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Knee Pain

Old 10-16-22, 01:22 AM
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Yesterday I tested my knee with a 12 mile ride. I had very little discomfort. Also, I did not have the usual night pain. Perhaps the PT is helping.
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Old 10-16-22, 02:29 AM
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Originally Posted by daniell View Post
Yesterday I tested my knee with a 12 mile ride. I had very little discomfort. Also, I did not have the usual night pain. Perhaps the PT is helping.
Just a reminder: there is no cure for arthritis, so pain is a part of uour life from here on out..unless you get the knee replacement.

The challenge for you right now is sussing out what is arthritis pain and what is meniscus tear pain.
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Old 10-16-22, 05:09 AM
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I will be 69 next weekend so I am younger than you are, but I will write something anyway. About twelve years ago, after a 600 km brevet that crossed the Blue Ridge Parkway three times, I decided that my click-in pedals were responsible for a lot of my knee pain. I switched to flat pedals and haven’t looked back. A few years ago, I ordered some 165 mm cranks to replace 175s on my touring bike because I sometimes had pedal strike when riding on trails. Since then knee pain has not been an issue. This year I was able to ride from my home in North Carolina to the Pacific Coast — took the train home — and then to the Atlantic and back. I had very little knee pain and that little bit was only transitory.

Click-in pedals have some advantages, but flat pedals allow my feet to relocate slightly any time they feel like it. I also notice that my right foot rides further forward on the pedal than my left and that is points out just a little bit. As for the crank length, I wouldn’t hesitate to go to 160 mm. I couldn’t find shorter cranks locally and ended up ordering directly from Sugino in Japan; that was pretty easy.
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Old 10-16-22, 10:56 AM
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I can't stand Click In, Or Clipless Pedals. Guess I would never win a race.......
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Old 10-16-22, 03:57 PM
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Knee replacement isn't necessarily a cure for pain. I know far too many people whose surgery did not go well, despite using highly recommended surgeons. I know at least one person whose first TKR was great and whose 2nd left him in pain for several years until the end of his life.
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Old 10-24-22, 01:36 PM
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Please research all ways to relieve inflammation before getting surgery. Look at low inflammation diets and IM fasting. I would have had mine replaced years ago if I had listened to my doctor. I can manage as long as I stretch and eat right. If I indulge in inflammatory foods, I can really tell a difference for a few days.
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Old 10-30-22, 12:42 PM
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Well I just got the bad news from my doctor last Friday: Stage 4 arthritis (bone-on-bone) requiring total knee replacement on my right knee at age 61. Did a twenty-one mile ride yesterday after a cortisone shot and it felt fine but there was still slight pain at times, not in my knee but up and down my lower leg feeling like a mild electric shock. Not too bad, I can handle that.

More bad news is that I can't seem to ride a conventional bike at all anymore. It appears that my whole lower leg is now bowed from the bad knee and I simply can't bend it enough to pedal and I even have trouble getting my leg over the top tube. Thankfully my father gave me his Trek Pure (an Electra Townie copy) a few years ago that he wasn't riding anymore and I can ride that one. That one is ok for now but I'm looking into getting a suitable recumbent if I want to ride faster and father.
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Old 11-08-22, 04:04 AM
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Not sure if this helps or not.

Years ago I had a torn meniscus fixed. No big deal. Did not even require PT
Now the ACL repair on the other knee. That HURT.

I would caution against relying on NSAIDS.
Dong so, to get me past every morning back pain landed me in the hospital with a bleeding stomach ulcer.
Healed now with meds and time. Thankfully.

The G.I. doc that treated me in the hospital explained the facts of life to me re: NSAIDS.
I can still take Excedrin Extra Strength, now and then, as needed.
Do Not Make it a Habit.

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Old 11-17-22, 10:17 AM
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daniell I usually refrain from offering medical advise here, but in this case I'll share my experiences and thoughts.

