Sport Sciences for Health

, Volume 14, Issue 3, pp 645–654 | Cite as

Effects of a prophylactic knee bracing on patellofemoral loading during cycling

  • Jonathan Sinclair
  • Bobbie Butters
  • Darrell Brooks
  • Philip Stainton
Original Article



The aim of the current investigation was to utilize a musculoskeletal simulation approach to examine the effects of prophylactic knee bracing on patellofemoral joint loading during the pedal cycle.


Twenty-four (12 male and 12 female) healthy recreational cyclists rode a stationary cycle ergometer at fixed cadences of 70, 80 and 90 RPM in two different conditions (brace and no-brace). Patellofemoral loading was explored using a musculoskeletal simulation approach and participants were also asked to subjectively rate their perceived stability and comfort whilst wearing the brace.


The results showed that the integral of the patellofemoral joint stress was significantly lower in the brace condition (male: 70 RPM = 8.89, 80 RPM = 9.76, and 90 RPM = 12.30 KPa/kg s and female: 70 RPM = 11.59, 80 RPM = 13.07 and 90 RPM = 14.14 KPa/kg s) compared to no-brace (male: 70 RPM = 10.23, 80 RPM = 10.96 and 90 RPM = 13.20 and female: 70 RPM = 12.43, 80 RPM = 14.04 and 90 RPM = 15.45 KPa/kg s). In addition, it was also revealed that participants rated that the knee brace significantly improved perceived knee joint stability.


The findings from the current investigation, therefore, indicate that prophylactic knee bracing may have the potential to attenuate the risk from the biomechanical parameters linked to the aetiology of patellofemoral pain in cyclists. Future, longitudinal analyses are required to confirm the efficacy of prophylactic knee braces for the attenuation of patellofemoral pain symptoms in cyclists.


