Cycling training takes strength, endurance and stamina, which is strenuous in itself, but many cyclists seem to want to push it a bit harder and the knees take the strain.
As a result, the knee is the most cycling-injury-prone of all the joints.
Although racing or century rides can cause severe damage to the joint, most problems are caused in training, where the knee is often overused and abused.
Diagnosis of any joint injury is difficult even for a professional, but the knee can be a particular minefield. Do not attempt self-diagnosis of any joint injury; any prolonged knee problem should be looked at by a doctor.
But before you hit the panic button, it's worth remembering that most cycling-related knee aches, pains and poppings encountered by sports therapists are not the dreaded cartilage trouble, and sometimes the knee joint is not the problem at all.
Problems can arise from poor position on the bike, incorrectly fitted cleats, and in some cases, from the thigh muscles working excessively, especially on cold, wet or windy days.
At the end of a hard ride in such conditions, when the quadriceps muscles have been continually contracting and have become gradually tighter, you tend to get minor muscle pulls at the muscle insertions around the knee area.
If you use ice massage and quadriceps stretches, the condition often eases in a couple of days. If it persists, then seek qualified help.
Bursas are small fluid-filled sacs or cavities that are designed to prevent friction. They allow muscles and tendons to slip over bones and areas of ligaments. There are many bursas in the knee, and any of them may become inflamed through overuse doing too much too early in the season, for example or as a result of injury, especially falling on the knee; or because of an infection in the knee joint.
Bursitis, as this inflammation is called, can vary in degree from mild irritation to an abscess formation that causes excruciating pain. Signs and symptoms are tenderness, swelling with redness over the affected bursa, pain on movement, and limitation in the movement of the knee.
A doctor may prescribe non-steroid anti-inflammatory drugs, a cortisone injection, sometimes mixed with a local anesthetic or antibiotics, according to the condition, and/or painkillers if there is severe pain. Swelling also may call for draining some of the fluid.
Finally, the condition may require an arthroscopic examination in which a tube is inserted through which the interior of the knee can be looked at and/or surgery to remove the inflamed bursa.
Training may be resumed once the pain and swelling has been reduced. The progression should be guided by any pain felt. You can always expect some degree of discomfort when restarting training after an injury, and you must learn to discern between discomfort and pain.
Bruising of the knee due to a crash or direct blow. Bleeding from damaged blood vessels allows blood to seep into the surrounding soft tissue. There often is skin damage and discoloration, along with pain, swelling, tenderness and restricted knee movement. Do not confuse this with hemarthrosis (blood in the joint) in which the knee will rapidly swell and become painful and hot. This condition requires immediate medical attention to drain the blood if long-term problems are to be avoided.
Injury to the muscles or tendons that attach to bones of the knee. Usually caused by prolonged overuse, sudden fierce effort or subjecting the knee to a level of effort without sufficient preparation, or a crash causing a violent blow or force to the knee.
Symptoms can include muscular spasm, swelling and pain on moving or stretching the knee. Your doctor should make a diagnosis and recommendations for treatment unless the injury is very slight. Your doctor may have prescribed analgesics or anti-inflammatory tablets, or you may wish to use aspirin or Advil if the condition is painful.
Riding may be resumed once there is pain-free movement; the turbo trainer would be an ideal way to start riding, or flat roads using low gears. Use ice massage for 10 minutes before riding.
Damage to the moving surface of the patella, the kneecap, causing an aching pain behind the kneecap. Pain begins and progresses slowly, tending to occur in individuals between 10 to 25 years of age. It can be brought on by structural problems, but more often is due to our old friend, overuse—often by using gears that are too big for your state of fitness or by riding and/or running up hills.
Symptoms can include widespread pain in the knee joint and behind the patella while applying pressure on the pedals. Symptoms are worse after a hard race or hilly training ride. Painful when climbing stairs: the knee "gives way" at times.
A doctor would usually prescribe rest and anti-inflammatory medication or physiotherapy. If there is no improvement in the condition, you may be referred to a specialist for arthroscopy, an examination of the inside of the knee to confirm the diagnosis and to remove any degenerative cartilage.
Although this condition is often diagnosed, my opinion is that it is not as common as we are led to believe. The problem may arise from the patella moving in an abnormal action during the flexion and extension of the knee. There often is no real damage to the inside of the knee; instead, what has happened is that overwork has caused the muscles fixing into the knee to shorten or seize up.
Sometimes the vastus medialis, the inside thigh muscle, may be slightly weaker, so a visit to the physical therapist may be in order.
Rest is essential; trying to "ride it out" will only make matters worse. Apply ice packs for 48 hours then ice massage over the whole of the knee and thigh area followed by gentle stretches to the quadriceps (thigh muscles). Cold limb wraps and/or heat pad treatment can often ease the condition.
Once the pain has subsided you may start to use the mag trainer or some light riding on the road using low gears. Stay off tracks and rough ground.
A good stretching routine, paying extra attention to your thighs and hamstrings, before and after riding, is strongly advised.