Patella from Hella?

We asked a Consultant Orthopaedic Surgeon specialising in knees, to diagnose those nasty cracking sounds. Is MTB fundamentally bad for your knees?

>>> How to prevent knee pain on your mountain bike

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Is mountain biking fundamentally bad for your knees?

The answer is a definitive yes… and no. “When you load the knee with the joint in a bent position, it stresses the front of the knee heavily and it puts a large load on the cartilage surfaces behind the kneecap (the patella) and in the groove at the front of the femur (the trochlear groove),” Ian says. Too much loading or a weird kneecap shape (apparently plenty of have wonky ones) can lead to cartilage wear and tear and those grim crunching noises that “sound a bit like walking through fresh snow,” Ian says. This can lead to osteoarthritis.

That does sound very bad, should we all stop cycling then?

No, some people’s knees crunch and crack in a normal way, when “bits of soft tissue catch in the knee,” Ian says. Painful, but not nowhere near as bad or serious as cartilage damage.

“Also, there’s more to life than just your knees — and there’s no point in having pristine knees if you don’t exercise,” he says. “The injuries potentially sustained through exercise far outweigh the health risks associated with not exercising and it’s proven to help both physical and mental health.”

What should we do though if we think something’s wrong?

Don’t self diagnose online, for starters. “Instead see a proper qualified and experienced healthcare professional with a specific specialist interest in knee issues, and not just a generalist,” Ian says. “You need to do your homework and properly research the person whose advice you’re potentially going to be following.”

We need to listen to our knees more too. “’No pain, no gain’ is fine for muscle power and cardio fitness training; however, if you feel pain in a joint then this is a sign of potential damage, and if you ignore this warning sign then there’s a significant risk that you might simply make the damage worse,” Ian says. “So, if it feels good — do more. If it hurts — stop. It’s simple biofeedback.”

Can I self-heal my hurting knees?

Depends on the pain. You can use a foam roller to stretch out a tight iliotibial band (the band of fascia that runs down the outer side of the thigh, from above the hip down to below the outer side of the knee). Add in some ITB stretches and you’ll help treat conditions like ITB Friction Syndrome, and it can also help with some people with lateral patellar maltracking and patellofemoral pain.

“However, it’s certainly not a ‘cure all’ or a panacea for all knee ailments,” Ian says. “Importantly, what you need prior to any form of treatment is an actual diagnosis first — so make sure that you see a qualified healthcare professional and that you get a clear and specific diagnosis (which often requires imaging of the knee) prior to starting any form of treatments.”