Treating knee pain in Cyclists with Acupuncture

 

Acupuncture treatment for Cyclists with Knee Injuries

In cycling one of the most common injuries  is knee pain just below the patella (kneecap).   Endurance cycling can cause pain progressing to the lateral side of the knee and the lower back – iliotibial band syndrome.  Of course, muscle compensation plays a part and the medial side of the knee, the vastus medialis oblique (VMO), begins to hurt.

These injuries are considered an overuse neuromuscular response, arising from either excessive use of an unconditioned, agonistic muscle in a very short period of time or repetitive agonistic use of a muscle over a long period of time. Treatments include Acupuncture, Chinese liniments, auricular therapy and Chinese herbal medicine. Anterior knee pain is one of the most common conditions treated in this particular setting. The two most common symptoms are the patello femoral pain and patellar tendonitis.  Both of these conditions are the result of agonistic neuromuscular overuse, with signs/symptoms surrounding the patella. When cycling, the hip, knee and ankle joints are synergistically working together.  These joints will respond to neuromuscular compensations associated with the neuromuscular tightness (agonistic movements).  Of course, all are dependent upon how one is sitting on the seat and the position of the foot while cycling. Over time, improper positioning can lead to neuromuscular imbalances that cause a variety of muscular compensation patterns.  The key is to identify and anticipate where these compensation patterns are and treat them accordingly – before pain or other symptoms occur.

This neuromuscular tightness (excessive shortening) creates muscle imbalances and puts stress upon structures surrounding the patella, which causes pain. These neuromuscular imbalances create weaknesses in the VMO, vastus lateralis (VL), IT band (gluteus maximus and TFL) and the patellar tendon. The causative factors are: increased daily mileage (between 50 and 102 miles), hill work, biomechanical positioning of toe clips, seat adjustments and ride-duration fatigue.

The mechanism of injury involves physiological responses of the neuromuscular tissue to excessive agonistic movements of flexion/extension of the hip and knee joints, with slight internal or external rotation of the knee. This is dependent upon each cyclist’s toe-clip position and neuromuscular compensation. Essentially, the neuromuscular response of agonistic contractions stemmed from overuse of the quads, gluteals, and/or hamstrings producing stress upon the structure surrounding the patella (iliotibial band, vastus lateralis, biceps femoris and vastus medialis). These muscles can pull the patella laterally, and due to the neuromuscular imbalance of the surrounding structures of the patella, pain may be felt medially and/or laterally, depending upon the individual and their natural biomechanical gait, stress, compensation and fatigue factors.

The agonistic knee flexors include the bicep femoris, semi-membranosus, semitendinosus, sartorius, gracilis, popliteus and gastrocnemius. The neuromuscular compensation is the result of the excessive agonistic movements, which create neuromuscular compensation patterns with the glutes and iliotibial band. The knee extensors (rectus femoris, vastus lateralis, vastus medialis and vastus intermedialis) tend to trigger agonistic contractions at the patellar tendon so pain is present just below the patella. This is known as patellar tendonitis.

Cyclists are exposed to weather on every cycle.  In Chinese medicine, this plays a role in part of the diagnostic method of six external pathogens associated with bi syndromes (osteo-arthritis), wei qi deficiency due to pre-existing Lung qi, Spleen qi deficiency, damp accumulation, and Liver qi stagnation.

Acupuncture & Chinese Herbal Medicine

According to the Oriental philosophy, the primary pathological mechanisms are blood and qi stagnation, due to overexertion, with further susceptibility to the invasion of wind, cold, and damp affecting the channels externally and organs internally. This results in decreased nourishment to the sinews and bones. Of course, the manifestation of pathogenic factors varies, cyclists initially can develop  stagnation of qi/blood and, subsequently, liver qi stagnation.  Excessive physical exertion creates deficiency patterns, if not already present due to previous preparation training, resulting in system depletion or further deficiency of kidney qi/yin deficiency and spleen qi deficiency.

However, another aspect that needs to be considered is that excessive physical overexertion consumes the zheng qi, which can result in a lowered resistance.  With excessive physical exertion days, internal deficiency conditions start to become more apparent involving the following patterns: wei qi deficiency, Spleen qi deficiency, Liver/Kidney qi deficiency, Kidney yin and yang deficiency. Channel and organs became susceptible to invasion of wind, cold and damp due to the environmental conditions riders endure on a daily basis.  Deficiency of qi and blood is predicable for lowered resistance, allowing the invasion of the six exogenous pathogenic factors.

Acupuncture treatments include moxa over channels/meridians/vessels, herbal formulas and auricular acupuncture/plasters with heat/cooling or magnet plasters are given to those athletes for deficiency conditions to improve blood and qi deficiency  to prevent further deficiency from overexertion. Those who are susceptible to wind, cold and damp bi syndrome (arthritis) are given herbs in the morning and late afternoon. Those also with Spleen qi deficiency, Lung  qi deficiency, Kidney qi /yin/yang deficiency  among other conditions during their training prior to exercise.  In the sports medicine arena, most practitioners do their work after the injury already has occurred.   The key is to identify and anticipate where these compensation patterns are and treat them accordingly before pain or the symptom occurs. This is difficult because there are a variety of ways to prevent these compensation patterns. One of the easiest is stretching, but getting the riders to stretch is rather difficult if pain is not present. This is a double-edged sword in education and application. The other dilemma is using Oriental medicine as prevention rather than after the injury has occurred.  This is particularly due to lack of understanding of what Oriental medicine has to offer athletes/patients in general.

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