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Thread: Hip Arthritis

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    Hip Arthritis

    Hello all,

    Long time lurker, first time poster.
    I have been riding off and on for over 20 years. Cycling is not my passion (no offense to anyone), it's actually 3rd in the list of sports I like but it is currently the only one I can do with any intensity. The other 2 (rock climbing and submission grappling / Brazilian Jiu Jitsu) require too much hip movement and flexibility to be feasible.

    Anyway, as the title suggests, I am a rider with a case of arthritis in one of my hips.

    I am 46 years old and my left hip has gone bad. I only have about 30% range of motion on one side. While I can pull my right knee up to my chest, my left only makes it not even half way. I can also only do the splits to the point where my feet are about 36" apart.

    This is very depressing as I used to have excellent flexibility.

    I've returned to cycling in order to get some exercise (being fit and getting outside is very important to me), but this situation with my hip has made things somewhat difficult.

    I currently have 2 bikes, a Spesh Roubaix Comp and a Lynskey R230. The position on both is much more "relaxed" than typical aggressive road position. Even so, I find myself unable to get my upper body low and out of the wind much at all unless I curl my back into a "C" shape in order to be able to get my left knee up. The lower I want to go, the more pronounced it is. Obviously this not ideal and a flat back would be better both for aerodynamics and for my lower back health. Riding on the bar tops is about the only way to keep my back flat.

    I also find my left side pedal stroke is not nearly as smooth as my right and I'm sure I am wasting all kinds of energy.

    This is not an ideal situation but it's better than nothing. I guess ultimately I am going to need surgery, but everything I have read suggests I should put this off as long as possible.

    Outside of the impediment to participating in sports, it's still livable. I have pain, but it isn't severe. I can't really walk very long distances or even stand in one place for a long time before the ache sets in.

    I suppose I don't have a specific question, per se, just wondering if anyone else here has gone through this and can impart some advice / experience to me.

    Thanks and happy riding.
    Last edited by rideBjj; 01-16-15 at 12:34 PM. Reason: incomplete info

  2. #2
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    Please say more about what you have learned regarding putting off the surgery assuming it is inevitable anyway. I find that very interesting.
    Robert

    My hero: "Tar-Baby ain't sayin' nuthin'..." (Joel Chandler Harris, Uncle Remus")

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    Is your hip painful? Achy is one thing but debilitating pain is another. My wife had hip issues for years and was told to delay hip replacement till she was 60+, but it got to the point where she wasn't getting a full night's sleep from the pain (her joint was bone on bone). It really limited her ability to do a lot of things. She really had trouble getting on her bike - she just couldn't get her leg up over the seat, even with the bike tilted at an extreme angle.

    Anyway, long story short - she had hip replacement a year ago when she was 47 and I think she'd tell you it was the best decision for her. Apparently they can replace the joint sleeves now, so it's not the same situation that it used to be where you're stuck with just one replacement. Everything seems to be peachy, and she's even taken up jogging again. I wouldn't assume that you can't do anything about your hip at 46, that's for sure.

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    Quote Originally Posted by TrojanHorse View Post
    Is your hip painful? Achy is one thing but debilitating pain is another. My wife had hip issues for years and was told to delay hip replacement till she was 60+, but it got to the point where she wasn't getting a full night's sleep from the pain (her joint was bone on bone). It really limited her ability to do a lot of things. She really had trouble getting on her bike - she just couldn't get her leg up over the seat, even with the bike tilted at an extreme angle.

    Anyway, long story short - she had hip replacement a year ago when she was 47 and I think she'd tell you it was the best decision for her. Apparently they can replace the joint sleeves now, so it's not the same situation that it used to be where you're stuck with just one replacement. Everything seems to be peachy, and she's even taken up jogging again. I wouldn't assume that you can't do anything about your hip at 46, that's for sure.
    Pain level depends on a few things.

    Most of the time, day to day, it only hurts a little. About a level 2 out of 10.

    If I try to walk long distances, or carry heavy things or stand in one spot, then it can go up to about a 6 out of 10 depending on the level of effort.

    When it's all warmed up and I'm riding, no it doesn't hurt then, but I still have very limited range of motion.

    After I've cooled down, then sometimes it will hurt a fair bit. Sometimes it will wake me up in the night if I am laying on that side and I will have to flip to the other side.

    Lots of ibuprofen can mitigate things to some degree, but I try to avoid overdoing it with that.

    So, I guess it isn't debilitating pain if I don't overdo things. But it is affecting my quality of life. If I were a sedentary person who didn't care about not being able to do the activities I enjoy then it would matter less. But not being able to do those things is having a pretty profound effect on my sense of well being.

