PREVENTION OF BIKE INJURIES

The Prevention of Knee Injuries Associated

With Improper Bicycle Use

Bicycling is a sport ever increasing in popularity. It has enthralled millions worldwide as a form of entertainment and has aided many in maintaining the health of their bodies. However, with this increase in popularity there are some injuries that can occur if they are not prevented by proper physical care and bicycle maintenance.

For many years the number of people using bikes has continued to steadily rise as the popularity of the sport has increased. According to a study found in Physician & Sports Medicine by the US Department of Transportation, there are approximately forty-nine million Americans that ride bicycles at least monthly, and over 5 million Americans riding at least 20 days per month (Asplund, & Pierre, 1993, p. 23). These statistics can be explained by the amazing health benefits of biking such as decreasing hypertension, cholesterol, and chances for osteoporosis, and slowing the aging process. One author writes “bicycling strengthens your heart, reduces blood pressure if it’s too high, improves the ability of lungs to deliver oxygen to your muscles, and keeps your energy level up all day’ (Sloane, 1988, p. 135). However, most people bike for the shear enjoyment and exhilaration of being on a bike. “[One] British Transport and Research board survey established that individuals enjoyed bicycling because it gave them a sense of health, independence, and enjoyment and a means of transportation […] They also associated bicycling with economy, cleanliness, freedom, and “doing your own thing” (Burke, 1992, p. 12).

Biking is famous for its high exercise and strengthening components combined with the ability to be easy on the knees. One article stated that “cycling is ideal because it develops aerobic capacity while imposing far less stress on joints. You can ride indoors on an exercise bike--one of the most convenient forms of aerobic conditioning--or ride outdoors, which offers more variety and mobility than almost any other form of exercise” (Fitness, 1993, p. 46). Orthopedic surgeons and physical therapists world wide recommend biking to many of their knee injured patients to assist them in a more rapid recovery. Bicycling is an excellent way to strengthen the knee joint to assist in healing and injury prevention.
With this influx of bikers there is also an increase of biking injuries. Although biking is wonderful on the knees, knee injuries are increasingly common among bikers who don’t take appropriate precautions. Pruitt states that “cycling is famously easy on the knees, because the joint never has to bear your full weight, no matter how big a gear you’re in or how steep a hill you’re climbing … Many avid cyclists have serious knee problems” (Davis, 2003, p. 62). Asplund, & Pierre, when reporting on the statistics of overuse injuries obtained on bicycles, said:

Knee pain is the most common lower-extremity overuse problem in
cyclists. In one recreational long-distance bicycling tour, 65%
of all riders reported knee pain. Another study of more
than 500 recreational cyclists indicated that almost 42% of all riders
experienced overuse knee pain. While major problems such as fractures,
dislocations, and ligament ruptures usually occur only after major
trauma, overuse injuries are much more common. (1993, p. 23)

As America has become more active, the amount of injuries has also increased. The in Davis’s article “Knees like these, she says that not only the number of knee injuries have increased but also the number of young people with chondromalacia which leads to osteoarthritis, the wear-and-tear form of the disease that often results in a total knee replacement. The good news is that in this sport your knee problems are almost always your own fault which means they’re almost entirely avoidable (Davis, 2003, p. 62). This pain located on the front of the knee is referred to as anterior knee pain, which can be caused by a number of conditions. Asplund, and Pierre, in their article “Knee Pain and Biking,” states that

patients frequently report anterior knee pain that may be related to repetitive stress or to inflammation. In fact, anterior knee pain is the most common reason bicyclists seek physician care. Causes of anterior knee pain include patellofemoral pain syndrome, chondromalacia, quadriceps tendinosis, patellar tendinosis, and, occasionally, prepatellarbursitis. (1993, p. 23)

This article continues to explain how these overuse injuries develop and cause chronic injuries that potentially can encumber one for the rest of their life.

Overuse injuries occur when a tissue accumulates damage caused by repetitive submaximal loading. Repetitive activity fatigues a specific structure, such as tendon or bone. Without adequate recovery, microtrauma stimulates an inflammatory response, causing the release of vasoactive substances, inflammatory cells, and enzymes that damage local tissue. Cumulative microtrauma from further repetitive activity eventually leads to clinical injury. (Asplund, & Pierre, 1993, p. 23)

It is easy to get excited for the exhilarating ride ahead and overlook some small maintenance items that will help prevent these types of injuries. One can avoid these horrible problems if they would take a few minutes to prepare their body and inspect their bike before they hit the trails.

First, we will address the anatomical aspects that cause overuse injuries. Research shows that the major anatomical factors that affect bikers are leg-length discrepancies, muscle imbalance, flat feet, and inflexibility. Fatigue also causes alterations in pedaling technique. These inconsistencies cause increased strain on muscles of the body causing inflammation and pain. “Cycling is very repetitive; during 1 hour of cycling, a rider may average up to 5,000 pedal revolutions. The smallest amount of malalignment, whether anatomic or equipment related, can lead to dysfunction, impaired performance, and pain” (Asplund, & Pierre, 1993, p. 23).

Next, one needs to make sure their bike and their equipment is properly set and adjusted. When one is riding a bicycle their thigh bone is firmly set into their hip, and their foot is securely fastened to the pedal especially if they are using clip or clip-less pedals. When a bike is maladjusted it causes abnormal or excessive force on certain parts of the knee. This forces the knee to adjust and reposition to accommodate the unusual forces. The article “Knee Pain and Bicycling” addresses how to adjust a bike to reduce knee pain. A simple saddle height adjustment may ease the forces placed on the
knee. If the saddle is too low, too much stress is placed on the knee. If the saddle is too high, pain may develop behind the knee (Asplund, & Pierre, 1993, p. 23).

Another common cause of knee pain is improper cleat position. If the foot is rotated inward or out ward to much this can cause strain on the lateral and medial ligaments and tendons that surround the knee. “Knee Pain and Bicycling” further explains that “excess internal tibial rotation, either anatomic or caused by improper cleat position, places significant stress on the distal ITB (iliotibial band) as it crosses the lateral femoral epicondyle. Varus knee alignment or excess pronation will increase the stretch on the ITB” (Asplund, & Pierre, 1993, p. 23).

Experts suggest two types of treatment for this pain commonly known as biker’s knee. First they suggest medical treatments of rest, ice, compression, elevation, modalities, and medications (such as anti-inflammatory medications). This should be accompanied by a physician’s examination to help identify and repair any anatomical discrepancies. The second treatment is on the bike. There are bike manuals and bike repair shops that can explain the proper height and angle of the saddle in relation to the angle of your knee at the peak of the pedal rotation. Proper cleat position should be addressed as well to prevent any injury.

As the age old saying says, education is the best prevention. Bicycling is fun and a wonderful cardiovascular and lower body workout. There are only a few precautions to consider before you jump on that old Schwinn, which has been hanging in your garage for ten years, and venture out on a crusade of biking.

Referances

Asplund, C., & Pierre, P. (1993) Knee pain and bicycling. Physician and Sports Medicine, 32 (4), 23-31. EBCOHost, Utah State University Lib. Logan, UT, May 14, 2004, .

Burke E. R. (1992). Benefits of bicycling and walking to health: Federal highway association (FHWA) case study # 14. Washington, DC: Government Printing.

Davis L. (2003). Knees like these. Bicycle, 10, 62-65.

Fitness comes in cycles. Saturday evening post, September 1993, 26 (5), 46

Sloane, E. A. (1988). The complete book of bicycling. New York: Simon and Schuster.