172.5 vs. 175mm crank - knee tendinitis - need help

Discussion in 'Cycling Equipment' started by teetopkram, May 3, 2006.

  1. teetopkram

    teetopkram New Member

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    Greetings to everyone:

    In very early February I developed a case of patellar tendinitis in right knee during one of our training crits, due mainly to going too hard too fast after getting back into cycling last August. It happened on my old bike with 172.5MM cranks. Right after this I bought my new racing bike which came with 175 mm cranks and have been riding on them since. The new bike fits me perfectly in every way except for the cranks...172.5 is what is recommended for me.

    I trained and raced throughout Feb and March, tried to manage soreness, then took first 3 weeks of April completely off the bike. Finally went to doctor during that three week period, who put me on Naprosyn, recommended icing, and light riding 3-4 times per week to build up collagen and strengthen tendon. He said physical therapy probably not needed.

    Well, after about 2.5 weeks of light riding (strictly high cadence, low gear, Z1-2 riding), stiffness and pain is still there, though reduced, typically hours AFTER a ride (I really don't feel pain during the ride). So, I am going to seek physical therapy.

    HOWEVER, I am interested in getting your opinion as to whether going back to 172.5MM would help with the recovery (less extension of leg)? For what it's worth, I've had three bike shops verify my bike fit, I had one shop install the LeMond wedges to correct slight pronation, and the bike fit RECOMMENDS 172.5mm crank for me. So my current crank is technically too big, though I am not sure it would really make a difference for the tendinistic issue...YOUR OPINIONS?

    Money is not an issue. Also, the "advantages" of the longer crank (e.g., leverage for climbing and time trialing) aren't really that important for me here in Florida as we don't have climbs and I don't do lots of time trials. In fact, I think the smaller cranks would help with the sprints we have in these fast, flat crits.

    Any thoughts/opinions as to whether to switch back to 172.5s?

    Thanks in advance.

    Mark
     
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  2. twntbo

    twntbo New Member

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    In my opinion. I would go back to the 172.5s. I had similar knee problems a couple years ago. 75% of the time, I was on my road bike w/ 172.5s, I had no problems. But anytime that I put in more than 30 miles on our tandem w/ 175s, my knees would give me trouble. I measured saddle height, top tube length, had the same pedals, etc.. Everything was the same except for the crank arm length. Granted my riding style was a little different on the tandem, but I am still convinced that it was brought on by riding a tandem with 175 cm crank arms. My wife and I ended up selling the tandem before I had a chance to swap out the cranks, so I really don't have any science behind my opinion.
    Since your bike fit recommended a 172.5, I would switch back to the 172.5s.

    Best of luck
     
  3. Postie

    Postie New Member

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    Your question is one that I have pondered long and hard myself. I've found that fore/aft position of the seat and seat hight is critical in controlling knee issues.

    I have a bike with 175s and two others with 172.5s. The bikes are much different, but I can't say the crank length is noticeable. My current conclusion is that, for me, bike fit is much more significant then crank arm length. Hence, I'd have to say that the 2.5mm likely won't assist your recovery much.
     
  4. Doctor Morbius

    Doctor Morbius New Member

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    I think going for physical therapy is a good idea. RICE is also an excellent way to treat tendonitis. Ice is your friend. You might also want to look into ART treatment.

    I don't know that changing crank lengths is going to help until your injury improves. It's been my experience when something causes pain to avoid that activity for a while. Whether it's 172.5 or 175 you are still going to be putting the same stress on the knees and tendons.
     
  5. Postie

    Postie New Member

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    I'll second that.
     
  6. teetopkram

    teetopkram New Member

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    Thanks for all the help. I am seeing the PTist next Tuesday and will get their suggestions. The primary physician recommended continuing with light cycling to strengthen the tendon, and I've read in several places that shorter cranks cause less extension of the knee, so I thought it might help. But I see everyone's point about it not really helping UNTIL the injury has healed. I think after it heals I may try the shorter crankset anyway.

    Given other conditions surrounding the knee (i.e., For a few years I've heard lots of crunching in my knees though they have never hurt until now; lots of contact sports growing up involving running, current age of 38), I am also wondering if the root cause of the pain is chondromalacia. Sounds like all the symptoms are there...I'll ask the PTist about this too.

    Thanks again.

    Mark
     
  7. Insight Driver

    Insight Driver New Member

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    Take guidance from only your doctor about taking care of your knee. You may have a tendency to get inflammation in that knee and it is quite possible that you need 172.5 cranks and a wedge to help that knee. You likely have a slight difference in leg length. Not only do I deal with that issue, but I also am genetically pre-disposed to joint inflammation. I currently have inflammation in my right knee. Rather than stop riding, what I must do is to continue to ride and take NSAIDs as well. My riding technique has to be very deliberate. With proper motion in my knee and with the NSAIDs that I take, the lubrication through the motion of pedaling and the balancing of leg muscles holding the joint in place helps, in time to quell the inflammation. The worse thing for me is to stop riding. The inflammation will go down in time, but so will muscle tone, and when I start to ride again, I'm on the same roller coaster and my knee swells up again.
     
  8. teetopkram

    teetopkram New Member

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    Great information Insight. I can empathize with a couple of your points. I did have the LeMond wedges put on, but that hasn't helped yet (though it's not fair since I put them on AFTER the injury). Haven't had leg lengths measured, so I'll do that.

