# Dodgy knee help.



## willhub (25 Jun 2009)

My 3rd thread, I assure you I'm not spamming.

Forgive me if I've made a thread on this subject, I think I recall something in a thread and a link but cannot find it.

I think at the moment as far as cycling is concerned I am on thin ice, I got an MRi scan results back and I have worn articular cartilage on the knee cap, I guess the bottom of the knee cap.

Anyway I did a 118 mile ride on Saturday and felt fine, next day I did 12 miles, I think I rested that day after, maybe the day after that, but I had one rest day than after that I did 25 miles and about 22 yesterday attempting interval training, now today my knee has being hurting, clicking when I bend it, I'm sure sometimes when I bend it or when I am in bed I can feel something in my knee that could be catching and sometimes it must be in a different place. I've got a bandage on and it's helping, I'm not planning on cycling tomorrow but I really want to do the 100ish miles on Saturday or Sunday, if it's Sunday then I'll do around 26 miles Saturday, to and from the club run but not doing the club run. 

So does the worn cartilage heal back? Will the use of Omega fish oil capsules, Glucosamine sulphate tablets and glucosamine gel that I apply onto the knee help? 

Does the worn articulare cartlidge just infalame and hurt due to being iriated by use and resting maybe double than normal help it go down? 

I've got a 180miler on July 5th and I dont want to miss it, I paid for it and was quite looking forward to it and stocked up on energy stuff for it 

Thanks
Will.


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## fossyant (25 Jun 2009)

Nope..cartilage is gone, it's gone - you may need some removing...to fix the issue. If you are as far as having an MRI, then you have some problems (I am in the same issue with my spine/neck - hence no big rides over 2 hours....)

Don't do the any big miler....you'd be stupid, until you can address the issue - so keep it to short fast rides....FFS..I don't often (nearly ever) do big miles like that.....

You are fairly young aren't you...FFS look after your knees..... no.1 if you plan to cycle until you kick the bucket.........

Miss the event..you'd be stupid not being 100% knee fit....sorry Knees are No.1 for cyclists.......then heart/lung capacity...watch it if they are dodgy...otherwise you may not be riding.....


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## willhub (25 Jun 2009)

So I should not do long rides but can do short fast rides? How long is short? I mean for me short is around 60 miles, are you thinking more like 30? I'd have thought short fast would be just as bad no? I feel sick being told I have to stop doing long rides though, I know it probably was going to be said but still, not a good thing.

If I had some cartlidge removed surely that would not totally have me off the bike full time over the course of weeks?

My doctor who got the MRi scan is in Manchester, if I booked an appointment here and told the doctor what's happened would he be able to advise me/refer me without seeing the MRi scan?

I'm going to book an appointment at the docs tomorrow for tomorrow.

I do hope when/if it's sorted it wont impair my ability to do long big miles, 100+ is common for me, usually every saturday or sunday it's 115 miles minimum here in York.


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## montage (25 Jun 2009)

This really really sucks....sorry to hear this 

I hope it isn't as bad as you think!


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## willhub (25 Jun 2009)

I hope not, when I rest my knee over say 4 or so days it goes back to being painless and I can do rides for a week or so but then it comes back, if I put my hand on my knee as I sit here and put pressure on the knee slightly pushing it, you know when you have gloves on and make a snow ball and crush it, the sort of vibration that is caused or the feeling, that's the sort of sensation I feel. I'm hoping it's not serious, before I took up cycling I was uber unhealthy slob and now I'd say I'm quite a fit cyclists that is quite fast, and want to improve, not go down hill.

I just don't understand why I have this problem?? Maybe it was cadence? But I always keep 80-90RPM. I think the knee problem is impairing my performance on the bike though, just worrying seems to make me slightly slower. Cant wait for tomorrow to come and hope an appointment is available!


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## jimboalee (26 Jun 2009)

Sounds like some minor surgery and a couple of months off the hilly rides.


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## willhub (26 Jun 2009)

So after this "minor" surgery if that's what I'd need would I be able to be straight back onto the bike for like commuting, on flat roads.

It seems to have eased down today but I cant go to the docs there is no appointments FFS 

I don't understand, a small paths of wear was described, so why's it causing all this??


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## willhub (11 Aug 2009)

Bumping this.

I got reffered to a physio but I've heard nothing and it's beinh like 4 weeks, so I rang the doctors, they told me I have being referred but I would have to ring the physio department at Selby Hospital, but that is pointless it appears as if no one ever answers, I'm not exactly confident anyway my mum says I would not hope for much with those physio's my mum says they are useless.

I have being cycling normally on it since my last posts as the doctors said it was fine and I had no problems really at all for some weeks, but then it flared up again and it's really p155ing me off, I can't afford to go private, yes I know my knee is very important but I'd dry my account up going private. 

I know one guy and he cycles all over he's about equal in terms of performance as me and his left leg I think he has no cartilage that happened from running and cycling seems to be ok without cartilage?

I guess I'm stuck in a rut ot whatever you'd say now untill I can cough up the cash to pay for physio's.


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## Paul_iow (12 Aug 2009)

Why not just wait for the physio apointment to come through or keep phoning them to find out what is happening? In the mean time rest your knee as you say: 


> when I rest my knee over say 4 or so days it goes back to being painless


This is good and you are unlikely to do more damage if you rest it. Just be patient as you seem all to worried about getting everything done yesterday. These things take time and unfortunately the NHS is pretty snowed under.


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## Bigtwin (12 Aug 2009)

When I had a knee problem, I went to see a private sports physio.

She and the NHS version were chalk and cheese in approach and results. It wasn't that expensive (about £50 a hour and I did 3 sessions) and it cured the problem entirely.

