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cycling knee pain

Gluteal Muscle Activation Exercises

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It has been mentioned before in this Comox Valley Chiropractor Blog that improper activation of the gluteal muscle can lead to many lower limb issues such as knee pain (patello-femoral syndrome) or IT Band problems. A research study was recently published which sought to establish a group of exercises that were the most effective at activating the gluteal muscles.

The study, published in the Journal of Orthopaedic & Sports Physical Therapy, measured the EMG (muscle electrical activation) of the gluteus maximus and medius during various exercises. They came up with a group of 5 exercises which are the most effective.

1. Side lying hip abductions – abducting the top leg to 30 degrees.
2. Single leg squats – ensuring the knee stays above the second toe, and start with knee and hip at 30 degrees of flexion.
3. Single leg dead lifts – keep knee bent at 30 degrees to maximize hip and trunk flexion.
4. Lateral band walk – side-stepping against the resistance of a band tied around the ankles.
5. Side-hops – hopping sideways off the non-dominant leg to land on the dominant leg.

These exercises may not be appropriate for all patients and all conditions. Consult a professional in order to determine your diagnosis and any other issues you may have. A good home program lets you achieve the results you desire in terms of stability, with exercises that are easy to do and won’t result in further injury.

Dr. Debbie Wright is a practicing Courtenay Chiropractor.

The Broken Spoke saves the day!

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I’d like to extend a huge “Thank You!” to Mike and Tomiko over at The Broken Spoke in Courtenay. For those of you who have not had the pleasure of frequenting this new shop, its part coffee shop, part bike shop.

The coffee shop is superb, and in my opinion ranks very high on list of good coffee shops in Courtenay. If you’re ever bored on a Saturday, swing by the shop at 2 pm for a round of “Cupping”. Its like wine tasting but with coffee. You’ll leave educated, buzzed, and with a larger appreciation for a simple cup of coffee.

As for Mike in the bike shop, I have nothing but raves. Not only did he masterfully outfit my ancient 10-speed with paniers over the lunch hour, but he also managed to adjust my bike so I no longer get nagging leg pain. As a Courtenay Chiropractor, I knew that something about the bike’s setup was causing my pain – my knee was too bent when I started my downstroke. I didn’t think I could do anything since the bike is already pretty high for me, and raising the seat wasn’t an option. Mike took the time to watch me ride on my bike and adjust the handlebars and the seat. He somehow managed to move the seat further back and it instantly got rid of my problem. 5 months of pain gone in an instant – that’s even better than I can do!

I encourage you to support a great local business and head out to The Broken Spoke. It may even entice you to dust off your bike and get out on the trails, thereby decreasing the chance you’ll end up in my office!

Dr. Debbie Wright is a practicing Comox Valley Chiropractor.

Healing IT Band Syndrome

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Iliotibial Band
Iliotibial Band

Iliotibial band syndrome (ITBS) can be described as outside (lateral) knee pain that is made worse by any lower limb activities, most notably running and cycling.  The incidence of this injury is on the rise in my practice, but research also shows that ITBS is the most common running injury in the lateral knee, with an incidence of 1.6-12%. In cycling, ITBS may account for up to 15-24% of all overuse injuries.

It is thought that ITBS is an overuse injury in which the portion of the iliotibial band which runs over the outside knee rubs over the femoral bone with repetitive knee bending and straightening. This results accumulated tissue damage and irritation of the ITB. Specifically with running, as each leg comes forward before heel strike, the tensor fascia latae (TFL) and gluteus maximus/medius are contracting to slow down the leg, which can result in a large amount of tissue tension generated in the ITB.

A study published in Manual Therapy systematically reviewed all studies on ITB treatment in order to determine which was the most successful method. What they found is that there is a marked lack of good evidence to support any one given treatment for ITBS. All forms reviewed – ultrasound, friction massage, medication or ice all had very little benefit on the condition.

Part of the reason for this is that different treatments could work for different subsets of people (i.e. older cyclists respond better to one thing, while runners with chronic ITBS respond better to another). This Comox Valley Chiropractor will often see good results with ART (active release therapy) and other such soft tissue therapies, kinesiotaping,  and chiropractic adjustments to restore proper function of the pelvis, hips and back. Of course, one must always look above the problem (pelvis) as well as below the problem (feet) for a source of dysfunction.

So the bottom line of this post? So far, the evidence doesn’t point to one therapy being better than another. So when seeking out treatment, be sure to set an appropriate treatment plan that includes regular re-evaluation with your therapist. If something isn’t working, don’t be afraid to move on and try another modality once you’ve given the first one a good shot.

If you have any questions about ITBS, feel free to contact your Comox Valley Chiropractor for more information.

Cycling – A Pain in the Knee?

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This article was originally written for Wings of Steel – a blog created and maintained by Karley Cunningham, a cycling woman of steel!

Did you know that knee pain (or patello-femoral pain) accounts for one quarter of all cycling problems?

While cycling can provide an amazing workout without the repetitive high-impact forces (like those associated with running), it is in fact associated with a great number of overuse injuries. Patello-femoral syndrome, which is the most common cycling injury, accounts for around 25% of all cycling related complaints.

Biomechanical irregularity of the knee joint, along with demanding training, are believed to be responsible for most cases of chronic knee pain in cyclists. These irregularities are believed to put excessive pressure on the cartilage within the knee during the constant knee flexion and extension associated with cycling.

This produces degeneration of the knee cartilage and other structures. As the cartilage degenerates, more stress is put on the bones as they compress, producing pain and inflammation.

Why do people develop biomechanical problems with their knees? Explanations abound, including weak quadriceps (most notably the vastus medialis oblique), over-pronating arches, poor flexibility, genetic structural problems, improper bike set-up or poor equipment.

Training aspects that could aggravate the knees include excessive hill training, riding slowly in high gear and a sudden increase in training volume. Interestingly, research has shown that most cyclists with knee pain have too much side-to-side swinging of their knees during the down-stroke of their pedal cycle.

Usually, people will feel pain in the front and inside of the knee, which is hard to pinpoint. Often people will say it is inside the knee, or under the kneecap. Activities that can worsen the pain include walking up and down stairs, sitting for prolonged periods of time, squatting and of course riding.

If you’re a cyclist who develops knee pain, your first line of defense should be the familiar RICE – rest, ice, compression and elevation. Most cyclists with knee pain will find that this relieves the symptoms quite quickly.

It is important to note that this self-therapy will only serve to reduce the symptoms, but will not resolve the biomechanical problem that is causing the pain. Therefore, the pain will return when you go back to your regular training.

Your ultimate goal is to improve your joint motion, flexibility and strength. The quadriceps muscles need to be strengthened, abnormal biomechanics of the lower limb need to be identified and corrected, and training errors need to be rectified.

When introducing hill training or when increasing your training volume, be sure to do so in a gradual and measured manner. You may also add in some spinning, or cycling at low gears in order to maintain volume while minimizing stress on the knees.

If you are unsure of the source of your knee pain, or are unable to manage the condition on your own, consult your Comox Valley Chiropractor. A chiropractic doctor can diagnose a specific cause of your pain, provide treatment to manage the condition, and prescribe sport specific and injury specific rehabilitation exercises.