Watch Out for Knee and Shoulder Injuries

Many an avid cyclist knows firsthand that two of the most common bicycle injuries are those affecting the knees and shoulders. These maladies can turn a fantastic outdoor sporting experience into a painful episode that can result in frustrating periods of being unable to ride while the body recuperates.

The largest and one of the most complex joints in the body, the knee is composed of four bones -- the femur, tibia, fibula and patella. They are held together by muscles, ligaments (which provide stability to joints) and tendons (which connect muscles to bones). Essentially, the knee joint is a hinge joint.

For cyclists, knee injuries can result from riding too hard for too long (overtraining), maintaining low rotations per minute, steep climbing without proper buildup time and poor cycling technique. Regarding the latter, examples are using too high a gear, incorrect saddle height, shoe cleats that don't allow the foot to be at its natural angle, lateral (sideward) movement of the knee during the pedal stroke and cranks that are too long.

Some disorders that can affect cyclists' knees include:

• Chondromalacia patella. The cartilage under the patella (kneecap) degenerates. Causes are overuse, trauma and too much force on the knee. Symptoms are knee tenderness and pain that gets worse after sitting for a long time, when climbing stairs or when rising from a chair. Some patients sense a grating or grinding when the knee is held straight out. To prevent this problem, avoid abnormal stress on the knee and do exercises to keep leg muscles strong.
  
  
• Chronic knee pain (patellofemoral syndrome). When cartilage breaks down it puts extra pressure on the bones at the knee joint. This results in significant bone pain and inflammation. Biomechanical problems (often, side-to-side swinging of the knees while riding) as well as overtraining are causes. To reduce pain and swelling, rest, apply ice and use non-steroidal anti-inflammatory drugs as the first course of action. Once the condition has been stabilized, the cyclist is advised to undertake an exercise regimen designed to improve joint mobility and muscle strength.
  
  
• Kneecap dislocation (patellar subluxation). With this condition, the kneecap is unstable and does not track properly in its groove on the femur (upper leg bone). Patients complain of tenderness and swelling around the knee, discomfort when active, pain at the edges of the kneecap and giving-way of the knee. High-impact injury is the most common cause. Treatment may include physical therapy, bracing and taping, and, in some cases, surgery.
  
  
• Fractured kneecap. Fractures can be partial or complete. Attached ligaments and tendons may also be sprained or torn. Severe pain around the kneecap, swelling, tenderness, pain when moving the knee in both directions, problems extending the leg and a deformed appearance of the knee are symptoms of a fracture. The cause is usually a direct blow to the front of the kneecap from a fall. Surgery is required to repair the kneecap.

The shoulder joint -- the body's most versatile joint since it is able to move in many directions -- is composed of four joints. The sternoclavicular joint lies between the sternum and collarbone. The acromioclavicular is located between the collarbone and the acromiom (shoulder blade). The glenhumeral is situated between the socket of the scapula and the humerus (ball). The scapulothoracic sits between the scapula and the rib cage. Of these, the glemhumeral joint is the must susceptible to injury because it is dependent solely on non-bony connections.

For cyclists, shoulder pain usually becomes apparent during longer rides. Placing too much weight on the hands and riding with straight elbows are the causes. To reduce the risk of shoulder pain problems, riders are advised to keep their elbows slightly flexed to stop the shock of the road from transferring to their arms and upper body.

Shoulder injuries include:

• Broken collarbone (clavicle). The collarbone connects the top part of the breastbone to part of the shoulder blade. Causes are often sports-related trauma. Symptoms of a break are immediate pain in the area of the shoulder, a grinding or cracking sound when moving the shoulder and a snapping sound at the time of the accident. If shortness of breath, arm pain and progressive swelling occur, the patient must receive immediate medical attention. Treatment typically includes placing the arm in a sling, applying ice, use of pain relievers and avoiding contact activity for about six weeks after the injury.
  
  
• Dislocated shoulder. The ends of the shoulder bones disconnect or separate and are therefore forced into an abnormal position. Sudden and severe pain occurs and the shoulder is immediately immobilized and temporarily deformed. Numbness and tingling may occur in the neck and arm and the shoulder may spasm. Trauma is the most common cause of a dislocation. Treatment involves putting the shoulder back in place (closed reduction), which almost always results in immediate reduction of pain. Surgery (open reduction) may be required if bones will not go back into place correctly. A sling may be used to stabilize the area. With proper treatment, the shoulder bones will return to their normal positions. However, individuals who experience dislocated shoulders are prone to repeated dislocations.
  

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