I would certainly give that a go.


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## willhub (12 Aug 2009)

But that is expensive for me, I don't have £150!!!

So is it worth even botering with the Pysio at the hospital? I dont need anything amazing all I want it for my knee to be at a level where I can keep cycling and not get constant dull pain.

The Physio department wont ever answer at the hospital so I'm going to go back to the doctors, I dont know what they'll do but I'm totally ***** off, I might just let my knee detroy it's self I'm sure I'll get 6 months at best out of it, plenty of time to think of another sport, maybe even those bikes you pedal with your arms. I've only being cycling like 14 months and my knee is a mess, it's an absoloute p155 take, I bet when my leg was pulled and snapped back into place when I broke my tib and fib back in 2000 they have not done it right and it's healed wrong and causing this wear.


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## Paul_iow (12 Aug 2009)

Keep trying them on the phone, try them at different times throughout the day. They will be incredibly busy and not every department have their own admin people who can answer the phone. Without knowing the exact problem you have it won't be possible for anyone to say "dont bother with the physio" as everyone is different. 

I agree with you that it is frustrating that you can't get an answer from the physio but you appear to have the attitude everything should be done this minute but unfortunately the NHS do have a waiting list. The physio department in the trust I work in have a 3-4 month waiting list!



> I've only being cycling like 14 months and my knee is a mess, it's an absoloute p155 take, I bet when my leg was pulled and snapped back into place when I broke my tib and fib back in 2000 they have not done it right and it's healed wrong and causing this wear.


This is the kind of thing that really p***** me off and can end in law suits and people going to court. If you feel things weren't done right go down the appropriate channel but you can't blame people for something which may not be their fault. 

My advice to you, lay off the bike for a while (yes this can be frustrating, but whats worse, a break from the bike or a knee that doesn't work?) and keep trying the physio's. You will get an answer but you just have to be patient!

*sorry for the mini essay*


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## willhub (12 Aug 2009)

Well if it's 3-4months here she should not have bothered referring me and told me that, I said I'd be back in Manchester in 2 or so months.


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## Will1985 (12 Aug 2009)

Why not see if your GP will refer you to a physio in Manchester? Wrecking your knee even more won't help your knee and it won't help your case with the doctors/physio if they see a person who won't listen to professional advice.


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## willhub (12 Aug 2009)

But I am listening to professional advice, the doctors tell me it's safe to cycle, it's not really a contact sport and it should not cause any more harm. I've being to the doctors, all he did is try speed up the physio referal. I'll get onto being referred to a physio in Manchester closer to the time as I think they will do that.


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## Scoosh (12 Aug 2009)

In the mean time read these articles :
Part 1 and Part 2

There is a very silly advert on the TV at present which says something like 'impatience is great'. This is absolute rubbish and especially when applied to knee pain/injuries.

As others have said (and I will repeat it, so you might get hold of it) - *DON'T AGGRAVATE A KNEE INJURY*  Irrespective of how old or young your are, if you knacker your knees, you will regret it big time later.

You seem to have an slight attitude towards anything which doesn't work to your timetable. Welcome to the real world . Relax.  Chill  - or whatever the current expression is for not being uptight 

I have had to learn that trying to get back to (full) fitness too early doesn't work and takes far longer in the end. Sometimes you have to slow down or even stop what you are doing for a while and let things heal .... and don't worry, you will not lose all your fitness in a couple of weeks 

And +1 for a physio referral. Yes, it might take ages but, unless you go private, it's all there is and is worth the wait. Physio stuff some years ago used to be about the physio pummelling/massaging your sore bit and it got better. Nowadays it is all about you doing exercises/stopping doing certain things to provide long term gain, which you can manage yourself for ... well the rest of your life.


Here endeth the lesson 


Do I sound like your parents ???


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## willhub (12 Aug 2009)

My knee is not always bad, it's just flared up badly the past couple of days, I take lots of rest despite what people may think, every doctor I have talked to says there is no reason I should stop cycling though. And with my voluntery job I have to cycle there as I can't drive, no busses at all, far far far too far to walk and my parents certainly wont take me. It's 8 miles there and the same back.

Maybe those omega 3 oil and glucosamine sulphate was helping it? I stopped taking those abit ago as I thought I was seeing no benefits.


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## Will1985 (12 Aug 2009)

willhub said:


> I'll get onto being referred to a physio in Manchester closer to the time as I think they will do that.


Why wait? You know there is a waiting list - get on both ASAP and then cancel the one which is less convenient.


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## willhub (12 Aug 2009)

Is it possible for me to not tell the doctors here at home as it's be a faff and just contact the doctors in Manchester directly and ask them to refer me? Or would they need to see me?


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## Paul_iow (12 Aug 2009)

Why would you not want to contact your own GP? For someone to refer you they would need to see you. You can't just phone up a doctor and ask for a referral without an assessment. You can ask your GP here to refer you to a physio nearer college.


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## Will1985 (12 Aug 2009)

If your GP is helpful they may be able to write a second referral letter to a Manchester NHS physio saying that you are a student in Manchester, and that it would be more convenient to see them there given your academic schedule. This obviously ignores any 'rules' about where you are supposed to be registered as students are a complicated situation - some departments can get picky about this sort of thing.
As long as you cancel the uneccessary appointment in good time you shouldn't be wasting any NHS time/money.


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## willhub (13 Aug 2009)

Well I'm only a temp resident at the doctors near home, I'm registered in Manchester, I don't know who my GP is here?? The doctor I seen yesterday was rather unhelpful not answering much questions about my knee saying I just have to wait for the Physio blah blah blah. So I still contact the doctors near here? Well I wont need to book a new appointment will I could I just call the reception and get them to do it?


