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Cycling and Knees

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Cycling and Knees

Old 05-17-16, 07:51 PM
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DaveLeeNC
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Cycling and Knees

67 years old and over the past year or so had upped my weekly mileage pretty consistently into the 150 to 200 miles/week range. I didn't really encounter a problem here until late January. I was literally sitting down in my chair and it felt like somebody hit the back of my knee with a cane. That intense pain went away quickly, but it was a week before I felt comfortable trying a careful 30 minute ride. I built up slowly and after 2-3 weeks I was back to normal.

That lasted about 6 weeks when I started to notice an ache in that knee after maybe an hour of riding. It got to the point where I was only riding maybe half of my norm's. So after 4 doctor visits, x-rays and an MRI here is the story. Nothing other than 'expected degradation given my age' showed up anywhere (and this is my 'good knee'). I have severe inflammation of that area of my knee along with a bunch of excess fluid. And there is nothing to treat. And this came from an orthopedic surgeon who makes his living fixing painful knees of old guys (and gals). I am to ice it twice a day, avoid anything that involves impact, and wear a custom (610 gram) brace that (per the ortho) is a bit of a Hail Mary but might be helpful. And this might go away or it might not. And he actually said "I could put you in a cast for 6 weeks and I seriously doubt that you would improve any more or less than if you just don't go around running or doing other 'impact stuff'.

He had no qualms with me riding as much as I wanted. Then two days later I left for Mo. to help close out my aging mother's house. There was no impact and all the heavy furniture moving was hired out to various folks. It was just a full week of packing boxes, moving boxes up and down stairs, etc. Well, that should damn well have been on 'the list of things not to do'. This work had to be done and I needed to be there to do it, but other than the day after that mysterious January event, my knee (with Meloxicam - a prescription pain thing but not a narcotic) has never hurt so badly.

I am now a week of rest after that horrible week and am back to square 1 and did a cautious 30 minute ride today (I think I have been here before). I guess I really ought to get a 3rd opinion here as I feel like there should be better information to go on. But my GP (who I trust and has shown very good judgement in the past) doesn't think there will be a better answer. His best guess is that my 200 mile weeks are pretty much over (I think - I was just reading his body language when he gave me a 'maybe yes, maybe no' answer to the question).

I don't know why I am posting this here - guess I just wanted to ***** about it.

dave

ps. It is interesting to note that cycling is actually not a 'knee heavy sport'. If you do the analysis (and keep your RPM's up) you would have to be a drug-driven LA to push much over maybe 80 pounds of force with your legs.
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Old 05-17-16, 08:32 PM
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I'm not convinced high rpms are beneficial. If someone is biomechanically correct, it's a question of slower cadence with more work or faster cadence with less work per revolution. Maybe more rpms can do more damage?

Even slow cadence at high output doesn't put as much effort on knees as walking, running, or climbing/hiking.
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Old 05-17-16, 08:41 PM
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Yeah, well . . . As Rudy says, it's not for sissies. Sucks.

But maybe . . . You can try these things. The combination may make a difference.

Cut way back on the mileage and effort. When stuff like that happened to me, I cut it back to 30' on the rollers a few times a week, and didn't do more until my knees felt totally OK.

Increase your whey protein dosage: https://authoritynutrition.com/10-he...-whey-protein/

Recent studies show that we olders need a heckuva lot more protein than younger folks to maintain a positive nitrogen balance. I take 70g/day when I don't workout. I increase that to 90 if I do. Before every ride of an hour or more, I take 15g with half that much sugar.

I agree with and do HeathPack's routines centered around recovery: https://www.bikeforums.net/training-n...l#post18692533

I do these stretches: https://www.bikeforums.net/road-cycli...l#post15372967

And add some woo-woo: 1000mg of MSM and 1500mg of glucosamine suphate every day.

