Knee pain in the triathlete is often very debilitating and if not treated correctly can be career ending. The miles put in on the bike and in running puts a tremendous load onto the knee joint. If the muscles are out of balance or the biomechanics are compromised, then the athlete can develop severe knee pain.
One of the most common causes of knee pain in the triathlete is a condition called ITB Stress Syndrome. Due to a tight fascial band called the ITB which runs down the outside of the leg, the knee gets overloaded from the outside changing a person’s running mechanics.
Over time this creates scar tissue around the outside of the knee and will cause ongoing problems for any future running or cycling.
Right (1) is a picture of the ITB. You can see how it runs from the outside of the hip/gluts down the leg and wraps into the outside portion of the knee. When this is tight it can pull the patella/knee cap sideways, it can squeeze the structures of the lateral/outside of the knee, and it can squeeze the structures around the hip.
Two of the most common biomechanical causes of ITB syndrome are pelvic girdle muscle weakness and incorrect knee alignment issues during running. Right is a picture of a weak pelvis with poor gluteal activation.
If the pelvis can’t stay level during running then the load is transferred down the outside of the leg at impact causing huge stress down the ITB. If the pelvis is strong then the knee stays in line with the hip and foot.
The second picture (2) is classic genu valgum or “knock kneed”. Again this starts with the weak pelvis and hip, but it creates a poor tracking movement of the patella and will really damage the knee.
If you are a cyclist or runner the below exercises are a must do.
To release the ITB and quad/hip flexor use the Obie Roller as shown in the pictures below (7-8). Roll each muscle group slowly from hip to knee repeat 10 to 15 times per muscle group. Keep your muscles as relaxed as possible to let the roller get into the muscle nice and deep. If it’s painful at all use the other leg to reduce the pressure on the muscle.
Two of my favorite gluteal strengthening exercises. The first one is the modified clam (5-6) and according to EMG studies is the best exercise to get the deep gluteal muscles firing. The average athlete should be able to do 90 easily, if you can’t pump out 90 then you may have poor control of your glutes.
The Swiss ball exercise (3-4) is a great functional movement in that you are mimicking the way you run or walk. The key is to keep the pelvis level and stand tall during the knee lift. You will feel the burn in both glutes after only 10 to 15 reps.
If you are having any trouble with your knees and want to take your sport or activity to the next level of performance please feel free to contact the team at Advance Physiotherapy.