Naughty knee!

[Baggy]

My knee has been a bit twingy, twangy and puffy (all scientific terms) recently.

I’ve been steadily increasing my mileage since mid-January, but a hilly ride a few weeks ago appears to have really set this off. I've had a similar thing before, caused by tight ITB and weak inner quads, and a bit of physio, stretching and strengthening usually sort it out.

Not this time

The physio thinks I have early stages of cartilage damage and uttered dreaded phrases like: "you might need to cut back the amount of cycling you do" and "if you carry on doing the same thing it's likely you'll need keyhole surgery in 5 to 10 years". I'm also not allowed near any hills for the time being (ok, so I'm not really sad about that).

Although the physio is very good, she's not a cyclist and has advised I see someone who can look at cleat position, insoles, pedalling technique etc. If I can get my backside, inner quads and other bits working more effectively it will help to slow down the rate at which the cartilage gets nibbled away at...

Am seeing another physio who is a cyclist and used to look after triathlon teams tomorrow, but am feeling very gloomy today

 

[Globalti]

My sympathy. Exactly a year ago I came back from cycling overseas feeling really fit and went out looking for hills. Suddenly I developed Baker's cysts behind both knees caused by over-use. Had some physio, saw a specialist and eventually they went away on their own as the specialist predicted. I did take up post-ride stretching and I'm sure that helped them on their way; now they have almost gone and the knees feel almost normal again but it was a worrying time and it interfered with last year's build up of fitness into the summer.

The knee does strengthen with time if you stress it but as you've written it's important to ensure that you're not damaging it by stressing it in the wrong directions. Check out cleat settings and seat height etc and even shell out for a professional bike fit session if you can. I can recommend a good bike physio in Clitheroe if you're in Lancashire!

 

[Fiona N]

Don't despair Baggy - I've got half the cartilage in my left knee missing and it does give problems e.g. never had any ITB issues before the op despite 30 years of fell running, but they're not getting worse and the physio is happy for me to keep on cycling (in fact, would much rather I cycled myself into the ground rather than take up hill walking and mountaineering again).

Like you I do a fair amount to keep the knees stable and as strong as possible but odd things do exacerbate the problem (driving long distances is disastrous in many (hire) cars) and I have to take a break from cycling for a couple of weeks until things settle down. I use these periods as a chance to get back into swimming and probably make a nuisance of myself at the local pool by thrashing up and down in the fast lane for an hour to get some semblance of a good workout.

And the threat of needing keyhole surgery in 10 or 15 years ...well, I know rugby players how have their knees 'cleaned out' (in the surgeon's technical term) every 5 years or so in order to keep playing in the 'maturer' leagues. I've had multiple arthroscopies - on both knees - over the years including the one which removed the torn cartilage and if it keeps you going, it's not a bad deal. Need to book in early on the NHS though as sporting issues are not high priority on the waiting lists.

So chin up and good luck finding a knee expert who's got experience of treating cyclists

P.S> one way to avoid some of the cleat positioning issues is to move to very floaty pedals like Speedplay or Crank Bros. But having a bike fitter look at your pedalling style's probably not a bad idea too.

 

[Crackle]

I was going to say bad luck Baggy and then I read Fiona's post and thought, jeez.....

Knees are funny things aren't they. I've had slightly dodgy ones for a long time, used to be particulalry bad when I was mountaineering but also on tour when cycling everyday seemed to aggravate them. It's one of the reasons I've changed my cycling style slightly and become more of a spinner.

I'm sure your new physio will be a lot more positive about it as she understands the sport and will hopefully sort you out.

Age eh, catches us all up

 

[Baggy]

I was going to say bad luck Baggy and then I read Fiona's post and thought, jeez.....

Yes, I suddenly feel as if I'm worrying for nothing!

Thanks all for your positive comments though – recovery stories are just what I need! The short-term disappointment of having to withdraw from rides is just that, disappointing, but the implication that carrying on will limit what you can do over a long period of time is different. I agree it's great that we have surgery as an option to get us going again, but It’s an odd feeling that something that’s supposed to good for you is actually turning out to be damaging.

