Believe it or not, I was a big cyclist in high school. While the sport is really popular right now, back then it was pretty obscure, which is likely why I liked it. I had a short career that was eventually ended by kneecap pain. Now, a new company is marketing pedals that I just heard about from a patient this past week. The concept makes sense to prevent kneecap pain, so I thought I’d tell our patients as we have many that are big cyclists with burnt-out kneecaps.
We see many cyclists with anterior knee pain, or pain in the kneecap area. They tend to lose cartilage here more so than in the inside or outside parts of the knee. Why? Let’s take a look at if it may be how we power our bikes.
If you look at modern clip-in pedals, they have a key flaw. They basically replicate running on your toes. In the diagram, note that since the toes are extended and bent, the force from pushing on the pedal goes up through the front part of the leg and knee. This ends up overloading the anterior compartment (kneecap). Now, let’s look at what happens when we change the foot position.
Consider how the forces get transmitted when you have pedals a bit more like those you had on your bike when you were a kid. These allow you to place force through the center of your foot, more like walking. So instead of running on your toes and transferring the force to the front of your knee, the forces now get transferred up the leg and distributed to the front and back of the knee. In addition, if we make these bigger pedals without any feature that forces the foot to be fixed (like the “clip-in” feature of modern pedals), the foot can float on the pedal. This is important because this is how we walk: our foot adjusts how it hits the ground to distribute forces to different parts of the knee and hip joint.
As I’ve said before, the weakness of regenerative medicine is that while you can help tissues, if they continue to get overloaded, the problem will come back. The same holds true with surgery. So I always look for new and innovative products that can help my patients move more naturally and take the load off their injured parts.
A patient came in this week with an interesting story. An avid cyclist, we had treated a few issues in his knee, including his anterior compartment, with HD (high-dose) platelet rich plasma. This treatment helped his pain, but he still noticed issues after cycling. He went on a quest to optimize his cycling posture and eventually found a local Colorado company that was redesigning high-end pedals by thinking back to old-fashioned pedals. He explained the new concept to me and reported that his kneecap pain all but vanished when he made the switch from clip-in pedals to this new type.
I’m not into pushing products, and I have no financial connection to this company. I also can’t tell you that I know that all of this works by observing many patients make the switch. However, biomechanically, it all makes sense to me. So if you’re interested, this is the link to their site.
The upshot? I do think we need to redesign how pedals transmit forces more naturally to the knee. It makes little biomechanical sense to get hours and hours of high-intensity exercise by running on your toes. That’s just asking for problems. However, in the meantime, I also can’t say that I know that this switch will work, but it makes sense to me. It’s one of those simple ideas that when you hear about it, you say to yourself, “Oh, that’s obvious!” So I thought I’d blog on this innovative solution just in time for Christmas!
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About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…