stevelewis

Started cycling Sept 2014. About 3 months ago I increased my weekly mileage from 170 per week to 230-260 per week in anticipation of a double century ride coming up in August. Started having a lot of knee pain the last 2 months around the kneecap, especially when pushing hard on the down stroke. The pain was sharp at times and dull the rest of the time. It would last after rides: inflammation, pain around front of knee, grinding sensation, pain walking down slopes/stairs. Saw orthopedic surgeon and he diagnosed it as "chondromalacia" which is basically damage to the cartilage under the kneecap. Doc said increasing my mileage overloaded the cartilage and now I need 3 months of absolutely no riding to let the knees heal. No surgery thank god.

Questions:
will I have the fitness of a sack of potatoes after 3 months off the bike?
Anyone have stories of knee pain or injury to share that might shed light on this?
What is the best way to increase training/hills/mileage to prevent overuse injuries? I'd like to be doing 300mile weeks to train for the double.

Also... Please console me. Haha!

Dave Cutter

Bummer about your injury!

Sounds like you need a coach. I can't imagine competing or training without someone keeping an expert an emotionally detached eye on my behavior/progress. Most such injuries could be avoided with a decent coach.

Thankfully your injury was caught early. Much better to take a slight set-back now... than a serious problem later. A perfect time to take up swimming.

steelbikeguy

back in the early 80's, I had some overuse knee injuries that never healed, and wasn't helped by the fact that I was in college and walking many miles every day. After a year of things getting worse, I had surgery that left me on crutches for 3 months.

I do recommend being nice to the knees and avoiding the need for surgery. On the other hand, spending 3 months on crutches and with a knee immobilizer certainly helped. I wonder if I could have just skipped the surgery and gone straight to the crutches and immobilizer?

As a general rule, it does take time to build the various muscles as you increase mileage. Knee pain, as you've learned, is not a good thing and needs to be listened to. If there is any pain, you'll want to stop whatever is causing it. Don't let your short term goals get in the way of letting the knee heal and building up all the muscles and ligaments that support the joint. It took me a long time to get fitness back.

Steve in Peoria

berner

Too much too soon. Build up mileage much slower, actually over many more months. Also, bike fit will effect, not only comfort, but how well your musculature and bone structure work. It is a bit late for you for now but avoid overuse injuries like plague because it takes so much time to come back to full function. There are many videos on You Tube with good tips on bike fit or pay for a bike fit from a pro. Good luck and don't rush getting back on the bike.

Carbonfiberboy 

This is the result of some combination of incorrect bike fit, incorrect pedaling, plus incorrect muscular development, plus you continued on the wrong course for much too long. Overuse injuries are very common among endurance athletes. The trick is to catch them early on and take immediate corrective action. Any time you have some little nagging pain or stiffness, figure out what the problem is and how to fix it. That usually involves talking to a bike fitter or a very experienced rider or a coach. Pretty hard to figure it out by yourself, though there is a lot of information online if you can sort out the nonsense.

While you wait for things to heal, you can still take corrective action. See a bike fitter and get fitted. Learn to pedal circles. A good start is watching this video:

Usually chondro pain comes from the patella mal-tracking, which with cyclists is usually due to a weak or inactive VMO. You might read this thread and see if it sounds familiar:
https://www.bikeforums.net/training-n...ee-health.html

Usually the recipe for mild chondro is raise the saddle 5mm and take easy30 minute spins on the rollers every day. It goes away. BTW, if you don't have rollers now, a set of resistance rollers would be your best investment in cycling.

It's not really the mileage increase. This week I quadrupled my usual weekly average and I feel fine. It's more the technique and neuromuscular control, which you're also not going to get by sitting around off the bike.

One last thing: you don't need 300 miles a week to ride a double. You need about 150 miles of properly targeted training.

Heathpack 

You don't need to be riding 300 miles/wk to prep for a double.

I picked up a bike in March 2013 and rode my first double in Dec 2014. For the two months prior to that double, I was averaging 175 miles/wk (range 75-240). For the two months prior to my second double, 6 months later, I was averaging 140 miles/wk (similar range). I had zero problems completing the doubles.

