Q: Some of my athletes experience knee pain located directly behind the patellar tendon after cycling rides. Are there certain adjustments that can be made to better protect them from experiencing pain and perhaps injury?

A: What type of cycling are you refering to? (Road, mtn, or indoor?) Let me make a few generic suggestions: First I would look at the type of cycling the individual is doing. It is common for a less experienced rider to develop knee pain (retropatellar) if he/she is "pushing" too big of a gear. This puts a lot of pressure on the patella as well as the lateral or outside part of the knee. The other suggestion is to look at the seat adjustment. Make certain the knee is about 5-10 degrees of flexion when the crank is in the "down" position. If the knee is flexed greater than that, it may cause more pressure on the knee when the crank is in the "up" or the highest position. Finally, if you can get the individual on a "roller" or a "trainer" and look at the motion of the knees from in front of the bike. the knees should follow a path straight up and down, and not "drop" in towards the top tube on the "down stroke." If the knee(s) do drop in towards the top tube, a correction in the cycling biomechanics needs to be addressed. If a cyclist develops anterior or retropatellar knee pain from cycling, look at these common problems. Also encourage the individual to include some patellar rehabilitation, including short arc leg extensions, hamstring curls, calf raises, 1/4 squats or leg presses to increase the strength of the musculature around the knee. Focus on the Vastus Medialis Oblique fibers to aid in the proper tracking of the patella. I hope this is of some help to you. Thomas E. Koto, Jr., ATC/R