Many athletes, including runners and footballers, who have suffered from knee problems turn to cycling as a ‘low impact’ sporting option, but it is not altogether risk-free of injury. According to Road Cycling UK, the knee joint is particularly susceptible to injury and many cyclists are affected by some degree of knee pain, but this is often preventable and even if not prevented, can usually be successfully treated.
Michael Core from Össur Webshop takes you through the various types of support used to prevent and treat injuries in the third instalment of our look into cycling injuries.
During cycling, the knee is repeatedly bent and stretched, and this can cause some of the muscles and tendons around it to become overloaded. If you experience knee problems even once and are satisfied that your bicycle is set up correctly with the pedal cleats and saddle positioned correctly, you may need a patella or knee brace. Knee braces are designed to compress or stabilise the knee, or to carry out both functions (depending on the design selected).
Compression knee braces
Compression knee braces can help to reduce inflammation and swelling following an injury, and also help to reduce pain. These braces are frequently used when a cyclist has a relatively mild sprain or slight weakness of the knee. Compression braces can have a closed or open patella. An open patella can provide compression without putting pressure on the kneecap, with some braces having a padded area (or buttress) around the patella for increased comfort. A gap over the patella can help to ensure that it stays in the proper position and is aligned correctly. In other braces, a gel cushion over the patella can perform a similar function whilst providing protection from impact as well.
Sometimes, no specific injury has been diagnosed, but there is a feeling of instability in the knee and a compression knee brace will provide the low level of support that is needed for comfort.
These types of braces are typically sleeve-based in that they can be pulled on and manoeuvred into place. The materials will differ depending on the brand chosen but neoprene is often used to maintain its shape, as the last thing you want is a knee brace that is baggy and slips down your leg. There are some bespoke materials on the market, such as BioSkin, which are marketed as performance bracing, designed to offer a higher level of compression and breathability compared to its neoprene counterpart.
Stability knee braces
Stability braces are more complex and are available as purely stability braces, or stability combined with compression. The stability feature is the inclusion of a hinge within the brace which works as you move. Stability braces with compression are used to maintain mobility following severe sprains. Inflammation is controlled by the compression whilst increased support is supplied by straps that act as external ligaments.
Rigid stability braces are designed simply to offer protection and stability. They can be worn to provide protection from injury, often in sports such as mountain biking, motocross or skiing, but can also be used to give the knee joint stability following injuries such as damage to ligaments. These types of braces are manufactured from super strong yet lightweight material, such as carbon fibre, which can withstand huge impacts.
Knee braces can be used to prevent the kind of ligament damage that often occurs in sports such as cycling.
Following knee surgery, an immobilising knee brace may be recommended. These are worn after your operation to prevent the joint from moving around and damaging the repair that has been made, giving the knee a chance to heal properly before any pressure is put on it. Once you are mobile, a hinged brace will normally be offered to provide protection. In some hinged braces, you are able to limit the range of motion (ROM) of the knee, thereby allowing you to remain active without allowing your knee to move beyond certain degrees of flexion or extension.
Knee supports vary widely in cost, with simple compression supports manufactured from materials such as surgical elastic or neoprene which are relatively inexpensive. In comparison, some of the highly engineered knee supports used in high impact situations cost considerably more, and there are many different styles of support to choose from, including hinged supports and even bands, which are primarily designed to apply compression to the patella.
Different supports are needed for different injuries, so it is important to obtain an accurate diagnosis from a doctor or physiotherapist before selecting a knee support for your particular knee injury or problem. Not all GPs are sufficiently knowledgeable about sports injuries to provide an accurate diagnosis, but they will be able to refer you to a colleague who specialises in this field. Once the specific condition is identified, you can choose a knee support with the appropriate level of support.
Many knee braces are available ‘off the shelf’ but others need to be fitted and, in this situation, you will need accurate measurements to ensure that the correct support is obtained.
Solutions for common knee injuries
Overuse and repetitive motions can irritate the knee and cause pain and injury. Knee pain can occur in four areas; anterior, posterior, medial/lateral and iliotibial band syndrome.
