How to 'bulletproof' your knees

[matticus]

Rested, then went privately to a physio, got a diagnosis of torn inner VMO attachment, a brilliant massage and left with a strengthening plan.

I would also ask yourself: what do internet cyclists know that your physio didn't about recovering from your specific injury?

 

[Big John]

I ran for nigh on 25 years and had to stop when I was diagnosed with arthritis in my right knee. The specialist told me the damage was probably done when I was a young guy and played Sunday league football. I tore a cartilage (how many footballers have you heard say that?) and had an op to put things right but almost 30 years later it caught up with me - arthritis. When I had my op I was 22, it was 1978, and I went to a rehabilitation hospital in those days where they used to send us all out on bikes (with different crank lengths depending on what your problem was) to strengthen our joints. When eventually I had to stop running I concentrated more on the bike. I'd always ridden a bike but not as a hobby. Now I took it a bit more seriously. That was about 15 years ago and although I was told arthritis is a degenerative disease I'm still riding pretty well even if I say it myself. I only packed in vets racing (TLI and LVRC as they were called in those days) about 5 years ago. You want to keep your knees in good nick? Keep riding your bike but as others have said - do it sensibly. Overcooking things, no matter what sport you do, often results in injury. Has the arthritis got worse? Honestly? Yes, but I'm still riding and still able to get a wriggle on in the right company. I can't stand on the pedals like I used to do but providing I stay seated I'm fine. Cycling, I honestly believe, is pretty kind on the knees. Don't push too big a gear, keep spinning, and you should - all things being equal - keep going till old age 👍

 

[Peter Salt]

Knees are one area I would give ample recovery time and follow Physio directions on exercise. It worth the investment not to ride to avoid a lifetime of niggles.

Yup, definitely took it easy after the injury - still am to be honest.

Whenever such questions are asked her somebody will pop up and say "Cycling is good for knees, just take it easy" or "Deadlifts" or "Squats"

All of which might be fine for some conditions but absolutely wrong for others.

Twice I've had knee issues where I was told not to ride and not to work out in the gym.

For a recent issue that involved fluid in the knee capsule and inflammation around it, I was instructed to REST: No cycling. No gym. Limited walking. Very specific exercises to do 3/4 times a day with ice after. Over a month the knee issue and related hip issue caused by dodgy gait protecting the sore knee completely resolved.

If you are consulting a sports physio - listen to them and ignore any exercise advice on-line.

People on the Internet telling me not to listen to the Internet - that's a paradox if I've ever seen one. But jokes aside, of course I understand what you mean. My physio is a specialist but hey - I'm sure the forum is full of people who had all sorts of injuries and it's interesting to see what they think.

Learning to listen to your body is key if you are going to progress injury free. Most definitely do not cycle through pain. Ache yes, after exercise, but pain is a very different sensation.

Yeah, and a very painful lesson at that. I must say, as a beginner I actually found it somewhat difficult to differentiate between legs telling me to stop cause it's hard and legs telling me to stop because something might be broken.

I would also ask yourself: what do internet cyclists know that your physio didn't about recovering from your specific injury?

That's not what I'm looking for. As outlined in my earlier posts, just interested to see what others do to avoid all kinds of knee related issues and strengthen their legs overall.

I ran for nigh on 25 years and had to stop when I was diagnosed with arthritis in my right knee. The specialist told me the damage was probably done when I was a young guy and played Sunday league football. I tore a cartilage (how many footballers have you heard say that?) and had an op to put things right but almost 30 years later it caught up with me - arthritis. When I had my op I was 22, it was 1978, and I went to a rehabilitation hospital in those days where they used to send us all out on bikes (with different crank lengths depending on what your problem was) to strengthen our joints. When eventually I had to stop running I concentrated more on the bike. I'd always ridden a bike but not as a hobby. Now I took it a bit more seriously. That was about 15 years ago and although I was told arthritis is a degenerative disease I'm still riding pretty well even if I say it myself. I only packed in vets racing (TLI and LVRC as they were called in those days) about 5 years ago. You want to keep your knees in good nick? Keep riding your bike but as others have said - do it sensibly. Overcooking things, no matter what sport you do, often results in injury. Has the arthritis got worse? Honestly? Yes, but I'm still riding and still able to get a wriggle on in the right company. I can't stand on the pedals like I used to do but providing I stay seated I'm fine. Cycling, I honestly believe, is pretty kind on the knees. Don't push too big a gear, keep spinning, and you should - all things being equal - keep going till old age 👍

Sorry to hear about your ailment. Good to know there's something that kept you moving despite the setback. Rock on I can only hope to be as active when I'm your age.