I'm 66, have had meniscus repair and arthritic deposits removed from both knees. My right, 7 years ago with no particular incident causing it - just crept up on me. I spent a year and a half in pain trying non-surgical protocols - lots of PT, anti-inflammatory injections, platelet-enriched prolotherapy, etc. Finally had the procedure done and while the recovery was longer than expected as a result of the work to clear up the arthritis cleanup it reached the point where it's like it never happened.

About a year ago I twisted my knee in an emergency stop when commuting home from work and tore my left meniscus. I did not want to spend months in pain and after checking with my PT I saw my orthopedist who agreed to do the repair right away. Even though there was also arthritis cleanup involved this one was much more comfortable right away. That's good and bad - I overdid it and caused additional inflammation that I'm still working through nearly a year later but it's on track.

In both cases I threw my body off by compensating for the pain, walking and pedaling differently. I'm undoing that as well.

A few points:
  • A primary care physician is great but generalized. It sounds like your doc is being conservative and you've been categorized as too "old". I'd suggest you find a proper Orthopedist and work with them. Similarly, an experienced sports-oriented PT is a key to preparing and recovering.
  • My PT is a middle-aged former athlete (football) and sustained injuries that make him personally empathetic to active people, he walks that road too. I told him in both cases (and other age-related fun - rotator cuff repairs, etc) that my goal is to come back as good as or better that pre-injury. That means doing the work pre- and post-op.
  • As it happens, my orthopedist is a cyclist, he even rode his bike to my surgery last December! He doesn't jump to surgery, and like my PT he understands the physiology and psychology of active patients.
  • I don't think you have to settle for pain. If it slows down your activity you will get age faster. Cartilage can't repair itself and arthritis is progressive. These knee procedures are minimally invasive and typically outpatient.
Last: EVERY PERSON AND EVERY CASE IS DIFFERENT. Your experience is unique to you just as my left knee was different from my right. Get a team and work with them.

Wishing you success!
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Old 11-26-22, 03:45 AM
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How did you make out with the jel shots? I am a proud member of the elite knee surgery team. Hang in there. The key is getting the right Orthopedic surgeon if you decide to go down that road. Hopefully, all is well and take care.
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Old 11-26-22, 03:58 AM
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Originally Posted by Jumpski View Post
How did you make out with the jel shots? I am a proud member of the elite knee surgery team. Hang in there. The key is getting the right Orthopedic surgeon if you decide to go down that road. Hopefully, all is well and take care.
I never had a gel shot. I had a cortisone shot. Presently the knee has improved to the point that I can live with it. Cycling for the most part is painless and I no longer need to take Aleve. I don't know whether the improvement is the result of the PT or in spite of it. Thank you for your concern.
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Old 12-01-22, 02:54 AM
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Originally Posted by smurfy View Post
More bad news is that I can't seem to ride a conventional bike at all anymore. It appears that my whole lower leg is now bowed from the bad knee
Are you sure about the direction of the arrow of causality?

I had knee pain from about 2.5 years ago, from my 55th year, and it was progressing. I was taking glucosamine, doing all sorts of exercises, trying different bike fit, pedal extenders, pulling on my pedals etc.

I was lucky in that the pain was worse in my right knee, which was clearly related to my weak right butt due to a spinal hernia on that side.

Thanks to this hint, I eventually discovered that it was my weak butt that was causing my painful knees.

I then did more and more exercises to find out what part of my butt weakness was causing knee weakness and in my case it seemed that my weakening ability to rotate my femur was causing my legs to bow, that was causing my knees to hurt.

The standard exercise for rotational strength in the femur are reverse clamshells, clamshells, Rumanian squats, and (what I do now) standing (reverse) clamshells.

