Niggling knees

Knowing the point to refer out

Most bike fitters will have clients with niggling knee pain, but knowing when to defer cases to medical experts is key to getting to the root of the problem. In their second article on knees, UK osteopath Alice Monger-Godfrey and bike fitter Lee Prescott share an example of how a multidisciplinary approach can achieve the best possible outcome.

ALICE:

I’ve been seeing more and more patients coming through my clinic door complaining of knee discomfort that just won’t go away. One of them is Jo, who loves riding her bike, but after increasing the mileage started experiencing pain on the inside of her knee. Thinking it would go away by itself after some rest, she didn't seek medical advice. But nothing changed, and if anything, it started to niggle her during everyday life, not just on the bike. That is what brought Jo to me, as she wanted to know what was going on and how it could be treated.

The knee can’t be looked at in isolation, as many of the muscles cross over the ankle and the hip, which means the whole body needs to be treated in order to help the knee function better.

With Jo we noticed her Vastus Medialis (one of the quadricep muscles), popliteus muscle and psoas muscle (hip flexor) were extremely tight, causing a pull on the knee cap. When the joint was under strain it would highlight this imbalance and cause Jo discomfort.

From my experience, the best way to treat this is with acupuncture to the quadricep muscles, manipulation and massage to the ankle, knee, hip and lower back, and muscle energy techniques/stretches to the surrounding structures of the knee.

With Jo, as her upper and mid back were tight, it was imperative to make sure they move well so that less torsional forces are placed onto her knees.

For me, it was important to look at Jo's musculoskeletal structure, how it functions and work through various tests and examinations to identify what muscles are working, which ones are not and which areas as a result are becoming vulnerable.

After treating Jo in an extremely short time, we significantly reduced her knee pain, making that once irritating niggle a distant memory.

LEE:

Working side-by-side with Alice, I was able to use this information to adjust Jo’s position on her bike, to aid her recovery.

Firstly, we ensured that Jo’s cleats were set up correctly and that her knees were tracking in line with her natural hip and ankle movement.

Then we checked that her saddle height and position weren’t adding any extra pressure to the knees. We also raised her bars slightly to open up her hip flexors and take some flexion out of her lumbar spine.

We could see quite quickly on her saddle pressure map that her weight distribution became more symmetrical as Alice was able to release the tension in the muscles under strain.

We recommended Jo changes her cranks to 165mm, which would allow her hip angle to open up more at the top of the pedal stroke, reducing the strain on her hip flexors. This will allow us to also gradually move Jo back to her lower bar height, after the treatments with Alice have finished.