather rude things. 

The fix:

You use your quads while cycling to push DOWN on the pedal.  I want you to stop that.  Instead of pushing down, think of pulling UP on the pedal during the upward stroke motion (this assumes you have clipped in shoes).  To accomplish this you’ll need nice strong hip flexors and knee flexors.  Practicing this kind of pedal strokes makes them stronger.  Know the nice thing about strong hip and knee flexors?  They don’t hurt your knees!  And that is a win! J

The recommendation:

Challenge yourself to PULL UP on the pedal stroke instead of pushing down.  And yes, especially when climbing a hill!

The tight stuff:

Repeat after me: “I promise to do all I can to keep my TFL and ITB loose.  I will do what Dr. Chad tells me because I know it is good for me.  If I don’t do this, I will donate $5,000 to my own rider fundraiser page to teach myself a good lesson.”  Got it?

What the what is a TFL and an ITB? 

TFL: Tensor fascia lata

ITB: Iliotibial band

See those two juicy little morsels on the picture above?  Now look at where those morsels attach…  Your KNEE!

More specifically, the lateral side of your knee.  Wonder what happens when those two things get too tight?  You guessed it, your knees get grumpy.  Super grumpy.  Tightness here causes a condition called a laterally tracking patella.  Next time you are bored (which is clearly now as you are reading my writing), Google that phrase and see the goods.

The fix:Many of you might already be rolling out your ITB on a foam roller.  Go you!  If you haven’t, Google search “IT Band foam rolling” and you’ll feast your eyes on the magical experience that it truly is.  Do this…really.

The other fix that fewer of us do is give “love” to our TFL.  It’s a tricky little dude and cannot be adequately loved on with a foam roller.  The muscle is too small and a foam roller is too large.  You need something smaller and more dense to get the TFL.  Your options include lacrosse balls, rubber balls, golf balls for the sadists among us, or my offensively boney elbow. 

The recommendation:

Give yourself a deep “massage” on your IT Band with a foam roller as well as a massage to your TFL with a nice hard ball (lacrosse ball is the best in my opinion).  Do this for 2 minutes on each leg before you ride and 2 minutes after.  Yes, I’m serious.

The fine print:

The above recommendation comes with a bit of needed forewarning: it freakin’ hurts.  Foam rolling and pancaking your TFL feel like many shades of horrible.  I know it does – I get paid money to do it to people!

Just keep this in mind: the more it hurts the more necessary it is to achieve optimal balance.  It’s only 2 minutes, and it can save your ride.

The wrap up:

That’s enough to start for now.  Cycling can be awesome – knee pain, less so.  Many of the riders my team and I treat during BRAKING AIDS® Ride are seeing us because of knee pain.  Most of them would need us less with the above information.  And yes, me telling you this information makes me the worst businessperson of all time.  Nonetheless, I’d rather see you on the road than on my table.  It’s a better look for you!

In summary, do this every time you ride:

-2 minutes of loving torture to your ITB and TFL

-when riding, PULL on those pedals like you’re getting paid for it

-2 minutes of well-earned ITB/TFL work afterwards

Go out.  Ride that bike.  Smile.  Remember why you’re doing this. 

And if your knees get grumpy, my team at Symbio is ready for you, elbows and all…

—Dr. Chad Woodard, PT, DPT, OCS, SCS, CSCS -