Knee problem

Discussion in 'Cycling Training' started by vovk, Apr 11, 2003.

  1. vovk

    vovk New Member

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    I have developed a bit of a (left) knee problem(I might have a Patellofemoral syndrome ). It begun 10 days ago as a result of trying to achieve a new PB on a climb (2km, 11%) I use as a benchmark (and I did it, it went form 9min 40sec to 9min 01sec). I did ride in a bit of a low cadence (60 to 65), but I think that the main problem is that I tend to move my left knee toward the top tube during the down stroke.

    So how should train to adjust my down stroke?

    Thanks, Blaz
     
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  2. J-MAT

    J-MAT New Member

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    Don't worry about your knee yet, just give it a rest for a while with no climbing.

    You should always strive to keep yours knees toward the toptube. I try to gently scrape the toptube with my knee sometimes when I'm really working on my pedalling form. If you notice, all good pro riders have their knees almost touching the toptube no matter if they are out of the saddle or seated.

    Nice test climb. I have two favorites, 1.5 miles @ 6% and .5 miles @ 12%. I really dread the 12% climb!!! It's very hard to get anywhere near "normal" climbing cadences on 11% climbs, so holding 60 rpm is not uncommon. The lower the cadence, the higher the tension or force you must exert on the knee. When doing strength work, some riders gear up and go down to 30 rpm on climbs. This really loads up the knee!!!

    It's probably just tendonitis, and will probably go away on its own. The knee is so complex. You can damage tendons, collateral and cruciate ligaments, menisci, or the smooth surface under the kneecap. Tendonitis is most common. Tendons attach the muscle to bone and have to trasmit the muscular force to the skeleton. That's a tall order with strong muscles!!! Muscles recover very quickly, tendons do not. Your muscles might be ready for a hard ride, but the tendons might need many more days of recovery before going hard. Push a tendon too far and it will swell up and be painful.

    Back off the intensity, but continue to ride. It might take some time before you are ready to climb again.

    Strengthen your legs and tendons with isolated leg training (ILT). It will strengthen the legs and knee joint considerably without putting the huge compressive load an 11% grade does.

    Do the ILT indoors on a trainer. Clip in with one leg, and support the non-working leg on the back of the trainer. Work up to 3-5 minutes or more. Gradually increase the resistance. Keep cadence around 40-80 rpm.

    ILT is so taxing that it will be very hard for the strongest of riders to finish 60 seconds in an easy gear at first, but you will rapidly improve. ILT is a miracle cure for riders with muscle atrophy from broken bones or knee surgery. ITL will help leg strength and power output considerably for all riders. I used to push a 53x11 into strong winds at 60+ rpm for strength. Now I just climb and do ILT!!!

    ILT really helped me to recover from climbing induced tendonitis where my muscles we ready for speed but the tendons weren't!!!

    ILT is so potent of a training tool, I'm almost afraid to share it with anyone. It truly is a secret weapon of the highest order!!!

    Good luck!!!
     
  3. andrewnyc

    andrewnyc New Member

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    I'm not sure if this is a similar issue such as tendonitus or not, though I am experiencing similar problems.

    This is with my left knee, though I don't feel any discomfort until about 1.5 to 2 hrs into a ride.

    The pain streches for about 2-3 inches along the out side part of the knee almost conecting the bottom of the IT band to the top of the fibula head.

    Can cleat position be an issue. I use red look cleats, but honestly, I don't think the float is at all usefull since the floating action is quite stiff. Meaning, I need to mildly force the shoe to float.

    Andrew
     
  4. J-MAT

    J-MAT New Member

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    First of all, let me temper my comments with the caveat that I am not a medical doctor. I do have a strong science and physiology/anatomy background though.

    It's hard to tell exactly what is going on. Is the pain superficial or deep? Is the pain pinpointed sharper in a small area or duller over a larger area? These clues can help point you in the right direction. Sometimes pain "identification" is of little help.

    Based on your description, there are two main structures present here and they are the lateral (fibular) collateral ligament and the lateral meniscus. The two knee ligaments (medial and lateral) stabilize the knee and prevent excess range of motion. The menisci are the cartilage that prevent bone-on-bone contact between the upper and lower leg. There are two menisci in the knee: Lateral and medial.

    Of the two, damaged menisci are the most serious and often require surgery. Menisci normall tear in an environment of high pressure combined with simultaneous twisting which is why stadium-sport athletes often require knee surgery. Cycling provides an ample high-pressure environment, but fortunately minimizes rotation of the knee capsule, making this type of injury less common for riders. It can happen though.

    The first thing to do is back off all intensity training, especially sprints and hills until the knee feels healthy again. No competetive rider likes to back off the pace, but think how knee surgery will slow you down!!! Most likely it is a straining of the fibular ligament. A rider's anatomy combined with a given shoe/pedal combination can produce unique stresses on the knee. No two cases may be the same. For example, riders with wider hips (usually women) can have more ITB (illiotibial band) problems than riders with narrower hips.

