Syscrush

Hey all.

My knees are a total mess. Hypermobile patellas, femoral patella pain syndrome due to incorrect tracking of the kneecaps, a bit of arthritis (I'm 42), IT band problems, and some creaking & clicking.

Last year I was riding a moderate amount - the last real ride I did was a 120k sightseeing ride mostly on rec trails. It seems like my knees have gotten significantly worse since then, which sucks since I'm putting a lot of effort and care into trying to nurse them to health.

In order to give myself the best chance at improvement, I want to have a proper bike fitting done, along with some analysis of my pedaling technique. I've seen systems that use cameras, markers, and software to track knee position relative to hips, feet, and ankles, and I think I could only gain from that kind of analysis. Can anyone recommend a good place in the Toronto area to have a detailed fit and pedaling mechanics analysis done?


FYI, things I've done to try to get my knees into better shape:

1. Switched to running barefoot (helped).
2. Regular IT band massage (helped).
3. Lost a bunch of weight (220 down to 180) (helped).
4. Listened to my body and tried to not overdo it (helped).
5. Got frustrated and tried pushing it a bunch in the hopes of toughening up (did not help).
6. Got really frustrated & kind of depressed, stopped doing anything that caused knee pain - ate and drank too much and got fat again (back up to 220) (definitely did not help).
7. Quit running (I might start again if I can get my weight down into the 170's).
8. Stopped riding my fixie and switched to a geared bike (helped).
9. Started doing yoga 1-3 mornings/wk (helped other things, not my knees).
10. Started an 8 week restorative Pilates class that targets hip/knee issues (I feel great coming out of the class but have not had lasting improvement).

I started the yoga and then the PT/Pilates in order to try to get ready for spring. I want to put 1000km on my bike in the month of April (my contract ends tomorrow and I'm looking forward to some time off), but right now I'm worried about being able to manage even a 30k ride. I know I could do the ride itself, but expect that I would have significant pain for several days afterwards.

Any advice on where I can go to get help/guidance/care that's specific to being able to ride a bike without knee pain would be very, very much appreciated.

Thanks,
Phil.

Canadian_giant

Maybe you have done this but I didn't see it in your story but did you do physiotherapy? I tore my MCL this winter and have been doing physio for 3 months. Like you, I fear being able to do long rides without pain. I learned alot about what caused other knee issues I have had though physio. The good news is my knees are significantly better.

Elevation

I have pretty much the same exact problem, plus a little more, and have been in P.T for three weeks. I have been off the bike for 6 weeks so far. It will take time to heal. I'm guessing you've seen a doctor? Ideally you shouldn't be riding if there is pain, as its not going to help you heal. How long were you off the bike?

P.T is helping me tremendously and I would encourage to do the same if you haven't done so already. It is going to take time, as do most things.

It really does suck, I feel for yah.

Syscrush

Yes, I did a round of PT a couple of years ago, did not find that particular therapist helpful, so I ditched my fixie, switched to a geared bike & a relatively high cadence (90+ most of the time), kept the miles down, and did OK.

This year I started the yoga and the restorative Pilates (5 months of yoga so far and 2 months of RP/PT). The RP classes are PT designed specifically for the knee. I have also done some one-on-one sessions with the physiotherapist to tailor a program of exercise & stretching to get me sorted out. I am willing to do anything that she tells me, but I think that a full-service bike fit is going to help at least as much as anything else.

Syscrush

I've been off the bike for almost 6 months, and haven't run for 2.5 years.

Syscrush

It looks like Gears has what I want:

seajaye

i had some IT band problems in the fall that are only now starting to get better, after doing physical therapy for most of january and february.

one thing i kind of realized is that while my therapists were saying a professional bike fit would be very beneficial for me, to make sure that there's no fundamental problems that would exacerbate the lingering IT stuff, not very many bike fitters have medical/physio degrees per se, but just years and years of bike-fitting experience and related credentials. so, how am i 100% sure that the bike fitter, no matter how good they are, will be able to determine my ideal 'fit' and make sure it completely jives with my body?

basically, my physical therapists are trained and know how the body works, and are able to prescribe me stretches and exercises that will help my IT band. BUT, they wouldn't be able to fit me on a bike, because that's not what they are trained to do. conversely, bike fitters would be able to fit me on a bike according to their own methods/experience/knowledge, but since their background isn't necessarily physiological, would their prescribed fit be the end-all-be-all solution? i would be hesitant to say yes.

what i am trying to say is it would be great if every physical therapist was a certified bike fitter, and if every bike fitter was a certified or degree-carrying health professional. i know that they exist, so those are the people i would want to seek out.

Syscrush

I am 100% with you.

I'm going to check out Gears and will share my experience here.

xjustice09x

Ive had a BG fit and it was pretty good. I recently had a Retul fit when I built up my new bike, which was even better. I think the Retul sensors allow for more accurate measurements than the video capture from the BG fit. Of course the BG, and Retul systems are only tools. The fitter is the most important part.

My current fitter was very good about trying to find out what the best position is for me, regardless of if the measurements fit into the typical range. Once you find your position everything should just feel right. You shouldn't have to adapt to it.

