Cycling And Knee Pain

With the OCBC bike race this weekend, both our clinics have been seeing quite a few cyclists this past week and so I thought I'll do a write up on the combination of cycling specific factors that can cause ailments/ grief to your knees.

These factors can often be divided into cycling specific reasons, bike specific and cyclist specific reasons. Cycling specific causes are mainly due to suddenly increasing distances, intensity, hills, using heavier gears and lower cadences while bike specific reasons are likely to occur when radical changes are made to your saddle height, setback and/ or cleat position.

I will elaborate more on the cyclist specific factors that can cause your knee injuries as this often happen due to your own individual make-up and biomechanics, i.e. intrinsic rather than extrinsic reasons.

The first cyclist specific factor that can cause your knee pain is usually due to anatomical differences such as a leg length discrepancies (bearing in mind most of us will have this). Most often though, I've found that most cyclist tend to favor one leg over the other. This is usually the leg with your thigh closest to your seat post when you are pedaling which partly explains why knee pain seldom affects both knees equally.

All of us have had falls, knocks, scrapes and other injuries which may lead to us subtly changing the way we move and so previous injuries (cycling related or not) can also be a contributing factor to causing knee pain. This is especially more so when we decide to ride more than normal at the start of the season or when we have a new bike etc.

The cumulative effect of the two reasons mentioned above can then upset the forces your knees have to deal with while pedaling. Each pedal stroke bends and straightens the knee joint but it should never straighten your knees fully (if it does, your saddle is too high). The push (straightening) phase starts when your knees are bent at about 110 degrees, and the knees start to bend again at about 35 degrees (when you start the pull phase of your pedal stroke). Your muscles and tendons around the knees are the direct shock absorbers for the forces transmitted there. Hence overused or tight muscles which arise from repetition (with you turning the pedals over and over again) can contribute to increased forces to your knees.

The accumulation of excessive loads over time can exceed your body's ability to dissipate forces which can lead to damage if not given a chance to recover, which then leads to injury (hence the need for rest days).

The good news is the vast majority of these cycling specific knee pain improve quickly (with non-operative intervention) with correct identification and treatment of the cause of your pain, something which we at Physio and Sports Solutions are good at.

Please come look for us if you need. And all the best to all of our patients who are taking part in the race.

*Thanks to my patient KM for allowing me to take a picture of his knees.

Adidas miCoach Pacer

Received this from Adidas recently and have put it to test.

The miCoach Pacer combines a heart rate monitor, pedometer, calorie counter and real time coaching that you can connect to your iPod. It also has online coaching tools that allows you to keep track of your workouts and guide you along to improve your times.

It comes with a heart rate monitor device to strap around your chest, a stride sensor which attaches to your laces and the main control unit which collects data. After your calibration is done, the Pacer can start collecting data.

I've only just tried it a few times, stay tuned as I try it out a few more times before I can comment further.

Dr Kenso Kase Visits SS

Dr Kenso Kase, founder of the Kinesio Tex tapes and taping technique dropped by at our clinic today for a visit and also to be interviewed by the media.

Besides using the Kinesio tapes as part of our treatment process when needed while treating our patients, we will soon be teaching Kinesio taping courses as well. Stay tuned for more details.

Please also see http://physiosolutions.blogspot.com/2010/02/certified-kinesio-taping-instructor.html

New Kinesio Tapes

Got a roll of the new Kinesio tapes from Dr Kenso Kase himself. It's on the right of the picture, called Kinesio Tex Plus. It's thinner, lighter and made especially for people with ultra sensitive skin (even though the original Kinesio tape has no latex). See the new "leaf" like (that's what Dr Kase calls it) patterns.

According to Dr Kase, this new tape will only be released later this year in June. Well, you get a sneak preview here first. You get to see the skin color here. Apparently there will be up to 7 colors with the new tapes (there's skin, pink, blue and black now).

Well, we'll be trying out the new Kinesio tapes in the clinic.

Please also have a look at this (http://physiosolutions.blogspot.com/2010/02/certified-kinesio-taping-instructor.html).

Barefoot Running Versus Running In Shoes

Here's the latest and hottest debate in online running forums this past week after this article was published last week in the Nature journal (reference below). The article reviewed landing patterns while running barefoot or with running shoes and which produced more forces. You know what, the barefoot debate is about to get hotter.