More is not necessarily better. Sometimes, as you found out, more is worse.

texaspandj

IME knee pain can be attributed to too much too soon, or too fast too soon. You need time to let the ligaments, tendons and muscles strengthen before increasing mileage or speed.
The rule of thumb for pain is if it hurts as you engage in your activity, stop. If it ceases as you engage in your activity, generally it's safe to continue. Ymmv.
Either way it sucks you're out 3 months. Time to hit the pool. Fwiw some of my best times running were when due to an injury I was relegated to swimming and cycling only. I would run only during the running portion of a triathlon.

Heathpack 

Lol I answered before reading your reply!

FBinNY 

Odds are that your knee problems weren't caused by overuse, or because you increased your weekly mileage. More likely it was caused by poor gear selection, and high pedal pressure.

I can't tell you if/when you can resume riding, but I can tell you that when you do so, focus on turning lower gears at higher cadence. Knees are very tolerant of motion, in fact more may be better. However, they are far less tolerant of load and even worse, motion under load.

This is why cycling is better on your knees than running is. On a bike, you spend most of the time seated, so your legs are loaded far less than your body weight. That's what you want to keep in mind. Riding a bike shouldn't be like climbing stairs. Use your gears, and beat your legs up only for sprinting or climbing.

stevelewis

Thanks for the feedback guys.
First of all, my main concern is really just making sure that I can return to cycling and hopefully ride for the rest of my life. Kinda having anxiety about whether this will go away! I'd be adrift without the damn bike. So, I figure I can't do harm by staying off the bike for 3 months? (besides fitness loss but who cares... that comes back.)

I just started swimming to hopefully maintain cardio fitness, it certainly elevates the HR!

As far bike fit, I saw my shop guy and he raised the saddle a bit and moved it forward. He said it was way too far back.

As far as cadence, I am RELIGIOUS about cadence. Almost always 90 or higher. Unless I'm climbing and I do a lot of climbing so there could be an issue there?

I see physical therapist on July 21 so hopefully he can suggest some good exercises. Is the VMO imbalance something that needs to be tended to forever or can it be resolved after a while?

As far as technique, I used to pull on the upstroke but I found that it strained my legs and seemed to be inefficient. Just focusing on the down-stroke was more intuitive, comfortable and felt more powerful. But, if you think pedaling circles will help solve my maltracking patella/muscle imbalance I'll certainly give it another try.

Heathpack 

You have an overuse injury, the lesson is not to overuse that joint- ie don't attempt to put in excessive miles (why did you think you needed 300 miles/wk to ride a double?). The other lesson is that if something hurts you must rest that area and not continue to injure it. Climbing for sure stresses the knees more, if you're doing something like 300 mi/15000 ft climbing per week, when you come back, you'll need to scale way back. It's also really important to have some rest weeks in your monthly schedule & some rest days in your weekly schedule.

Interestingly neither my fitter nor my coach ascribe much to the idea of perfecting athlete's pedal stroke. They both feel like we each figure out the pedaling technique that works best for use in various scenarios. So I just pedal my bike.

If you're worried about your fit, you could go see my fitter. He's a big kahuna expert guy and I guarantee your fit would become something you don't need to worry about afterward. Pm me if interested.

Ill bet you'll be back on the bike if you let it heal up. Just be clear on what you are and are not to do during your rehab process.

f4rrest

I'm working back from grade 2 chondro in one knee.

Was at 200mpw last year, and I think what set it off was banging the knee on something and continuing to push through very minor pain over the following months. Used to push 39-25 in the mountains.

I'm currently back to 100 mpw but have to limit power to under 200 watts, which is like low Z2. That takes a ton of discipline.

@Carbonfiberboy 's recommendation of 30 minute roller sessions helped, as did swapping the road double for a compact.

Spending 15 minutes per quad, vmo, and adductors foam rolling and then stretching quads multiple times daily has been helpful. Also, 5 minute glute bridge sessions with weight a couple days a week. And light hamstring curls with a band or cable. Ice on knee frequently.

Oddly, pedaling in circles can feel worse for me, while mashing a bit with the glutes firing but at higher cadence feels better currently.

MonsterFat

I am dealing with knee tendonitis now which according to my orthopedist isn't chondro but I feel your frustration. I was approaching some of the best fitness of my life and now I am off the bike for 4-6 weeks and its really frustrating. Mine was a combo of too much too fast and some slippage of my seatpost I didn't notice. Not really sure which was the main of culprit or if it was a perfect storm. Some days it is better and some its worse so I go from almost there to feeling no improvement. On the bike didn't seem to hurt, it was after the fact I really noticed it.

