Alice Monger-Godfrey and Lee Prescott, from Velo Atelier, recently saw a patient exhibiting the sort of niggling pain in her knee that many cyclists will recognise. Below is a great example of how a multidisciplinary team of bike fitter and medical practitioner can work together to get the best possible outcome for their client.
Alice writes,
"I have been seeing more and more patients coming through my clinic door complaining of knee discomfort that just won’t go away. One of them is Jo who loves riding her bike but after increasing the mileage she has started experiencing pain on the inside of her knee. Thinking it would go away by itself after some rest she didn't seek any medical advice. But nothing changed the problem and if anything, it started to niggle her during everyday life, not just on the bike. That is what brought Jo to me, as she wanted to know what was going on and how it can be treated.
The knee cannot be looked at in isolation as many of the muscles cross over the ankle and the hip, which means the whole body needs to be treated in order to help the knee function better. With Jo we noticed her Vastus Medialis (one of the quadricep muscles), popliteus muscle and psoas muscle (hip flexor) were extremely tight causing a pull on the knee cap. When the joint was under strain it would highlight this imbalance and cause Jo discomfort. From my experience, the best way to effectively treat this is with acupuncture to the quadricep muscles, manipulation and massage to the ankle, knee, hip and low back, and muscle energy techniques/stretches to the surrounding structures of the knee. With Jo, as her upper and mid back were fairly tight it was imperative to make sure that they move well so that less torsional forces are placed onto her knees. For me it is important to look at Jo's musculoskeletal structure, how it functions and work through various tests and examinations to identify what muscles are working, which ones are not and which areas as a result are becoming vulnerable.
After treating Jo in an extremely short space of time, we have significantly reduced her knee pain and that once irritating pain and niggle has become a distant memory."
Working side-by-side with Alice, Lee was able to use this information to adjust Jo’s position on her bike, to aid her recovery.
Lee Writes;
Firstly, we ensured that Jo’s cleats were set up correctly and that her knees were tracking in line with her natural hip and ankle movement. Then we checked that her saddle height and position wasn’t adding any extra pressure to the knees. We also raised her bars slightly to open up her hip flexors and take some flexion out of her lumbar spine. We could see quite quickly on her saddle pressure map that her weight distribution became more symmetrical as Alice was able to release the tension in the muscles under strain.
Going forward we have recommended that Jo changes her cranks to 165mm, which would allow her hip angle to open up more at the top of the pedal stroke, reducing the strain on her hip flexors. This will allow us to also gradually move Jo back to her lower bar height, after the treatments with Alice have finished.
Alice was a professional cyclist for 8 years racing on the track and road at international and national level representing Great Britain. After retiring, she studied and gained a Masters in Osteopathy alongside a sports massage degree and medical acupuncture qualification.
Alice set up AMG Osteo Clinics in 2013 where she runs two practices out of Clapham Junction and Liverpool Street. She works with a wide range of patients from Olympic athletes to keen sports people. In both 2016 and 2017 Alice was the lead Osteopath to Team Dimension Data looking after Mark Cavendish amongst other top professional riders.
She has partnerships with companies including Rapha, Saxo Bank, Mako and Sigma Sports.
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