The scientists studied 5 different groups of runners and had them run barefoot and in shoes while measuring their foot strike patterns, (whether the runner landed on their heels, midfoot or forefoot) impact forces, loading rate and joint angles .

What did they find? The runners who ran barefoot landed more towards the fore and mid foot. Nothing new here as many previous studies showed this already. They also found that while running barefoot the runners had a reduction in loading rate and peak impact forces (3 times lower in fact).

We know in theory that with higher impact forces means greater injury risk and this paper's findings may suggest that people who run barefoot (or at least in minimalist shoes) may have a higher chance of avoiding injury.

I guess the media will probably have a field day over this and suggest that running shoes have caused all your injuries and that you should throw away your running shoes and start to run barefoot.

Now before you all go out and chuck your running shoes away, please bear this in mind. If you haven't at all been running barefoot or even in minimalist shoes and you go try and run say even 5km barefoot I bet you'll be sore and probably even get injured the next day. Why? Well, you are now loading your muscles and joints (that have been used to shoes) that are definitely not used to this sort of loading. Even the authors suggested that there needs to be more controlled studies on whether runners who run barefoot have reduced injury rates.

So the question remains on whether barefoot running reduces injury rates or help you run faster. Well, what we do know from this latest study is that barefoot running may protect you, your feet and lower limbs from some of the impact related injuries experienced by a high percentage of runners. If you want to try it, please do so progressively.

If you enjoyed this please also see this and this and please pass this information on. Please email me if you want the articles referenced below.

References

Jungers W (2010). Biomechanics: Barefoot Running Strikes Back. Nature. 463: 433-434.

Liberman DE, Venkadesan M et al. (2010). Foot Strike Patterns and Collision Forces in Habitually Barefoot versus Shod Runners. Nature. 463: 531-535.

*Picture from Nature cover

No Pain, More Gain?

Before you carry on reading, I'll like to get this straight right from the start. If you choose to take high doses of pain medication before your races, there may be a potential risk of higher injury as pain may be an important warning of impending muscle or joint damage. Large doses of pain medication taken often, too may have harmful effects on your liver, kidneys and gastrointestinal (stomach) tract & lining.

I am saying that I do not recommend the chronic & frequent use of analgesics (pain medication) to help enhance your athletic performance. So if you insist, don't say I didn't warn you.

Now you're ready to read what this is all about. A group of British scientists have found a novel way of for elite endurance athletes to go even faster. Since the "pain" of high intensity exercise affects our performance (meaning if racing hard & fast is too painful, we slow down), one way to improve performance is to then lower our pain levels to enable us to go faster.

In their randomized double-blind study(meaning both participants & researchers don't know which cyclist gets the meds or a placebo), they gave the elite cyclists a dose of 1.5 grams of acetaminophen (the active ingredient found in Tylenol) or a dummy tablet before a 16km time trial - (distance like a prologue stage of the Tour de France).

The results were astonishing to say the least. Cyclists were 2% (or 30seconds over 16km) faster while on the pain medication while recording a higher heart rate and producing more lactate (meaning they were able to push themselves harder) and rode faster while rating the effort easier. What's more, the authors also hinted that this actaminophen effect could be even more dramatic in longer duration events.

Before all of you run out to get hold of some even stronger pain medication (I shan't tell you what) than acetaminophen (as acetaminophen is actually quite mild, which makes the research even more remarkable) similar research has been done with stronger pain medication. The subjects in that study felt super and went out too hard in the first half of the time trial and slowed down big time in the second half. Now you wouldn't want that in your race would you. Please see this. Previous studies using aspirin or ibuprofen returned conflicting results.

Now I can hear some of my readers and patients asking me already, so what did I take while I was still racing. I didn't take anything in the "small" races, I only took them in my goal races. What did I take and what was the dosage? Come speak to me and I will reveal all.

Mauger AR, Jones AM & Williams CA. (2010). Influence of Acetaminophen on Performance during Time Trial Cycling. J Appl Physiol Jan 108(1): 98-104.

*Picture from Flickr

How To Fight Fat The Fun Way

.

Have a look at today's Sunday Times (241010) and you will see Sports Solutions quoted in the Lifestyle section on page 10.

I've just been told that if we (Physio and Sports Solutions) use their headlines or their photos (Singapore Press Holdings) we have to pay them a yearly fee so I've taken out the photos and changed the title so you'll have to look for it in the papers.

We've even been slapped with an "investigation fee" if we refused to pay a yearly fee for each article.