Although considered to be a low-impact sport, the repetitive nature of cycling, coupled with the high reactive forces produced between the foot and the pedal, create an immense amount of pressure on the lower extremity and can predispose a cyclist to musculoskeletal problems.
Anatomical asymmetries or biomechanical inefficiencies can further precipitate the development of overuse injuries and affect the performance of a cyclist; this does not exclude extrinsic factors such as incorrect training, ill-fitting cycling shoes or a faulty bicycle.
With the knee reported as one of the common problematic sites for cyclists, it is beneficial to gain an insight into the pathomechanics behind anterior knee pain and patellofemoral conditions to prevent reduced training capacity or limited performance in cyclists.
While studying lower limb pedal kinematics in 18 cyclists with and without anterior knee pain, Kennedy et al. discovered asymmetrical cycle patterns, the presence of patellar chondromalacia and vastus medialis obliquus weakness in cyclists experiencing pain in the knee.
The patellofemoral joint, in particular, becomes susceptible to overuse injuries because of the large reaction force generated at the surface of the joint while cycling, which is amplified further by the tremendous amount of knee flexion achieved at the beginning of a downstroke.
Among the biomechanical causes responsible for patellofemoral pain or ‘biker’s knee’ are malalignment of the patella, hyperpronation, an increased Q-angle and a valgus knee alignment.
Mechanical errors related to the cycle such as a low saddle can also increase the incidence of patellofemoral joint pain as the decrease in saddle height, increases extensor torque at the knee because of higher knee flexion and affects quadricep muscle activation patterns.
Iliotibial Band syndrome is another frequently reported condition among cyclists because of repeated friction of the distal iliotibial band posterior fibres against the lateral femoral condyle.
This is aggravated further by the presence of biomechanical inaccuracies during several hours of cycling such as an internal tibial torsion, hyperpronation or a tight iliotibial band.
Other lower limb pathologies often associated with the sport of cycling include Achilles tendinitis and plantar fasciitis, with the latter possessing a diverse aetiology – training errors, hyperpronation, incorrect seat height, old bicycling shoes or leg length discrepancy.
The treatment and management of overuse injuries in cycling should involve a correction of both intrinsic and extrinsic factors which contribute to the onset of lower extremity pathologies.
Stretching exercises should be incorporated in treatment modalities to counter the tightness of soft tissues such as the tendons around the knee, which is necessary for improved flexibility throughout the sport.
A hyperpronated foot can be addressed in the initial stages of treatment with the use of customised foot orthotics in order to reduce internal tibial rotation, optimally re-align the lower extremity and to decrease any excessive stress that may be placed on the joints.
This is necessary to reduce muscle fatigue and to correct compensatory movements of the body whilst protecting the individual from the mechanical strains related to the sport.
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