 

[Ming the Merciless]

I would also ask yourself: what do internet cyclists know that your physio didn't about recovering from your specific injury?

It used to be the belief that for ligament and tendon tears that a number of weeks rest was best practice. But the evidence that accumulated showed that this caused weak repairs as the fibres didn’t mesh back together in alignment with the forces transmitted through them. Now it is best practice to get the injured party moving as soon as possible and progressively increase the demands.

What a physio knows often depends on when they learnt, how much they keep up to date with the latest thinking, and what they observe. The problem they have with observation is that they don’t have a baseline. Yes it improved (maybe) from when they saw the injured party, but they have no idea whether recovery is 80% or 100% of what that indiv could do before injury.

What do Internet cyclists know in comparison?

Well if they’ve had injuries they know what their baseline was, they know what they were prescribed, they know if they followed it, they know how close to baseline they returned, and how long that took. They know what they did once signed off by the physio. They know if they had ongoing problems or a repeat injury etc.

If an Internet cyclist has never ever suffered an injury due to over use etc in decades of reasonably high volumes of cycling. Then there’s probably something they are doing right, to avoid injury, even if a sample of 1 over decades. The OP may find some wisdom in that, that complements the physio recovery plan. Such that they don’ make the same mistakes and get another injury in the future.

The physios knowledge is cross sectional, and specialised. The Internet cyclists is longitudinal and very much not cross sectional, but still useful. Get enough Internet cyclist though and you may get both cross sectional and longitudinal.

 

[Peter Salt]

It used to be the belief that for ligament and tendon tears that a number of weeks rest was best practice. But the evidence that accumulated showed that this caused weak repairs as the fibres didn’t mesh back together in alignment with the forces transmitted through them. Now it is best practice to get the injured party moving as soon as possible and progressively increase the demands.

What a physio knows often depends on when they learnt, how much they keep up to date with the latest thinking, and what they observe. The problem they have with observation is that they don’t have a baseline. Yes it improved (maybe) from when they saw the injured party, but they have no idea whether recovery is 80% or 100% of what that indiv could do before injury.

What do Internet cyclists know in comparison?

Well if they’ve had injuries they know what their baseline was, they know what they were prescribed, they know if they followed it, they know how close to baseline they returned, and how long that took. They know what they did once signed off by the physio. They know if they had ongoing problems or a repeat injury etc.

If an Internet cyclist has never ever suffered an injury due to over use etc in decades of reasonably high volumes of cycling. Then there’s probably something they are doing right, to avoid injury, even if a sample of 1 over decades. The OP may find some wisdom in that, that complements the physio recovery plan. Such that they don’ make the same mistakes and get another injury in the future.

The physios knowledge is cross sectional, and specialised. The Internet cyclists is longitudinal and very much not cross sectional, but still useful. Get enough Internet cyclist though and you may get both cross sectional and longitudinal.

What a great reply. Never a bad idea to ask much more (empirically) experienced bunch what they think or do - might end up learning a thing or two and maybe even testing some of them.

On physios: I can say with a reasonable degree of confidence that the one I've ended up seeing was really quite good. Not only examined me physically but also asked how long I've been training, what exactly was my load prior and on the week of injury and just plainly why did I end up doing what I did (carry on despite the pain). I feel that the strengthening program she gave me is to some degree adjusted to my personality - competitive and eager to get going again. She did tell me to start getting back on the bike as soon as I felt I could pedal, but keep power below pain threshold and slowly try to increase my effort week by week.

But about that strengthening plan - it's very quad-focused with bits of hamstrings and glutes. Would training other parts of the legs, even if their participation in cycling is minimal, be of any use? I'm thinking hip abductors, tibialis muscles, etc.

 

[vickster]

What a great reply. Never a bad idea to ask much more (empirically) experienced bunch what they think or do - might end up learning a thing or two and maybe even testing some of them.

On physios: I can say with a reasonable degree of confidence that the one I've ended up seeing was really quite good. Not only examined me physically but also asked how long I've been training, what exactly was my load prior and on the week of injury and just plainly why did I end up doing what I did (carry on despite the pain). I feel that the strengthening program she gave me is to some degree adjusted to my personality - competitive and eager to get going again. She did tell me to start getting back on the bike as soon as I felt I could pedal, but keep power below pain threshold and slowly try to increase my effort week by week.

But about that strengthening plan - it's very quad-focused with bits of hamstrings and glutes. Would training other parts of the legs, even if their participation in cycling is minimal, be of any use? I'm thinking hip abductors, tibialis muscles, etc.

Not just strengthening but also stretching / increasing flexibility. Shortened/tight muscles are as much as issue as weak or imbalanced ones (overdeveloped in some eg quads, weak in others eg glutes) ..if not even more so

When do you go back to the physio?

