Leg, Knee, and Hip Pain in Cycling continued

Knee Pain
Knee Pain Location
One way to classify knee pain (and identify possible solutions) is to look at the location of the pain.
• Anterior (see chondromalacia below)
o Reasons
• patellar tendonitis
• patellofemoral syndrome
o Causes
• pushing BIG gears - cadence too low
• saddle too low or too far forward
• foot too far forward on the pedal
• crank arms too long
• leg length discrepancy with seat set for shorter leg
o Possible solutions
• ride at 75 rpm or higher
• raise seat (in small increments of less than 5mm) or move seat back
• move cleat forward 1 to 2 mm
• shorten crank arms by 2.5 cm
• set seat for longer, not shorter, leg with correction for the shorter leg
• Posterior
o Reasons
• hamstring/gastrocnemius
• neurovacular bundle
o Causes
• saddle too high or too far back
• too much pedal float
• leg length discrepancy with no correction for shorter leg
o Possible solutions
• lower seat (in small increments) or move seat forward
• limit float to 6 - 8 degrees
• set seat for longer, not shorter, leg with correction for the shorter leg
• Medial (inner side)
o Reasons
• medial collateral ligament
• pes anserinus
o Causes
• cleat position too wide - foot held externally rotated (toes point out)
• excessive knee frontal plane motion
• too little pedal float
o Possible solutions
• narrow foot position by moving cleat towards the outside of the foot (thus your foot moves nearer the bottom bracket)
• orthotic or wedge to correct foot alignment
• pedal float should be 6 - 8 degrees
• Lateral
o Reasons
• iliotibial band
• degenerative lateral meniscus
o Causes
• cleat position too narrow - foot held internally rotated (toes pointed in)
• too little pedal float
• excessive knee frontal plane motion
o Possible solutions
• widen foot position by moving cleat away from the bike
• pedal float should be 6 - 8 degrees
• orthotic or wedge to correct foot alignment

Saddle Adjustment

A simple seat height adjustment may ease the forces placed on the knee. If the seat is too low, stress is placed on the knee from the patellar and quadriceps tendons and is generally felt anteriorly below the patella where the tenson inserts on the tibia. If the seat is too high, pain may develop behind the knee.
There are several different ways to determine proper seat height. The easiest way is to allow one pedal to drop to the 6 o'clock position and observe the angle of the knee joint. There should be a 25-30 degree flexion in the knee when the pedal is at the bottom most point. Another is to measure your inseam (in centimeters) and multiply this measurement by 0.883. This should be your distance from the top of the seat to the center of the bottom bracket. If you place your heels on the pedals, have someone else hold the bike, and pedal backwards, your hips should not rock back and forth. Likewise if your hips rock when you are riding, lower your saddle until you achieve a smooth pedal stroke.
Seat fore/aft position and cleat position may also contribute to knee pain. Saddles that are too far back cause the cyclist to reach for the pedal and stretch the IT band with resultant knee pain. Saddle position can be evaluated with the "plumb bob technique". Seated with the pedal in the 3 o'clock position, a "plumb" hung from the most forward portion of the knee, should intersect the ball of the foot and the axle of the pedal.

Cleat Position

Thanks to Chad Asplund and Chris Carmichael ("The Ultimate Ride") for the following. These comments are meant for those using fixed cleats systems as the newer systems allowing internal and external rotation of the shoe,or "float" (such as the Speedplay system) have minimized cleats as the issue in knee pain.
Cleats that are too far internally rotated may cause increased stress to the IT band as it crosses the outside of the knee. This can be caused by a narrow stance width on the pedal (cleats too near the bottom bracket) and generally the toes will point in as you look down from above. The solution is to return the cleat to a more neutral position (let the toes point more fore/aft) and/or widen the stance on the pedal. Remember to make these adjustments in millimeters as a small movement on the cleat can translate into major changes at the knee and hip level. Rotational cleat position can also be evaluated by use of a commercial/bike shop "fit kit" or rotational adjustment device - this is more important for cleats with less than 5 degrees of float.
Medial knee pain can result from external rotation (toes pointing outward) and/or stance too wide on the pedals. As you might surmise, the remedy is to align cleat toward neutral with the tooes more foreward) and perhaps narrow the stance on the pedal (move the cleat towards to bottom bracket). Cleats should be positioned fore/aft so that the ball of your foot is directly over the axle of the pedal.

Relationship of Knees and Top Tube

Should My Knees Be Closer to the Top Tube? (excerpted from www.roadrider.com)
Question: I recently rode with an experienced racer. He said my knees are too far out to the side as I pedal, and I would benefit from bringing them closer to the top tube. "Think of holding a ball between your knees," he said. I'm quite bowlegged (thanks Mom) so for me to make my knees touch the top tube is almost impossible. Should I work on keeping my knees closer to the frame? -- Randy S.
Answer: I see quite a few riders with knees splayed outward. This can be caused by anatomical characteristics or bad bike fit -- or a combination. Narrower knees are certainly better in terms of aerodynamics. Watching the Tour de France this summer, head-on camera shots made some riders look knock-kneed. But it's a common misconception that pedaling with knees nearly brushing the top tube increases power.
Knee position is determined by your anatomy. Ideally, your knees will be directly over the pedals. But if you're bowlegged, they will tend to be fairly far from the top tube. Trying to pull them in is likely to strain and ultimately injure ligaments and tendons. If you have had a professional bike fit , let your knees do what they want to do, naturally. That's the best way to avoid injury and produce the most power your body is capable of generating.