May the Force be with you.
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Old 05-17-16, 09:06 PM
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Maybe try lowering your saddle a tiny bit and/or trying shorter cranks. I was getting a bunch of pain and inflammation in the backs of my knees for awhile. I moved my saddle down and back a little and changed from 175 to 170 cranks and it seems to have fixed it. I haven't put in enough miles to really be sure yet, but it's definitely better than it was.
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Old 05-17-16, 10:34 PM
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I go nuts on this subject as I've spent 9 years dealing with rules about gears for kids.
It takes 4-5X as long to build supporting tendons as it does muscle.
You CAN over fatigue tendons. If you are riding too much all of a sudden, then back off a bit. It may be age, but that is not my first guess.
But if you take your time you and I will both have a hard time finding evidence cycling harms knees.
Maybe for women, but I doubt it, and not for men.
I also don't buy higher cadence is better. Higher = more use. More use is typically what leads to fatigue. Inlaw is a USA champ 75+ power lifter with no knee issues and way more force than cyclists. It is not force as much as it is fatigue that causes knee issues.
Ride what you feel like.
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Old 05-18-16, 01:38 AM
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So "expected degradation" means arthritis? I have arthritis in both of mine, one bad enough that it aches constantly; I'm posting now at 3am because I can't sleep for the pain.

Each knee has had one intial, painful, heavy swelling episode, which hampered cycling for almost 8 weeks before the swelling started to abate. Both now get Euflexxa injections which seemed to help, except that this second round (6 months after initial injections) on the one knee is not controlling the aching that arises from inactivity. The other, more recently arthritic knee is perfect.

Cherry juice concentrate seems to help, so I try to make that a habit, but I haven't had any in a couple of months now. I'm recently taking both bromelain and glucosamine/chondroitin tabs, hoping for some prophylactic effect there.

As for cycling, I foind that once the swelling goes away, I can cycle as normal and pain free. Sometimes there's a little twinge in the "really bad" knee (they're both "bad" knees!), but while it erodes confidence in my ability to make sharp efforts, it doesn't hurt, per se.

In short, I'd say to wait for the swelling to abate and/or seek out an opinion from your doc on Euflexxa or similar halyuronic acid injections, which have anti inflammatory properties. Then, resume cycling as before, and just see what happens; I can still do what I want and put through good power without problem, especially if I keep the RPMs up; if I dump +300w for longer intervals at sub 80rpms, that will sbe felt afterwards, but doesn't trigger swelling and acute pain, just a day or two of greater tenderness in the really bad knee.

Good luck. The other option is to jump on the replacement surgery, rather than sit around watching things slide slowly into the crapper. I'm getting close to that myself, but am seeking another opinion here first, for sure.
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Old 05-18-16, 03:32 AM
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Sorry to hear about your knee pain and the fact that it is putting a damper on your riding. I am having knee problems for the first time ever this season and am frustrated by it too.
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Old 05-18-16, 05:22 AM
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Originally Posted by StanSeven View Post
I'm not convinced high rpms are beneficial. If someone is biomechanically correct, it's a question of slower cadence with more work or faster cadence with less work per revolution. Maybe more rpms can do more damage?

Even slow cadence at high output doesn't put as much effort on knees as walking, running, or climbing/hiking.
In my case (where I am running an experiment of one) it is my sense/speculation that there is some amount of force that is "free" (WRT this knee) and it is only forces higher than this amount that cause a problem. So (if this is true) higher RPMs (at the same power output) will be less stressful.

dave

ps. Just to be picky your post should replace the first use of the word 'work' with 'force' to be correct, but I understand your point.
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Old 05-18-16, 05:27 AM
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Thanks for all the comments.

What is interesting here is that the ortho doc was fully expecting to be using some kind of injections to relieve this, but he needed to see the MRI before going down that road. He did not see what he expected on the MRI (apparently).

FWIW, I changed to 170mm cranks some time ago and lowered my seat a tad, and both those actions were kind of pre-emptive on my part. Been taking Glucosamine/Chondroitan for a long time. Am less enthused about that these days :-)

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Old 05-18-16, 07:04 AM
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You have probably done this but if not make sure that your cleats are far enough back and at enough angle to not be adding stress to your peddling. At 65 & lots of miles that small tweak actually recently fixed my back of knee pain.
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Old 05-18-16, 07:17 AM
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Originally Posted by Carbonfiberboy View Post
I'm not surprised that this is the only mention of stretching. Cyclists in general don't stretch enough. All bets are off if the OP is not stretching.


Originally Posted by Doge View Post
It takes 4-5X as long to build supporting tendons as it does muscle.
Runners know this. Some learn the hard way.

Cardiovascular ability and muscle strength improves rapidly but it can take two years for a new runner to build up the tendons and ligaments needed for long, hard efforts. Cycling is no different.

