Cranky Knee Notes
 

I can't be the only BF member with a cranky knee. I had an ACL reconstruction on my right knee in 1989. Now it's getting arthritic @ age 50 after nearly 20 years of hard cycling (I don't have a lot of cartilage in that knee, I can walk on it but not job or play sports like basketball). Synvisc shots last February worked great until recently. Swollen since a ride last Friday. I'm taking a couple of days off the bike and sucking down Naproxen like Pez.

So here's my theory: I think cycling is generally GOOD for an arthritic knee like mine. However the steep hills around here and the hammering (I ride competitively and race a bit) can put stress on the cartilage denuded joint surface. At that point, rest and anti-inflammatory meds, ice, etc. can help calm things down. I talked to my knee guy today, he prescribe a different anti-inflammatory medication which I'll pick up and save for another day, the Naproxen does appear to be working. One rest day my knee is halfway back to 'normal' (or what passes as normal for that knee). It was so bad this weekend I almost turned back after 5 miles each day, but continued to ride 31 miles Sat and 50 Sunday. The longer I rode, the more it loosened up. Moderate hills and pace. Odder still the harder I hammered, the better it felt.

He says I can repeat the Synvisc shots for a decade, they don't lose their effectiveness in many patients. I'm hoping to limit those treatments to one round each year. That means I'd like to avoid another visit to him for the treatment until at least Feb. 1. We'll see.

Any other arthritic knee experiences to share?

Fifty years of wear and tear left my knees rather beat-up. Surprisingly, riding my bikes more often has actually reduced the amount of knee discomfort I have.

I've made a number of adjustments to my riding to help my knees. I've found that riding every day is important. When I was riding mostly just two or three days a week, soreness was a problem. Riding every day, even just thirty minutes, seems to prevent soreness.

Second, I've learned to ride in really easy gears. Spinning along at a high cadence (90 RPM's to 100 RPM's) in a 60 inch or 65 inch gear is very easy on the knees. Riding at a slower cadence (such as 70 RPM's) but in an 85 inch gear will eventually lead to knee pain, and could cause knee damage. Even folks who race can benefit from building up the speed of their cadence and trying to use gears of below 85 inches as much as possible.

Third, I've switched my bikes to large BMX pedals. They support the entire forward portion of the foot, and enable you to move your foot forward a bit when accelerating, or back a bit when just cruising along. Being "locked" into a single foot position with clipless pedals is the major cause of knee pain, knee injuries, and the "boom" in knee surgery among cyclists. Because you like to race, the chance you will be willing to try BMX pedals is probably a bit less than zero.

You mention that you like to "race" and "hammer" the steep hills. Well, you are gonna hurt. That sort of riding is tough on knees, regardless of your age or condition. I can only suggest that the day before and after that sort of stressful riding, you try to take a nice easy cruise and give your knees a bit of rest.

I was told at 37 a knee replacement was a question of when, not if. I seem to be an equal opportunity kind of guy, and subsequent back and shoulder surgeries have revealed more than their fair share of Osteoarthritis as well.

My left knee has been bone on bone since 2000. It was probably that way a good bit before that. There is absolutely nothing left except whatever scar tissue has formed since the last surgery and what ever damage the arthritis has done since then as well. Other than that, it's down to ligaments and tendons.

My Rheumatologist told me to do whatever I can tolerate, whatever escalation toward a replacement is worth it. She asked if I would rather have X amount of years of doing nothing that I enjoyed and then have a replacement, or say X-2 and have fun doing it.

I absolutely have to start each ride with a real low spin to get things going. It usually takes me 2-3 miles of spinning to get warmed up. After that I seem to do OK with the exception of hills. I simply cannot hammer up a hill, I have to spin. When I get knee pain while riding it is generally a sharp shooting pain seemingly straight though the knee cap. I've had two arthritic ridges dremmeled down under my knee cap so that's not surprising.

I don't seem to have a problem pushing tall gears on flats, just on hills. It's getting better the more I ride. I find some hills I am spinning in a taller gear than I used to. I have had rides where my day is completely finished due to knee pain after a long ride. I takes some planning.

I also have a little thing called Chondrocalcinosis (sp, sorry Dr. Pete) where I can get fluid on the same knee that has calcium and pyrophosphate crystal deposits in it. It works kind of like wet sanding when it flairs up. I've only had three bouts with it over the years, but there isn't much to be done except get it drained and endure a hideous med regiment until it passes.

I haven't tried the Synvisc treatment yet, but I have broken down and taken the needle a few times over the years when I had something special approaching and was having trouble.

