Ask the Experts: Cycling Smart

If you suspect you have patellofemoral syndrome, adjust your saddle height so that your leg bends slightly, about 25 to 30 degrees, at the bottom of the pedal stroke--this will help the kneecap track properly. (Your bike-fit specialist can measure the angle with a goniometer, a kind of protractor for your joints.) The saddle should never be so high that your leg straightens out completely while pedaling, causing you to overextend and rock side-to-side on the saddle.

Another common knee overuse injury is tendonitis of the patella tendon, which sits just below the kneecap. This tendon becomes swollen and painful and can hurt when walking, and in severe cases, even at rest. In cycling, a sudden increase in mileage or riding hills often causes the problem. Ride in easier gears and avoid hills to reduce stress on the patella tendon. And always ramp up your miles or add hills gradually.

Although usually associated with runners, iliotibial band (ITB) syndrome also affects cyclists. Poor flexibility of the ITB--a strong, thick tendon that runs along the outer side of the thigh--running on off-camber roads and running downhill can all contribute to increased rubbing of the ITB over the outside of the knee. An increase in cycling mileage and hills or standing on the pedals while riding can also aggravate it.

The pain is usually felt on the outside of the leg, just below the knee, but ITB syndrome can cause pain anywhere on the outside of the leg from the knee to the hip. By lowering the seat height so that your knee bends about 30 to 35 degrees at the bottom of the pedal stroke, you can avoid the friction along the knee that contributes to ITB syndrome.

As a female cyclist, what crotch-related problems do I need to worry about--saddle sores or infections, for example? How can I avoid these, and how important are women-specific saddles and bike shorts in preventing these problems?

The majority of crotch-related problems come down to three factors: pressure, friction and moisture. An ill-fitted or badly positioned saddle can produce pressure problems. The widest part of the saddle should be at least the distance between your sit bones, and should be positioned forward enough on your bike to support them.

Having your saddle at the right height also will help reduce pressure. Women-specific saddles generally are wider than men's and usually have a hole or "cutout" in the narrow part designed to relieve pressure at the genitals. But don't feel you must get a women's saddle; proper positioning is more important to your comfort than what gender a saddle is marketed to.

Wearing properly padded bike shorts with a comfortable chamois (the crotch pad) is also important. Women's specific shorts have chamois and stitching designed to relieve pressure and eliminate chafing on female anatomy, but I know women who swear by the fit and comfort of men's shorts. The bottom line: Try different pairs until you find a chamois shape that's right for you. To avoid chafing, rub petroleum jelly, cold cream or chamois cream on the chamois pad.

After gear, the most important thing to consider is hygiene. Wearing clean and dry shorts should keep saddle sores to a minimum. After a ride, change out of your cycling shorts as soon as possible. Wearing shorts for longer than you need perpetuates the right environment for the growth of bacteria, yeast and fungus.

On hotter days or longer rides, reduce moisture by using medicated powder in your shorts. In cold weather, avoid the temptation to dress for the start of the ride; instead, dress for the second fifteen minutes. The rule of thumb for cold weather is if you're comfortable at the start of the ride, you're overdressed.

Related Articles: Active Expert Gale Bernhart talks about women-specific bikes, and tackles female-only cycling issues.

Michael Ross, M.D., is the team physician for the Jittery Joe's and Navigators Insurance Professional Cycling Teams. He is the author of Maximum Performance: Sports Medicine for Endurance Athletes and Maximum Performance For Cyclists. When he isn't riding his bike, he practices sports medicine near Philadelphia.
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