    As for the pedal system, the float should not be restricted so much as to prevent your knee from "adjusting" itself when riding. I've used just about every pedal system out there such as Look, Shimano SPD, Speedplay, and Time.

    I have used Time pedals for many years and find them to be the best I have tried. They have a large platform (haven't tried the Time Impact yet) and float well, but not too much. If you want a pedal with extreme float try the Speedplay. When first using them, your feet will float so easily it feels like you are walking (slipping) on ice. That sensation quickly disappears. I broke a Speedplay pedal (8 months old) 40 miles from home (trashed the retaining nut and bearing). That was a long ride home for sure. A friend of mine knows the owner of Speedplay and even he couldn't get him to give me a new pedal. Also, in my experience, the small platform of the Speedplay concentrates too much force into a small area on the ball of your foot creating a "hot spot" (I wear size 48 shoes). Look into the new Time Impact. Also check out the new Shimano Dura Ace pedal. It's really light, has a large platform and floats. Maybe I will switch to these.

    Also look for a product called "Big Meat" wedges. They might be hard to find (bicyclefit.com/818-562-9550). They are small plastic shims (under the cleat) that correct the poor knee-foot alingment when using modern, clipless pedal systems. They recomend you start with 2 wedges per shoe (the kit has 8 total). I went straight to 4 per shoe, and may buy another kit and put in more!!! They can really help straighten out ergonomic problems.

    Most riders worry about their head, but the most important part of a riders body is the knees. Treat your knees with respect. Pamper your knees 24/7. This means using them as little as possible outside of riding. Don't jump, play basketball, run, etc. If you really love to ride, save them for riding!!!

    Also, always wear knee warmers below 70 degrees F. Don't blow this off; cold weather can cause or make knee problems worse!!! Think of the wind chill of riding 20 mph when it's only 60 degrees F. outside!!!

    As for knee pain 1.5-2 hrs into a ride, examine your base fitness. What is a long ride for you? How many miles do you ride in a typical week. Did you increase mileage too quickly? Did you mix in too much intensity too soon? Are you recovering (ligament-tendon) enough between sessions? You are from New York and this year has seen record cold and snow. It's still early in the season, meaning opportunities for longer outdoor rides in your area have been few. Muscles recover much faster than ligaments and tendons. Maybe you are doing too much too soon. Also, read what I said about ILT in my first reply "vovk." Try it and see if it helps. It will make you a much better rider no matter what!!!

    Good Luck!!!
     
  5. andrewnyc

    andrewnyc New Member

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    Thank you for the reply. I incorrectly mentioned that it was my left, but it's actually my right knee. I forgot my right's from left's. :)

    The pain is more localized to a specific area. There seems to be a bone that protrudes to the outside of the knee and that's where the focal point is.

    I wear custom orthotics for flat feet, which I've been wearing in my cycling shoes. Since you use your feet differently in cycling rather than running, I wonder if this can cause a problem.

    I rode a light 30 min roller seesion the day after the longer ride. I felt ok. I still felt a little something there, but of course it was only 30 min on rollers as opposed to 4 hrs. I took yesterday off and I'm going to go for a light 2 hrs tongiht.

    It's the beggining of the season for me. I've only ridden a total of about 15 hrs and about 240 miles. This is my third week of riding after recovering from a stress fracture along the LEFT fibula head/Tibia joint (which is now arthritic; I've had a slew of injuries to say the least).

    So now that I'm experiencing pain in my right knee, it's a bit of a bummer and major cause for concern.

    Thanks again for your insight.

    Andrew
     
  6. Vo2

    Vo2 Member

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    Great info from J-MAT!
     
  7. J-MAT

    J-MAT New Member

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    There is a very small ligament that attaches the fibular head to the tibia. Either the fibular collateral ligament or this smaller ligament is the most likely the problem. The bony protrusions you feel are the head of the fibula or the lateral condoyle. Big deal.

    I can tell you some "good" news. The pain in your right leg is most likely the result of the stress fracture on your left leg. Due to that injury, you had to overcompensate by placing more stress on your right leg. Instead of an ideal 50/50 use of both legs, you may have had something more like 40/60 (Left/Right) or 30/70.

    Do the isolated leg training. ILT forces you to use one leg at a time, strengthening everything from the hips to your feet. This also means all the delicate structures in the knee. ILT will make your legs much healthier overall. If you had been doing ILT sets, you may not have had any pain while you recovered from your stress fracture. After a while, you may find that your pants fit a little tighter from all the new fast-twitch muscle packed on in your thighs, hips, and butt. ILT is a very potent weapon to have in your speed arsenal.

    By all means, rehab your left leg with the ILT sessions. Isolated leg training doesn't sound very glamorous, and most people would rather do some other form of training, but you are missing out on one of the most substantial performance enhancers out there. It doesn't do anything for your aerobic power, but will substantially improve leg strength, and your pedal stroke. You will find it easier to spin bigger gears and go faster.

