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  • Posted May 6, 2001

Health: What to do about sore knees, numbness, and other concerns.

SORE KNEES

Q: I cycle about 100 miles a week, but if I ride more than 25 miles at a time, the outside lower portion of my knee hurts and becomes stiff. The tendon that runs along the outside of the knee joint gets sore and seems to pop in and out of the groove that runs just to the right of my kneecap. The stiffness goes away several hours after riding. What's the problem and what can I do about it?

A: You have an iliotibial band fraction syndrome. It is common in cycling novices as well as experienced riders just beginning their spring workouts. The iliotibial band is the large tendon on the side of the knee. It moves over the bony prominence of the knee as the joint moves past 30 degrees of flexision. (Zero degress is a straight leg.) If you use step-in pedals, try some that allow for 5-10 degrees of float. You also might try widening your stance with spacers (2-3 mm) between pedal and crankarm. But most important is stretching your iliotibial band. One good stretch is the Ober stretch. It's done while lying on your side, with the leg that is to be stretched on top. In this case, let's say it's the right one. Your shoulders and hips should be aligned as if you were standing at attention, with the left leg slightly bent for balance. Bring your right foot back and hold it behind you with your right hand. Keeping hold of this foot, bring your right knee forward and begin making a big circle with the knee going toward the ceiling. This motion aligns the ITB over the knee and hip bone, maximizing the effectiveness of the stretch. Continue the circle, bringing the right knee down and behind the flexed left knee. This is when the actual stretch occurs. Using your abductors (groin muscles) hold this position for 10-15 seconds, then relax. If your hip flexors are tight, you might need someone to help stabilize your position. Do 4-5 reps for each leg, 304 times a day. Cyclists who want to use the stretch to prevent problems should do 4-5 reps a day. Andrew Pruitt, Ed.D.

ACHING ACHILLES

Q: I've concentrated on pedaling with a strong pushing and pulling technique, particularly on hills. My Achilles tendon became sore and swollen, and now I'm in a cast for a month. When the cast is removed, what can I do to strengthen my Achilles? ld I alter my riding technique? Are tendon problems common among riders who pull up during the pedal stroke?

A: Achilles tendinitis is becoming more common among cyclists. During the pedal stroke, the usually flexible foot must act as a rigid lever. A group of muscles known as the plantar flexion mechanism provides much of this rigidity. Some cyclists' feet cannot maintain adequate stiffness and place increased stress on the Achilles tendon. This result is tendinitis, or microtears in the tendon. Casting is an effective type of forces rest that allows healing, but it often results in stiffness when the cast is removed. A stretching program will help you regain a normal range of motion. I suggest splinting or taping your Achilles when you return to cycling. To prevent a recurrence, try moving your feet forward on the pedals 3-5 mm ahead of neutral (ball of the foot over the pedal axle) by moving your cleats backward. This shortens the foot as a lever, which reduces stress on the Achilles tendon. Sometimes this is a permanent adjustment--sometimes it's only temporary. Andrew Pruitt, Ed.D.

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