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## Fiona N (13 Aug 2009)

Some thoughts as a sufferer of knee problems over the years:

If you cycle - ice the knee(s) when you get back - every time. This means getting a tray of ice cubes in a plastic bag with half a cup of water and sitting with the bag over the knee cap for up to 10 minutes. This will reduce any tendency to inflammation and help the knee settle down quicker;

The problems you're getting suggest that the knee isn't tracking properly and you'll need some remedial exercises to balance the muscles around the knees to correct this - only the physio will give you these, GPs are pretty hopeless at anything like this (to be fair, they're not trained to do it) so you need to hang in there and see a physio;

Being told you can cycle by doctors (especially GPs) can be misleading as (very)often the doctor means a couple of miles when he/she says cycling - they're not thinking over 4 hours or more or big hills - make sure they specify what they mean and tell them that you cycle long distances.

Arthroscopy to fix / remove a damaged cartilege isn't that bad - I've been back on the bike (gently) after a couple of days, so don't despair if you have to take this route.

Finally, your body's very resilient when you're young so problems now don't necessarily mean that you'll be troubled forever - but make sure you get the problem sorted as far as possible as soon as possible otherwise the action needed in future can really set you back. 

Let me give you my own example - I used to do a lot of orienteering and fell running as a kid and was always spraining my ankles. I rested just long enough 'til the pain went away then was back out. I never saw a physio. When I got to 30, a final sprain snapped the last bit of ligament holding my right ankle joint together resulting in a joint so unstable I couldn't do anything - not even swim. Walking required crutches as I couldn't put any weight on the ankle. In the month before I got an operation (which I paid for myself as the NHS waiting list was nearly a year) to reconstruct the ankle (and this wasn't arthroscopy but fairly major surgery) and the 3 months when it was in various plaster casts then supports, I put on about 10kgs, just from not being able to do any exercise (compared to what I used to do). The surgeon was quite specific - if I'd had physio in the past for the previous injuries, the chances were that I would never have got to the stage I did as the previous ligament damage could have been sorted with physio and a minor op if necessary and, more importantly, the weaknesses in my ankles could have been addressed with some remedial exercises. 

So don't tough it out.


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## willhub (13 Aug 2009)

Thanks for that post very informative. I talked to the doctor in Manchester a while ago and he told me I should consider backing off doing lots of miles, so I've being cycling allot less, usually around 3 days a week, it did help abit and I got allot faster from it.

I have being discharged from the physios, I never replied to the letter I got that never came on the 5th of this month, but my mum told them this on the phone when I was out and got an appointment at the physio for 25th August. I'd have thought the doctor yesterday would have knew about the letter sent out must have bieng in the records :

I'll try the ice cubes, I had ago with a bag of peas but my mum went mental so I had to swiftly put them back in the freezer, what's the half a cup of water for?


Thanks
Will.


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## Fiona N (14 Aug 2009)

The water is for the ice cubes to cool. The problem if you use just ice cubes is that they don't transfer the cold very effectively as they contact the skin in just a few places and this can cause those contact points to freeze - which you definitely don't want. So adding a bit of water means that the ice cubes cool it down to a bit above freezing then the contact area is bigger as the plastic bag/water can drape effectively over the joint and, even more importantly, you can't freeze any flesh causing cold injuries. 

Those bendy sports ice packs you can buy are a major source of cold injuries as people place them directly on the skin and leave them for too long only to find that they've frozen the skin which causes blistering like a burn - basically shallow frost bite - not good.


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## Will1985 (14 Aug 2009)

willhub said:


> I'd have thought the doctor yesterday would have knew about the letter sent out must have bieng in the records :


Unlikely - it sometimes takes ages for letters to reach a GP...there have been cases where a patient has died and the doctor informed by relatives weeks before any official confirmation arrives from the hospital.

Being told to cut down should mean shorter rides in duration as well as fewer times in a week. For instance, if you're doing 3 hours a day, reduce it to 2 hours or less.

Big +1 to Fiona N's post yesterday.


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## willhub (14 Aug 2009)

Can anyone shed some light on what this may be? When I am sat down, or jsut got my leg bent a certain way, when I sort of rotate my ankle when on the floor or slightly bend my leg, my knee has a weird hard to describe sort of crackling sensation, or a creaky vibration or something. That's something that I want to know, the doctors haven't answered that before.


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## paraffinlamps (16 Aug 2009)

Willhub I fully sympathise with you .I`m a runner and because of problems with my right knee ( medial side osteoarthritis ,a displaced meniscus flap tear and a smaller horizontal meniscus tear ) ,I have started to cycle to keep my fitness up while I wait to get my knee sorted and because of my arthritis cycling will now start to play a bigger role in my fitness .
I`m fortunate in that my running club is at the local hospital and a couple of members are physios .
It was the physios that advised me of my cartilige tears ,the NHS orthapedic surgeon just did an xray ,told me I had significant osteoarthritis and that I would need a partial knee replacent ,when I mentioned the possibility of cartilige tears he said no ,its arthritis and you need partial knee replacement and there was no point having an mri scan .He told me my running days were over and to start cycling and swimming instead .
I left feeling somewhat confused and slightly angry that he just wanted to replace my knee ,I`m only 46 .
After chatting to the physios and another runner who went through something similar , I decided to get an mri done privately .The mri showed the arthritis and the 2 tears.
I have now got myself refered to a sports injury specialist of the knee at The Orthapedic hospital in Oswestry ( I live in the West Mids ) using the choices option of the NHS .
My advice would be to ease of as mentioned and wait and see what the physio says and re read Fionas long post a few times especially the last bit .
I was told to wear knee pads several times when I was younger for my job ,I was young and thought I knew best and couldn`t be bothered most of the time. How I wished I`d listened now .
I have been advised by quite a few people that glucosamine does help and to take 1500mg a day .


