Crunching in the knee joint
Question:
After twelve years of cycling as a competitive sport, I now have constant slight pain and strong crunching noises in my knee. How can I regenerate my joints so that I can continue cycling without pain?
Answer from Dr Merkl:
Its clinical picture is common in cyclists, as the pedalling force of the thigh is transmitted downwards via the kneecap. This puts strain on the cartilage covering the kneecap and can lead to damage. Injuries, incorrect movement, overloading or congenital deformation are usually the cause. Unfortunately, worn cartilage does not grow back. Unlike muscles, cartilage, tendons and ligaments only adapt slowly to training stimuli. Why don't you try the following?
You can do the following as a preventative measure:
* Reduce the amount of training and avoid excessive loads.
* Ride with a high cadence and low pressure.
* Allow sufficient regeneration phases.
* Wear knee warmers in cold weather, as the knee joint is insufficiently insulated with subcutaneous fat.
* Check and correct your position on the bike if necessary!
Do not sit too far back, too low or too high; with the cranks in a vertical position, the knee joint of the outstretched leg should still have five degrees of complete extension. If necessary, correct the position of the pedal plate - the feet should be as parallel as possible to the chainring, the centre of the ball of the foot (metatarsophalangeal joint) should come to rest above the pedal axle.
* Use pedals with lateral freedom of movement
* Stretch the rear thigh muscles frequently and well. Their shortening leads to increased tension in the front muscles and thus to a nutritional disorder of the posterior patellar cartilage. To support this, you can take cartilage building supplements such as gelatine. Although destroyed cartilage cannot be rebuilt, it can be stabilised. (For extreme cases, there are now new forms of therapy in specialised clinics using cartilage tissue grown from individual cartilage cells).
Painful knees after angle change/jumper's knee
Question:
During winter training, I tried to improve the power transmission by correcting the angle of the pedal plates. Since then I have had pain on the outside of both knees. Even resetting the pedals and using cup pedals did not bring any relief. What should I do?
Answer from Dr Merkl:
Your problem appears to be patellar tendinopathy or "jumper's knee". The tendon at the bony insertion of the kneecap is inflamed The tendon-bone junction - here between the kneecap and patellar tendon - is generally a problem area. Irritation and inflammation can easily occur here due to overloading or incorrect loading. I think it would be helpful to continue working on changing your sitting position. Physiotherapeutically, physiotherapy with transverse friction (massage) of the tendon insertion, local infiltrations and therapeutic local anaesthesia, acupuncture and physical measures help. I have also achieved success with shock wave therapy in 70 to 80 per cent of severe cases: The tendon insertion is targeted with the energy of the kidney stone burster. Otherwise, the remedial and preventive measures mentioned under the question "crunching in the knee joint" apply.
Trapped meniscus
Question:
After an intensive ride, I sat down cross-legged on the floor. I felt a sharp pain in my knee, which quickly subsided. During training, however, I noticed a slight "growling" in my knee, which didn't hurt but worried me. What could have happened?
Answer from Dr Merkl:
Your description suggests that a part of the meniscus between the femoral condyle and the tibial plateau has become trapped. This leads to severe pain. However, if the meniscus is not damaged, you will be able to put full weight on your knee again after a few weeks. However, such an impingement often occurs in connection with a cartilage weakness of the back of the kneecap. This causes the "creaking" you have described (see the recommendations mentioned under the question "Creaking in the knee joint").
Cyst in the knee
Question:
My wife has a cyst in her knee following a meniscus operation. Despite taking various medications and exercising (cycling, hiking, swimming), the cyst is getting bigger and bigger. What can she do?
Answer from Dr Merkl:
A cyst in the hollow of the knee is known as a "Baker's cyst". The cause is increased fluid production in the knee joint, which is caused by a disorder inside the joint. The reason for this can be cartilage damage caused by an injury or inadequate regeneration. The fluid presses into the hollow of the knee and can be felt there as a swelling of varying size. It is important that your doctor identifies and eliminates the cause of the problem. A mechanical irritation can only be treated surgically, a rheumatological irritation only with medication. She should only exercise as long and as hard as she can without pain.
Twisted knee
Question:
Almost two years ago, I had to brake suddenly during a training ride and couldn't get off the pedals. I twisted my knee in the process. Since then I have had constant pain in my right outer knee. Can you help me?
Answer from Dr Merkl:
You probably have a functional disorder of the head of the fibula, which can become stuck due to abrupt movement. Therapy should focus on infiltration treatment in the affected joint. In addition, the mobility of the joint should be restored through manual physiotherapy and stretching exercises. I would also recommend that you correct your sitting position on the bike so that you can ride without pain.
When the tendon in the knee pinches/Runner's Knee
Question:
After increasing my training considerably, a tendon in the back of my thigh is now hurting. I was able to run, but always had severe pain when I got on my bike. Where does the problem come from and what can I do about it?
Answer from Dr Merkl:
This problem is widespread among endurance athletes and is also known as "runner's knee", but is also common among cyclists. It is a functional disorder of the fibular head (the tendon insertion at the upper end of the fibula) with simultaneous shortening of the biceps femoris (a muscle at the back of the thigh that attaches to the calf bone at the bottom). The shortened muscle creates a lot of tension at the tendon insertion. For acute complaints, I recommend physiotherapy to mobilise the head of the fibula and stretch the ischiocrural muscles (the muscle cords running across the buttocks and back of the thigh). The complaints often stem from a misalignment of the foot and leg when cycling. I therefore recommend using insoles in cycling shoes (an orthopaedic technician can fit these into the shoe) and checking the position of the pedal hooks or plates for compatibility.
