As previously mentioned in this column there is a number of predisposing factors in anterior knee pain that need to be addressed to help manage the condition and ultimately help reduce discomfort and irritation of the patello femoral joint or PFJ.  As we have noted there is a real need to ensure that the setup of the bike is both efficient and at an optimal relationship with the rider.  The knee needs to be reaching to the top of the upstroke at 90 degrees or less to be efficient and to reduce loading of the PFJ and prevent unnecessary compression of the joint at this loading point.

The knee needs to be tracking centrally over the 2nd and 3rd toes of the foot without moving forward past the front of the shoe in the down stroke phase. You can check this yourself by looking at the knee/foot angle during work on the wind trainer or with a mirror. Once again bike shops or trained physiotherapist/exercise physiologists can help with this. Small adjustments can be made and always less than 5 mm to ensure that the rider has time to assess the effects on his next ride and that the changes are not too gross.

If the patella is not tracking centrally this is often due to a tight ilio tibial band or ITB which tracks down the outside of the knee from the hip joint.  The ITB is often a source of lateral knee pain or contributor to anterior knee pain in cyclists, due to the small range of movement and repetitive nature of the sport. The best way to address this issue is the use of a good quality foam roller.  Foam rollers help reduce ITB tightness in the lateral thigh and above the knee. Good foam rollers should be an essential part of any cyclist tools as they are a great way to reduce muscle tightness post riding and help reduce knee pain issues such as the ones mentioned above.

The best technique is to use the foam roller and roll on the outside of your thigh for as long as you are able to cope with the pain!!


Other exercises to help reduce anterior knee pain are:


Plies for quadriceps strengthening


Step Ups


Ball squats


Bosu squats


With any medical problem if there are any concerns you should consult your physiotherapist or doctor and make sure there are not other more significant issues producing the pain. This column is not designed to solve all Knee issues but to help give cyclists some direction in self management.

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.