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## Will1985 (16 Aug 2009)

FFS, why bother asking for help if all you're going to do is continue riding long distances? 114 miles yesterday and planning 160 next week suggests that you aren't taking this problem seriously.


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## postman (16 Aug 2009)

Ok old Postman here.
Time passes quick.Have been retired three years so it's about 5-6 years when i was discovered to have Osteoarthritis in both hips and secondary Arthritis in both knees.

Two knee ops.Three holes drilled into knee then flushed out,and some frayed cartlidge tidied up.

But it started up again further examination i had a star shaped rip in the cartlidge.
This was repaired and hey bingo it's ok i am 59.

But if i twist and turn or carry heavy objects the knees react and swell up.

This has happened twice this year.After being a volunteer to move heavy objects .

Do what i did REST them.Give them time to heal.And build up your distances.Short rides then increase by five miles or so every month.

Then your knees will tell you this is far enough.

I would rather cycle shorter and often than never at all.

My longest rides this year have been 65 and 67 miles in the day.

Leeds to Bridlington and Leeds to Grassington.

Don't push it.Enjoy the riding it's not about bragging how many miles we have done.

Not if you suffer for weeks afterwards.


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## willhub (16 Aug 2009)

Will1985 said:


> FFS, why bother asking for help if all you're going to do is continue riding long distances? 114 miles yesterday and planning 160 next week suggests that you aren't taking this problem seriously.



The doctor was mainly on about the frequency of riding, between yesterday and next week I'm not riding at all.

It's not as if I've increased the miles massivly, I've being doing 70+ every week with the odd 100+ i Manchester and every week here for weeks on end is 100+, yesterday was short and easy compared to some of the rides.

I take Omega 3 capsules and Glucosamine Sulphate that should help, I have ibuprofen that helps with swelling and glucosamine gel.


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## postman (17 Aug 2009)

Watch out with the IBUPROFEN.I got called into the Doc's this year.I had taken a Well man programme.And an abnormal reading was found in the liver.Was told to stop with the Ibuprofen.All was well after that.
So just a thought.


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## willhub (17 Aug 2009)

I don't take it allot, I've heard about people getting addicted to it and all that, so I only take it when I really need to. I'm sure if it causes anything bad then a blood test would find it out? I'm having one today to see if it sheds any light on my sleeping issues.


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## Bill Gates (18 Aug 2009)

If you take your weight on a daily basis you should notice a correlation between taking a course of Ibuprofen and a sudden increase in weightof 2/3lbs. I noticed it first after crashing my bike during a TT for a few days after and recently I was proscribed Ibuprofen for my arthroscopy. 

In each case my weight went up by 3lbs and a couple of days after I stopped went down again. It must have been due to fluid retention.


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## Billloudon (18 Aug 2009)

I was prescribed Ibuprofen after my bike fall and also noticed a marked increase in weight. I thought it was because I was less active. When I came off them I lost the weight again. I think because they were so effective I found it difficult to come off.
Coincidence - I think not!!!!


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## willhub (18 Aug 2009)

I don't know if me taking ibuprofen really is the cause of this weight increase I have, I only take 2 a day sometimes I might not take any.

I did weigh about 11.5stone but it was around 12 most of the time, now I'm at between 12.1 and 12.5stone, I'm thinking this might slow me down when I get back on me bike again sometime. People say it could be muscle but I don't know, recent weeks I have notice the bit of muscle above the knee cap, it's like a line or something that goes across looks bigger, like I never noticed it before, but muscle takes ages to build up I thought.

I'm going to search the internet for knee exercises that help with muscle imbalance and tracking problems, it's the only thing I can think of that could have cause my dodgy knee as I have never ran for any period of time that could actually cause knee problems.

I was reading last night and a website said you can damage cartilage when you break other bones, or if for example you broke your leg and twisted your leg round, and in 2000 that's exactly what happened when I jumped off a big hill and landed straight on the leg twisted it around and fell to the ground snapping tib and fib.


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## Nigel-YZ1 (19 Aug 2009)

I'm currently attending weekly NHS physio gym sessions focused on leg strength building to aleviate knee tracking problems. I've not ridden more than a couple of test run miles in 7 months.

I sprained both knees, then I listened to the GP telling me to rest and do nothing, over and over. No mention of RICE either. I ended up with patellar bursitis.
Then I went to a different GP who signed me up for physio without question.

In my opinion you really need to ask for that referral. Some GP's will tell you to cut back and rest until you stop altogether. Then you end up like I did.

A physio can then refer you further if need be.


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## willhub (19 Aug 2009)

Well as I said, I've got a physio appointment for 25th August.

It's likely I won't be satisfied with what the physio does as from what I can tell physio will not fix my knee from the feeling and sound of it all this clicking, I'll book an appointment the day after and try get the doctor to have more tests done maybe refer me for another MRI scan, It feels like I need an operation tbh.


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## willhub (20 Aug 2009)

Instead of using ice cubes and water would it be just as effective to get the shower head and move it around my knee area with ice cold water?


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## Paul_iow (20 Aug 2009)

willhub said:


> Well as I said, I've got a physio appointment for 25th August.
> 
> It's likely I won't be satisfied with what the physio does as from what I can tell physio will not fix my knee from the feeling and sound of it all this clicking, I'll book an appointment the day after and try get the doctor to have more tests done maybe refer me for another MRI scan, It feels like I need an operation tbh.


