Spring Knee

This article is currently under review and may not be up to date. Please come back soon to see the finished work! (6/01/2021)

Original Editor - Puja Gaikwad

Top Contributors - Puja Gaikwad, Olajumoke Ogunleye, Kim Jackson and Lucinda hampton  

Introduction

Cycling is great exercise and a wonderful way to explore your local area and bike trails. But too much too soon without enough preparation can lead to a soft tissue injury known as 'Spring Knee'. It is an overload injury more likely to occur when ramping up outdoor riding in early spring after undertraining in winter. This overloading frequently takes the type of 'mashing' up hills or through tough efforts utilizing big equipment to get fit after a reduction in biking activity over winter.

A Sudden increase in activity, either by a rapid increase in load, mileage, or intensity in an attempt at last-minute fitness gains is the commonest cause of spring knee. This could be an effect of both the training intensity and the duration. Both situations can give rise to knee pain. This type of soft tissue injury occurs because the new recruitment pattern may not be optimal, and at 5,400 pedal revolutions per hour, it adds up, leading to neurological reprogramming, muscle imbalance, and, ultimately, causing an overuse injury.

Knee Anatomy

The knee joint is fundamental in providing pedaling power on the bike. The torque applied through the downward segment of the pedal stroke is the highest area of force production, achieved through a combination of hip and knee extension. The extension of the knee is a result of contracting the quadriceps muscles in the front of the thigh, which crosses the front of the knee joint and pulls against the lower leg. Since the quadriceps make up the largest muscle group (especially in cyclists) the knee joint deals with much of the overload during cycling.

Causes

• Riders increasing the amount of riding volume and or intensity dramatically over a short period of time.
• Inadequate training and physical conditioning
• High intensity, harder rides, climbing, or riding with a low cadence all of these can put a lot of strain on the knee.

Contributing Factors

Some of the contributing factors in developing this type of knee pain in cyclists involves:

• Training Errors: Include heavy training loads and high mileage (beyond what the body is conditioned to do), or a rapid increase in training duration or intensity, particularly hill work.
• Gearing and Cadence: Pushing hard gears at low revolutions put a high load through the patella, whereas lower gears at a high cadence (85-90rpm) will put less load through the patellofemoral joint with each stroke.
• Pedaling Mechanics: Inside drift (internal rotation) of the knee, especially during the push down phase, can be due to weakness or fatigue of the gluteus medius or VMO muscle. This increases the lateral forces on the patella.
• Muscle Tightness: Most cyclists’ quadriceps and hamstrings will be tight with prolonged riding due to the repeated contraction and shortening of these muscle groups. The inflexibility of the quadriceps, hamstrings, or iliotibial band (ITB) can limit the range of motion around the knee and are likely to increase the forces on the knee.
• Weak Lower Limb Muscles: May lead to fatigue-induced alterations in pedaling technique, which will also alter the forces on the knee. As muscles fatigue, their ability to take load reduces, increasing forces through the joint.

Signs & Symptoms

This is marked by a sharp pain at the top of the patella. Cyclists generally report that the pain is worse when the knee is loaded for example when climbing or descending stairs, during prolonged sitting or squatting, when climbing hills, or pushing high gears.