josephjhaney

I'm more just venting, but here goes. I have been back to biking this year, finally, after some time away, well, this past Monday I drove to work to do the old change out of work clothes, bring in food for the week, etc, then Tuesday I rode in and home, legs were feeling awesome and I hit the pedals hard. Had a great ride both ways, fastest of the year, and felt awesome. Wednesday was a little slower, and my knee was a little unhappy, but I pushed though, and felt pretty good when I got home, but about the last 2 miles my kneecap felt "off". I've had PFS in the past, and this was like the start of it. This knee has been totally out a few times, but never since 2006 when I started biking. I took yesterday off, and hoped to be able to bike today, no go as the knee was having none of it this morning.

So my plan is to do a short easy ride tonight just to get that motion going and see how it feels, then give it two more days of gloious rest and get back at it Monday morning.

I'm 45, so it's not like I'm in my 60's or older, but I am learning that not listening to my body can have much worse effects than listening. Hopefully I can get a full week in again next week (Had my first full week last week, and it was great!) My ride is almost 20 miles each way, so stacking 40 mile days has a way of really clearing the mind, I love it!


Thanks for listening!

Joe

79pmooney

I had to look up PFS. Chrondomalacia patella for us older folk. Been a part of my life for 40 years. I wrote about my experience with it years ago for another forum as I had never seen in any one place the key elements that the doctor who diagnosed me stressed (back in 1987). So rather than reinvent wheels, I am simple going to paste that post here. The final addition at the end I put on about 14 years ago. CP is still with me and I still ride. I have ridden Cycle Oregon the past 6 years, 4 on fix gears, without my knees being the governing factor.

Chrondomalacia patella. Yes, I can tell you a little about it. I was diagnosed in ’78 and given very good advice by the doctor (an orthopedic in sports medicine. He was also a novice bike racer, so he had more understanding of the cycling aspects of CP than most). I will do my best to pass on what he told me.

In CP, the kneecap is not aligned with the knee under it, hence there is chafing as the knee is moved. This causes wear, first to the cartilage, then to the bone under it. The wear accumulates with number of repetitions and pressure. At some point, the wear can cause permanent damage.

Some people are more prone to CP than others. It can be triggered by exercising in cold weather, exercising without adequate stretching of the hamstrings, i.e. touching your toes or less extreme stretches of the same tendons. It can be brought on by exercising without adequately strengthening the small quadriceps muscles just above the kneecap.

I brought on my CP by training to return my body to racing form after a very serious accident. (I was weak enough after my hospital stay that I was no match at 24 years old for any 7 yo. The accident was in November, and I returned to riding miles in March. I did nothing to keep my knees especially warm and did no stretching exercises (rationalizing that since my leg never extended to anywhere near straight, there was no chance of injury, hence no need to stretch). I was wearing just full tights and thermal underwear under them in Boston. The temperature was probably not much above 30. The ride that started it was 100+ miles on my racing bike, my first outdoor ride on that bike. It had 175 cranks. My trainer, with fixed gear and very low BB, had 168’s. After the ride I had a dull pain in my mid to upper knee in front. That Saturday was the first race of the season. I was forced to drop out, my knees hurt so much.

After that race, the race promoter introduced me to an orthopedic surgeon who diagnosed me in the back of a cold van. He laid out for me then and in later phone calls a plan that I will pass on here.

He first stressed that I had to stretch my hamstrings, touch toes or lean forward against a wall or post with one leg back and straight and stretch that hamstring or sit and touch toes. I now prefer the lean forward method. Very specific and hard to hurt yourself. (I am now a 48 yo, I damage if I am not careful.)

Second, he had me sit on the floor and do leg raises. He had me raise one leg at a time and hold it several inches off the floor for a while (I don’t remember the time, but 15 secs should work. Important – while the leg is raised, tense up your quads big time and tense up those little quads just above and beside the kneecap. Feel for them and get to know them. It is those little guys that keep you kneecap aligned. If you are in riding shape, you can do this with say 5 pounds on your ankles, but the tensing up is much more important than the resistance.