 

[Peter Salt]

Not just strengthening but also stretching / increasing flexibility. Shortened/tight muscles are as much as issue as weak or imbalanced ones (overdeveloped in some eg quads, weak in others eg glutes) ..if not even more so

When do you go back to the physio?

I like to think I'm actually quite good when it comes to stretching/flexibility overall. Always do a bit of that before and after riding.

Next physio visit... Well, I've picked up the injury about 4 weeks ago and it's pretty much healed now. Probably going to go for a sports massage after my first really serious session. Maybe beginning/mid next week?

 

[vickster]

I like to think I'm actually quite good when it comes to stretching/flexibility overall. Always do a bit of that before and after riding.

Next physio visit... Well, I've picked up the injury about 4 weeks ago and it's pretty much healed now. Probably going to go for a sports massage after my first really serious session. Maybe beginning/mid next week?

Do you stretch on your rest days too?

 

[Peter Salt]

Do you stretch on your rest days too?

Yeah, but not as much. Usually as break in between a set of morning exercises... So, say, I'll do my pull-ups, do a calf stretch, push-ups, hamstring stretch, plank, quad stretch, bow pulls, groin stretch and so on...

 

[HLaB]

Touchwood I've only once had a proper injury to my knees, an ITB problem about 15 years ago. It might have been to do with a leg length discrepancy. I had to stretch rigorously before the leg length issue was identified and when it was identified everything seemed less 'clicky' within a few weeks and stretching is sporadic rather than rigorous now.

 

[HLaB]

I like to think I'm actually quite good when it comes to stretching/flexibility overall. Always do a bit of that before and after riding.

Next physio visit... Well, I've picked up the injury about 4 weeks ago and it's pretty much healed now. Probably going to go for a sports massage after my first really serious session. Maybe beginning/mid next week?

Do you warm up before you stretch? Stretching before things have warmed up can do more harm than good. If I do stretching its after a ride.

 

[Arrowfoot]

The physios knowledge is cross sectional, and specialised. The Internet cyclists is longitudinal and very much not cross sectional, but still useful. Get enough Internet cyclist though and you may get both cross sectional and longitudinal.

I disagree with your entire post but sectioned that one that is more concerning.

Physios are qualified professional, licensed after taking 3 years or more of medical studies. They read what the doctor's report and know which part has been damaged and need to recover. Physios will always asks what activities that you do and where the pressure points are likely to be. All you have to do is say you are a cyclist and give them an understanding how often and type of cycling you do. If there is concern with a physio, a second opinion would be the approach.

The physio will tell you when you are ready to go on the bike.

 

[Peter Salt]

Do you warm up before you stretch? Stretching before things have warmed up can do more harm than good. If I do stretching its after a ride.

Not always but I modify the intensity of the stretches depending on whether I'm warmed up or not. So for the stretching I do in the mornings or before rides it would be just 2x10s hold for each position but the ones after a ride or strengthening exercises are 3x30s hold.

I disagree with your entire post but sectioned that one that is more concerning.

Physios are qualified professional, licensed after taking 3 years or more of medical studies. They read what the doctor's report and know which part has been damaged and need to recover. Physios will always asks what activities that you do and where the pressure points are likely to be. All you have to do is say you are a cyclist and give them an understanding how often and type of cycling you do. If there is concern with a physio, a second opinion would be the approach.

The physio will tell you when you are ready to go on the bike.

Both points are valid, in my opinion. In the same sense you could completely scrap the 'bicycle repairs' section of this forum and just tell everyone to go to a mechanic and listen to him. However, given that this is a cycling forum, chances are there are people on here that have been successfully fiddling with their bikes for decades and have good knowledge of the topic. Of course, your LBS mechanic doesn't need a degree, but you get the point - it's not about the group of people that the advice is coming from, it's about the individual.

It would be, again - in my opinion, equally unwise to just treat what a physio said in an absolutely dogmatic fashion, as it would be to take advice from the Internet without cross-checking it with an expert.

 

[MichaelW2]

I put my computer printer on the floor. Compulsory squats.
I have had bad knees since I was 16 with a torn cartalage at 30. I try to avoid sudden hard and unexpected panic pedalling, stay in a lower gear , stretch, avoid cold knees, do a good warm up.. Mix walking and cycling. Tai Chi is good for strengthening all the little muscles used in stabilising the legs.

 

[Dogtrousers]

I have two dodgy knees. One from an op in the mid 2000s*, the other just old and creaky.

Oddly enough I find that my knees never suffer from cycling. At the end of a long ride my knees might actually feel better than usual. Unlike the rest of me.

* Meaning the first decade of this century