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Other way around John. Anterior knee pain is generally from the
patello-femoral mechanism. If the saddle is too low this means that the
rider but force across the patello-femoral mechanism while the knee is in a
more flexed position, i.e. there is more strain. So, if the pain is in the
front RAISE the saddle. I have attached a brief file on the subject of
cycling knee pain.
Mike Murray
-----Original Message-----
From: John Beaston [mailto:jo-@beaston.com]
Sent: Friday, July 02, 2004 10:37 AM
To: 'obra'
Subject: [OBRA Chat] Knee pain rule of thumb
I seem to remember that there's a rule of thumb regarding knee pain.
Something like 'pain in front - saddle too high' or somesuch. Does anyone
have it handy? I'm tweaking a newbie's setup and they are having a bit of
front knee pain.
Thanks
-John
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Patello-femoral problems are the most common type of knee problems seen =
in cyclists. All these anterior knee pain problems can be recurrent and =
difficult to fix completely. Some patients will benefit from surgery to =
remove plicas or to treat chondromalacia by shaving the underside of the =
patella but it is pretty difficult to identify which patients have these =
problems and which ones will benefit from surgery.
Patello-Femoral syndromes are problems related to the knee cap mechanism =
and the joint between the knee cap and the femur. There are several =
different entities which can cause this; patellar or quadriceps =
tendonitis, chondromalacia, patellar instability, pre-patellar bursitis. =
The tendonitis problems are caused by strain and subsequent inflammation =
on the attachment between the tendon and the bone. Chondromalacia is a =
problem with developing irregularities under the knee cap in the =
patello-femoral joint. Pretty common problem for bike riders. Patients =
often notice a clicking or catching when extending the knee from a =
flexed position. Patellar instability is a condition where the knee cap =
does not track in the groove of the femoral well and causes problems =
with surrounding tissues. Bursitis is inflammation of the fluid filled =
area in front of the knee cap. Bursitis is not common and can have =
several causes.
For all these problems the pain is in the anterior portion of the knee, =
around the knee cap. They will all get worse if there is increased force =
applied by the quadriceps, particularly if this occurs while the knee is =
in a more flexed position. Climbing stairs or ladders causes more =
problem, as does riding up hill or in higher gears.
In general for all anterior knee pain problems and cycling the approach =
is the same; heat before and ice after riding, NSAIDs (ibuprofen, et. =
al.), keeping knees warm while riding, lower gears, standing =
occasionally rather than sitting and grinding. For positioning you want =
to raise the saddle and put it further back. It can also help to use a =
shorter crank. These positions make it so there is less flex in the knee =
at the top of the stroke (during max quadriceps contraction) and =
therefore less force against the patello-femoral mechanism. Avoiding =
hills and using lower gears is also a good idea. Standing, rather than =
sitting and grinding, on hills is probably better. This decreases the =
force across the patello-femoral mechanism.
Stretching the opposing (hamstring) muscles may decreased force a bit. =
Use of a knee sleeve or infra-patellar strap may limit the excursion of =
the patella or move forces away from the attachment of the tendon to the =
patella and help somewhat. Exercises are often recommended but I suspect =
that they are probably more useful in the non-athletic population and/or =
those with patellar instability issues.
Beyond this there really isn't much info. Unfortunately there are not =
many orthopedists that have much experience with problems seen in =
cyclists, in part because the number of injured cyclists is pretty =
small. =20
There is a reasonable article at:
http://www.aafp.org/afp/991101ap/2012.html
Posterior knee pain is usually a sign of inflammation inside the joint =
and possibly a development of a Baker's cyst (an extension of the knee =
joint capsule into the "knee pit"). The other alternative is tendonitis =
of the hamstrings, which is fairly uncommon. Hamstrings tendonitis =
should be treated by lowering the saddle, using lower gears, keeping the =
legs warm, etc. Baker's cysts need to be addressed by looking at the =
underlying problem, often a cartilage tear obtained in another sport.
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