One of my fellow indoor cycling instructors has been teaching for over 10 years. Recently she was invited to speak at a local certification workshop, specifically about injury prevention, proper bike setup and posture. While these topics have been discussed at length, one particular issue regarding knee health has not received enough attention. The following post is dedicated to the instructors who teach several classes a week and who may have suffered from patellofemoral pain syndrome.
The knee is a hinge type joint connecting three bones: the thigh bone (the femur), patella (kneecap) and shinbone (the tibia). The knee joint joins the thigh with the leg and consists of two articulations: one between the femur and tibia, and one between the femur and patella. It is the largest joint in the human body. The knee joint permits flexion and extension as well as a slight internal and external rotation. The knee joint is susceptible to both injury and the development of osteoarthritis.
Ligaments are connective tissues connecting bones to other bones. There are four major ligaments in the knee:
- The medial collateral ligament (MCL) provides stability to the inside of the knee
- The lateral collateral ligament (LCL) provides stability to the outside of the knee
- The anterior cruciate ligament (ACL) limits forward movement of the tibia
- The posterior cruciate ligament (PCL) limits backward movement of the tibia
Knee Joint Cartilage
There are two types of cartilage within the knee joint: fibrocartilage and articular cartilage. The meniscus acts as a shock absorber and dissipates friction between the femur and tibia.
Patellofemoral Pain Syndrome (PFPS)
The Patellofemoral Pain Syndrome is not a well defined subject. The consensus seems to be that the pain can be described as “discomfort originating from the contact of the posterior surface of the patella (back of the kneecap) with the femur (thigh bone)”. It is sometimes caused by wearing down of the cartilage under the kneecap. I’ve also heard of the PFPS being called as “runner’s knee”.
The main reasons for PFPS in indoor cycling instructors is overuse, injury, improper bike fit or a condition called “patellar tracking disorder” caused by a kneecap that is not properly aligned. The pain is most pronounced when teaching long endurance/strength rides, riding outdoors in the cold for prolonged periods, squatting with heavy weights, or when using the stairs. Sometimes you may feel a grinding sensation (or a pop) when moving your knees or walking.
Additionally, if you encounter pain that you can’t pinpoint, it’s likely bursitis. Bursitis often occurs from knee joint overuse. (fluid in the bursa helps articulate the knee smoothly).
Patellofemoral Pain Syndrome Treatments
PFPS can be relieved by avoiding activities that make symptoms worse – that is, taking a break from teaching. As an indoor cycling instructor, I can imagine that some of you would rather continue teaching than taking a break. In fact, some of you would rather live through the pain than be subbed (am I being too harsh?…read this about the benefits of subbing). But, we can all find a happy medium. Here are some suggestions to alleviate PFPS:
- Adjust your bike so that the resistance is not too heavy and the seat is at the proper height (I know…sounds obvious).
- Avoid bent-knee workouts for a while. These include squats with heavy weights, prolonged rides or kneeling in the bent-knee position for long periods of time.
- Ice the affected area, rest and use a nonprescription anti-inflammatory (NSAIDs), such as ibuprofen or naproxen, to mitigate swelling and pain.
- Schedule a wellness massage with a therapists who is experienced in sports massage.
- Use a brace to stabilize the kneecap if necessary.
Remember, you may be superhuman 🙂 but you still need to take care of yourself first. Commit to your health by listening to your body.