    As for the orthodics, if they were properly fitted, they should bring your feet back to "normal." It shouldn't make a difference between dress shoes, work shoes, running shoes, or cycling shoes. Cycling shoes do fit tighter, and they may possibly be hanging up inside the shoe preventing a normal correction. If you are confident they are fitting properly in your cycling shoes, keep them in, but also try riding without them on a trainer for 20-30 minutes to see how it feels without them. Go with whatever makes your knee happier!!!

    By all means get those Big Meat wedges. As a former Army paratrooper and Special Operations soldier, I have trashed my knees from parachute jumps and humping 80-100+ lb rucksacks on my back. I get pain from time to time in different parts of my left knee. Of course, my left knee is the one that got injured on jumps. The Big Meat wedges helped to eliminate a good deal of pain!!! If your knees hurt, you will never go fast. Anything that can make your knees healthier is worth investigating.

    Good luck!!!
     
  8. andrewnyc

    andrewnyc New Member

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    Thanks again for you insight and info. I agree with the overcompensation that the right leg has done for the left. Throughtout my rehab and physical therapy, I did work with ankle weights to strengthen the muscles in my left leg surrounding the injury. I'm continuing to doing those things and I will add the ILT workout.

    I went for about an 1.5 hr ride last night. Felt the pain again after about a hr. One thing I noticed: My ball of the foot sits in front of the pedal axel and It feels like I'm not getting on top of the pedal stroke throughtout causing me to some how compensate up my leg (sorry, a little hard to describe). After the ride, I shifted my cleats as far forward as they could go so at least the ball of the foot was directly above the pedal axel. I rode the rollers for about 10 min and there was less pain. I'm wondering if this minor adjustment could have been part of the cause.

    Thanks again for your help and info. I'm going to the orthopeadist on Monday and I'm happy that I'll have some great info to discuss with him. I'm also sure the visit will also shed light on the subject.

    Andrew
     
  9. J-MAT

    J-MAT New Member

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    The ball of your foot should be directly over the pedal spindle for road racing. Track riders sometimes move their feet back more. It sounds like you are on the right track now.

    In earlier posts, you said you had pain 1.5 hours into a ride. Your latest post says you are getting pain at 1 hour of riding. This is a trend in the wrong direction. It could be nothing, but it could be a sign that what you are doing to get well is not working.

    Just an observation, but I am a little suspicious of your physical therapy. You say you are using ankle weights. Ankle weights typically weigh around 2-5 lbs. Unless you are doing 10,000 repetitions of an exercise, this is hardly enough resistance for even an elderly person with poor leg strength.

    The best exercise for islolating the quadriceps and knee joint are leg extensions done on a machine, which doesn't sound like what you are doing. I'm curious about your P.T. alltogether, because stress fractures normally require no treatment (casts) other than the passage of time. Since your leg probably wasn't in a cast you could still move it and maintain the majority of your muscle mass.

    The isolation from movement in a cast is what accelerates muscle atrophy. Even walking to the bathroom is enough stimulus to maintain "normal" muscle mass. Obviously, strength and size from hard training won't be as well maintained, but for the most part you shouldn't suffer from too much atrophy, which makes me wonder why you are using light ankle weights or in therapy at all.

    I can only speak for myself, but if it were me I would have never gone to P.T. or a doctor in the first place, other than to have a x-ray to confirm what was wrong. I would focus on riding my trainer until I felt confident enough to get back on the road.

    Stress fractures can be worse than a clean break, and can take longer to heal as well. Short of the passage of time, there is really nothing that anyone can do for you. If your insurance pays for everything great, but if you are paying out of pocket, that money would be much better spent on new pedals/wheels/etc.

    I've had stress fractures before and I know how painful they can be. I think you would have been able to ride a trainer with light resistance without any problems from day one on the fracture. 30-60 minutes a day would have eliminated the need for physical therapy (if it even helped at all), and it would greatly accelerate the healing process by increasing the flow of nutrient-rich blood to the bones with far greater effect than standard P.T. exercises. Most importantly, you would be riding, and riding is sport-specific to riding. Ankle weights are specific to lifting ankle weights.

    Some people might think I'm way off base, but why go back to your doctor or therapy unless there is actually something they can do to heal you? When you go back, will you doctor actually heal your leg or just talk to you? Do you know of any other profession where you pay $100 or more for nothing in return except 10 minutes of conversation? That's very often what a follow-up (or initial) visit to a doctor is.

    Nature endowed mammals with a rich nervous system that registers pain when something is wrong. Let pain be your guide. You will know when your leg has healed because it won't hurt any more. Why pay someone a lot of money to tell you what you already know?

    If I had some AK-47 rounds in my chest, I would see a doctor. But for something like this, I wouldn't waste my time or money.

    The ILT will give you a boat load of leg strength. If you serious about riding, I feel you would be much better served by doing this. Additionally, how did you get the stress fractures? If you love riding, consider stopping the activity (running?) that caused them in the first place.

    Just my observations, Andrew, don't take it the wrong way. I'm not trying to say your doctor or therapy is bad, I just don't think they can do much for you with this particular injury.

    Do whatever makes you happy!!!

    Good Luck!!!
     
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