I now regularly exercise rotational strength in my femur, and my knees don't hurt.
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Old 12-04-22, 01:05 PM
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I've (M57) had both knees replaced, left five years ago, right one year ago. Both were bone-on-bone. I go back in tomorrow to have my right knee worked-on again, because the joint is overly sloppy, causing some serious problems. Not sure yet exactly what they're be doing, it'll depend on what they find once they open me up. The left knee has been great, no problems with it. Obviously there's limitations to what an artificial knee can do, but biking hasn't been an issue. Even the problematic artificial right knee isn't too bothered by bike riding, it's walking that's the big problem. Different mechanics involved, I guess.

If your doctor says you need a new knee, go for it. The artificial knee itself isn't prone to problems (my own right knee nothwithstanding), it's the healing of the surrounding tissue that determines the success of the knee replacement. I'm guessing that you're relatively fit and active, which will help immensely with the rehab. Rehab ain't easy, but as long as you stick with it, you'll come out the other side in pretty good shape, knee-wise. The pain involved in rehab isn't the same sort of pain you're currently's "good" pain, if that makes sense, pain from working hard rather than the sick and grinding pain from inflammation and irritation.

My first knee was cemented into place. You can see the layer of cement on X-rays. As I understand it, when they say that an artificial joint has about a 20- to 25-year lifespan, it's usually the cement that eventually fails, rather than the joint itself. The teflon puck in the middle can wear out, too, but that's (relatively) easy to replace. That's what they're probably doing to my knee tomorrow, replacing the teflon puck with one that's about 4mm thicker, to tighten the joint up so there's not so much slop.

My right knee (again, done a year ago) is a press-fit into the bone. They literally hammer it into place, and the barbed titanium stub is held in place for the long-term by the bone that grows into the ridges of the stub. This is supposed to be far more permanent in the long-term than cement. There's more pain in the short-term, because of the violence involved (the doctor said it's not pleasant to watch being done), but the end result is much more permanent. Also, these new joints are shaped in such a way that the patella can be left as-is, instead of having the back milled flat and a thin teflon puck attached, like with my previous knee.

All in all, my experience with knee replacement has been pretty positive. The last eight months since I started having problems with the right knee have been admittedly discouraging, but overall I'm not regretting it. Like I said, bike riding hasn't been a problem with either knee. Obviously, I'm not going at it really hard in high gears, but I average about 18-20mph without any issues, including some pretty steep ascents. I think it's because the problem with the right knee is that it's very loose and sloppy, but while riding it's almost constantly compressed so that the sloppiness doesn't come into play.

Again, rehab is going to be what determines success, but you have to plan on it taking about a year before you're anything like 100%. You'll be amazed at how much you improve in the first 6-8 weeks...after that, the rate of improvement levels off, but assuming everything else goes well, you'll see gradual but constant improvement. My doctor said that, in general, non-rehab problems arise only about 15% of the time, and are generally straightforward to remedy. My right knee is in that 15%, I guess.

Hope this helps.
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Old 12-12-22, 03:23 PM
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Gel treatments for knee pain

I am 73 years old and, combining indoor & outdoor cycling, ride 80-100 miles/week. I started getting gel shots in both knees semi-annually in 2018 when osteoarthritis in my knees (primarily left) got so bad I often had trouble walking. It proved to be a game-changer. I was even able to participate in a few 5K runs. Because of relocations, I've been to three sports medicine doctors to get these shots. The middle doctor used a regimen of three shots per treatment, spread out over three weeks; the two other doctors administered a single shot. He was the only doctor who caused significant pain. With the other two, the procedure was/is virtually painless. So I highly recommend discussing this treatment with your doctor if osteoarthritis is the cause of your knee pain. A couple of months ago, I began to experience periodic right knee pain ascending hills. I felt that I was allowing my right knee to flare out. I have Look Keo pedals on my two bikes and was using Look's gray cleats which have a 4.5-degree float. I switched to the black cleats which have zero float and that appears to have solved the problem.

Hope this helps.
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Old 12-13-22, 08:15 AM
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It's the doctor not the procedure!
From time to time, I get a 5 shot knee gel procedure.
An older Physicians Assistant does mine, he does several each week. Totally pain free. When a young Physicians Assistant did it , it hurt!
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