Embrace your future PCaddy.

http://hotels.about.com/library/photos/ger_msr/bike.jpg

I'm 27 and have the same thing. I ride 10 miles one way to work. It takes about 2-3 for the pain to start to subside. Hills hurt, but by the time I get to work, there's almost no pain. I got towards the end of a 35-miler on Sunday and thought I was going to cry (insert HTFU jokes now). But it is a sharp, almost unbearable pain. I haven't had anything looked at yet, but I'm trying to find a good sports med Dr. here in town. Shameless cliche: I feel your pain Pcad.

Shouldn't this be in the 50+ forum?:innocent:

You've summed it up pretty well.
Problem is, keeping it in the small chainring and avoiding intense workouts, gear-mashing/hills etc. is easier said than done (and accepted), specially by "athletic" types.

One reason it may feel better the more you hammer, may be simply due to a temporary joint lubricating effect (helping decrease friction in your cartilage de-nuded joint) and obviously the endorphin liberation associated with all relatively intense/sustained activity.

Although usually the best ex. for cycling is...... cycling, when one's injured you have to compromise and even lay off and rest for a while.
Maybe cross-train a bit with your knee in a different joint-range position (ie. cycling necessitates approx. 115-25 degrees of flexion) such as swimming (only 0-30 degrees knee flexion needed- never 115!).
This'll shift the cartilage weight-bearing, joint-stress area for a while at least.

You may also try basic inner range quads ex.s if (ie. terminal extension from 25-30 degrees knee extension) as a strength variation, although this by itself will not be enough for your endorphin rush. You'll have to combine it with relatively intense, general weight-training ex.s for that (while protecting your knee).

Finally, if a knee is swollen & inflamed (even mildly) it is telling you something's wrong. If one persists on hammering, one is only aggravating the joint irritation by causing more inflammatory by-products to be released in the joint- which eventually will cause accelerated cartilage erosion...

Usually, PROGGRESIVE return to pre-injury levels are advocated, rather than diving in cold-turkey, specially for midleage / older athletes.

See your sports-physio for more details if this is somewhat unclear.

You got it right basically. Pressure on the joint = bad, lots of pedaling without lots of pressure = good.

Warm up slow and take a long time doing it, this can loosen the joint and the muscles. Once you get going, as you noticed, keep going, stretch your knee on the bike during rides, no need to stop.

Make sure the doc says the stretching is OK for you! I don't have torn anything, just joint arthritis.

Just like standing and leaning forward to stretch the back of your leg, stand on the pedal and lean forward stretching the back of your leg. If your knees hurts during a ride this stretch can help you get home or keep going, by making your knee feel better. Stretch going down hill if you want to keep your average speed up.

Two days off is a lot better than one day off. The long rides loosen things up a lot. Then you can hammer more. I can ride harder after 75 miles than 5 miles.

Once warmed up a long ride is better, with two days off, than riding every day and shorter rides. The time off reduces the swelling in the joint. Oddly, if you train hard enough to really get stronger (damage muscles enough) it takes two days for full muscle recovery anyway. This may make you stronger over the season anyway. Most people never take two days off and partial recovery is plenty, but more recovery can be better if you train right. I get stronger faster over the season only riding a century on the weekend and climbing huge hills on Wednesday, then a group ride that evening. Intermittent hammer fests on the century here and there. But only part of it. Two days off heal the swelling and the muscle damage from hard training about the same time for some, like me. If I ride hard with no time off in between then I need more time off the bike to reduce the swelling.

When It hurts stop riding, you can recover faster and ultimately will spend less time off the bike overall, even if you miss a favorite ride. Hammering more produces more endorphins and you feel better. Hammering does not make the knee better, it probably makes it worse, but keeping riding after being warmed up (not much stress on the joint) can keep it from being stiff.

The range of motion of the pedaling and keeping riding is good, hammering is not, but the endorphins from hammering more reduce the perceived pain, so you feel better at the time. (So does caffeine and Tylenol).
A long ride loosens the joint and makes hammering feel better too, but it probably is bad for the joint over the years. WTF... I did it for over 14 years so far. You might be able to go a lot longer, who knows.

BTW- I was told at 27 I would need knee and/or hip replacement some day. I'm now 57. As you know the trike was spinning 160 rpms Sunday. I cranked the 100+ lbs load up a small hill and into some wind. Low gears are my solution.

Shouldn't you be relegated to Fred Hell? Wait, you're on BF, this is Fred Hell.

Never mind.

But I don't read the 50+

Are you still riding 53/39 12-25? Might be time to go 50/34 11-25 to start with and fine tune from there.

P - in your initial post you made no mention of your recent week of climbing in Greece. The Friday ride may have just been the last straw for that knee. A good rest should bring it all back to normal. We're counting on you to keep up your blistering pace for the next 20 years. Avoid Greece is my advice to you.

