Reader question from Tobias W.: I'm now in my second year on a road bike and I'm disciplined and committed. For some time now, however, I have been experiencing pain in my right knee after riding. This is probably the head of the fibula, from which a ligament or tendon runs to the thigh. I suspect that the fixed foot position in the clipless pedal could be partly to blame for the problem. What else could be causing the pain, what should be done or advised?
Dr Christian Merkl: I think that in your case, a disturbed tension relationship within the body's force-transmitting systems is probably to blame for the painful changes. These systems - also known as lines of force, chains or myofascial meridians - consist of muscles, tendons and fasciae, the soft tissue components of connective tissue. They are found in all regions of the body. There are, for example, back, frontal, lateral and arm lines. These transmit the forces in an ascending or descending direction. At certain points, the force must be transferred from one line to another. At these so-called deflection pulleys, there is a risk that the tension will increase beyond a healthy level. This can be the case particularly in the case of malpositions, after injuries and operations.
In your case, the pulley from the head of the fibula to the lateral femoral condyle is probably affected. To solve the problem, an experienced osteopath should look for the primary cause or disorder, which may be localised elsewhere in the body. He must then work through force fields and tensions. Physiotherapeutically, the focus is on stretching the lateral line, whereby you should mobilise the following areas: the transverse arch of the foot, the outer foot muscles, the outer tendon bandage of the thigh (tractus and outer hip adductors) as well as the lateral upper body and possibly also the head of the fibula. Frame geometry, saddle height and the position of the pedal plates on the cycling shoe naturally play a role. Make frequent changes in small steps to gradually work on solving your problem.