B. Carfree

My injury was totally different, but my lay-off was longer and had a happy ending, so perhaps it is of use to tell the story. Over three decades ago, I rode and rode and rode. Suddenly, one knee started to give me a bit of pain at the end of the day. Then it started to bother me while on the bike. Eventually, I couldn't ride any more (quite a change from 300-400 miles per week). Then I couldn't walk. Uh oh, maybe it was time to see a physician.

Well, I figured that if I was going to go see a surgeon, I might as well really screw things up. So, after six months of no activity, I got on my bike and pounded out a short local loop, about fifteen miles. When I got home, my legs were cramping and a little "thing" appeared on the surface of my knee. Long story short, that "thing" turned out to be a piece of cartilage that I had torn playing basketball a decade earlier. The little "mouse" had dislodged and landed in a bad place in the joint and had finally worked its way out.

To celebrate my newfound ability to ride, now that the mouse was back in a happy place, I went out and rode a nice 50 miles with 5000 feet of climbing the next day. Along the way, a friend pulled up lame. Since he had already paid for our local double century scheduled for the following weekend, he gave me his number and my third ride in six months was that double century.

Yes, I finished the double, but not without wishing that I hadn't started it a time or two. At one point I skipped the wrong rest stop and woke up in the middle of the road with a banana on my chest that a passing rider had donated to this obviously bonked person. I didn't crash, I just got off and fell asleep on the road. Mind you this was a very easy, flat double century course that I later rode in under eight hours, but I did enjoy that sixteen hour trial and it did show me that one can ride with minimal baseline miles, but the riding will be slower and a bit more painful.

stevelewis

Carfree, that cartilage story made me cringe! Sorry that happened! Hope that's not what I've got!

Monsterfat, I think I have tendinitis also. Definitely feel stiffness and dull pain in that area below knee cap after rides and even after a long walks.

I am beginning to think that my foot biomechanics are a piece of the puzzle. I noticed that my right foot rolls outwards (over supination) and things like that can have very big effects "up the chain" like in the knee joint. Might see a podiatrist and see what he thinks? Maybe an orthotic?

blacknbluebikes 

Smart move on the swimming.

Bikeforumuser0019

I spent four months last winter working with a personal trainer. I've never done that before!

I am overweight for my height and have not always been smart in the past about how I've exercised. I injured myself several times by doing too much too soon. It was so wonderful having a trainer to build up my weak areas and get me in shape even if my ankles (for example) were too weak to do jumping jacks.

My trainer was struck by a drunk driver while riding a bicycle years and years ago, his spine was broken in four places. After doing "physical therapy" he was dis-satisfied that they never took him as far down the road to recovery as he needed to go, so he taught himself how to rehab himself, then got certified and opened his own personal training business.....

..... all this to say I commend to you finding a personal trainer who can coach you how to stay in shape while also letting your knees heal up. I think there are some guys out there who know more about health and fitness than a doctor.

I went to many doctors over many years, including two different Orthopaedic surgeons for weakness in my ankles, and esp. pain in my right foot and lower leg. I had several rounds of physical therapy AND I had to wear one of those big boot bracess for a long time, and did many expensive scans at least one of which required an injection with a radioactive dye. Then, my personal trainer spent about one hour teaching me to fix a pronation issue, and after one month of practice "walking" I never had the pain again.

If you don't like what your doctor recommends get a second opinion! You have more options than you think.

Nachoman

I had the same diagnosis years ago.
A proper fit, and switching to speedplay pedals, basically cured all my issues.

stevelewis

Hi Nachoman (mmmm, Nachos!!)

A few questions for you:

I've been considering a bike fit but the guy at my shop has spent about 20 minutes checking saddle height and fore-aft/cleats/stem/knee angle and I'm not sure what a full blown "$150-$300" bike fit would avail me beyond what my bike shop dude did for free. (My bike shop dude is a former Olympian BTW!) Do you recall the sort of things that your pro bike fitter changed or adjusted to aleviate your knee pain?

What about the speed play pedals made a difference? Is it the float? I actually asked about that at my LbS and he said the pedals I'm using (shimano spd mountain bike pedals... Yes, on my road bike) are fine because they have about 4-5 degrees of float and he thinks that's plenty for anyone.

