The Cyclist’s Guide to Injury Prevention: Addressing Knee and Hip Pain
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By Dr. Shara Labelson, PT, DPT
Cycling is a popular and beneficial activity that offers numerous physical and mental health advantages. However, like any sport, it can also lead to injuries if proper precautions are not taken. Two common issues cyclists may face are anterior knee pain and hip pain, often stemming from inadequate core and hip strength and improper bike fit. Understanding these injuries, their causes, and how to prevent them is crucial for any cyclist.
Anterior knee pain, or patellar tendinopathy, is a prevalent issue among cyclists. This typically manifests in the front of the knee, just below the knee cap, when an inflammatory response occurs in the tendon that attaches the thigh muscles (quadriceps) to the shin (tibia). With increased riding intensity or duration, undue stress and strain can be placed on this tendon and subsequently cause pain. Similarly, incorrect saddle placement such as it being too low or set too far forward, can force the rider into increased knee flexion and then, when put under tension of riding, can cause strain. With a proper bike fit, this positioning can be corrected and place the rider and the most appropriate posture to ensure optimal knee alignment during pedaling to maximize power and minimize strain.
Hip pain in cyclists often arises from a lack of core and hip strength, which can lead to poor biomechanics during cycling including an inefficient pedal stroke or increased instability of the pelvis on the saddle resulting in excess strain on the hips. Just like with knee pain, an improper saddle placement can cause the hips to move excessively. A saddle that is too high or too low can lead to excessive lateral movement of the hips during pedaling. A common recent trend in bike fit is even to use a shorter crank arm to accommodate limited hip flexion mobility and decrease “pinching” pain at the front of the hip.
A good starting point for cyclists to begin independently to avoid injury, is to focus on lower extremity flexibility as well as strengthening the core, quadriceps, hamstrings, and hip stabilizers. Since cycling only occurs in one plane, lateral and rotational movements are often neglected. Incorporating exercises such as planks, bridges, hip abductor and rotational movements to build core and hip strength are a great supplement to training on the bike. Additionally, a weak core can lead to poor posture and inefficient pedal stroke, resulting in excess strain on the hips and low back.
Bike fit is also critical in preventing injuries in cyclists. A bike that is not properly fitted can lead to a host of issues. A saddle that is too high or too low can cause improper leg extension and excessive strain on the knees and hips.Fore-aft positioning of the saddle affects knee alignment. The knee should ideally be aligned over the pedal spindle when the pedal is in the 3 o’clock position.Handlebar height influences body posture. A position that is too low can lead to excessive strain on the lower back and hips.
Cycling injuries such as anterior knee pain and hip pain can significantly hinder performance and enjoyment of the sport. By understanding the causes and implementing strategies for prevention—particularly focusing on bike fit, strength training, and flexibility—cyclists can minimize their risk of injury. Proper attention to these factors not only enhances performance but also contributes to a more enjoyable cycling experience. Always consider consulting with a professional for a bike fitting and injury prevention strategies tailored to your individual needs.
May the wind always be at your back and you stay rubber side down.
Dr. Shara Labelson, PT, DPT is a Physical Therapist at ProClinix Sports Physical Therapy & Chiropractic in Yorktown. For any questions regarding her article or to learn more about ProClinix, feel free to reach out to her at 914-898-3338 or via email at slabelson@proclinix.com. In addition to their Yorktown location, ProClinix has other convenient locations in Ardsley, Armonk, Larchmont, Pleasantville, Tarrytown, and West Harrison.
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