Cyclist`s Knee or Patellofemoral Pain Syndrome is the most frequently reported lower extremity repetitive stress injury incurred by cyclists. With a 40% recurrence rate after 2 years and 50% of the patients are still symptomatic or have functional impairments 5-8 years post treatment, makes this a frustrating and perplexing condition for both athletes and medical professionals. Numerous extrinsic and intrinsic risk factors have been theorized and researched. To date, no definitive etiology has been determined. Historically, cycling research and treatment has taken a cause-and-effect approach to this repetitive stress injury focusing on factors responsible for patellar maltracking. This pathomechanical action was felt to result from muscle imbalances. Research has also found malalignment and/or dysfunction at either end of the kinetic chain, the foot/ankle or pelvis/hip complex may negatively impact the functioning of the LE as a whole. The purpose of this clinical commentary is to elucidate evidence substantiating patellofemoral pain syndrome may be a simultaneous multifactorial repetitive stress injury due to the complex regional interdependent biomechanical nature of the LE. With this knowledge the development of more effective treatment protocols may bring about better outcomes.
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