    I have health insurance that will pay for 90% of a repair / replacement (provided, I suppose, they deem it medically necessary, which I assume most insurers will fight tooth an nail against).

    It's hard to know what to do.

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    SuperGimp TrojanHorse's Avatar
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    Well, if it's affecting your quality of life then perhaps you should start doing your research to see what can be done about it. I only say that because everybody is different. My wife went here: Arthritis Surgeons Medical Group They specialize in the anterior approach, which might make it easier to get back on a bike sooner. People fly in from all over the country to see this guy, but he's fairly local for us, fortunately.

    You'll probably hit your out of pocket max anyway, I can't imagine that 10% is cheap either. I'm sort of in the same boat with my knee - got hit by a car and the cartilage is trashed, so i'm doing the wait-till-I-can't-stand-t approach with a periodic scope job to clean it out.

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    Quote Originally Posted by rideBjj View Post
    I have health insurance that will pay for 90% of a repair / replacement (provided, I suppose, they deem it medically necessary, which I assume most insurers will fight tooth an nail against).
    Of course there is no way I can make a prediction about your insurance coverage and would not even try. I will say that my experience with major insurers (Blue Cross, Aetna, United Healthcare, etc.) is that common, obvious conditions with routine solutions are not usually the focus of dispute by the insurer. If the physician makes a diagnosis that indicates a surgical remedy and has the "pictures" and patient history to back up it up, that is commonly all that is required. A fly-by-night insurer could be different. And if the insurer thinks a less aggressive treatment is preferable (for them perhaps), you may have to subject yourself to that before getting them to agree to the surgery. I think my main point here is that there is no reason based on concern about insurance to not pursue the surgical remedy to a definite decision point IF THAT IS WHAT YOU REALLY WOULD PREFER. Now or later of course. When you are ready.
    Robert

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    I have hip arthritis in left hip plus a partially torn labrum. My discomfort ramps up after a long day at work on my feet. Last night I could not find a comfortable position with the pain in the hip. Ended up taking vicadin and two ibuprofen after a few hours of tossing and turning. I have a wonky pedal stroke as a result of my hip. Cycling is the only sport I can participate in that I can do for any length of time.
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    64yo and have been climbing since 1970. Osteo in the hips toes and hands I've been climbing less and less and the riding has really begun to become a replacement exercise form.

    I really started to ride seriously only last year and got in 3500+ miles for the year. Previously I'd been commuting on an old mt bike (really upright) and started out on a road bike with the steerer fliped up, the entire stack of spacers underneath and for the first six months rode almost exclusively on the tops.
    I'm now almost exclusively riding on the hoods and have gradually moved the spacers back, but haven't graduated to flipping the steerer back over yet. For me it was more a mater of developing back and core strength and flexibility rather than the hips. I've been trying to discipline myself to spend at least some time in the drops on every ride and do more core work.

    As far as the osteo in the hip, (the right is a lot worse) the riding really helps and it really hurts worse when I can't ride for a few days.

    Stretches for the hip area really help also.
    Last edited by TGT1; 01-16-15 at 11:05 PM.

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    Have you had a professional bike fit?

    You might find some solution to your pain and aero issues with short cranks. Shorter cranks let you put the saddle higher relative to the bars, giving you a flatter back, and also require a smaller range of motion at the hip. There are some very short options out there.

    Look for a Retul fitter or medical bike fitter in your area. You may even be able to have the medical bike fit covered by insurance, I had that for a knee problem.
    ...

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    True. A professional fit might help. Years ago I got one and my knee pain was totally alleviated.
    Also, fyi, I know a woman that got a hip replacement and she was back riding her bike, after just a month.
    And she was riding hard. Three times a week, plus aggressive spin classes.
    .
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    Two wheels good. Four wheels bad.

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    I've got the fit exactly right (for the version of me without this injury). I have owned numerous bikes and know how to fit myself.

    But, I had not considered a different fit centered around my hip problem. I wasn't aware that was possible without throwing everything else totally off. I will say I had not considered the idea of shorter cranks. I run 172.5 now. I am not sure if even 165s would make much difference. How short can you go on cranks before needing something custom made and sacrificing leverage / speed / whatever from going too short?

    The position on my R230 is pretty much perfect, and when I'm properly warmed up (and with some ibuprofen in my blood stream) I can get into the drops for short periods or ride on the hoods with my body lowered with minimal pain or C shape in the spine. But thats on a good day.

    http://www.bigandtallbike.com/Zinn-C...yle_p_162.html

    Looks like you can go as low as 130! That's crazy. An extra 4.2 cm would for sure give me better range of motion, but what is the trade off in performance?