That trip to Greece was amazing, all climbing, every day, lots of vertical, but generally grades that weren't as steep as the ones I ride here. Then I came back here and rode nearly 300 miles, hard, no problems. The knee just flared up - as the remnants of that hurricane were moving up the Eastern Seaboard. I'm convinced it was the Barometric Arthritic Joint Syndrome. Anyway after two complete days of rest and popping Naproxen like crazy the knee is feeling much better tonight. Hope it's better still in the AM. I may take a third day off, I haven't had three days off in a year.

My knee surgeon prescribed Meloxicam today, a more powerful anti-inflammatory prespcription drug. I'm holding that in reserve. If the knee doesn't calm down, that's next. Just trying to put the Synvisc shots off as long as possible. He says I can have those injections twice annually for ten years and they'll work. But they're a bit painful - mainly in your wallet if you know what I mean, and I know you do.

By the way, any more suggestions that I alter my gearing to a 'compact' or 'triple' will leave me little choice but to revert to Pcad Defcon IV and Vaporize the hapless BF member who posts that comment. That would be a shame, because I realize you Freds do mean well. But try to restrain your silly remarks and please remember who you're talking to here. I'm trying to remain your kindly Uncle Pcad, but you dweebs don't make it easy sometimes.

You got a cite for that? It's a nice-sounding just-so story, sounds perfectly believable (I don't think it's implausible), but there are a few things to establish:

1. That there has indeed been a "boom" of knee surgery among cyclists.
2. That said boom is indeed the result of increased injury rates, not the increasing availability of effective surgical procedures.
3. That these increased rates of injury are caused by clipless pedals, not other equipment changes or a general adoption of poor technique.

Until we're given some reason to believe that your claim is based upon something other than your desire to have reasons for your preferences that allow you to feel superior, it is only so much noise. I am not saying this out of defensiveness. When I am not mountain biking or riding my road bicycle, I prefer not to use clipless pedals. Currently, that means most of riding is without a fixed foot position.

Wait. What's wrong with feeling superior? Don't challenge the whole Road Nazi Ethic. And don't ask how that can possibly dovetail with Self Loathing. It is far too complex for the average Fred to ever understand. Or the average Cat 2/3 dude for that matter. True Cycling Zen is the purview of Peloton Dogs. So we have that going for us.

Woof.

I don't have arthritis yet, but some mornings when I get up I just fell like sh*t, you know, like this...

http://i166.photobucket.com/albums/u...ie-oterror.jpg

Time to poke the stick in the tiger cage.


Get a compact and embrace that inner spinner.

You get a compact and put your rouge on you fairy.

Use both, as a matter of fact. 50-34 on the Specialized, 53-39 on the Trek. They both work great but I get a lot more use out of the 50 than I ever did the 53, since I prefer to spin the gears at a bit higher cadence. (A season racing down at the Dick Lane Velodrome has done wonders for my pedal stroke too.)
I will admit the 53-39 shifts smoother because of the smaller size gap between the rings, the 50-34 is far easier to turn over at both high and low speeds for me.

Nothing womanly about 'em for my money. If you drop someone, they sure as heck can't see what you're turning over.

I've never had a single knee problem since I've been riding seriously (5 years). Then I decided to add in some running recently...first ever knee problem and it's spiraled into two knee problems. If you have a proper bike fit, I think it's VERY, VERY hard to get a knee problem biking. But running? It's very hard NOT to get a knee problem.

You'll never get it my little Flashy. Sigh.

All I know is when my body starts barking at me about something, its usually wise to sit up and listen.

Really just looking out for your miserly old butt so that you can continue to discuss how fat and slow you are for this sport. Heck, a compact could even make you even slower. Think of the self-loathing possibilities!

Seriously though, as someone who ignored a twinge in his IT band with ibuprofen and "ah, its just tired quads" and now has to stretch daily, basically for the rest of my days on this Earth, I highly recommend adjusting to whatever your body can handle and responding seriously when the problems emerge. I've learned from personal experience you lose that fight with your body every time.

Had a co-worker last year who finished up his third knee replacement, on the same knee. He was a hard-core runner, did every marathon you could think of, but his knee finally gave out in his late 40's.
Well, third time under the knife after ignoring doctors orders and continuing to run on a fake knee, he gets an infection and is basically laid up 6 months on top of the normal rehab.

He swims now, and wears Aquaman t-shirts around intermittently, thinking Aquaman is a cool superhero.

I'm just trying to keep you from becoming the guy that thinks Aquaman is cool.

So does the knee often give you problems during any big storm/low pressure weather pattern? The only arthritic joint on my body so far is the first (furthest from hand) joint on my right pinky finger. I suspect it's the result of a hard impact at some point in my life (lots of sports as a kid, lots of sprains, but never a broken bone), but I can't recall the moment. I'll go days without feeling a thing, then all of a sudden it flares up with a dull, constant pain. But that's a finger I hardly ever use. I can't imagine what that must feel like in a knee, leg or arm joint. Just shoot me!