GeorgeBMac

I just returned from seeing the sports medicine doc and got the results of the MRI -- and it was all good new. He said nothing was broken and nothing was torn... But he did see some arthritis and some deterioration of the meniscus (on the iniitial X-Ray). Then today he saw some inflammation as well as some wear on some of the tissue around knee and mecisicus (I don't remember what it was). I asked him if the wear was from age or from over use? He thought it was from over use.

He prescribed some Naproxen to bring the inflammation down and PT where he wants them to work on: stretching and strengthening the quads and hamstring as well as a "Hip 6 way"...

So, although he didn't say it, I suspect the original injury was that I had strained or strained one of the muscles or tendons. And over the past 4 weeks of rest it has mostly healed -- but some inflammation is still there.

But, after my visit I took a walk on the river side trail outside of the sports medicine center and realized that the foot on the side I had injured (the right) had the toes pointing out at about a 15-20 degree angle (do they call that a duck walk?). Also, the other day I noticed that I had worn the "X" off of the new "Deore LX" crankset I had very recently installed -- so I have probably been riding with my toe out and heel in on the right side without realizing it. And that ties in with some of the posts on this thread that talk about balance between the medial and lateral muscles of the gluteals. I need to go back and re-read those posts because there was a lot there.

So, I will work on balancing those out as part of PT. Also, the sports medicine center also has a bike center where they fit bikes and some other stuff. i might tap into that as part of the PT.

And, now.... I am going for a ride! My first in exactly one month! it will be gentle -- but it will be a ride!

Best of luck to you and YOUR PT. Keep us posted.

pbass

Great to hear you don't have anything too serious going on in there either! I actually JUST returned from my first PT session. Seems that I'm pretty "unbalanced" as far as my legs compare--my right aka "good" side is stronger, much less tight, you name it, compared to my left. Everything is tracking/firing better and so on. On the left however, he thinks there isn't so much something wrong with my knee per se, but everything else above and around it--hip, upper leg muscles, etc. That side is weaker, tighter, and the knee has been suffering as a result. Quite likely that cycling exacerbated the situation (especially considering I had gotten to where that's pretty much ALL I was doing with my legs of any real intensity). So I have a variety of stretches and exercises to start doing daily. He thinks I could get this straightened out fairly quickly, as I'm very fit otherwise. He said I could try riding, just don't go too hard for the time being, and naturally stop if something feels bad. It's tricky for me where I live--I walk out my front door and am immediately faced with a pretty intense climb in order to get anywhere on the bike, so for now I guess I'll be driving over the hill to go for a ride

GeorgeBMac

Sorry -- but I had to chuckle...
Dr: I have good new and bad news...
Pt: What's the good news?
Dr: Your knee is fine
Pt: What's the bad news?
Dr: Everything else is falling apart...

Sorry, sick humor...

But I'm glad to hear that its all fixable with a little sweat and hard work. Clearly you will do what you have to do to back up to speed...

Best of Luck to you that all goes well!

ps The ride was my first in a month. It was just 6 easy miles before I ran out of light -- but it was GREAT! (and my knee felt better after the ride than it did before!)

And, BTW, I mentioned in my previous post that it looked like my heal had worn the decal off of the crank -- but looking at it while I was riding I realized that is impossible -- it had to be just the inside of my foot too close to the crank arm rubbing the decal off.

Again, best of luck to you!

pbass

Tell me about it! This aging business is for the birds.

GeorgeBMac

But, better than the alternative -- or so I am told!

... But, seriously, not many people mind the chronologic aging -- but most complain about the physiologic aging that often accompanies the chronologic aging. I saw it in nursing homes: people would come with a minor issue, they would sit them in a wheel chair and not them do anything. In a couple months they had aged years on a physiologic basis -- and in a couple years they were dead.

You are doing the right things... Cycling (aerobic exercise) helps the heart and (more importantly) the vascular system that feeds the brain and other important organs. So, even if you aren't younger chronologically, you will be younger on a physiologic basis. And you'll feel better and be able to live a happier, fuller life.

Keep up the good work! (and get well soon! You need to get back on that cycle -- like they say: "Move it or lose it"

Carbonfiberboy 

I believe the theory is that one's weight should come vertically down onto the pedal. I kinda poked around in my hips and think my hip sockets are about 23 cm apart, or at least the center of my thighs seems to be about there. My bikes' Q factor is around 28-29 cm, thus it would be better if that were even smaller, though that's about as narrow as seems possible with current road tech. If your Q factor is greater than your hip width, then that would seem to put an inward strain on your knees. See also:
https://www.ncbi.nlm.nih.gov/pubmed/22612455

GeorgeBMac

Increasingly, that is what I think my problem was (and, damnit, still is!)

