Lived experiences of male recreational cyclists with patellofemoral pain in Al Madinah, Saudi Arabia

Abstract

BACKGROUND : Patellofemoral pain (PFP) is a prevalent overuse injury among recreational cyclists worldwide. Despite its ubiquity, little is known about the lived experiences of people with PFP, especially in Saudi Arabia, where healthcare and cultural factors may have a specific impact on how the condition is managed. The aim of this study was to explore the lived experiences of recreational cyclists with patellofemoral pain in Al Madinah, Saudi Arabia. METHOD : A qualitative, descriptive design using reflexive thematic analysis was employed. Eleven male recreational cyclists aged 28-44 years diagnosed with PFP were purposely recruited from Al Madinah Physical Therapy Centre. Female participants were excluded due to cultural constraints regarding sports participation. The participants consented to participate in the study and to be audio recorded. Data were collected through semi-structured interviews using an interview guide. The interview data were transcribed verbatim and thematically analysed using Atlas.ti, version 24. RESULTS : The thematic analysis revealed six themes highlighting the multidimensional impact of PFP. The participants described localised mechanical impairment with rapid onset during activity and persistent symptoms lasting up to two weeks. Pain was exacerbated by eccentric loading and cycling-specific stressors, such as uphill riding, leading to significant anxiety and avoidance behaviours. To maintain activity, these cyclists employed adaptive strategies, including bike modifications and self-management. Notably, PFP imposed substantial cultural and social burdens, hindering spiritual practices, specifically Salah (prayer) postures, professional duties, and family caregiving. While the participants demonstrated resourcefulness through a hybrid of physiotherapy and independent research, pharmacological relief was viewed as a transient solution. CONCLUSIONS : Patellofemoral pain imposes significant multidimensional burdens on recreational cyclists in Al Madinah, which are exacerbated by cultural practices. Physiotherapy offers targeted interventions for pain relief, functional restoration, and participation enhancement, necessitating the need for culturally sensitive management programmes.

HIGHLIGHTS Public Health Relevance—How does this work relate to a public health issue? • This study explores the lived experiences of male recreational cyclists with patellofemoral pain (PFP), a condition that significantly limits physical activity, a key determinant of health. • Understanding real-world challenges faced by cyclists with PFP provides insights into barriers that hinder sustained physical activity in an active population. Public Health Significance—Why is this work of significance to public health? • The findings reveal that culturally grounded factors influence symptom management, help-seeking behaviour, and exercise participation among cyclists in Saudi Arabia, which is an understudied population. • By capturing patient-centred perspectives, this study contributes essential qualitative evidence that can inform the design of more responsive, context-specific health and rehabilitation strategies. Public Health Implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health? • The insights generated from this study can support physiotherapists and healthcare planners in developing tailored self-management and injury prevention programmes that promote safe and sustained physical activity. • The findings highlight gaps in awareness, early interventions, and access to appropriate physiotherapy care areas that can guide policy, practice, and future community-based health initiatives.