Solve Mountain Biking Knee Pain for Good!
At least one out of three mountain bikers will suffer from knee pain at some point. Along with low back and neck pain, knee pain is among the most common overuse injuries a mountain biker will face. Often, a good bike adjustment, proper fitting and smart gear shifting can help quite a bit. But, sometimes there are biomechanical causes of mountain biking knee pain that must be corrected. In my Active Release Technique chiropractic practice in Tamarindo, Costa Rica, I treat knee pain often. Here are the most common causes and treatments.
Most often knee pain is caused by one or more alterations of lower body mechanics. We can correct most of these problems with manual therapy, improving mobility, stability, and strength in different areas. Often, the treatment must be at regions around the knee, like the hip or ankle. Here at PerfromPro, we look at knee movement in relationship to foot/ankle, hip, and low back movement. Any treatment that only considers the knee will surely fail at resolving the problem over the long-term.
Anterior Knee Pain
One of the most common types of knee pain in mountain bikers is anterior knee pain or patellofemoral pain syndrome (PFPS).
PFPS is a condition that affects the patella or kneecap and the femur or thigh bone. The patella normally glides smoothly over the femur during movements such as bending or straightening the knee. However, in PFPS, the patella does not track properly over the femur, causing pain and discomfort and can cause tissue damage to the cartilage of the knee.
Symptoms of PFPS typically include a dull ache or pain at the front of the knee, especially when climbing uphill, using high gears, or at a low cadence. The pain may also be aggravated by activities such as squatting, kneeling, or jumping.
A common cause of PFPS is overtraining or not enough rest and recovery time. Other risk factors for PFPS include weak or tight muscles around the knee joint, such as the quadriceps or hamstrings, as well as imbalances in the muscles of the hip and pelvis. These imbalances can cause abnormal knee mechanics and increase the stress on the patella.
Fortunately, there are several steps you can take to prevent or manage PFPS as a mountain biker. Firstly, it’s important to ensure that your bike is properly fitted to your body and that you are using the correct technique when riding.
Stretching and strengthening exercises can also be helpful in preventing and managing PFPS. Specific exercises that target the quadriceps, like weighted knee extensions, can help. Increasing the flexibility of the hamstrings is important. When soft tissue adhesions prevent hamstring flexibility, that must be addressed either with self-myofascial release or by a professional manual therapist.
Lateral Knee Pain
Pain on the side of the knee while mountain biking is often due to IT Band Syndrome (ITBS). This is when the thick fascia band that runs from the hip to the outside of the knee becomes irritated. Pain is often felt on the outside or under the front of the knee.
The cause of ITBS is often farther away from the knee than you might expect. Often, the IT Band can become tightly adhered to the side of the quadricep muscle. These two tissues are supposed to move in different directions during the pedaling cycle, when they can’t, the IT Band will become irritated. In this case, treatment is often manual therapy to eliminate the adhesion between these two anatomical structures.
As is often the case with Low Back Pain in Mountain Bikers, knee pain is often the result of core instability, weakness or fatigue. The force produced by the legs while riding can only be allied to the pedals if there is a bracing force produced by the core muscles. When weakness or fatigue reduces this bracing force, the leg will move inefficiently, reducing power and causing injury.
In order to prevent ITBS you should improve core stability and strength. Exercises like planks, bridges, and bird-dog can be very effective in increasing core strength. Increasing the strength of the hip stabilizers is also critical. Targeting the lateral hip muscles like the TFL and gluteus medius, with a clamshell progression can increase the stability and power of the hip. This, in turn, reduces damaging forces on the knee.