And how much medical training do you have? If you go into it thinking it wont work then it is more likely it wont. Psycology has a lot to do with healing. Why not go to the appointment with an open mind and you never know, you may actually get better!


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## Paul_iow (20 Aug 2009)

willhub said:


> Instead of using ice cubes and water would it be just as effective to get the shower head and move it around my knee area with ice cold water?


The shower head wont be "ice cold" so ice will be better.


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## willhub (20 Aug 2009)

Paul_iow said:


> And how much medical training do you have? If you go into it thinking it wont work then it is more likely it wont. Psycology has a lot to do with healing. Why not go to the appointment with an open mind and you never know, you may actually get better!



It's cause it seems that NHS physio's aint that good with knees and I have to pay lots of money to get my knee fixed, that's the impression I get.

And all the clicking I get and the dull pain I sometimes get makes me think how could a some exercises fix that? And how would the current cartilage wear effect it.

The shower felt pretty cold, it was enough to make my feet numb and feel abit uncomfortable for my feet.


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## montage (20 Aug 2009)

Right.... I would double check you saddle height on your bike. Get some people with experience...or even a bike fitting (you could ask the LBS that does bike fitting just to do saddle height for less cash if you are really short of money). If your saddle is currently too low, even if it is just 1/2 a cm ...then come back to use here 

I would also get off your bike and stretch at various points during training ..... just do the entire leg's muscles .....especially the IT band.

You can also buy deep freeze...just the same as deep heat...but it freezes!! Works for some.. £4 a tube though isn't that cheap.


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## willhub (20 Aug 2009)

What exercises can I do now that help with muscle imbalance and just generally help?

My current bike position has being set up for a fee of £50 a Paul Hewwit cycles near Preston so I'd hope it was correct. Saddle height is marked by a piece of tape now and does not appear to have slipped. My heels cannot tough the pedals as the saddle is high up, but I was told that this was not that important, and I trust what he says since he is apparently one of the best in the country.


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## Fiona N (21 Aug 2009)

To be somewhat cynical - the reason NHS physios have less success with knees than private physios is because the clients who pay for the advice are more likely to follow it. But all physios are limited in their success by the diligence of their clients in following up the exercise regime. 
My physio (private) reckons than perhaps 1 patient in 100 does as many of the exercises as she advises and keeps on doing them, about 20 in 100 do them for the first month then as soon as the problem goes, stop - whereupon the problem often comes back in a few months (which they blame on the physio and go elsewhere), most patients do some exercises for a while but it's hit and miss, and about 10% don't bother to do any at all.
And that's people who are paying £30 a session, so why would NHS patients getting it for free do any better - plus NHS physios are more likely to be treating the chronically overweight, the chronically lazy, the aged and infirm as a major part of their workload. 

I'm convinced that most physios are pretty good at what they do but obviously, if you go to a physio who treats mainly patients after knee replacements or post-stroke rehabilitation, they're going to be much better at advice for problems related to these than someone like my physio who gets a lot of fell runners and cyclists so is pretty good at the sort of ankle/knee/back problems associated with these sports. A previous physio worked with a lot of triathletes and was an expert on muscle imbalances in the shoulders due to bad swimming techniques. But who ever you get, you're going to have to do the exercises they recommend to get the benefits - not even the best physios can just wave a magic wand (or a Megapulse) to fix the majority of problems.

As an aside on the 'clicking' in the knee - this is most likely just the ligaments slipping over rough edges in the joint. When the joint is nice and healthy, everything slides really nice and smoothly. But with advancing age or overuse damage, rough spots develop where the ligaments and tendons 'catch' then snap past, a bit like an elastic band. So it's likely to be a feature of your knees now and even the best outcome from the physio may not stop it. Sometimes during an arthroscopy, the surgeon will look for obvious rough places and smooth them off as part of the 'general wear and tear' maintenance. I know ex-rugby players who go for such arthroscopies fairly regularly - every 3 or 4 years - just to keep their knees as good as possible after the rigours of a pro-sports life.

P.S> waving cold water shower at your knee is a waste of time and water - you need to have contact with near zero degrees material for 10 minutes to cool the joint sufficiently. It's the mass of the joint you're trying to cool down not the skin. Cold showers are good for sunburn not cooling joints to reduce inflammation.


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## willhub (21 Aug 2009)

Any idea when I do small movements do I feel when I put my hand on the knee cap a sort of creeking sensation, it's also the sort of sensation you'd feel when compressing snow. I went for a steady ride today, 15 or so miles and my knee felt fine, I've being doing random stretched that I think might help but not really sure, can't wait to go to the physio on Tuesday hopefully they will give me some exercises then. 

Would the ice cubes be as effective as deep freeze aswell? I spray that stuff just it does not seem like a can would last for long.


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## montage (21 Aug 2009)

I dont think deep freeze works that well myself. Go with the ice


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## willhub (21 Aug 2009)

Ok will do.

I'm starting to think about the near future, on Sunday I am doing 165ish miles very hilly, now this is pretty silly, but if it where any other ride I'd skip it and do maybe 20ish miles on my own not thrashing it, but this is a special sort of ride, after this I've got the physio on tuesday. Now I'm thinking about my fitness and how it may be impacted, I think it may be likely I'm going to have to stop doing long rides and have to shorted them, probably stop doing club runs after this weekend.

Now will it be ok doing shorter rides, around 60miles and flat, and maybe sometimes some hillyish? And if I do this when my knee gets better and I return to doing longer rides would be endurance be impacted? 

