Pain around the patella (kneecap) is typically the result of excessive force through the patellofemoral joint when it's not aligned properly as the knee flexes and extends. Unlike a "deep joint" like the hip, the patellofemoral joint has a lot of movement.
As the knee bends there is greater pressure between the patella and the femur. Like a train on tracks, if the train (patella) slides off the track, excessive friction occurs. Likewise, if the track (femur) moves excessively, friction will also occur.
When it hurts: Patellofemoral pain is typically most poignant during exercise, although it can occur with prolonged sitting, squatting or walking up and down stairs. Pain on the bike is usually the worst during the power portion of the pedal stroke.
Why it hurts: Abnormal tracking of the joint can be the result of quadriceps muscle imbalance, gluteal weakness, ITB/hip tightness, leg length discrepancy and/or poor foot or ankle mechanics. It might also be caused by issues related to training (climbing in too big of a gear) or bike position (saddle height and fore/aft position, cleat position or saddle and frame geometry).
How to Combat Patellar Pain:
- Foam-roll your ITB.
- Strengthen gluteals with lateral and rotational movements.
- Avoid knee-extension machines, deep squats and stairs.
- Try patellar taping techniques (kinesiology or McConnell taping).
- Raise the saddle slightly—if you start rocking, it's too high.
- Check cleat position and pedal float.
- Focus on higher cadence and avoid strenuous climbing in the saddle.
- Get a bike fit from an experienced professional.
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