The Effects of Saddle Alignment and Pedal Stroke Training on a Competitive Cyclist with Anterior Knee Pain: A Case Report

Background: Among competitive cyclists, anterior knee pain is a common overuse injury. Alignment of the rider on the bicycle and the loading pattern on the pedals are proposed as factors in this pain. The patient was a 23-year-old competitive female cyclist who was riding up to 200 miles weekly and had developed bilateral anterior knee pain within the 3 months preceding our examination. The purpose of this case report is to demonstrate the effectiveness of adjusting this patient’s static alignment (ie. position while seated on bicycle, but not actively pedaling) on the bike and modifying her habitual pedaling pattern. Methods: The patient was analyzed using both static and dynamic measures of alignment while on her bicycle. Her bicycle seat was raised and moved rearward, and her pedaling force output was analyzed using a Computrainer™. Over a 4-week period, she was taught to modify her pedaling force using video biofeedback. Outcomes: After adjustments and training, she could ride for over 3.5 hours without knee pain. Visual analog scale pain score improved from 6/10 to 0/10; Lower Extremity Functional Score improved from 65 to 79; and Knee Injury and Osteoarthritis Outcome Score improved from 81 to 98.5. Clinical Relevance: This case illustrates how application of biomechanical principles and training in pedaling movement patterns can be effective at eliminating knee pain in competitive cyclists. While rest, decreased training volume, and appropriate medication should be considered as treatment components, we believe the initial treatment for competitive cyclists should include biomechanical evaluation of alignment and pedaling pattern.