I'm hoping I won't be advised to stop cycling all together, I commute to college, it's only 3 miles there though, but I'd like to continue doing decent rides.


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## Paul_iow (21 Aug 2009)

Personally I think you're a bit of an idiot for wanting to do 165 miles, this is not a short ride by any means. You have been advised by a lot of people not to do long rides but you choose to ignore them all. At the end of the day though it is your knee!


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## willhub (21 Aug 2009)

Hmmm, did you just read what I posted?

Everything you just posted then I know, but you're wrong about that I apparently choose to ignore everyone.

If I ignore them, it means I don't pay attention, and basically, don't absorb the knowledge, not putting what I hear into practice is different to ignoring someone. I know I'm an idiot for doing it, but I've planned to do this ride and so hyped up about it I'm going to do it, one ride won't kill my knee beyond repair, if it was a normal 100+ club run I'd not be doing it, same goes for next week I won't be doing a club run.

What I want to know is, will it be ok doing shorter rides, around 60miles and flat, I don't know if that's considered long? To make that's a short ride, I'd like to be able to do abit hill if I'm ok to, I just don't want to end up loosing fitness and ending up back at square one and putting weight on which will result in me back to 2005 = not very healthy person who plays computer games all day long. 

I DO hope I won't be advised by doctors or physios to stop cycling, that would be awfull for me. If a doctor or a physio told me I'd end up destroying my knee if I kept cycling then obviously I'd not continue, but as long as the doctors or physios say I can continue to cycle then I will do so. It baffles me as to why cycling has caused my knee problems as cycling is recommended for people who HAVE knee problems, my doctor even said so, I'd hate to find out it was related to my leg brake in 2000 because if it was I'd probably like to try and sue.


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## Will1985 (21 Aug 2009)

You make no sense at all - who gives a toss how important the ride is....if you are willing to ignore the advice given by older people who have experienced problems, then go ahead but don't keep complaining on here about it and the sub-standard medical treatment you are expecting.

There is no justification for doing 165 miles if you wouldn't do a 100 mile club run.

Your fit sounds completely mad as well - I'd be seriously concerned that your heels can't touch the pedals (presuming sitting on the saddle with leg straight and crank in 6 o'clock position)....pointing your toes down like that to such an extent is bound to put added strain on the front of your knee.


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## willhub (21 Aug 2009)

I'm not complaining about it due to a 165 mile ride, please read my post instead of skimming it. The only reason I expect sub-standard medical treatment is from what people have said on the forums. Oh an as I've said and continue to say I'm not ignoring advice. 

Well I went to a well recommended bike fitter. I don't know who to believe with bike fit tbh now.


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## Will1985 (21 Aug 2009)

Believe me, I have read these posts very thoroughly trying to decipher the content.....

Every answer has already been given to those questions in the previous 50 posts.

This thread dates from November 2008....you've had problems for that long?!?


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## willhub (21 Aug 2009)

Yes, I had to go to the doctors about 4 times before I got referred for an MRI scan and about another 4 times untill I got referred to physio. I kept cycling because the doctors said it was fine. I keep asking and they still say it's fine. I don't really want to quit cycling.


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## HeartAttack (22 Aug 2009)

Well I think you really need to go and do the 165 mile ride, do it as hard and as fast as possible, big ring it all the way, no chickening out and dropping to the granny ring, thats for wimps and wosses!! that way you'll know what pain is like and then maybe just maybe you'll take enough time off the bike etc to rest the knee properly and allow the experts (medical that is!) to do their job without someone (namely you) going out and undoing all what they are trying to achieve.

As for the argument of well the doctors told me I could cycle, did you really tell them what you do, do they think you do the normal joe public ride of maybe a couple of miles a day taking 30 odd minutes, wearing trainers etc on open pedals, getting off and walking when the road rises above your head rather than your ego? I bet not, so again if you aren't telling them the full facts how can you expect the correct treatment?


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## willhub (22 Aug 2009)

I told them that I do around 100 miles. What's with the first paragraph? Who said I insist in staying in the big ring? Who said I'd do it as hard and fast as I can? The whole point of getting round a 165 mile loop is the pace myself and not push too hard.

So that question I asked that has still not being answered, is 60 miles too long? Do I need to quit cycling apart from toodling along to college?


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## Bill Gates (22 Aug 2009)

If you get your saddle height wrong then most people agree that it will have an impact on your body by putting a strain on joints/hamstrings/muscles/back etc. In a race or a long ride or over weeks and months this can cause injury.

There are various formulae published that profess to be an accurate guide for all riders. However we all different heights and have limbs in a diiferent proportion re overall length, bone length etc. Also where you position your cleat is important (the centre of the spindle should be just behind the ball of the foot).

The formula that I take most issue with is the one that takes measurement taken from the top of the saddle to the centre of the pedal spindle along the line of the seat tube and the crank in the same line to be 109% of your inseam length taken fron crutch to floor with no shoes on. IMO this is much too high.

The one which I believe to be closest to opitmum for comfort and power is to sit on the bike with your cycling shoes on and with the pedal in the same position as before, i.e. furthest distance away, then just have the heel scraping the pedal with a straight leg. With me that works out to be 104.4% of my inseam measured as above. 

A difference of 4 cm. See avatar


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## willhub (22 Aug 2009)

Maybe if I take some pictures of me on the bike it might be easier to see? I paid 50 quid at paul hewitts for my bike fit done and lots of people say he's a good bike fitter.

