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Cyclist Video - bad knee - Varus Wedge?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by bigvern, Mar 15, 2012.

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  1. bigvern

    bigvern Welcome New Poster


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    Howdy,

    General Pain / swelling in left knee after cycling - not bad whilst doing it, but it's now a chronic problem and only getting worse.
    No Pain in feet
    I know I've got bowed shins.
    I can feel by left leg is all over the place when cycling but not sure what to do.
    I have specialized BG green foot inserts which have high arch support
    Physio who cycles himself has suggested varus cleat wedges under left shoe (thick side of wedge nearest to the bike?).
    Any advice appreciated.
    First Video at normal speed:


    Second video (skip the first 12 seconds, frozen for some reason) is slowed down with a red line to show the knee swinging in on the downstroke.


    cheers
     
    Last edited by a moderator: Sep 22, 2016
  2. Admin2

    Admin2 Administrator Staff Member

    Related threads:
    Other threads tagged with cycling
     
  3. I didn't think posts from patients seeking advice were tolerated here?
     
  4. phil

    phil Active Member

    If he suggested it, then do it. I'd say he's on the right track. Let us know how you go.

    Phil
     
  5. pd6crai

    pd6crai Active Member

    I am very glad to have found this thread. My husband is a cyclist, and he has been complaining of knee pain aggrivated by cycling. We gave him orthotics, but the slim fit ones for his cycling shoes dont really help. I hadnt realised you could actually get cleat wedges.

    I know just have to source a pair and get him sorted. Thanks.
     
  6. David Wedemeyer

    David Wedemeyer Well-Known Member

    They're not so I won't give advice or diagnose over the internet.

    However, this is educational IMO because I am a cyclist and treat them. The big problem that I see is a rapid adduction of the left leg on the downstroke. There is a lot of sway side to side, leading me to believe that there is a leg length discrepancy on that side. There are other problems, compare the tracking of the knees right to left but this could be explained by a FnLLD. There are other possibilities as well, notice the brief period when he is not tucked this disappears? Think lumbar and pelvis…
    ;)
     
  7. Bikefitter

    Bikefitter Welcome New Poster

    I know this was posted a while ago, but it looks like it could be a number of things. It could be a FnLLD like @David Wedemeyer said. It could also be that the saddle is not supporting your pelvis correctly, and as a result on the down stroke of your right leg, your pelvis moves and swings the left leg out. It could also be a result of asymmetrically tight IT bands and your left IT is pulling your leg out at the top of the pedal stroke.
     
  8. David:

    Rapid adduction of the knee toward the top tube during the power phase in cycling, in my clinical experience, is nearly always due to excessive subtalar joint pronation motion during the power phase (this is easily noted by looking for a rapid decrease in the distance from the medial midfoot to the crank arm during the power phase).

    In turn, excessive subtalar joint pronation motion will be, by definition, due to excessive subtalar joint pronation moments during the power phase. Appropriate foot orthoses and/or varus cleat wedging can cause quite dramatic changes in the cycling kinematics to a more "straight" power phase (i.e. less knee adduction) once the excessive subtalar joint pronation moments from the pedal reaction forces are neutralized with orthoses and/or varus cleat wedging during the power phase.
     
  9. More likely is that there are excessive subtalar pronation moments from pedal reaction forces acting across a medially deviated subtalar joint axis.
     
  10. Bikefitter

    Bikefitter Welcome New Poster

    A lack of medial glute strength can also result in adduction of the knee.
     
  11. bigvern

    bigvern Welcome New Poster

    thanks for your help and advice, and for not closing the thread, the knowledge on here was streets ahead of what I was reading elsewhere. Not posted back until I reached some kind of conclusion.
    The pain has been largely solved (after much trial and error) by using x3 bike fit cleat wedges (http://www.bikefit.com/products.php) between the cleat and the shoe. The power phase looks and feels a lot more stable and my left knee no longer shoots towards the top tube.

    Another physio (not a cycling specialist) noticed that I don't sit centrally on the saddle but with my left hip hanging over to one side (when viewed from behind), although my leg lengths are the same - he suggested some kind of muscle imbalance and I am rather stronger on my right side - so I may be treating the symptoms rather than the cause but its working for me at the moment.
     
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