The good news is that the XRay and MRI showed nothing broken or torn or ripped -- which leaves strained muscles and inflammation... And, more good news is that after the first PT session where she had me doing a lot of yoga like stretches and strengthening exercises and with 2 days of follow-up at home, my knee feels like it's 99% back to normal...

But, I have been riding again and, every once in a while (especially when I am tired) I will feel a twinge and, when I look down I will see my knee pulled in and even rubbing the top tube...

I'm pretty sure that it is just putting too much strain on the vastus Medialis. But I doubt there is anything I can do with fit -- it's just the way I've been riding...

But I am considering going from the freeride pedals that I love to clipless (because I would be less likely to do that (I think!)...

When I become aware of it I push my knees out over top of the pedals -- but darn that feels like I have knees sticking out and looking like one of the weekend warriors on their kid's bike that's too small for them.

Body

Its al about unblance.
Many factors can contribute to the problem. One is muscle imbalance, where some muscle groups are tight and others are weak or fatigued. The basic cycling position can feed these imbalances.
Tightness, or a loss in flexibility, can occur in the hip flexors, hip abductors and internal rotators. Correspondingly, it often helps to strengthen the hip extensors, abductors and external rotators.

Something interesting to read: https://pt-solutions.us/patellofemora...a-case-series/

GeorgeBMac

Thanks... A couple things I have learned in PT are: My adducters are tight and my abductors are weak -- which would tend to bring my knee in... But, in addition, and probably more importantly, when I lean forward into a more aggressive position, my knee also comes in. We think that happens because when I lean forward I lean from the hips more than the waist and that moves my pelvic bone backwards on the saddle. When that happens, it pulls the adductors attached to the pelvic bone and femor which is much like contracting them -- so my knee comes in. (and when it does, it puts more load on the vastus medialis muscle -- which seems to be the problem.

So, far I've been doing both stretching and strengthening exercises several times daily -- and that seems to be helping...

The other thing that has helped even more was following her advice about pulling my knee in: "Don't do that anymore!"

Body

Right,

Good exercises to stretch the Abducotors:

https://www.youtube.com/watch?v=IzssyeIzDWo

https://www.youtube.com/watch?v=ZjvQInHSHBA

531Aussie

I pinched my cartilages badly doing the "kneel on the floor" quad/adductor stretch, even though I was kneeling on a pillow.
I recommend kneeling on a bed, couch or similar

GeorgeBMac

Thanks! I don't have time to watch the whole thing right now -- gotta run -- but I did watch the first couple minutes and that looks good. I will check it out in detail when I get back...

Thanks!

Body

Thanks for the tip!

Body

I used to get knee issues around the 1.5 hrs cycling. Since this week I ve been started with hip stretching
Yesterday I cycled almost 3 hrs without an problems. I feel much better after these exrcises.

531Aussie

Nice. Which stretches? Hip flexor, or something on the side, like tensor fasciae latae, upper/outer glutes or similar?

Body

I do these ones
stretch the Abducotors:

https://www.youtube.com/watch?v=IzssyeIzDWo

https://www.youtube.com/watch?v=ZjvQInHSHBA

I have been suffering and tried everything till I found these exercises.

Body

I do these ones
stretch the Abducotors:

https://www.youtube.com/watch?v=IzssyeIzDWo

https://www.youtube.com/watch?v=ZjvQInHSHBA

I have been suffering and tried everything till I found these exercises.

GeorgeBMac

My problem has been tightness in the back and outside part of my hips -- especially on the right. The second video shows how to stretch these quite will, but seems a bit overly intense for me.

But I have been doing a variation of this for years and it has helped: Basically, I just have 2 variations from her video that make this stretch more doable for me:
1) on the opening, cross legged lotus/meditation style position she starts with, I put BOTH ankles on the floor rather than one on the thigh.
2) I skip the part where she extends one leg behind her and simply lean forward as far as possible from the cross legged position. This stretches the back of hip, buttock and lower back on the side of leg where the foot and ankle are in the most forward position.

In addition, after straining a muscle near my knee, I have been taking PT to stretch, strengthen and balance the muscles and tendons of both legs (although the problem is only my right side).