Can you relate your "recovery story"? How long before you could ride again? Did you see a physical therapist? Did you need to address biomechanic/alignment or muscle imbalance issues? How did you approach resuming your training? How slowly did you build back up to your original training volume/intensity?

Thanks, I appreciate it!

79pmooney

Steve, I am going to post here what I have posted several times on this forum and another. To sum up very briefly: what you have is life long but manageable. (If you don't manage it, and keep using your knees to cycle or run, you will destroy them. Only real cure is knee replacement. I wrote this years ago, but after being correctly diagnosed 20 years before and riding ~70,000 miles since. I have changed very little since I wrote this except I did have super kneewarmers made that I wear for nearly every ride.

So, I wrote:


Chrondomalacia patella. Yes, I can tell you a little about it. I was diagnosed in ’78 and given very good advice by the doctor (an orthopedic in sports medicine. He was also a novice bike racer, so he had more understanding of the cycling aspects of CP than most). I will do my best to pass on what he told me.

In CP, the kneecap is not aligned with the knee under it, hence there is chafing as the knee is moved. This causes wear, first to the cartilage, then to the bone under it. The wear accumulates with number of repetitions and pressure. At some point, the wear can cause permanent damage.

Some people are more prone to CP than others. It can be triggered by exercising in cold weather, exercising without adequate stretching of the hamstrings, i.e. touching your toes or less extreme stretches of the same tendons. It can be brought on by exercising without adequately strengthening the small quadriceps muscles just above the kneecap.

I brought on my CP by training to return my body to racing form after a very serious accident. (I was weak enough after my hospital stay that I was no match at 24 years old for any 7 yo. The accident was in November, and I returned to riding miles in March. I did nothing to keep my knees especially warm and did no stretching exercises (rationalizing that since my leg never extended to anywhere near straight, there was no chance of injury, hence no need to stretch). I was wearing just full tights and thermal underwear under them in Boston. The temperature was probably not much above 30. The ride that started it was 100+ miles on my racing bike, my first outdoor ride on that bike. It had 175 cranks. My trainer, with fixed gear and very low BB, had 168’s. After the ride I had a dull pain in my mid to upper knee in front. That Saturday was the first race of the season. I was forced to drop out, my knees hurt so much.

After that race, the race promoter introduced me to an orthopedic surgeon who diagnosed me in the back of a cold van. He laid out for me then and in later phone calls a plan that I will pass on here.

He first stressed that I had to stretch my hamstrings, touch toes or lean forward against a wall or post with one leg back and straight and stretch that hamstring or sit and touch toes. I now prefer the lean forward method. Very specific and hard to hurt yourself. (I am now a 48 yo, I damage if I am not careful.)

Second, he had me sit on the floor and do leg raises. He had me raise one leg at a time and hold it several inches off the floor for a while (I don’t remember the time, but 15 secs should work. Important – while the leg is raised, tense up your quads big time and tense up those little quads just above and beside the kneecap. Feel for them and get to know them. It is those little guys that keep you kneecap aligned. If you are in riding shape, you can do this with say 5 pounds on your ankles, but the tensing up is much more important than the resistance.

Third, KEEP YOUR KNEES WARM WHEN YOU RIDE!! For me, this is critical. I wear these dumb looking “knee warmers” for most of my rides, always below 70 degrees, often under tights. Since keeping the hamstrings loose is important, I had to stretch the elastic. To keep them from falling down, I sewed on garters that I clip onto my shorts.

Fourth, back off riding until you have been doing these two things long enough to make a difference. Keep up the exercises and especially the stretches after you resume riding. Build up your riding slowly. The doctor stressed this to me and it has been very true. My ability to come into real form and resilience on the bike is limited more by my knees than by my lungs/muscles.

After rides, take aspirin or Ibuprofen to speed recovery. I personally think aspirin is better, that my knees recover more with it. I disagree with the ice. I have always felt that moving my knees when they are cold is causing the damage I am trying to avoid. Perhaps ice speeds recovery, but I feel it also continues the damage (at least in my knees).

Big gears are the enemy of CP knees. I love to climb hills standing. I love to ride hilly country on fix-gears. It is a fact of my life that I can only ride certain not-so-steep hills on my commuter and that I have to have and use a granny ring on my custom. It is a fact that there are days, weeks and months when I have to let whippersnappers blow by me on hills where I know I can humble them.