Again, stretching helps avoid injury to tendons which have not yet developed to the level of the muscles they are attached to. Increasing mileage dramatically and not stretching is asking for trouble.


-Tim-
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Old 05-18-16, 08:38 AM
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Originally Posted by TimothyH View Post
I'm not surprised that this is the only mention of stretching. Cyclists in general don't stretch enough. All bets are off if the OP is not stretching.

Runners know this. Some learn the hard way.

Cardiovascular ability and muscle strength improves rapidly but it can take two years for a new runner to build up the tendons and ligaments needed for long, hard efforts. Cycling is no different.

Again, stretching helps avoid injury to tendons which have not yet developed to the level of the muscles they are attached to. Increasing mileage dramatically and not stretching is asking for trouble.

-Tim-
I used to be in the anti-stretching camp . . . until I got bursitis in my knees. Stretching fixed me right up. Younger folks can get away without it, but there comes a point . . .
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Old 05-18-16, 09:05 AM
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I pushed heavy gears and had bulletproof knees for years, but this season the left knee started acting up, as well as random pain in some other joints that comes and goes. It's really bizarre.

Giving up wheat and sugar has helped reduce overall stiffness. I stretch regularly but am normally tight anyhow. This made a big difference, even though I'm not celliac.

Eliminating all supplements is worth trying too. Google the connection between excess vitamins and minerals such as D, iron, C, or calcium and joint pains.
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Old 05-18-16, 09:36 AM
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MTB riding when I lived in Santa Barbara did my knees in. Exact same scenario as the OP, even the bad experience helping someone move.

These days I limit my hill climbs, avoid unnecessary stairs, and take an Advil before any ride longer than ten miles.

Getting old sucks but it does beat the alternative...
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Old 05-18-16, 10:45 AM
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Originally Posted by TimothyH View Post
....

Again, stretching helps avoid injury to tendons which have not yet developed to the level of the muscles they are attached to. Increasing mileage dramatically and not stretching is asking for trouble.


-Tim-
The racers know/think that stretching hamstrings before the race robs power. Again, true or not is is widely held belief. And rec riders often follow the racers.
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Old 05-18-16, 11:24 AM
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Originally Posted by Doge View Post
The racers know/think that stretching hamstrings before the race robs power. Again, true or not is is widely held belief. And rec riders often follow the racers.
I don't think it robs power but stretching cold muscles and tissues can cause injuries. Most of the things I've read said ride easy for 10 minutes of so and then stretch if you really want to stretch. The best time is after a ride is over or maybe at a rest point part way through a long ride.

I know many runners that suffered major injuries from stretching when cold.
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Old 05-29-16, 07:48 AM
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An update for no particular reason other than the symptoms here are interesting. When all is said and done I can ride reasonably comfortably for 45 to 60 minutes. After that the knee becomes more uncomfortable and after 75 minutes I am ready to get off the bike. And this is pretty darn consistent and more interestingly, from my limited data so far, days off do NOT matter. In fact the worst riding day that I had in the past 2 weeks was the day after a rest day. This is really strange, although it is kind of consistent with what I was told about riding.

I am going to give this a couple of months and then take one more pass at 'the medical community' here. I still feel that there is something going on that hasn't been identified yet.

FWIW.

dave
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Old 05-29-16, 02:31 PM
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Originally Posted by Doge View Post
The racers know/think that stretching hamstrings before the race robs power. Again, true or not is is widely held belief. And rec riders often follow the racers.
Studies suggest that static stretching before an effort is counter-productive (a good warm-up is much more effective). However, static stretching after riding or later in the day is still of significant value.
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Old 05-29-16, 02:58 PM
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I'm of the opinion that balance in training is good. Cycling strengthens all the structures in the legs, muscles and tendons, that move the legs front to back as in pedaling. I have a cranky right knee that seems to maintain it's function with minimal discomfort when I add lateral movements to my exercise routine. i use 10 pounds per leg at the ankle and while lying flat on my back, do side splits for a while. Then lying on my side I raise the legs which works the outer muscles of the legs that surround the knee. This all requires some flexibility but I've been doing this for a while. Whether something similar would help you I wouldn't know but it works for me. Best wishes for resolving your issue.
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Old 05-29-16, 03:05 PM
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Yep, all the runners, cyclists, and most popular gym exercises focus on sagittal plane movement.
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Old 09-12-16, 10:02 AM
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Originally Posted by DaveLeeNC View Post
An update for no particular reason other than the symptoms here are interesting. When all is said and done I can ride reasonably comfortably for 45 to 60 minutes. After that the knee becomes more uncomfortable and after 75 minutes I am ready to get off the bike. And this is pretty darn consistent and more interestingly, from my limited data so far, days off do NOT matter. In fact the worst riding day that I had in the past 2 weeks was the day after a rest day. This is really strange, although it is kind of consistent with what I was told about riding.

