This is the first in a series of articles highlighting the benefits of clinicians working side-by-side with bike fit experts, which can reduce time off the bike due to injury.
Knees are always a particular injury prone area in cyclists. Considering the stresses that we exert on them and muscles that support them, it is hardly surprising.
Alice Monger-Godfrey, lead osteopath, working with Velo Atelier, providing clinical bike fit services; recently saw a patient exhibiting the sort of niggling pain in her knee that many cyclists will recognise.
"I have been seeing more and more patients coming through my clinic door complaining of knee discomfort that just won’t go away.
One of them is Jo who loves riding her bike but after increasing the mileage she has started experiencing pain on the inside of her knee. Thinking it would go away by itself after some rest she didn't seek any medical advice. But nothing changed the problem and if anything it started to niggle her during everyday life. That is what brought Jo to me, as she wanted to know what was going on and how it can be treated.
The knee cannot be looked at in isolation as many of the muscles cross over the ankle and the hip, which means the whole body, needs to be treated in order to help the knee function better. With Jo we noticed her Vastus Medialis (one of the quadricep muscles), popliteus muscle and psoas muscle (hip flexor) were extremely tight causing a pull on the knee cap so when the joint was under strain it would highlight this imbalance and cause Jo discomfort. From my experience the best way to effectively treat this is with acupuncture to the quadricep muscles, manipulation and massage to the ankle, knee, hip and low back, and muscle energy techniques /stretches to the surrounding structures of the knee. With Jo, as her upper and mid back were fairly tight it was imperative to make sure that they move well so that less torsional forces are placed onto her knees. For me it is looking at Jo's musculoskeletal structure and function and working our through various tests and examinations what muscles are working, which ones are not and which areas as a result are becoming vulnerable.
After treating Jo in an extremely small space of time, we have significantly reduced her knee pain and that once irritating pain and niggle has become a distant memory."
Working side-by-side with Alice, Velo Atelier were able to use this information to adjust Jo’s position on her bike, to aid her recovery. Firstly we ensured that Jo’s cleats were set up correctly and that her knees were tracking in line with her natural hip and ankle movement. Then we checked that her saddle height and position wasn’t adding any extra pressure to the knees. We also raised her bars slightly to open up her hip flexors and take some flexion out of her lumbar spine. We could see quite quickly on her saddle pressure map that her weight distribution became more symmetrical as Alice was able to release the tension in the muscles under strain.
Going forward we have recommended that Jo changes her cranks to 165mm, which would allow her hip angle to open up more at the top of the pedal stroke, reducing the strain on her hip flexors. This will allow us to also gradually move Jo back to her lower bar height, after the treatments with Alice have finished.