    Its funny you mention what happens when you stop riding. When I was running a lot (e.g., 15 mile long runs) I would never have joint or tendon pain when I ran just about every day...however, if I took a week or so completely off (e.g., when our family moved), when I came back my achilles tendon flared up like crazy. Same thing with cycling...I swear that the three weeks off the bike tightened it up more such that it hurts a little while I am riding (NEVER used to do that) and more during the evening. Don't know why that's the case, it just is.

    This also happened after I switched from non-float cleats (always rode these) to SPD-SL float cleats when I got back into riding last August. I have read that some people actually develop knee problems with float cleats as the knee has more room to "wiggle." I plan to ask the doctor about that as well.

    Anyway, thanks again.

    Mark
     
  9. teetopkram

    teetopkram New Member

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    **UPDATE**

    Just wanted to let everyone know what happened at PT. PTist took a lot of time to move my legs in every direction possible to test flexibility, and also did some minor strength tests. She confirmed the physician's diagnosis of patella tendinitis, and said she felt nothing structurally wrong with the knee. She said the kneecap is floating a little bit, but that's probably due to the fluid build-up. Her ideas as to what is contributing to knee pain are:

    1. My right quads are less flexible and slightly less strong than my left leg (where there isn't any knee pain).
    2. My hamstrings are very flexible (I do stretch these quite a bit), but comparatively weak.
    3. My calves are comparatively weak.
    4. She does not think it's chondromalacia, as there does not seem to be abnormal imbalances between the strength of the three quad muscles.

    Interestingly, my knee was more sore this morning, which I attribute to all the twisting and stretching she did of my leg yesterday. In short, she thinks strength and flexibility imbalances between different muscle groups on my right leg could be contributing to the pain. She doesn't think it's serious, as there is just a little bit of fluid, but has cautioned that I should not go hard until the pain has subsided. She has prescribed...

    1. 2x daily stretching of the specific quad muscles that are tight, before and after riding/exercise.
    2. Ice knee post ride ( I actually do this several x per day)
    3. Continue with Naprosyn
    4. PT 2x per week (stretching, ultrasound), for 3 weeks.
    5. After three weeks of stretching to increase range of motion, she will then focus on several weeks of strengthening the specific muscles that could be contributing to this. She doesn't want to do this now as she thinks the 1 hour of cycling I do 4x per week is enough strength training for now, and she wants to focus on flexibility first.

    Personally, the skeptic in me can't see how some extra stretching exercises are going to all of a sudden make the pain go away, but I will give it a try.

    Oh, she saw the logic behind getting smaller cranks, but doesn't think at this point that's a step that will help in recovery and therapy. She wants to try the above first before making structural changes to bike. She also recommended I stick with floating cleats rather than fixed. Given all the positive feedback on Speedplay pedals and how they help relieve knee pain, I will need to look into those as I move forward. I'll still probably get smaller cranks once I do gear things back up.

    Thanks for all the help and comments, even if you have any on this post.
     
  10. DOUGEG

    DOUGEG New Member

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    I'm a 50 years old athelete with no medical training, but I've spent my share of time recovering from a wide variety of sports related injuries. I make a few points:
    1.Be skeptical. :cool:
    2.One leg or hammie will aways be stronger or weaker than the other.
    3.Re-fit you and your bike. Are you overextending your leg on the downstroke? Are both legs the same length?
    4.Perhaps your injury and your position on the bike are not related. You're 38, training hard when injured.
    5.Nothing will happen too quickly - unless you overstretch or overtrain and re-injure.
    6.Be confident that your seeing a qualified sports PT with a history of success treating your type of injury.
    7.Be optomistic :)
     
  11. curby

    curby New Member

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    You are fortunate to have access to all the medical help you are getting... use them! THEN.... do what YOU think is right, pain or no pain you think you belong on 172.5s so get them! today! ;) i have bouts of tendinitis in the knees, started where nothing could relieve the pain so I had to stop riding road for a time... taking ibuprofen before rides got me back at it and I got on the mtn. bike and didn't push or race for couple of years, rode every other day (never 2 days in a row) and found a way to make it manageable... now after 10yrs i am back on the road exclusively, still riding every other day, no pills this time...

    lots of massage helped me in the process too... stretching never really worked for my knees, although for my back its magic!

    all's'miles,

    curby
     
  12. Wobbles

    Wobbles New Member

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    I am a true believer that we know our own body better than any one else, Doctor or no Doctor. I have learned this the hard way.
    When I made the switch from Triathalons to Road Racing I was sold a bike which was too small. I went from a 59cm, 175 cranks to a 57cm 170 cranks. Three months later I had my first knee operation. After rehab and another three months I had my second knee operation and was told by a very prominate Doctor to give up the sport.
    This is when I became obsessed with correct bike fit and knee injuries. I visited just about every book store and libarary in town. It was amazing to be reading about a knee injury and think this is my exact pain and problem. I would purchase the book and follow the exercises and stretches. Over a month I purchased five sport injury books and had a heap of material from the libarary.
    To make a long story short, ten years later I am still racing with no knee pain and a few mates ask for advise when they start to get knee pain.
    So go out and read as much as you can and believe in the stretches and exercises. Sorry this is so long, All the best.
     
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