Physiotherapy & you Sports injuries Knee pain bike
Knee pain bike
Avoiding knee pain
Cycling? Knee pain? A common complaint amongst cyclists is Iliotibial Band Friction Syndrome (ITB). Physiotherapist Catherine McLean, discusses the causes and prevalence of ITB.
The knee is probably the second most injured part of the body, of which most injuries are sports related. Due to the repetitive nature of cycling (compared with sports like football that involve direction changes), cyclists are more likely to experience iliotibial band (ITB) friction syndrome. During one hour of cycling, a rider may average up to 5000 pedal revolutions. The smallest amount of malalignment, whether anatomical or equipment related, can lead to dysfunction, impaired performance and pain.
What is ITB Friction Syndrome
The ITB is a thick fibrous band that runs on the outside of the leg from the hip to below the knee. With ITB friction syndrome, you will feel the pain either just above the outside of the knee or where the tendon attaches to the bone, just below the knee joint.
Pain usually starts as an intermittent niggle, sharp in nature and very focal. If this pain is ignored, it can develop into a dull ache even when you are not cycling. You may also notice a decrease in pedal power. The pain is a result of the ITB running across the bony prominence every time you pedal, hence the name ‘friction syndrome.’
If you notice ITB pain, immediately ice the knee and begin gentle hip and hamstring stretches. It is important to see your physiotherapist as soon as possible — as it may be necessary to stop cycling — seek appropriate treatment and determine the cause of the pain.
How is it caused?
The two main causes of ITB friction syndrome are inappropriate training and abnormal biomechanics, both of which cause extra stress on the ITB.
Saddle position
Check your bike setup, especially saddle height. Too high a saddle will increase knee extension and irritate the ITB. If the saddle is too far back, having to reach further for the pedal will also stretch the ITB and possibly lead to irritation.
A simple method of determining correct saddle height is to have the saddle adjusted so that with the pedal at the bottom of the stroke (six o’clock position), you can rest the heel on the pedal while sitting. The knee is adjusted so that the knee is bent between zero and 15 degrees.
Foot position
Foot position on the pedal is also important. Whether using cleats or toe straps, ensure the heel is neither rotating too far — in or out — which in turn varies the knee position. An ideal position is such that the heel is kept in line with the lower leg through a whole pedal stroke.
Gear choice
One of the most frequently seen causes of overuse knee injuries on the bike, such as ITB friction syndrome, is riding in too high a gear. The optimal cadence for cycling is about 85 revolutions per minute, on the flat with minimal wind resistance. You should adjust your gears accordingly to achieve this cadence. On hills, choose a gear that will get you to the top with the least effort to minimise stress on the knees.
Anatomical factors
There are also anatomical factors which may contribute to ITB friction syndrome, such as leg length discrepancy, a wide pelvis, tibial rotation, and leg inflexibility. These factors would be identified by your physiotherapist on assessment.
Footwear
Footwear can also affect your knees on a bicycle, especially if you have pronated feet (‘flat feet’). An ideal bicycle shoe is more rigid than a running shoe and I would strongly advise a regular cyclist to invest in a good pair of cycle shoes. I know from experience, that when I wore my running shoes cycling, having forgotten to bring my clip-in cycle shoes, I experienced pain in the arches of my feet when climbing and when using the higher gears. This could, in turn, lead to variations in the position of the knee during a pedal cycle and hence, ITB pain.
So, check your bike setup at your local bike shop, check your footwear, stretch, stretch, stretch and see your physiotherapist if you experience ITB pain.
Disclaimer Physiotherapy and you articles are provided for general information only and should in no way be considered as a substitute for the advice and information your physiotherapist will supply about your particular condition. While every effort has been made to ensure that the information is accurate, the Australian Physiotherapy Association and the authors and the editors of the articles in this magazine and on this web site accept no responsibility and cannot guarantee the consequences if patients choose to rely upon these contents as their sole source of information about a condition and its rehabilitation.
Last Updated - Wednesday, 27 August 2008 12:27
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