Syscrush

Thanks. These guys do the Retul, looks like I have a decision to make. In addition to using more modern technology, the Retul fitting appears to be cheaper than the BG from Gears. We'll see.

clausen

Reply in red
All in all my knees are a mess as well. No Cartilage. I keep the RPMs over 80 all year and NO squats works for me. But there my knees. All the best. Where in Ford ville are you riding from.

Looigi

For some kinds of knee injuries or issues, stopping aggravating it and allowing it to recover/heal is the best course of action. Getting depressed, eating and drinking too much, getting fat and gaining weight are just about always bad.

Nachoman

It sounds like your knee issues are a lot worse than mine were, but my problems were solved with a professional fit and a switch to speed play pedals. (I also gave up running, riding my fixed gear and certain types of gym workouts, like squats.)

Syscrush

I hope it's clear that I wasn't advocating giving up & getting fat as an effective knee therapy...

For me, the central dilemma is this:
Being fat: sucks.
Being thin: fun.
Getting fat: fun.
Getting thin: sucks. Unless I can ride my bike.

I'm hoping that I can get all this crap sorted out soon and get back to a healthier groove. I have another one-on-one PT session next week, and will go for the fitting soon after.

Nachoman

Good one.

Syscrush

Here's a little update:

I found the Retul bike fitting an interesting and worthwhile experience. The adjustments made were:

1) Bring the seat up a bit (5mm) and forward a lot (25mm).
2) The bars were rotated back to bring the hoods up about 15mm and back about 5mm.
3) The cleats on my shoes were moved back about 7-8mm (they were in the full-forward position) to bring the foot-pedal interface just barely aft of the ball of my foot.

The baseline run showed that I was bringing my knees inboard on the downstroke and outboard on the upstroke - with the loop about 10-15mm wide at the widest, and my upper body was moving around despite my best efforts to keep it still. My back angle was way too extreme - on the hoods I was tucked in lower and reaching farther forward than what a pro racer would be. This is reflected in the nature of the changes that were made.

The changes were applied across 2 or 3 more adjustment/test sessions and by the end my knees were tracking much straighter and my upper body was more still.

This is not my graph, and I'm not concerned about the text talking about the testing stand, but the before & after traces look quite a bit like what I saw at the shop:


By adjusting the fit, being conscious of keeping my knees from dropping out to the sides while riding, and doing my PT exercises, I believe I have seen some modest improvement. Key word is "modest". I can do rides that involve climbing, sprinting, or headwinds, but really only 2 out of the 3 on any given ride, and the harder I push it, the more days of recovery I will need.

I think that the way I manage this going forward will include reducing the gearing on my bike, getting more serious about dropping weight, and continuing to resist the urge to go nuts and overdo it. I have also cut way, way back on caffeine and ASA. I used to use both for any ride of consequence, now I do my best to avoid either to keep myself from overdoing it.

I was hoping to do 1000k in April and didn't quite make it - I'm at 820 now. The plan is to go do a very easy 20 right now to get to 840, and then take a shot at a flat, slow century ride tomorrow to get to my 1000k goal (albeit a bit over a week late). I have done half a dozen rides over 80k since the start of April, including a 105k and a 120. The 120 was an out-and-back ride where the "out" portion was straight into a 30kph headwind. It also involved some moderate climbing through the bluffs region in Scarborough. I believe that by going over flat terrain on a calmer day I can do 160k with about the same effort as that 120.

We'll see.

Thanks for all of the advice & support in this thread.

bikebreak

You might want to try glucosamine, and experiment with cutting things from your diet. Some people get low level joint inflammation from wheat, tomatoes, nightshades, nuts, dairy... eliminating possible inflammation sources from the diet may help your knees recover.

pdxtex

i dont know much about food allergies but ive had good luck with glucosamine as well. knees and joints seem tighter, but in the good way, like less creaky and wonky. those are scientific terms.

Hiro11

I think you guys are making this way, way too complicated. 9 times out of 10, knee pain is caused by the saddle being too low. Op, calculate your recommended saddle height and measure, I'll bet you're way off.

Machka 

Have a read over this article on the Cycling Performance Tips website, entitled: Leg, Knee, and Hip
Pain:

https://www.cptips.com/knee.htm

As the article indicates, the location of the knee pain should give you some idea of what to adjust on the bicycle to fix the problem.

Syscrush

Did you even read the thread?

Do you think that going through a full Retul fitting they don't get the seat height correct?

Do you think that my seat height has anything to do with how my knees feel when I do yoga or when I run?

Syscrush

Well, I was careful about choosing the route (pretty flat) and the weather (some rain but very little wind) and yesterday I managed to do a 100 mile ride after my morning yoga class. I did need quite a bit of ASA to do it (6-7 325mg tablets) but I had a great time - by which I mean a lot of fun, not that I went particularly fast.

Today my knees are definitely sore, but I'm not debilitated like I expected. I also have DOMS in my VMO, which to me suggests that my conscious effort to keep my knees in line and my patellas tracking correctly are helping at least a little bit.