♪ Bob and Brad ♪
♪ The two most famous physical therapists on the internet ♪
- Hi folks. I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And together,
we are the most famous physical therapists on the internet.
- In our opinion, of course, Bob.
- Today, you wanted to cover how to stop knee pain
with bicycling.
- Absolutely.
Cause it is one of the problems with bicycling.
Back pain, knee pain are probably the more common issues
I come across with cycling.
- It's interesting you say this, Brad,
because I just started biking the other day again.
- Sure.
- You know, it was nice out.
And I started to feel a little bit of pain
on the outside of my knee.
And luckily I knew what to do, but...
I think it's, we will kinda allude to this later on...
- Otherwise you could wait
and watch this video and then figure it out.
- All right.
Well, I can do that too.
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- Excellent.
- All right, Brad
what's the first thing you wanna do to stop knee pain?
- Well, it doesn't matter what kind of bike you have.
Everything we're gonna talk about refers to mountain biking,
a road bike like this, or a cross trainer.
You're all sitting in the seat.
You're peddling, the knee's doing the same action.
So the whole thing is about, people say,
"Well we should bike, no impact.
That's gonna be good on our joints."
That's not exactly true because there is repetitive motion.
You know, if things are not lined up properly and you do
that repetitive motion over and over and things are grinding
or not, you know, misaligned, it's gonna cause problems.
- Yeah, it is. - Yep.
- It's just repetitive motion, injury type thing.
- Exactly.
- So what's the first thing we should cover, Brad?
- By far, the biggest thing for the knees,
in my opinion, is the height of the seat.
Make sure you've got the seat the proper height.
In my opinion and from the people I've talked to,
who know more about this than I do,
the seat in most people's cases is too low.
- Right.
And I see that all the time.
- Yeah.
- We were just talking about this.
I saw a guy in our neighborhood who's just peddling
around like a clown and I mean, he's gonna get knee pain.
- Right? Right.
And so let's get right to it.
You need to get on your bike.
If you don't have a trainer like this to hold your bike up
you're gonna have to have someone hold the bike up
cause you need to get on the seat.
And it is really helpful to have a trainer
so you can spin around a little bit,
get your seat bottom on the seat where it belongs,
where you would naturally have it when you ride.
Get your foot parallel to the floor.
The bike should be parallel to the floor.
- This part should be parallel to the floor.
- Right. So we're not gonna be pointing down like this
or in the opposite direction
with a knee closer to the floor, parallel there,
and go to the bottom dead center, six o'clock I call that,
like if you reference to a clock. And go ahead, Bob.
- Well, you're gonna have a slight bend
is what you're gonna have.
- Exactly. That's what you want.
- Oh you're at about a 13.
- Yep.
- Today. - Yep.
- Lucky 13.
- Right? And from the information I've got from the experts;
nine to 14 degrees is what's recommended.
- You barely made it Brad.
- Right? Yeah. So I'm in there.
If the seat's too tall, you're gonna find yourself
reaching down for that pedal.
And that may be harder on your back than your knee.
If you're too low and you come around and your knee,
you know, gets about this far,
that's as straight as it gets,
it's really hard on the patella. The knee cap.
And it's gonna give you a more increased risk of arthritis
as you get older.
This is one of those things.
You may not notice it that summer that you're riding.
But years down the road, it catches up with you.
- And Patellofemoral Syndrome too.
- Exactly.
We're we're gonna talk about some exercises
on how to take care of that.
- So you want to use your plumb line too, Brad?
- Yep. The next thing is, make sure the seat is forward
and backwards in the proper direction.
- If you have that adjustment.
- Right. A typical cross trainer may not. Any road bike
or a mountain bike typically does.
The adjustment's under here.
You can move the seat forward and backward
a few centimeters,
put the pedal at the three o'clock position.
That would be 12.
That would be three.
Or it could be nine
depending on which way you're looking at it.
It doesn't matter.
And then you take a plumb line.