Re: driving, I don’t drive a huge amount but oddly enough had recently noticed on a stint of motorway driving that it made my knee ache so it's interesting to hear that's one of Fiona's triggers.

I use Time ATAC pedals which have aquite a bit of float, but might try to borrow my brother's speedplay pedals and see how they feel.

I had a bike-fit from a local coach about three years ago, but he didn't look at my pedalling technique etc so will see if I can find someone who can advise.

Age eh, catches us all up

Having recently had a significant birthday I think there's definitely an element of that in there!

Anyway...off to see Physio Mk II now, so will hopefully report back with positive news later...

 

[ttcycle]

Good luck Baggy - I hope Physio II has more useful advice to offer!

 

[The Jogger]

How did you get on?

 

[Baggy]

Well, Physio II was very helpful and much more positive, it really helped seeing someone who is a keen cyclist themselves
Good news is my kneecap is tracking fine and not catching, so cartilage is probably fine. However, the tissue at the edge of the "cup" joint the end of the femur joint sits in is very inflamed - he described it as being like a cross beween a blister and a bruise - which sounds nice.

He thinks the problem has more to do with the action of my lower leg and foot than my quads. My right foot turns out slightly, so my cleat is turned out to accomodate this - this allows my foot to slide too far out on the down stroke so I'm pushing down with my big toe joint instead of straight down on to the ball of my foot. This makes my knee drift in towards the top tube and means it's twisting too far with each pedal stroke. Also good news in that my ITB is loose even though I've ridden a lot already this year, so the stretching and strengthening

The way he explained it, and the way the knee joint works seemed to make perfect sense, and I'm not just saying that because his prognosis was more optimistic!

It should settle well, the key thing is to get rid of the inflammation and put my cleat back in a neutral position. I've got to take a course of Ibuprofen for 10 days, cut down to flatter rides, lower mileage, and lower gears for the next two weeks and then build up to hill work and longer distances again. Trying a pedal with a wider foot platform and getting out of the saddle more on longer climbs (I'm a seated twiddler, not a honker!) should also help.

Fingers crossed!

 

[The Jogger]

Sounds like a lot better news to me.

 

[Crackle]

That's an excellent diagnosis, I'd be happy with that. I'd probably go the docs though and get Voltarol rather than Ibuprofen as it's better at dealing with inflammation. You can get it over the counter but it's expensive and in small doses.

 

[Ian H]

From the title I was expecting Victorian pornography.

Walking, particularly off-road, helped my knees, as did careful attention to smoothing out my pedalling technique.

 

[Baggy]

Thanks for the tip about the Voltarol Crackle. My GP is bike friendly, too.

From the title I was expecting Victorian pornography.

But Ian, I'm not that kind of girl, it would have to be ankles first!

Walking, particularly off-road, helped my knees, as did careful attention to smoothing out my pedalling technique.

Had been thinking about walking. I can see that the constant balancing off-road would help strengthen things if you started out gently. I used to do quite a bit before re-discovering cycling and had recently been thinking a bit more "impact" exercise wouldn't go amiss.

 

[potsy]

Baggy- I thought twiddling up the hills was meant to be better for your knees than out the saddle action?
Fingers crossed it gets better, don't want you falling behind too far on MCL

 

[Baggy]

Baggy- I thought twiddling up the hills was meant to be better for your knees than out the saddle action?

I think it puts stress on your knees in a different way, twiddling seems to come from the outer quads and lower glutes, whereas honking uses hips, hamstrings and both sides of the quads, so I think the knee doesn't fall in as much. It's maybe the case that a bit of variety uses different muscle groups and spreads the strain! Physio II suggested alternating every 20/30 pedal strokes.

Fingers crossed it gets better, don't want you falling behind too far on MCL

Oh, there doesn't appear to be an evil-look smiley

It's fair to say the mileage will be down a bit this month, though at least I can the pedals turning over (and hopefully continue the downwards weight trend). You can rest easy for a few weeks!

 

[Glover Fan]

Good news Baggy! Always good to get a second opinion!!!

My knees are the reason I am cycling as running was causing my left knee far too much grief! Thankfully I have a physio as a wife! Happy days!

Hopefully we shall see you out on some audaxes soon!!!