    Thanks for the help thus far.
    Last edited by rideBjj; 01-19-15 at 08:01 PM.

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    i gotta agree with some of the others... a professionally executed bike fit at one of your local, top end bike shops should go a long way in finding a position for you that will both be comfortable as well as take into account you hip issues...

    they may even have some suggestions about the hip in terms of what type of training on the bike would be ideal..

    If I was you, i'd just go in there and really get talking to them and see what they could do for me... Many guys at bike shops are super patient, listen very well and absolutely want to help you get the best fit/ride possible..

    good luck to you sir.

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    The trade off in leverage/performance is that you need to use a lower gear for the same gear ratio. If you are running standard cranks, you might consider compact, or you might need a wider range cassette. You can do the math with any gear calculator you find online.

    I don't think there is just one "perfect fit" for each person, mine has changed quite a bit over the years of changing fitness and a variety of injuries. When I switched from 170 to 165 my bars went lower and further forward and my seat went higher and further forward. I also stopped having hip pain, which is what made me chime in on this thread.

    Sounds like you might need to try some other saddles, too.

    Good luck, I hope you find a way to ride without pain.
    ...

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    Quote Originally Posted by valygrl View Post
    The trade off in leverage/performance is that you need to use a lower gear for the same gear ratio. If you are running standard cranks, you might consider compact, or you might need a wider range cassette. You can do the math with any gear calculator you find online.

    I don't think there is just one "perfect fit" for each person, mine has changed quite a bit over the years of changing fitness and a variety of injuries. When I switched from 170 to 165 my bars went lower and further forward and my seat went higher and further forward. I also stopped having hip pain, which is what made me chime in on this thread.

    Sounds like you might need to try some other saddles, too.

    Good luck, I hope you find a way to ride without pain.
    Thanks very much. I think what I'm going to do is see if I can borrow or "rent" (lots of shops in town, one probably has a beater set somewhere) a set of 165 standard cranks (bike has standard 172.5 on it now) for a while and see if that feels like a step in the right direction, without having to commit to buying them.

    If I understand the dynamics, shortening the cranks by 7.25mm also means I raise the seat that much which gives me 15 total less travel in my leg on the upstroke? That might just do it.

    Otherwise There seems to be cranks available for $300 from a company called Cobb in size 150, 155 and 160. None of the "big 3" make anything less than 165.

    Then on top of that I can also see if one of the shops has a good fit person with some experience in this area.
    Last edited by rideBjj; 01-20-15 at 01:23 AM.

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    Shorter cranks, recumbent or accept you can't use the drops..or set your bars even higher to make the drops and all positions usable.
    I am 60 years old, own a Roubaix and still have a need for speed. I like to ride fast. But, I don't have the neck flexibility...or rather the ability to ride in the drops for a long period of time without my neck hurting say after a 30 mile ride. So, I ride with a higher handlebar than most good riders. This allows me to use the drops a lot...which puts my hands beneath the level of the saddle. I don't have hip problems per se but lets say my entire body feels the affect of gradual aging in spite of being active my whole life...I still swim and bike a lot. I am on 175mm cranks and my crank length of choice.

    So I say, raise your handlebar even more on your bikes...use a riser stem even on your endurance style frames. Now you can use the drops. Go to a shorter crank. Btw, this 'philosophy' is pretty much the dirt drop credo where the drop position is the default position off road and the drop handles or hooks are at or just below saddle height. Only in your case you want the bars to be a bit more aggressive than an off road dirt drop mtb. I hope that makes sense. The more your body gets away from being a world class tour rider, the most different your bike needs to look. Even Floyd Landis who had hip problems ran his race bike with a riser stem....see below. But you want even less less aggressive.

    Practice your stretching and experiment with meds. But be realistic about your quality of life. There are guys I ride with in their 60's that have had hip replacements and they have been A group riders their whole life.
    Good luck.
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    Last edited by Campag4life; 01-20-15 at 04:38 AM.

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    Quote Originally Posted by rpenmanparker View Post
    I will say that my experience with major insurers (Blue Cross, Aetna, United Healthcare, etc.) is that common, obvious conditions with routine solutions are not usually the focus of dispute by the insurer. If the physician makes a diagnosis that indicates a surgical remedy and has the "pictures" and patient history to back up it up, that is commonly all that is required.
    +1. I now have United Healthcare. I had a second spinal injection with anesthesia last Friday. I had one a little over four years ago when an MRI showed bulging disks. Things started acting up again after a tour in late summer. My ortho was able to get another MRI approved with no problem. When that showed the possibility of bone cancer, CT and bone scans were approved without resistance. Thankfully, no cancer, and the injection was similarly approved without any resistance.