I am going to give this a couple of months and then take one more pass at 'the medical community' here. I still feel that there is something going on that hasn't been identified yet.

FWIW.

dave
An update to the update, FWIW. In summary I had an unexplained knee event (huge pain with no obvious source) that kind of resolved itself with a bit of time off. Then after a while with no problems a "knee ache" returned after an hour or so of riding. This led to a visit to an orthopedic surgeon (and the requisite MRIs and X-rays). Surprisingly he found nothing on these readings (other than swelling and inflammation) and the prescription was a knee brace and LOTS of ice for 3 months.

It was not a very satisfactory place to be, but I decided to follow the instructions and then go back. SURPRISINGLY, after close to 3 months there was a major improvement. I can almost ride normally right now, although I have not yet pushed anything beyond 2.5 hours. And I do have to wear the brace.

And I am now getting some of those 'knee lubricant injections' as I have a cartilage that mostly 'stays home' and does its job. But it can occasionally get pushed around (particularly with "out of plane" motion which the brace helps to control), so the lubricant helps that. And fortunately being clipped into a bicycle also tends to keep your motion "in plane" which is why I was able to do some biking even when the knee was inflamed and swollen.

FWIW.

dave
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Old 10-13-19, 08:02 PM
  #22  
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I have been finding that occasionally I get sore knees, partly due to poorly adjusted (toe inward) cleats, but I have been treating my knees pretty effectively with knee pulling and glucosamine.

The knee pulling idea comes from Dr. John Bergman
But I do it just by getting on my bike, clipping in, and going for a ride of an hour twice a day using almost entirely my upswing only.

The glucosamine is meant to be iffy, or an urban myth (if a very popular one) but knee pull pedalling, plus crunching on a few cheap glucosamine tablets before each ride, seems to get rid of knee soreness, hopefully by putting down some meniscus, in a couple of days, riding two hours a day.
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Old 10-14-19, 05:32 PM
  #23  
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A quick follow up on this recently resurrected thread (as I am the OP here).

Since post #21 I got onto a regular regime of every 6 to 9 month hyaluronic acid injections, tactical icing if things felt off, and religious use of my lateral stability knee brace. By late in 2016 through 2017 I was back to my old riding habits (and performance) other than I avoided rides longer than 2.5 hours. Knee issues were minimal to non existent.

2018 was a poor motivation year and my cycling dropped from 160 to 225
miles per week to down to the 100'ish range for the most part. It stayed in the 100 to 125 miles per week range (sometimes longer) until late May 2019 when I realized that my knee did NOT feel like a limitation any more, and age (DOB 1949) was beginning to affect performance (reduced training or not).

So starting June 1 2019 I went back to old training habits with the intent of riding the Six Gap Century on Sept 29, 2019. This training obviously included some longer rides plus a local century ride on Labor Day. I rode the Six Gap 'successfully' finishing the ride with no serious knee issues, although it is clear that I am pushing an envelope and living on borrowed time.

See post #49 in this thread Six Gap Century Training for the details.

dave

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Old 10-14-19, 06:16 PM
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It sounds like you're doing reasonably well.

I have found that I'm somewhat cycling addicted. My body does much better if I ride at least once every 3 days or so. I'm mainly a commuter/utility rider, rather than a fitness rider. But, the same applies. Walking doesn't do it. It needs to be riding.

I was up to about 6000 to 7000 miles for the last 2 years, but unfortunately down by quite a bit this year.

In early Sept I did tent support for Cycle Oregon. Whew, for the first several days we were doing long days, and hard, heavy work that I wasn't accustomed to.

Halfway through I was getting pretty hobbled up. We had a half day at Diamond Lake, and I just had to drag the bike out for a loop around the lake. Then every day after that, I got in at least a few mines around camp. And, back to "normal".
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