Third, KEEP YOUR KNEES WARM WHEN YOU RIDE!! For me, this is critical. I wear these dumb looking “knee warmers” for most of my rides, always below 70 degrees, often under tights. Since keeping the hamstrings loose is important, I had to stretch the elastic. To keep them from falling down, I sewed on garters that I clip onto my shorts.

Fourth, back off riding until you have been doing these two things long enough to make a difference. Keep up the exercises and especially the stretches after you resume riding. Build up your riding slowly. The doctor stressed this to me and it has been very true. My ability to come into real form and resilience on the bike is limited more by my knees than by my lungs/muscles.

After rides, take aspirin or Ibuprofen to speed recovery. I personally think aspirin is better, that my knees recover more with it. I disagree with the ice. I have always felt that moving my knees when they are cold is causing the damage I am trying to avoid. Perhaps ice speeds recovery, but I feel it also continues the damage (at least in my knees).

Big gears are the enemy of CP knees. I love to climb hills standing. I love to ride hilly country on fix-gears. It is a fact of my life that I can only ride certain not-so-steep hills on my commuter and that I have to have and use a granny ring on my custom. It is a fact that there are days, weeks and months when I have to let whippersnappers blow by me on hills where I know I can humble them.

Lastly, what you did not want to hear, but again what the doctor told me. Get used to the idea of CP. If you are at all like me, it will be a fact of your cycling life for a long time. 23 years later for me and I am feeling my knees now because of a very easy ride I did in street clothes without knee warmers at noon today.

Sorry to be the bearer of bad news, but you can still do a lot of riding. I raced that season (I already knew it was my last) and have done 60,000 (?) miles since. I still commute, but only on alternate days. (But for the first 7 years with CP, I did not own a car and rode everywhere.)

I took the time to spell all this out because in the 23 years I have had CP, I have never seen all of this in one place. In fact, I have only heard about the importance of keeping the knees warm from that one doctor. That is the single most important aspect of the program for me. Thank you Dr. Kish, wherever you are. I will probably ultimately need those carbon fiber knees, but by following the regime, I figure I can wait until a) the product improves, b) the price comes down and c) I’m old enough that my cycling level will be within the abilities of those knees. I hope to delay another 10 years.

Since I wrote this a year plus ago, my physician has recommended that I take glucosamine. He was very specific, that I should take 3000 mg/day in the form of glucosamine sulfate or glucosamine hydroxide, but to avoid chrondroitin. This I did faithfully for 9 months. Between riding steadily starting two years ago and the glucosamine, my knees never felt better than they did last summer. I was passing whippersnappers uphill. Then my riding tapered off, I tapered down on the glucosamine and got sick so my riding and conditioning dropped. Thanksgiving I rode 50 miles with 2500’ of climbing on a cool day. My knees hurt. How many of those rules outlined above did I break?

Ben

josephjhaney

Wow, Ben, man, thanks for all that info! I was off the pedals today for two reasons, 1- I didn't get a lot of sleep last night so I was a bit tired, and 2- My knee feels fantastic! Why is number 2 a reason? Well, In the past I jumped on the bike the first day my knee felt fantastic and it put me off for another week, because I pushed too hard, so I start back tomorrow, and I WILL keep my rpms high and my gears easy. I'm going to work in those leg lefts and stretches too, I think part of the issue is last time I built up to this level of speed/fitness it took me months, muscle memory this time had my quads popping faster than the bits around them to hold everything in place. My legs feel fantastic today, so tomorrow should be a solid bike day. I'll keep you posted.

Joe

noglider 

I was diagnosed with chondromalacia when I was 24. I'm 56 now and still doing OK. Exercise is the best treatment for me. That includes cycling and weight lifting. Lately, doing dead lifts at home has helped me a lot. It no longer hurts to go down stairs.

This is one place where cleated shoes can help you. I wear them almost every time I ride. I had a mechanic align them. It's important for the feet to be pointed forward. I tend to point them out. Misalignment increases wear on the knees. I also keep them unusually far back on the shoes, almost in my arches.

It took me a while to realize that time OUT of the saddle made my knees worse, so riding as much as possible seems to be good for me.

timvan_78

I have been lucky since i have started stretching more. Exercising the legs/hips in a lateral motion (hip adductor, hip abductor, lateral leg raises).