Anterior knee pain
Anterior knee pain is pain experienced around the patella (kneecap) at the front of the knee. This is the most common overuse injury in cycling because of the way in which the quadriceps muscles are connected to the shin bone. Pressure on the pedals causes force to be repeatedly transmitted over the patello-femoral joint, squashing it back against the femur.
Another cause of anterior knee pain is patellar tendonitis which occurs when the part of the tendon that attaches the patella to the bone below it becomes inflamed.
Physiotherapy, anti-inflammatory drugs and ice can help to relieve symptoms, and a knee support can also be used. With patellar compression syndrome, you need to work towards loosening tight lateral thigh muscles, but it is also worth considering a knee support to correct the position of the patella as overuse can cause it to track incorrectly. Anterior knee pain can be caused by poor positioning of the saddle and pedal cleats. A saddle that is too low or too far forward can increase pressure on the muscles and tendons and cause poor tracking of the patella. The pedal cleats being set too far forward will also have a similar effect.
A stabilising knee support will often help in rehabilitation following injury to the front of the knee and patellar supports are useful to improve tracking when pain is caused by patellofemoral syndrome or similar problems. Depending on the severity of the injury and the activity to be undertaken, there is a range of knee braces to help with stabilising the knee.
Posterior knee pain
Posterior knee pain is less common in cyclists than anterior pain. In most cases, it is caused by overextending the knee when using a saddle that is too far back or too high and can be relieved by adjusting your bicycle so that the knee is no longer overextended. If you have persistent posterior knee pain, you should see your doctor so that a Baker’s cyst can be eliminated. This is a collection of synovial fluids that gather in the space behind the knee that are harmless but uncomfortable. They usually disappear without treatment.
Medial/lateral knee pain
Pain at the sides of the knee, medial or lateral knee pain, is quite common and is felt in the collateral ligaments. Lateral and medial pain can be caused by problems with your pedal cleats. Lateral knee pain, or pain on the outside of the knee, is usually due to the pedal cleat being too close to the outside of the shoe or being positioned so that the foot is internally rotated. Medial pain, on the inside of the knee, occurs when the pedal cleat is too near the inside of the shoe or positioned so that the toes point outwards. Adjusting the position of the pedal cleats usually resolves the issue, but if it continues, any inflammation can be reduced by using a compression knee support.
Iliotibial band syndrome
The iliotibial band is a strap of thick, fibrous tissue that extends down the outside of the thigh from the pelvis to under the knee. When this becomes inflamed, the condition is known as iliotibial band syndrome or, strangely, Runner’s Knee. Iliotibial band syndrome can be caused by using cleats that cause the toes to be pointed inwards too far, but often occurs simply because of the repeated bending and straightening of the knee. This causes the iliotibial band to be moved backwards and forwards over the end of the femur just above the knee, resulting in inflammation and pain.
As with any inflammatory condition, immediate treatment includes ice, rest and anti-inflammatory medication. The iliotibial band can tend to become tighter over time, and can pull your patella off centre if it is not counteracted by strong vastus medialis oblique muscles. Treatment for this condition involves physiotherapy, ice therapy and anti-inflammatory drugs. For those who want to continue to cycle whilst recovering, a stability knee brace with compression will help to reduce pain and inflammation and support the knee.
Where ligaments have been damaged, a hinged brace with compression is likely to be what you need. The compression will help to reduce inflammation and the straps give support like external ligaments. There are many different types of hinged braces, and your specific condition will determine which is most suitable.
For degenerative conditions, such as osteoarthritis, a different kind of support may be appropriate to manage the condition which will offload the pressure on the affected side of the knee to the less affected side, which can reduce pain and increase mobility. The condition itself is degenerative, therefore, in severe cases, knee replacement surgery is often the only treatment option available.
Paying attention to what your body is telling you, not overdoing your sport and protecting your joints from impact and rough treatment by wearing a knee support will help to ensure that you remain free from knee injuries. If you do experience an injury, getting a proper diagnosis, following the medical advice and obtaining the appropriate knee support will mean a shorter recovery period.