Ask the physio
Sports injury maestro Sam Mak takes a deep dive into knee pain and S&C
I get pain in my knees during cycling. What could be the cause?
There are several possible diagnoses, so always consult a professional for the best results. However, the two common symptoms we see are:
Anterior knee pain – pain at the front of the knee, usually caused by overloading in the patellar tendon, known as patellar tendinopathy. This tendon attaches the quadriceps to the front of the knee. During pedalling, the quads activate to extend the knee. With repeated use, the tendon can get irritable. Here are the possible fixes:
Fix: Reduce your load. This doesn’t mean stop! Try reducing your duration, inclines or speed by 20 per cent to start. Monitor how this affects your symptoms and adjust again if necessary. Then gradually build things back up. Tendinopathies usually occur when there is a sudden increase in intensity.
Fix: Strengthen your quads, especially the VMO. Slow squats on a decline board are best. Moderate pain during these exercises is normal, but it shouldn’t be excruciating. Speak to a professional for the correct advice.
Fix: Look at your position, unnecessary load on your knee and patellar tendon through poor saddle positioning can cause pain, usually when the seat is too low.
Posterior knee pain – likely to be a hamstring tendinopathy. Hamstrings are used during the upstroke of pedalling and often can get overloaded when the saddle is too high. Here are the possible fixes:
Fix: Check your saddle height and fore aft positioning to optimise cycling position and pedal stroke. Again, reduce your intensity of rides until symptoms improve.
Fix: Strengthen. Look at performing some eccentric hamstring exercises such as hamstring bridges, Nordic curls, or deadlifts.
What strength and conditioning should I be doing to help performance?
Depending on your training goals, decide what aspects of fitness you need and tailor your conditioning programme accordingly. Base level of fitness, daily lifestyle activities and recovery periods should also be factored in. Some general guidelines:
For strength: Quadriceps, hamstrings, glutes and core are probably the most important areas to target. Use weights or resistance and try a variety of exercises such as Bulgarian split squats, lunges, deadlifts, single-leg hip thrusts, planks and supermans. Repetitions should be based on maximum effort and determines which aspect of strength is targeted. As a general rule:
Under six-rep max = Strength
Six to 12 reps = Hypertrophy
10 to 20 reps = Endurance
For mobility: Bear in mind that cycling only uses about 40 degrees of hip and knee range of movement, meaning we increase the risk of reducing mobility around these joints. Instead of just stretching, look at exercising with resistance through a larger range of movement. Some of the exercises mentioned above will help. Activities such as pilates and yoga can also be beneficial.
For recovery: This is as important as actually exercising. Sufficient recovery is vital to enable your body to get stronger. Lack of sleep negatively affects your nervous system, mood and increases injury risk. Aim for seven to eight hours of sleep a night and ensure you have enough recovery between workouts.
What’s your advice on setting up a saddle?
First up, seat height. Too high and it reduces power as the lower limb works beyond its optimum range. Excess stress is placed on the hamstrings and can also cause pelvic instability. A seat too low increases knee flexion during pedalling, adding excess load to the patellar tendon.
A rough guide is to measure your inseam. Stand with your feet six to eight inches apart, put a book snugly against the top of the crotch and measure from the top of the book to the floor. Multiply this number by 0.88 to find your saddle height (measured from the saddle to the centre of the bottom bracket).
Next, saddle fore aft positioning, crank length, cleat positioning and reach are other factors worth considering. Because everyone has unique riding styles and biomechanics, see a specialist for optimum results.
What’s causing the numbness in my fourth and little finger when I ride?
This is known as cyclist’s palsy or carpal tunnel syndrome. This occurs when the ulnar nerve is compressed and irritated in the wrist. Cyclists often rest their hands on the hoods in an extended wrist position for long periods of time, which compresses and stretches the nerve.
To fix it, reduce the pressure on the wrist through the handlebars. Try changing handlebar positions regularly, using cycling gloves and padded handlebars. Consider fitting aerobars so that you can change wrist positions during longer rides. Also look at your cycling posture and technique. Inefficient cycling posture can cause you to put more pressure through the handlebars and your upper body.