Potential factors associated with knee pain in cyclists: a systematic review

Abstract

The potential factors associated with overuse injuries and pain in cyclists that are supported by evidence remain unclear. Our study aimed at assessing, using a systematic search of the most updated evidence, the main factors related to overuse knee-related pain and/or injuries in cyclists. The search assessed any potential mechanism related to knee pain or injury that could be used in the clinical practice. Databases were searched (i.e., PubMed, Scopus, Web of Science, and EBSCO). Studies were included if they presented results from original studies. They had to include, preferably but not limited to, recreational and/or competitive cyclists with or without knee pain. Quality of articles was assessed. Eleven articles were deemed eligible for full text appraisal. Studies involved generally the assessment of biomechanical outcomes associated with knee pain in cyclists. Overall, studies showed that cyclists with knee pain present larger knee adduction and larger ankle dorsiflexion and differences in activation for hamstrings and quadriceps muscles. Unclear results were observed for knee moments and no differences were observed for knee flexion angle, tibiofemoral and patellofemoral forces. It is important to state that varied types of knee pain were mixed in most studies, with 2 focused on anterior-related pain. Cyclists with overuse-related pain or injuries on their knees presented an increased medial projection of their knees and an altered activation of the Vastus Medialis and Vastus Lateralis muscles. However, this limited evidence is based on retrospective studies comparing cyclists with and without pain, which limits the conclusion on how cyclists develop knee pain and what are the main options for treatment of knee pain.

The Incidence of Knee Pain Complaints in Pedicab Riders in the Kemuning District, Palembang

“…The presence of strong flexor and extensor muscle contractions when pedaling a bicycle followed by relaxation of the muscle contraction causes vasodilation which improves blood circulation. This is in line with several previous studies which revealed that increasing the strength of the knee extensor muscles will make the metabolic processes and local circulation in the body better so that the pain in the knee can be reduced 6,7,8,9 . But on the other hand, too much exercise can result in injury to ligaments, tendons and other tissues.…”

Changes in the Trunk and Lower Extremity Kinematics Due to Fatigue Can Predispose to Chronic Injuries in Cycling

“…Another key aspect is the change in the left knee, both in the y- and in the z-axis, with an increase in the adduction and the external rotation, and the increase in adduction in the hips in the y-axis. The kinematic alterations in the transverse and frontal planes could be related to the appearance of common cycling injuries such as patellofemoral pain [ 9 , 16 , 18 ]. Although this difference is only found in the left knee, it should not be assumed that the movement is cyclical and similar in both lower extremities [ 24 ].…”

“…Therefore, it becomes essential to monitor these planes to understand kinematics changes more accurately due to fatigue and the associated risk of injury. Some of those movements, such as a greater knee displacement (projection) to the medial axis or a greater ankle flexion, which would generate a change in knee motion, may be related to knee injuries [ 18 , 19 ]. Knee injuries have received special attention from the literature in an attempt to prevent them due to the higher number of injuries in this joint [ 20 ].…”

New Procedure for the Kinematic and Power Analysis of Cyclists in Indoor Training

“…• Knee: According to the different sources reviewed [2,9,41], the knee is the joint that supports the most workload during pedaling. Consequently, knee injuries in cyclists are very common due to their overload during the pedaling movement [2,3]. This is why, in the present research study, the influence of the use of different chainring type geometry in the correct knee movement will be analyzed.…”

“…On the other hand, while the technical innovation of the bicycle grows, the interest in the study of the biomechanics of cyclist is also rising [1]. This knowledge allows to maximize the cyclists' performance and avoids possible injuries [2][3][4]. Several studies have been developed on the position of the foot on the pedal, the height of the saddle, the displacement of the saddle and its inclination, the correct position of the steam and the handlebar, etc.…”