Chiropractor Chandler AZ

Pain Above Knee Cap When Cycling

Knee pain can occur with nearly any motion or movement, in this specific case cyclists are at risk to develop pain in the lower quadriceps, and sometimes where the patella tendon attaches to the kneecap. The repetitive strain due to so many hours on the bike creates micro tearing in the soft tissue, especially if the bike is not properly fitted for the cyclist.

This injury most commonly results in patellar tendonitis, which can cause severe pain around the kneecap without proper treatment. If left untreated, this can lead to chondromalacia patella and even patella femoral syndrome, or simply "runner's knee."

Patellar tendonitis is a description for pain around the patella or knee cap, also known as "jumper's knee." Even though activities with running and jumping can cause this, really anything involving the contraction of the quadriceps can result in patellar tendonitis. Many people often feel more knee popping or clicking going up the stairs.

When referring to chondromalacia patella and patella femoral syndrome, these are more serious injuries that normally occur when treatment is not sought after. Chondromalacia patella can cause chronic inflammation and pain, due to the deterioration of cartilage when the kneecap is poorly aligned. The difference between this and runner's knee is that with chondromalacia patella, the cartilage under the kneecap is damaged, with runner's knee the cartilage on the femur is damaged.

Causes of Knee Pain From Cycling

While cycling can cause this pain, certain types of cycling and even other exercises can cause the pain to become worse.

• Increasing time cycling
• Cycling on hills, frequently changing elevation
• Working on increasing speed, and increasing speed
• Intensive training, such as working towards a triathlon

We always encourage cyclists to have their riding setup evaluated by a professional. Improper riding positions can greatly increase strain on the knee, patella, and cartilage leading to injuries.

It is important to know these injuries are most common with any uptick in your training regimen, especially without proper care. Injuries can still occur without pain or swelling. It is important to learn the difference between muscle soreness from training and the beginning of an injury.

Anatomy of Knee

The knee is a massive hinge joint which allows over 130° of flexion. A straight leg (extended knee) can be bent (flexed) to where the heel touches the butt. This tremendous range allows us to run, jump, and squat. Your entire body weight and its resistance against gravity strains the joint. When we are running, jumping, or squatting, the forces are greater and shift through the joint depending on the level of flexion.

Your knee also has a slight amount of rotation. This rotation locks and unlocks the knee when standing straight-legged. Many times, people will feel a pop as they extend or flex a knee; some of this feeling is from the rotation.

Your knee is a complex joint. A simple version to that statement is that it has a lot of stuff in it. This stuff includes the bones. The weight-bearing femur sits on top of the tibia and the smaller fibula that is on the outside of the lower leg. Most of the weight is transferred from the femur to the tibia.

Underneath the patella is another layer of cartilage which faces the front of the femur. The femur is also covered in hyaline cartilage which allows the patella the glide up and down the femur. This area is called the patellar surface. Chondromalacia patella is when the cartilage underneath the kneecap is irritated. Patella femoral syndrome is when the cartilage on the femur is damaged. These are common locations of damage and pain with chronic knee pain.

Home Treatments

Proper care of your knees can prevent further injury. There are a few methods that are proven to help, but they are not always successful.

• Rest: decrease your training regimen, even if only slightly
• Ice: cold temperatures can reduce swelling, inflammation and pain
• Compression: wearing compressive clothing, or wrapping the knee after exercise can help reduce inflammation of the knee
• Elevation: rest the knee above your heart to decrease blood flow and reduce swelling

Combining these four methods will normally be the most effective method. One other at-home treatment that can be beneficial is the use of nonsteroidal anti-inflammatory drugs, or NSAIDs. Now, these treatments can sometimes be all that is required in moderate cases, but for most the pain will continue to reoccur until a treatment plan is employed. You can go two ways if home treatments are not solving the problem.

Medical Treatments For Knee Pain

MRI and x-rays will not usually be ordered to evaluate mild to moderate muscle, tendon, and ligament injuries. Severe cases may utilize advanced imaging to rule out bone fractures, edema, nerve entrapments, tendon or muscle ruptures. Nerve conduction velocity (NCV) testing may be utilized in cases that also involve muscle, sensory or reflex loss.

NSAIDs will commonly be prescribed for initial stages of knee pain. For more severe cases, prescription drugs may be used, such as muscle relaxers or an oral steroid. Steroid injections are another common treatment for severe cases, whether it is botox, steroid, or trigger point.

Stem cells and prolotherapy treatments are newer treatments for triggering the body's healing mechanisms. The treatments can enhance internal healing and repair, especially when combined with conservative therapy treatments.

A majority of the time these treatments will not fix the problem, but they will give relief to the injury for what can be a long time. To get the root of problem, you must correct your knee with therapy.

Conservative Treatments & Therapies

Therapeutic treatments for addressing soft tissue injuries involve massage therapy, manual therapy, trigger point therapy, Graston Technique, or Active Release Technique. These treatments increase blood flow, decrease muscle spasms, enhance flexibility, speed healing, and promote proper tissue repair.

Low level laser or cold laser therapy helps decrease pain and inflammation while enhancing cellular repair. Specific wavelengths stimulate the repair cells in the knee and under the patella.

When these treatments are incorporated into a treatment plan, patients heal faster and are less likely to have long-term pain, soft tissue fibrosis, or scar tissue in the injured muscle. These soft tissue treatments are incorporated with therapeutic exercise and flexibility programs.

Graston Technique is an advanced soft tissue treatment for eliminating knee pain in front and around the patella. Specific instruments help eliminate soft tissue pain sources in muscles, tendons, and ligaments.

Restorative Exercises to Eliminate Knee Pain

Knee pain is normally the result of poor strength and flexibility in important parts surrounding the kneecap. At our Chandler clinic, we work to improve movement and eliminate pain in a variety of methods.

Many therapeutic exercises can help restore proper strength and endurance to the leg muscles. Isometric exercises are often the initial treatment exercises, followed by single plane rubber band exercises for the hip, knee, and ankle: flexion, extension, adduction, abduction, circumduction, inversion, and eversion.

We also will employ a variation of dynamic knee exercises on unstable surfaces.

• Vibration plates
• Exercise ball
• BOSU ball
• Rubber discs
• Stability foam

The more unstable the surface, the harder your lower extremities work to provide stabilization. Vibration plates enhance neuromuscular learning throughout the foot, ankle, knee, hip and back.

Treatment for knee pain often requires a combination of therapies and treatments from multiple providers. Treatment goals are to eliminate pain quickly and then restore proper function to eliminate future risks of knee pain. More information can be found about advanced treatments for knee pain.

Our Chandler Chiropractic and Physical Therapy clinic treats a variety of people coming from different backgrounds with muscle, tendon, joint and ligament injuries. We provide treatment for cyclists, runners and triathletes in addition to common to traditional neck and back patients seen in Chiropractic, Physical Therapy and Massage Therapy clinics. We work with all ages and abilities for residents in Phoenix, Tempe, Gilbert, Mesa and Chandler.