This is what he did: I think the numbers with * are the values he set the bike up with. I don't actually get pain on the bike btw, any discomfort I get is off the bike. My heel can just about tough the pedal when my leg is fully straight, not bent. I specifically asked the bike fitter about this and he basically says it's a rough guide and leads me to believe it's not set in stone as in, if you can't tough the pedals with your heels then it does not mean it's deffenitly wrong. And everyone who has seen me think my position looks allot better and certainly feels better, I don't get back ache anymore.


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## willhub (25 Aug 2009)

Ok.

I have being to the physio today, he had a look at my knee, then the scan, he seems to think it's pain to do with the patella or something, there is a special name for it but I can't remember it, he thinks it's related to a muscle imbalance, so he gave me an exercise to do.

I stand up against a wall, I tense up the quads, then slowly bend my knees down, keeping the quads tensed, it seems quite tricky, I have to make sure my knee is in line with my foot at all times too.

He has also put some tape across my knee, he said it'll stay on for about 3 days, but I'm not holding much hope for it lasting long I'm sure it's going to stretch, I can go in the shower with it and all that, I should have asked him if I could put some more on by myself as it made an instant difference as far as I could tell, when I bend my leg normally I get clicking, on the bike I get a popping click and also small movements when sat down cause allot of cracking sort of like crushing a snowball sensation, all of the clicking and nearly all of the creaking appears to have being prevented with this bit of tape, I cycled home, I'm sat here now, no pain at the moment!

He said I can still cycle, he said yes, I told him, when I mean cycled, I mean 100+ and going up hills pushing hard, he said it's fine. I'm only going to do a short ride at the weekend though with a long break in-between when I'm watching a road race. 

My left knee appears to be getting the same problems as the right knee, but hopefully the exercises will prevent it from getting worse, I have another appointment next week where he will give me some sort of exercise program, I might ask him if there is anything like the tape but lasts for much longer. 

In the meantime the exercise he gave me I have to do 10reps 3 times a day.


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## montage (25 Aug 2009)

willhub said:


> Ok.
> 
> I have being to the physio today, he had a look at my knee, then the scan, he seems to think it's pain to do with the patella or something, there is a special name for it but I can't remember it, he thinks it's related to a muscle imbalance, so he gave me an exercise to do.
> 
> ...




ITBS. =IT Band syndrome. cant remember what the IT means.

So basically you need to strengthen the inside of your thigh and stretch the muscle on the outside....right?

Hundreds of people get this, infact I was completely off the bike for 3 months, and only been back on for a month due to this.


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## montage (25 Aug 2009)

oh, I would try and climb hill out of the saddle as much as possible, and plenty of ice. Of course spinning helps. Stretches etc.....you shall be fine 

(165miles ride is a no-no I would say..)


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## Will1985 (25 Aug 2009)

ITB = Iliotibial band.

Physio might have said a patellofemoral disorder...general term for pain of that sort around the knee joint.


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## willhub (25 Aug 2009)

Ah yes that's it, he said it seems like patellofemoral pain. 

Montage, 165 miles is a rare thing, when I go back to Manchester rides are usually about 97 miles max, 110miles is rare there. I will try climb out of the saddle as much as possible, maybe it'll improve my climbing getting used to out of the saddle more. 

I think it's with my quads, the left side, or the inside of my thigh is weaker than the outside, or could be the other way around, and causing the knee cap to rub. 

I don't think I'll have Iliotibial band syndrome, as from what I see on the internet it says pain usually stops when not doing activity, when with me, pain usually stops when cycling.

The effect of this tape he put on my knee on is wearing off allready, it's looks like it was stretched too much due to movement and my knee is clicking again.

**edit**

I think this tape is called a kneww brace basically, would it be simple for me to put it on? This tape is just an irritation now as it's doing crap all no it's stretched and gone all messed up. I have a bandage if that could help?


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## Fiona N (25 Aug 2009)

The taping is just a temporary measure to help the knee cap run in a better alignment - until you develop the muscle balance - and prevent further discomfort. It's generally not a good idea to use this sort of taping as a long term measure - it's much better to develop the muscles which do the same thing. 
You can visualise what happens in the knee if you think that the quads connect to the top of the knee cap (patella) and there's another set of muscles which connect the knee cap to the front of the shin. When you bend your leg under load as in cycling or running, if the three main bits of the quads are nicely balanced, they pull equally on the patella - to the left, centre and right - and the patella floats above the middle of the joint as it's supposed to do. But if the outer part of the quads gets too strong, you can see that this will have the effect of pulling the patella outwards so that instead of sitting nicely over the joint as it bends, it gets rubbed over the edge of the bone/tendons which causes discomfort and inflammation of the joint. Sometimes this also causes inflammation below the patella as the muscle on the shin gets pulled out of alignment. 

ITB syndrome is another type of imbalance mainly due to overtightening and lack of strength in the glutes (G. medius usually, possibly piriformis) which causes other problems but the pain is normally on the outer side of the knee just below the joint where you can feel a bony knob rather than under the patella.


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## willhub (25 Aug 2009)

Well the tape the physio put on I took off as it was not having an effect, I wanted to try and put it on again, I had a go but I could not get the right effect the physio did, it still clicked when I put the tape on whereas when the physio did it there was no clicking. 

I've being trying to exercise that I was given but I don't think I am doing it right, and I find it's causing abit of discomfort in my left knee, I don't know the name of exercise that I described. I've attempted 2 sets of 10 today, I know it wont do anything instantly but if I'd be doing it right surely it'd get harder each time I do a rep and also should ache abit?