I'm gonna hold this,
this is a lot easier to see in the camera,
directly below the end of the patella.
You're gonna go down.
You're gonna look at this edge of the line.
It should line up with the axle of the pedal
or your MTP joints, right through here,
where your toes connect to your foot.
- This one is going in front of the knee?
- Right. You go in front of the knee.
Actually, it should be one to two centimeters
in front of that axle line.
This, I'm not gonna spend a lot of time
on getting real accurate with, for this particular video,
but if you're way out here and you're hanging
in front of your toes, you've gotta change
and get that seat back a little bit.
- [Bob] Yeah. That's the whole thing
is you don't want that knee in front of the toes.
Just like when we do squats and everything else you...
- [Brad] Exactly. It's that same concept.
So make sure your seat is in the right position
forward and backwards, up and down is by far more important.
The other thing, if you have a pedal that has flats
or you're not clipped in to the pedals,
then you don't have to think about this.
But if you do, if you got clip less pedals
or if you happen to have stir ups,
mostly with clip less there's some adjustments on those.
Like on this, I had mine tight
and the guy who set me up with it at a bike shop,
he made my feet point straight ahead
so it looked anatomically correct.
Well, my body doesn't work that way.
My toes point out naturally.
- Brad tends to walk out like this a little bit.
- Yeah. Maybe even a lot, a bit.
And so he did that.
I'm riding my bike with my feet all nice
and lined up the way it's pretty, so it looked good,
but I could feel it in my knees pretty quickly, actually.
So I loosen those up and my toes do point out a little bit
when I ride, but I feel better.
And that's the way it works.
- [Bob] Yeah. That's how you're built anatomically.
- [Brad] Exactly, so that may have an effect on your knee,
having too tight or, I was reading,
even if it's too loose, which I haven't quite
figured that out yet, but I could see if it's too loose,
maybe things are moving too much.
But keep that in mind making adjustments
on the clip less pedals.
Now this other one is probably one of the biggest things
and it doesn't matter how you have your bike adjusted.
It's the old saying too much too soon.
You just buy a bike.
You haven't biked before and you go out
and you ride 20 miles, put a few hills in there.
You put some good stress on your knees
and you get off and you can't walk.
And the next day your knees are swollen up and painful.
And then you decide not to go biking anymore
cause it's hard on your knees.
You know, start out reasonable.
- Start off. Yeah, exactly. Start up slow and build up slow.
- Exactly. A few miles at a time.
If you're an experienced biker
you know what I'm talking about. Now let's talk about...
- Some of the injuries that could happen.
- Yeah. Probably one of the big things is the kneecap.
If the kneecap or patella's not tracking
in the femoral groove, we call it,
well that can cause problems
and you'll feel while you're biking
or maybe the next day or even years down the road.
So we're gonna talk about, if you feel pain in the knees,
you got everything adjusted right,
and you're still feeling knee pain when you're riding
and should we go through the taping?
- Yeah. let's go through the taping.
- Easy way you can do this to determine if it is the kneecap
not tracking properly...
- Actually Brad, if you wanna bring that stool over.
- You bet.
- So again, this kneecap, it actually moves
up and down when you bend and straighten your knee.
- Right.
- And it's going along in a groove.
And a lot of times what happens is the kneecap
is drifting too far that way.
- Right. So it's lateral or to the outside.
- It's too far this way. So what we do, as a test,
to see if this helps your knee pain, is we actually take,
usually we put some underlying tape down first
cause this is really hard on the skin,
but just for instructional purposes, we won't.
But what I do is, actually,
the leg has gotta be really relaxed.
Cause you gotta be able to move the kneecap
and I'm pushing it over here.
So you actually take the piece of tape,
put it on the edge here of the kneecap and you push it over
and then you tape it in place.
- [Brad] Right. So you can see,
if you can zoom in on this line.
I dunno if you can see it, but the skin is wrinkling.
We're actually pulling the patella slightly over
towards the inside now.
