Save your knees

Pain in the patella and a grinding feeling at the front of your knee? It’s not as bad as it sounds, but you need to get it fixed.

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What do you feel

Pain at the front of your knee — clicking, crackling or grinding — is usually the result of a loss of movement, or maltracking, of your kneecap. These noises are known as crepitus — basically, tissues rubbing together abnormally.

Eventually this will lead to cartilage breakdown, though don’t panic — the noises don’t mean you have arthritis. You can use a simple test for maltracking: contract your quadriceps muscles while you push down on your kneecap.

If this reproduces the pain, the test is positive. Watch out for swelling in the knee joint or a bursa (fluid-filled sac) around the knee. Severe swelling may indicate a more serious injury, such as cartilage or ligament damage.

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The diagnosis

Patellofemoral pain syndrome (PFPS) is one of the most prevalent types of anterior knee pain and is fairly easy to diagnose. It’s also known as runner’s knee, but there’s no escape for mountain bikers as pedalling is repetitive and creates compressive forces.

PFPS occurs when there are imbalances between different muscles groups and a tightening in the connective tissue across the outer part of the thigh. This results in patella maltracking — the kneecap doesn’t slide up and down in a straight line or is simply pulled to one side.

How to fix it

Research shows that there can be an 80 per cent reduction in pain and 75 per cent improvement in knee function where a specific exercise programme is followed during the early stages of PFPS, with possible long-term benefits.

Try the following treatment plan to reduce pain, add strength and improve joint flexibility:

  • Reduce your mileage
  • Avoid squats and lunges
  • Avoid prolonged kneeling
  • Move your saddle forwards
  • Foam roller your iliotibial band
  • Stretch quads and hamstrings
  • Strengthen vastus medialis (inner) quadriceps muscle
  • Massage your kneecap downwards to improve its mobility
  • Ice after exercise
  • Try a patella stabiliser knee brace

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Can I keep riding?

Check you have full movement in your knee joint and are able to fully bend and straighten your knee in a conventional quadriceps and hamstrings stretch. Second, your kneecap should be ‘floating’; you should be able to move it from side to side when standing.

If your knee is unable to bear weight, gives way or locks, or there is excessive swelling or crepitus, you must stop riding and consult your GP, a physio or osteopath to correctly identify the underlying problem.

  • Steve Bryant

    Hi James, what about a muscle pain on the inside of the thigh. I think it’s the Sartorius or Gracilis, from above the knee to about mid muscle on both sides but the left is worse. Thanks.