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## billflat12 (26 Aug 2009)

*knee*

I had nhs keyhole surgery for my knee as clicking worsened & knee would lock up after exercise, got painful clicking on straightening , was referred by my doctor and had the op within 4weeks, surgeon advised six weeks no sports , but to be honest i bought a road bike an was back in the saddle after 1w as doctor had said that the pain would dictate how much i could do, after a six week checkup i ditched the road bike and got back onto my heavy kona stinky riding local welsh trails like the beast at coed-e brenin , marin trail etc. never been a problem since , personally i would not leave it as long as i did again, recovery depends on overall fitness and the 6weeks is for nhs. regulars who don't exercise. i,m told if you go private you get a video , I only got pic,s


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## HeartAttack (26 Aug 2009)

I just can't believe you willhub, you come on here telling us that you have a knee prob, you've seen specialists and yet you then say its not helping and so do what you want, why the hell are you wasting the time of the doc's etc when its obvious that you are a medical expert cause you know best!

Crap like oh I'll ride easily for 100 odd miles when you say you have been advised to rest and gentle exercise. You get your knee taped up and take it off cause as you said it wasn't doing anything to help, then you say stuff like you don't expect instant results from exercises, so how long did you give the tape to help matters??

Personally I think you are a joke, I hope you knee gets better soon but in reality I know its going to take months and we're all going to have to put up with this thread getting longer and longer cause you aren't able to follow simple advice given to you by those specialists.


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## willhub (26 Aug 2009)

I just can't believe you HeartAttack, firing insults at me without even reading my posts. Since when have I fired insults at you?

Who has advised me to rest and only gentle exercise? You clearly have more information from my doctors than I do cause no one has told me that at the doctors, please can you give me the details? 

I stated that I ASKED the PHYSIO and he even said I could continue normal riding, have I? No, I've cut it down allot... I'm following the physio's advice perfectly well. He never said DO NOT take the tape off, he said it'd fall off in about 3 days; clearly the cycle home from the hospital of 5 miles with high cadence was enough to make the tape only last 2 hours.

The exercise the physio gave me has given me more discomfort in BOTH of my knees, but I'm still continuing doing them, is this not following advice? 

About being taped up, I've stated it was doing no good anymore, at first it was I'd have kept it on, then with my bending my leg it started to shrink as it had being stretched, I don't know what it did, if it let the knee cap go back to normal, but it ended up just like a piece of tape on my leg as an ornament because and it was clear because all the clicks and discomfort when sitting came back. It does not take someone qualified to know that a piece of tape on my leg has clearly started to shrink back to its normal width looking at the mark it left where it was, and the clicking that came back. I know this because he said the tape would force my knee cap into a better position and I'd instantly notice less clicking, which I did, that better position was no more when the tape stopped doing its job.

I can follow advice fine thanks. I've followed plenty of advice regarding my knee, IMO, for me, I would find it hard if a doctor or physio told me I had to stop or really tone it down to only gentle rides, because cycling is something I love to do and I enjoy the challenge of getting fitter and faster and the thought if losing all that is very dark and gloomy, yes I know if I went against someone who was qualified to tell me to stop cycling or take it really steady then I'd end up ruining my knee, but I've not gone against any sort of advice like that because I haven't being given any by the doctors or physio. You underestimate me I'm not as daft or stupid as people think I am.


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## lukesdad (26 Aug 2009)

HeartAttack said:


> I just can't believe you willhub, you come on here telling us that you have a knee prob, you've seen specialists and yet you then say its not helping and so do what you want, why the hell are you wasting the time of the doc's etc when its obvious that you are a medical expert cause you know best!
> 
> Crap like oh I'll ride easily for 100 odd miles when you say you have been advised to rest and gentle exercise. You get your knee taped up and take it off cause as you said it wasn't doing anything to help, then you say stuff like you don't expect instant results from exercises, so how long did you give the tape to help matters??
> 
> Personally I think you are a joke, I hope you knee gets better soon but in reality I know its going to take months and we're all going to have to put up with this thread getting longer and longer cause you aren't able to follow simple advice given to you by those specialists.



Seem to remember not long ago He had a post for help with his training plan, he didnt listen then either! He seemed to know best,dont know why he bothered asking.


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## willhub (27 Aug 2009)

lukesdad said:


> Seem to remember not long ago He had a post for help with his training plan, he didnt listen then either! He seemed to know best,dont know why he bothered asking.



What makes you come into a thread and post rubbish without reading properly? I've took plenty of notice in that thread but I've decided I might aswell get a training plan from someone who knows enough to make me a decent one.


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## Bill Gates (2 Sep 2009)

willhub said:


> I've took plenty of notice in that thread but I've decided I might aswell get a training plan from someone who knows enough to make me a decent one.



Apologies for the delay, but having just read your last post I felt that a late response was necessary. 

You are going to have to pay to get professional advice and to be honest unless you are a top rider there is little to be gained that you can't already get from reading a regular cycling publication. There are some on the internet and you can buy cycling magazines in stores.

The info given out on forums is pretty good as it's genuinely given by riders with many years of experience of training and racing. If you are going to use a coach I would find one who has actually performed at a top level as they will empathise more with your progress towards your goals.


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## willhub (2 Sep 2009)

There is this guy with a good repuation near me, called Peter Read who I will go to, he charges £20 and he's wrote this "black book" that appears to be very usefull, not so much for me as I don't have a turbo trainer. But it gives good info on intervals, it's a long read, 70ish pages I think.


Also about my knee, I've being given more exercise and some tape and shown how to do it so I can do some DIY on my knee, he said it should take 6 weeks to correct the problem assuming that I do the exercises, he also said that at my age the cartilage should heal. I mentioned cycling again and he said don't stop, just keep what you doing, which at the moment is not much, 45 miles a week. (one ride)

He said he would not recommend me using a splint or whatever you call it as I want to muscles to do the work.


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