Many cyclists have experienced knee issues in one form or another. When I was racing I can remember having bouts of tendonitis where riding was out of the question for extended periods. The high volume of miles, hours and pedal revs will wildly magnify any imperfections or alignment issues in the pedal stroke causing inflammation and irritation in the hip, knees or ankles. Two years ago I had a local pro with a notable US Pro team approach me with pain in one of his knees. Due to the knee issues, the athlete had missed going to Asia with the team to race. He was frustrated because traditional methods hadn’t yielded results. We agreed to work together to resolve the issue.
The athlete, we’ll call “A”, had worked with a noted fitting agent on his bike and they had made some changes to the balance of the bike and how he sat on it. A’s team requires him to use a sponsor saddle and the saddle was not the right width for him causing him to hold himself ever-so-slightly just off the saddle. We were able to communicate with the team to get a sponsor correct saddle that was the right width for him. That allowed him to comfortably sit ON the saddle without constant tension on the legs. This got us going in the right direction. We also made changes to his shoe/cleat interface based on recommendations from his team resources and observations gleaned from watching his pedalling style.
A chronic problem with cyclists is weakness in the gluteal complex (butt muscles) that cascades all the way down to the knee and ankle. In A’s case, this weakness caused his ankle to collapse at the power phase of his pedal stroke AND created misalignment of the knee. Because A had made the above mentioned changes to his shoe/cleat interface, this partially eliminated the collapsing of the ankle and knee alignment issue.We also added "varus" wedge under the ball of his toe in both shoes to cant the foot out slightly which cleaned up the tracking of the knee.
Next, we began a strengthening program that addressed three elements.
First, we worked to strengthen his gluteal complex. Because of the linear motion of pedalling, the musculature that helps to stabilize the pelvis and femur can become inactive and disproportionately weak compared to the rest of the gluteal muscles.
Second, we worked to create synchronization in the firing or activation of his quadriceps muscles. (medialis and lateralis). A, like most cyclists, has tremendously well-developed quads but his inner quadricep muscle (medialis) fired before his outer quadriceps muscle (lateralis). This created a slight turn of the patella (knee cap). The patella slides in a “groove” at the bottom of the femur and any misalignment is incredibly irritating which leads to inflammation and pain.
Third, we worked on core strength and stabilization. The muscles of the hips, legs, spine and of course, abdominals are attached to the pelvis. When a cyclist pedals the musculature of the legs, spine and abdominals pull on the pelvis. His legs and glutes were already quite strong but we needed to shore up the low spine and abdominals. If you’ll recall one of the t-mobile or HTC/Highroad physios a number of years ago said that …”if you’re core is weak, it’s like shooting cannon while in a canoe.” (I’m paraphrasing here) We also added in some stabilization exercises to “wake up” his little stabilizer muscles starting in the foot all the way up to the hip. Many of his exercises were done bare- footed and/or on an unstable platform. Many moves also involved holding weights over the head to elevate his center of gravity there-by destabilizing “the platform.”
This combination of elements allowed us to get A back on his bike in a limited capacity in 30 days and back at full capacity in approximately 75 days. I also gave him “homework” to do while he was on the road to help maintain the work we did.
At the time of writing he had been able to put in a considerable amount of mileage at team camp as well as on his own.
A holistic approach to issues with the hip, knee or ankle often yields favorable results. In my experience there is usually no ONE factor but a constellation of factors that lead to irritation/inflammation issues which in turn become tendon or joint issues.