Since spring-like weather is taking its sweet time in many parts of the country, full-on cycling season has yet to blossom. Not being a huge fan of the lingering cold, myself, I’m among all the fair weather cyclists that have been crowding into spin class, preparing for warmer outdoor riding. And tends to happens when you’re in our profession, 🙂 people have been stopping me after class to ask questions about the various aches and pains they are experiencing as they exercise and get ready for summer sports. The question I’m most frequently asked?
How can I get rid of the knee or ankle pain I experience with cycling?
Thus, I thought this might be a good time to discuss some common lower quadrant dysfunctions that I see when treating cyclists–both at the recreational and elite level.
Proper cycling technique entails utilizing the entire pedal stroke. This involves not just pushing down with your quads and glutes, but also pulling up, which most often involves a lot of psoas (and hamstring) action. According to Janda, one of the functional antagonists to the psoas is the opposite piriformis. If we have an overactive/facilitated psoas, we will have a weak/inhibited opposite piriformis.
One of the functional jobs of the piriformis and gluteus medius is to eccentrically control the internal rotation energy going down the kinetic chain during gait. If we have weakness of these muscles, we wind up with too much internal rotation energy going down the lower extremity chain leading to breakdown of joints distal to the hip.
Now, even though cycling is not largely considered a weight bearing activity, if your feet are clipped into your pedals you still have some ground reaction force from your pedals. The amount of internal rotation energy sent down the kinetic chain at the hip has to be absorbed by the conjunct external rotation of the joints distal to it. Energy cannot be created or destroyed, so if you do not absorb the internal rotation energy, you begin to get joint breakdown.
Upon examination of these patients, they all had one thing in common–functional eccentric weakness of their hip external rotators, indicating that they had too much uncontrolled internal rotation force going down the kinetic chain. This excessive internal rotation force at the hip is potentially what was causing the knee and ankle pain.
The treatment for weakness of the gluteus medius and piriformis is quite simple. Initially, you need to build strength, then follow it with endurance as most serious cyclists are riding 20 plus miles at a time. Here is a simple exercise progression:
- Have the patient performing bridging with a band tied around their knees. The patient’s feet and knees are maintained at a hip distance width. Maintaining the hip distance width engages the gluteus medius and piriformis to prevent internal rotation of the hip from occurring.
- With the band still tied around the knees, have the patient hold a bridge position and perform mini knee bump outs with controlled return to starting position. Once again this engages the gluteus medius and piriformis.
- For a standing exercise, you can have the patient move between a yoga warrior III post to a standing piriformis stretch position. While doing this, the patient needs to focus on not letting the standing leg “fall in.” They need to maintain the position of the patella tracking over the 3rd.
All of these exercises also have the added benefit of working the hamstrings and large gluteus muscles, which both play an important role in cycling.
Now the bigger unanswered question here is why was their psoas dysfunctional in the first place? For the answer to that question and many others, come and join us for a lumbar or lower quadrant course. You’ll come away with enhanced clinical reasoning and manual therapy skills that’ll come in handy with patients in the clinic. Here are a few coming up:
-Stacy Soappman, PT, OCS, DSc, FAAOMPT