For stretching the right leg: I lay on my back, legs extended and hold a towel around my right foot by holding the ends of it with both hands. Without bending the knee, I use the towel to:
1) pull my leg up and back as far as it will go (to about a 90 degree angle).
2) Then, while still on my back and keeping my right hip on the floor, lay the right leg over across my left leg as far over and back towards me as possible (again using the towel to pull with)
3) Then without moving my leg from the prior position, I roll my hip up off the floor but keep my right shoulder on the floor and pull the leg even further up and back with the towel.
4) Then, to stretch the adductors, I swing the right leg all the over to the right side and let it fall as far to the ground as possible while pulling back with the towel. i can feel the burn on the inside of the thigh

Per the PT, I hold each of those stretches for 30 seconds and repeat 3-5 times. Then, I do the same with the left leg.

For strengthening the right leg I use ankle weights (5Lb) and repeat each exercise 30 times in any set that works (3x10, 2x15, 1x30):
1) (Anterior Quads): Laying on my back, I lift the right leg to about a 45 degree angle and hold for 2 seconds.
2) (Posterior Gluteals): Laying on my stomach, bend the knee to a 90 degree angle and lift the thigh as high as it will go and hold 2 seconds.
3) (Abductors): Laying on left side, lift the right leg to 45 degree angle and hold 2 seconds.
4) (Adductors): Laying on my right side, position the left foot on the far side of the right leg and lift the right leg as high as possible and, again, hold it 2 seconds.

And, of course, repeat for the left leg.

The combination of stretching and strengthening ALL of the muscles of the hip and thigh have been effective in balancing out some imbalanced muscles that were over using the medial (inside) quads...

Body

Cross legged lotus/meditation style position she starts with is for me also not possible to do ;-)

Thanks by the way for your explanation how you perform your exercises.

You mentioned that you had problems with tightness in the back and outside part of your hips -- especially on the right.

I have problems with my lower back – the right outside part and got problems with my left knee after 1.30 hrs cycling. I had this for years and since stretching my hips I can cycle without problems.

Did you had also problems with your knee?

GeorgeBMac

I have a mild scoliosis (bent spine) that originates in my hip (the hips are not level, so the spine bends to compensate) -- so the first exercise I mentioned seems to help a great deal releasing the hips -- which in turn helps my back problems.

And, yes, I had problems in my right knee that probably originated from cycling with my knee pulled in towards the bike -- which caused the inside, medial glut muscle to be overstrained.... It seems that my knee was being pulled in when I leaned forward (like into the drops), which, because I was bending from the hip rather from my tight waist, pulled my pelvic bone back which then pulled my knee in. The other problem is/was that my abductors were weak. The PT exercises I mentioned have mostly resolved that problem.

pbass

Glad to hear the PT is working for you! I too am having success with my knee issue---have been going to PT and doing the various exercises religiously at home. Just in the past 2 weeks I've gotten back on the bike, going for rides no longer than 10 mi, but it sure feels great to be back on (but as you mentioned earlier, man, I sure lost some conditioning being off the bike for almost 2 mos!)
My knee feels almost "normal" now--nothing I would describe as pain, still a little stiff/weak I guess is how I might describe it, but markedly improved from before (that feeling that my kneecap is floating around wobbly is gone, as is the pain that moved around from side to side around the kneecap).
The exercises my guy has me doing are pretty much all about my hip, and strengthening muscles other than the ones I would expect are most used in cycling. For example, I do side-steps with the latex band across both ankles until I'm ready to cry. In fact, non of my exercises or stretches are particularly focused on the knee area itself--its all higher up the thigh and hip.
Anyhow, again, glad you're having success.

GeorgeBMac

Glad to hear things are working out for you as well...
... and, yes, I am doing that side step exercise as well... I turned out that those abductors were my weakest, so those can be work for me...

My PT will end in a week or two -- but I am intending to keep up most of the stretching and strengthening that she prescribed...

Body

Since 2 weeks I do hip stretching and hip strength exercises. Looks like a miracle but my knee issues are gone. Yesterday I ride 3 hours and today 2.45 without any problems.

I have been suffering for years and tried everything but never got these exercises.

I am happy I can cycle normal !

GeorgeBMac

Congratulations! I'm happy to hear that it is working for you...
... To get such good results after only 2 weeks must be very encouraging for you...

Keep up the good work!

But the hard part comes later, when the problems seem to be gone and its easy to put off doing the exercise -- and then the problems comes back...

Best of luck to you!

Body

Thanks for your words.

I have got my lessons of suffering years on years and happy to know these exercises.
I wont stop stretching daily