- [Bob] And usually I'll do two pieces right away.
I'll do it again. I'll put it on there and I'll pull it over
and do it again.
- [Brad] Now if you're at home, you could just go
to the pharmacy and buy some athletic tape and do this.
- [Bob] Yeah. And give it a try and then go ahead
and bike with it like this and see if it makes it better.
- [Brad] Exactly. So if you go bike a mile,
you got some knee pain, you feel it in the front
of the knee, get off, you know,
and make sure it's not sweating so the tape sticks.
Put the tape on, pulling it over,
and go ride the exact same route.
And if you feel an obvious difference, it feels better
because of the tape is on there,
it's pretty clear, you've got a tracking problem.
- And one of the things you can do for treatment, Brad,
for that, I'm just thinking of this right now,
is actually, you can stretch that kneecap.
I mean, you can work on pushing it over here
and stretching it this way.
We actually even stretch it down this way and up this way,
they stretch it in all directions.
- Right. We call that patella mobs.
- Yeah. And you can just push on yourself
if it doesn't give you the creeps.
- Right. Now, if you're doing this at home
and you go like this and you try to do it,
- That's not gonna work.
- Your kneecap is locked and you have to have it
up on something.
And now my kneecaps, the quads are loose,
as relaxed as they can be.
And then you can really get that kneecap to move around
and then you can do those mobs on it.
These mobs should not create any sharp pain at all.
It should be just a stretching, you know,
a general stretch type feeling.
- I'm gonna show one strengthening for the...
- You bet.
- For the Patellofemoral syndrome too,
it helps to strengthen the external rotators,
believe it or not, of the hip.
- [Brad] Okay.
And I'm not gonna go into why that works,
but let's say this is the knee Brad,
cause I don't wanna lay on my microphone.
- [Brad] Sure.
- So I'm gonna, you're just gonna do clamshells.
- Yep.
- Like this and you can do,
you could actually do it with TheraBand,
or resistance band too if you wanna make it harder.
But actually if you do quite a few of these, Brad?
- Sure, yeah. Let's give this a try just in case.
Gimme some room Bob. There.
But yeah, Bob was saying,
you don't even need to have resistance a lot of times
- [Bob] Especially to start.
I'll bet you do three sets of 15 on this.
It's gonna be burning.
- [Brad] So, you know, we've got some guys out there
that are pedaling a hundred miles an hour.
They're gonna need some resistance
- But they may be surprised how weak their hip is.
- Sure.
- So the other culprit quite often is the IT band, isn't it?
- Right. Exactly. That the band that goes from...
connects just below the knee, all the way up
to the TFL and into the pelvis.
- Yep and what you get is,
it's called IT band friction syndrome.
And that's if you're getting pain
on the outside of your knee.
- Yep.
- And so if you're getting that, and it makes sense,
cause your band is tight and it's just constantly,
you know, repetition here.
You're gonna want to stretch that IT band.
- Yeah. That band has gotta get stretched out.
So you can gain that flexibility
and take the pressure off of that.
- So you wanna show...
yeah, foam rollers are a great way to stretch it.
- If you're going use this technique on a foam roller,
I recommend the low density one.
If you get the higher high density one,
the black one, it's pretty aggressive.
So you're gonna go like this so you're supporting here
with this hand and you're gonna roll right across
that IT band.
- [Bob] And I'd really work up
in the tensor fasciae latae area too.
And even the glute max attaches into the IT band.
So you wanna really work those muscles cause that's the part
that's really stretching.
I don't know how much the IT band even stretches.
But I think if you foam roller the IT band,
it pulls on those muscles and stretches.
- Yeah, exactly.
And you can spend, you know, five minutes
on doing that if you'd like to, two to three,
depending on how it feels.
- [Bob] So those are probably the two most common things;
the IT band and the Patellofemoral.
So hopefully that has helped.
Thanks a lot.
- Have fun biking, less knee pain.