Lastly, what you did not want to hear, but again what the doctor told me. Get used to the idea of CP. If you are at all like me, it will be a fact of your cycling life for a long time. 23 years later for me and I am feeling my knees now because of a very easy ride I did in street clothes without knee warmers at noon today.

Sorry to be the bearer of bad news, but you can still do a lot of riding. I raced that season (I already knew it was my last) and have done 60,000 (?) miles since. I still commute, but only on alternate days. (But for the first 7 years with CP, I did not own a car and rode everywhere.)

I took the time to spell all this out because in the 23 years I have had CP, I have never seen all of this in one place. In fact, I have only heard about the importance of keeping the knees warm from that one doctor. That is the single most important aspect of the program for me. Thank you Dr. Kish, wherever you are. I will probably ultimately need those carbon fiber knees, but by following the regime, I figure I can wait until a) the product improves, b) the price comes down and c) I’m old enough that my cycling level will be within the abilities of those knees. I hope to delay another 10 years.

Since I wrote this a year plus ago, my physician has recommended that I take glucosamine. He was very specific, that I should take 3000 mg/day in the form of glucosamine sulfate or glucosamine hydroxide, but to avoid chrondroitin. This I did faithfully for 9 months. Between riding steadily starting two years ago and the glucosamine, my knees never felt better than they did last summer. I was passing whippersnappers uphill. Then my riding tapered off, I tapered down on the glucosamine and got sick so my riding and conditioning dropped. Thanksgiving I rode 50 miles with 2500’ of climbing on a cool day. My knees hurt. How many of those rules outlined above did I break?

Ben

79pmooney

With CP, float may or may not be good. For me, it is a disaster. Cleats that force my heels out line up my knees correctly. Rotating my heels out consciously places the opposite force in my knees and is a disaster. Letting my feet relax with float means that my knees simply aren't tracking right and I can feel the wear happening.

The big thing we have to get used to with CP is that once it is there, your knees call the shots. It's really pretty simple. What feels good is and when you feel the wear, it's happening. Get acquainted with those knees. Love them and treat them well and they will serve you for years. I took that approach in 1978. ~150,000 miles later I will roll the odometers for fix gear miles and geared miles each in a couple of months. Your cycling life is not over. But the carefree days of "what knees?" are over.

Ben

TexMac

I have had some knees slight pain and went to speedplays from Shimano and it's night and day difference. My feet esp left tends to point inwards naturally and the speedplays helps align it that way compared to shimano pointing straight. Knee issues started after rope skipping in the gym. Never again.

79pmooney

Oh, since that diagnosis, I have: raced that season. Climbed Mt Diablo many times, once on a fix gear. In my late 50s, early 60s ridden 130+ mile days three times, twice alone, once fixed and ridden Cycle Oregon five times, three times on fixed gears (but I did cheat - I stopped and flipped my rear wheel, even unscrewed cogs. Still, I rode up the 2 mile climb maxing at 14.5% on my flat ground 42-17.)

CP isn't a death sentence.

Ben

Nachoman

My knee pain was bad, but not that bad. Maybe I had a more mild case of chondromalacia than you do. I could essentially avoid debilitating pain by never cycling two days in a row. I tried PT, but it didn't help at all.

Then I bought a new bike and I sprung for new speedplay pedals. I got the X series - which have MUCH more float than your 4-5 degrees. I also sprung for a pro fit. In retrospect, my fit was just a lot of common sense stuff, but it did go well beyond my capabilities, especially regarding the cleat adjustments.

All knee pain subsequently disappeared. I was able to resume normal cycling, running and stair climbing.

nycphotography

All this (get your fit straightened out, but most obvious / common is seat is too low), plus a point on technique:

NO MASHING.

Ride at a 90-100 cadence. For a given power level at 90 vs 60 rpm, you'll be applying up to 1/3 torque (ft lbs), which is 1/3 less lbs since the ft (crank arm length) doens't change. That's 1/3 less force through your knees, and you will be applying it more consistently across a broader range of motion.

Btw, make sure your crank set is the right size too. Too short requires more force, Too long makes saddle height hard to get right.

The easiest way to estimate seat height: spin out at faster cadence w/ upshifting. if you end up bouncing on the saddle, then you are "probably" too low. raise the seat 2mm and try again.

If while riding, you are reaching for the pedals (hips rocking as seen frombehind) then you are probably too high. drop it 2mm and try again.