Cycling Patellofemoral pain Knee brace Biomechanics Musculoskeletal modeling 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Clarsen B, Krosshaug T, Bahr R (2010) Overuse injuries in professional road cyclists. Am J Sports Med 38:2494–2501. CrossRefPubMedGoogle Scholar
  2. 2.
    Hollingworth MA, Harper AJ, Hamer M (2015) Risk factors for cycling accident related injury: the UK Cycling for Health Survey. J Transp Health 2:189–194. CrossRefGoogle Scholar
  3. 3.
    Rissel C, Passmore E, Mason C, Merom D (2013) Two pilot studies of the effect of bicycling on balance and leg strength among older adults. J Environ Public Health 6:24–30. CrossRefGoogle Scholar
  4. 4.
    Wanich T, Hodgkins C, Columbier JA, Muraski E, Kennedy JG (2007) Cycling injuries of the lower extremity. J Am Acad Orthop Surg 15:748–756. CrossRefPubMedGoogle Scholar
  5. 5.
    Dieter BP, McGowan CP, Stoll SK, Vella CA (2014) Muscle activation patterns and patellofemoral pain in cyclists. Med Sci Sports Exerc 46:753–761. CrossRefPubMedGoogle Scholar
  6. 6.
    Callaghan MJ (2005) Lower body problems and injury in cycling. J Bodyw Mov Ther 9:226–236. CrossRefGoogle Scholar
  7. 7.
    Thomas MJ, Wood L, Selfe J, Peat G (2010) Anterior knee pain in younger adults as a precursor to subsequent patellofemoral osteoarthritis: a systematic review. BMC Musc Dis 11:201–205. CrossRefGoogle Scholar
  8. 8.
    Farrokhi S, Keyak JH, Powers CM (2011) Individuals with patellofemoral pain exhibit greater patellofemoral joint stress: a finite element analysis study. Osteoarthr Cartil 19:287–294. CrossRefPubMedGoogle Scholar
  9. 9.
    van Eijden TM, Kouwenhoven E, Verburg J, Weijs WA (1986) A mathematical model of the patellofemoral joint. J Biomech 19:219–229. CrossRefPubMedGoogle Scholar
  10. 10.
    Elias JJ, Wilson DR, Adamson R, Cosgarea AJ (2004) Evaluation of a computational model used to predict the patellofemoral contact pressure distribution. J Biomech 37:295–302. CrossRefPubMedGoogle Scholar
  11. 11.
    Herzog W, Longino D, Clark A (2003) The role of muscles in joint adaptation and degeneration. Langenbecks Arch Surg 388:305–315. CrossRefPubMedGoogle Scholar
  12. 12.
    Lerner ZF, DeMers MS, Delp SL, Browning RC (2015) How tibiofemoral alignment and contact locations affect predictions of medial and lateral tibiofemoral contact forces. J Biomech 48:644–650. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Martin TJ (2001) Technical report: knee brace use in the young athlete. Pediatrics 108: 503–507CrossRefGoogle Scholar
  14. 14.
    Warden SJ, Hinman RS, Watson MA, Avin KG, Bialocerkowski AE, Crossley KM (2008) Patellar taping and bracing for the treatment of chronic knee pain: a systematic review and meta-analysis. Arthritis Care Res 59:73–83. CrossRefGoogle Scholar
  15. 15.
    Paluska SA, McKeag DB (2000) Knee braces: current evidence and clinical recommendations for their use. Am Fam Phys 61:411–418. CrossRefGoogle Scholar
  16. 16.
    Theobald G, Parry S, Richards J, Thewlis D, Tootill I, Selfe J (2012) Biomechanical effects of different treatment modalities used in knee pain during cycling. Physiother Pract Res 33:16–21Google Scholar
  17. 17.
    Sinclair J, Stainton P, Sant B (2018) The effects of conventional and oval chainrings on patellofemoral loading during road cycling: an exploration using musculoskeletal simulation. Sport Sci Health 14:61–70. CrossRefGoogle Scholar
  18. 18.
    Menard M, Domalain M, Decatoire A, Lacouture P (2016) Influence of saddle setback on pedalling technique effectiveness in cycling. Sport Biomech 15:462–472. CrossRefGoogle Scholar
  19. 19.
    Drouin JM, Houglum PA, Perrin DH, Gansneder BM (2003) Weight bearing and non-weight-bearing knee joint reposition sense are not related to functional performance. J Sport Rehab 12:54–66. CrossRefGoogle Scholar
  20. 20.
    Sinclair J, Vincent H, Richards D (2017) Effects of prophylactic knee bracing on knee joint kinetics and kinematics during netball specific movements. Phys Ther Sport 23:93–98. CrossRefPubMedGoogle Scholar
  21. 21.
    Sinclair J, Hebron J, Atkins S, Hurst H, Taylor PJ (2014) The influence of 3D kinematic and electromyographical parameters on cycling economy. Acta Bioeng Biomech 16:91–97. CrossRefPubMedGoogle Scholar
  22. 22.
    Delp SL, Anderson FC, Arnold AS, Loan P, Habib A, John CT, Thelen DG (2007) OpenSim: open-source software to create and analyze dynamic simulations of movement. IEEE Trans Biomed Eng 54:1940–1950. CrossRefPubMedGoogle Scholar
  23. 23.
    Steele KM. DeMers MS, Schwartz MH, Delp SL (2012) Compressive tibiofemoral force during crouch gait. Gait Posture 35:556–560. CrossRefPubMedGoogle Scholar
  24. 24.
    Besier TF, Draper CE, Gold GE, Beaupre GS, Delp SL (2005) Patellofemoral joint contact area increases with knee flexion and weight-bearing. J Orthop Res 23:345–350. CrossRefPubMedGoogle Scholar
  25. 25.
    Besier TF, Fredericson M, Gold GE, Beaupré GS, Delp SL (2009) Knee muscle forces during walking and running in patellofemoral pain patients and pain-free controls. J Biomech 42:898–905. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Elias JJ, Kirkpatrick MS, Saranathan A, Mani S, Smith LG, Tanaka MJ (2011) Hamstrings loading contributes to lateral patellofemoral malalignment and elevated cartilage pressures: an in vitro study. Clin Biomech 26:841–846. CrossRefGoogle Scholar
  27. 27.
    Whyte EF, Moran K, Shortt CP, Marshall B (2010) The influence of reduced hamstring length on patellofemoral joint stress during squatting in healthy male adults. Gait Posture 31:47–51. CrossRefPubMedGoogle Scholar
  28. 28.
    Li G, DeFrate LE, Zayontz S, Park SE, Gill TJ (2004) The effect of tibiofemoral joint kinematics on patellofemoral contact pressures under simulated muscle loads. J Orthop Res 22:801–806. CrossRefPubMedGoogle Scholar
  29. 29.
    Wretenberg P, Németh G, Lamontagne M, Lundin B (1996) Passive knee muscle moment arms measured in vivo with MRI. Clin Biomech 11:439–446. CrossRefGoogle Scholar
  30. 30.
    Herrington L, Simmonds C, Hatcher J (2005) The effect of a neoprene sleeve on knee joint position sense. Res Sport Med 13:37–46. CrossRefGoogle Scholar
  31. 31.
    Julian FJ, Morgan DL (1981) Variation of muscle stiffness with tension during tension transients and constant velocity shortening in the frog. J Physiol 319:193–203. CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Williams GN, Chmielewski T, Rudolph KS, Buchanan TS, Snyder-Mackler L (2001) Dynamic knee stability: current theory and implications for clinicians and scientists. J Orthop Sports Phys Ther 31:546–566. CrossRefPubMedGoogle Scholar
  33. 33.
    Hannaford DR, Moran GT, Hlavac HF (1986) Video analysis and treatment of overuse knee injury in cycling: a limited clinical study. Clin Podiatr Med Surg 3:671–678PubMedGoogle Scholar
  34. 34.
    Bailey M, Messenger N (1995) Coronal plane kinematics of cycling and their relationship to injury. J Sport Sci 14:3–4Google Scholar
  35. 35.
    Bailey M, Maillardet F, Messenger N (2003) Kinematics of cycling in relation to anterior knee pain and patellar tendinitis. J Sport Sci 21:649–657. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre for Applied Sport Exercise and Nutritional Sciences, Faculty of Health and Wellbeing, School of Sport and WellbeingUniversity of Central LancashirePrestonUK
  2. 2.Faculty of Clinical and Biomedical Sciences, School of Pharmacy and Biomedical SciencesUniversity of Central LancashirePrestonUK

Personalised recommendations