As we have discussed in previous articles the tendency for cyclists to develop patella femoral pain is not uncommon and can lead to reduced ability to enjoy cycling and long term issues with the knee itself. Bio mechanics and knee pain are vital to reducing the inappropriate loading in the patella femoral complex and without question the bike set up is a crucial component in allowing the rider to be able to transfer load through the legs without compromising the integrity of the knee itself. One of the issues for riders is that there is a common belief that time on the bike will build the muscles required to cycle efficiently.  While this is certainly true of the endurance aspects of riding, the body itself has the unfortunate ability to recruit the muscles that are dominant to perform the required action rather than strengthening the weaker muscles to help.  Not sure if this is the true?  We would all have six packs if this was the case but while some of us do, a lot of others have a six pack on their back instead!

The solution to this is the joy of dry land training or cross training to help manage the body in other movements rather than the stationary cycling position. This helps to build a stable structure to deliver loading through the legs without risk of pelvic rotation or knee rotation during the crank phase.  There are a few options for the rider to help develop other supporting muscles.

Swimming, especially back stroke or kicking with a board while on your back, because this helps work the hamstrings and gluteals while the abdominals are in a lengthened position which is an action missing with cyclists as they are normally in a shortened position when on the bike. Deep water running is a good alternative if you hate swimming.

Strengthening for the gluteals and VMO muscles should include the exercises below.  The key for all of these is that the pelvis should be neutral throughout.  The easiest way to learn this is to stand and poke your buttocks out as far as you can and then tilt the pelvis under as far as possible.  A neutral pelvis is half way between the two extremes.  This should be a goal to maintain in all exercises.  Try to perform sets of 20 of each exercise and then run through all the exercises as a set as many times as your body is able to.

Plank 20 sec hold

Plank Exercise

Side plank 20 sec hold

Side Plank Exercise

Plie with wide feet

Plie with wide feet exercise

Forward lunge with the foot travelling over the front of the 2/3 toes (normally the black point on the front of the running shoe)

Forward lunge exercise

Mountain climber 30 secs

Mountain climber exercise

Step ups

Step ups exercise

Wall squats with a ball between your knees

Wall squats with medicine ball

Side lunges with your chest reaching your knee

Side lunge exercise

Dumbbell or kettle bell swings

Kettle ball swing exercise

Single leg deadlift (arabesque)

Single leg deadlift exercise

These are great to perform at least once per week to help strengthen the muscles that help to control knee and pelvic movement on the bike.  Obviously if pain persists or increases, stop immediately and seek professional advice or email us here at the site.

Tim Robinson

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Tim is an experienced musculo skeletal physiotherapist who has extensive sports medicine experience and has worked with a large number of athletes and sports teams for over 25 years. He has worked with international teams like the All Blacks and Waikato Chiefs in professional rugby and the NZ Ski team and members of the New Zealand Triathlon team as well. Tim is a keen cyclist and is often found riding his mountain bike through the forests of Noosa. Tim rides a Giant TCR road bike.