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    If you are in pain don't wait. Get checked out by a doctor. If it is 'bone on bone' there it will be very apparent in an x-ray.
    An old injury had destroyed the cartilage. I put off surgery for 2 years, who likes going under the knife? No one.
    Living in pain was just the biggest drag on everything. I haven touched ibuprofen since, 2 years w/o taking pain medication.
    Used to never leave home w/o it. After Hip surgery I have my life back. Easily did 3000 miles last year on the bike.
    It is not 100% but maybe 95% better, that's pretty good.
    Last edited by kraftwerk; 01-21-15 at 10:38 AM.

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    Ok, so quick update. I bought a set of 165 sram rival cranks on ebay for $120. I figured at that price it was worth it to see if it helped and is a step in the right direction. I took off the 172.5s mounted them up and also raised my seat about 8mm. I've ridden 3 days and about 70 - 80 miles like this.

    Verdict is: Definitely an improvement. It's subtle, but I feel like I can definitely get lower for longer and with a straighter back. Staying in a full aero in the lowest part of the drops while peddling is still a bit of a tall order, but besides that it does seem to be helping.

    Now the question is, if I should go even shorter, and if so how much more. I need to figure out how short I would need for the maximal improvement in terms of my aero positions, but without going so short that it sacrifices performance in other areas.

    I plan to ride with the 165s for a while and slowly gather research and probably go to the pro bike fitter in town eventually and see what he thinks.

    That's all the news.

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    OP I suggest high strength Krill Oil. It's the simplest thing you can do and think it will help you.

    Many years ago 10 or more I took fish oil but thought I got use to it and wasn't helping any more so gave up. Years later had a back injury multiple surgery's ending with spinal fusion with a lot of extra work done with that. Still healing 3 years later.
    Prescription meds were killing me with side effects and not helping pain so after getting off those against advise and incredible withdrawls got onto high strength Krill Oil 6 caps a day minimum and I'm doing much better, back pain now is more about weak muscle and a bad knee I thought would stop me cycling for good feels 100% cured. My left foot that's fused together feels fixed, my left shoulder and thumb joints (arthritis) are all good now and energy is building, walking 5km every night.

    I only started Krill 1 and a half months ago!! Worth a try I think?
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    I tore my labrum training for Boston 4 years ago. It has been devastating to me as an active person. While in PT they suggested biking. I rode my mtb ont HHS street for two weeks and then bought a hybrid. After two weeks,I borrowed a neighbors road bike. The next week the 1st road bike was in my garage. It is not running but it is still awesome. I am 46 and do not want a replacement as that means the end of running as I know and love it. I can ride any distance but when speeds go over 23 mph my energy in the left leg goes pretty fast. The imbalance causes back pain. Thus, I try to eat my ego and back off that pace. I now try to strengthen my hip and surrounding area in an attempt to push my limits further. My pain level daily is about 3-6. Keep fighting and figuring out what you can do to strengthen the area. I refuse to let pain dictate my life but it does alter it. My 1st bike was a relaxed geometry bike. My current is more traditional. This geometry is far better for me as the more upright I sit the more it hurts.
    good luck.

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    Quote Originally Posted by Shuffleman View Post
    I tore my labrum training for Boston 4 years ago. It has been devastating to me as an active person. While in PT they suggested biking. I rode my mtb ont HHS street for two weeks and then bought a hybrid. After two weeks,I borrowed a neighbors road bike. The next week the 1st road bike was in my garage. It is not running but it is still awesome. I am 46 and do not want a replacement as that means the end of running as I know and love it. I can ride any distance but when speeds go over 23 mph my energy in the left leg goes pretty fast. The imbalance causes back pain. Thus, I try to eat my ego and back off that pace. I now try to strengthen my hip and surrounding area in an attempt to push my limits further. My pain level daily is about 3-6. Keep fighting and figuring out what you can do to strengthen the area. I refuse to let pain dictate my life but it does alter it. My 1st bike was a relaxed geometry bike. My current is more traditional. This geometry is far better for me as the more upright I sit the more it hurts.
    good luck.
    Well actually, riding seems to be the single best thing I've been able to do for it since the problem arose. I've done all kinds of PT exercises, pilates, yoga, etc etc and all seemed to help to some degree. But riding consistently does seem to be making it better. Not in terms of regaining lost range of motion. I know that's not coming back without surgery. Riding has the added benefit of actually being fun and not a chore like having to go to pilates or stand around in my living room doing special exercises.

    So in terms of pain, it seems the more I ride, the less it hurts.

    I can still ride very hard (relative to myself) and put the hammer down to 9/10 in most situations with the exception of a full flat aero tuck and pedal, so for now that's good enough.

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