hexron

So riding too hard without stretching enough on an ill-fitting bike can lead to problems. So while I wait for my 2nd bike fit - time to rest and look into some yoga.

I've got some patella pendonitis in both knees that doesn't hurt all that much and sub-talar inflammation in both ankles that really does hurt quite a bit. With the knees doc just wants rest, ice and stretching. With the ankles he wants to do a steroid shot to get me back on the bike. He said "If it were December, I'd just tell you to rest for 4 to 6 weeks - but it's July... "

I asked him if the steroid shot was a one time thing - and he said yes - it should put out the inflammation and after that I wouldn't need another one. But that really does run counter to every story I've heard about someone needing a steroid shot. Once my mom started down that path - she had to keep going back. I'm wondering if I should avoid the steroid shot and instead stay off the bike for a month or two and just concentrate on PT, buprofen and ice?

redlude97

Nothing wrong with a steroid shot for an acute injury that you will address the root cause of. Obviously the conservative answer is to take the rest of the season off, but if you want to continue to ride then get the shot.

Seattle Forrest

Rest. Stay off the bike as much as humanely possible until you get the fit issue worked out. Your tendons need time to heal (they'll come back to 100 %) and you'll just **** them up again if you keep riding.

I had a steroid shot once. Buddy flipped the car I was a passenger in. Dislocated my sterno-clavicular joint. It was a *****, and the sports doctor gave me a cortisone shot in the neck. People told me it would be hell, and to be honest it was awkward and uncomfortable but nothing unbearable at all. And it helped a lot. Took a day or so to start to help. That wasn't for tendonitis though. I'm just telling you what to expect if you wind up needing one. I've had tendonitis, in my ankles from a period when I was kayaking a lot and had the foot pegs (for steering) too taught. Doctors just told me to stay off of them. I did, and it went away completely.

hexron

Thanks guys. I wish I would have not gotten a bike trainer over the winter and just rested.... sucks to be down in the middle of summer....

Seattle Forrest

Can you swim? I know it isn't the same, but it might help pass the time while you recover. And it's high summer.

canklecat

I'm practically begging my health network for an anti-inflammatory injection for my shoulder injury. Everything related to pain is punted to their pain management clinic, which is backed up for at least three months. So I'm going to try the VA next. I'm eligible, just never tried them. But I met a disabled Iraq vet last week who said he's getting good care at the VA for his lingering injuries and chronic pain, so I'll try them.

Frequency depends on the person's overall condition. Chronic issues such as osteo or rheumatoid arthritis can require more frequent injections, once or twice a year, sometimes more often. Most younger folks without debilitating diseases may need only the one treatment.

For my shoulder and neck I've been trying a variety of topicals, including DMSO as a carrier for common analgesics/anti-inflammatories like salicylates, menthol, camphor, eucalyptus, even capsaicin. (Hint -- never combine DMSO and capscaicin. It's like the worst sunburn you've ever had.)

But now I'm trying Ted's Pain Cream, which incorporates MSM rather than DMSO as a transdermal carrier. They advise giving it 4-7 days to work. It'll be 7 days Friday so I'm waiting. But so far it's not a miracle cure. I have low expectations for any topical balm since most of them work by massaging in the stuff, and a lot of placebo effect.

I've also tried CBD and related stuff given to me by a friend, including a topical balm. I can't tell that it makes any difference. I suspect hemp is a bit overblown as a cure-all. It's good for some things, according to researchers, but it's not the miracle cure some advocates claim. CBD orally has helped me with nausea, a side effect of another med. CBD was more effective than the anti-nausea prescription from my doctor, so that's good enough to recommend it on a limited basis. But I'm not convinced it's useful for chronic pain or inflammation. I still take a little ibuprofen for that, usually 400-600 mg in the morning.

Regarding rest, I dunno. I feel antsy if I'm immobile for too long. I started doing my own physical therapy at home even before the doctor okayed it. When I showed him what I was doing he said it was fine, probably more effective than anything the hospital's PT clinic would do. But I'm still having a lot of shoulder pain at night. Just takes time to heal, but I'm not going to stop the basic range of motion and stretching exercises. And I'm doing some very light weight lifting, less than 10 lbs.

colombo357

Stretching is best done off the bike anyway, but should be done daily. Even weekly would be a massive improvement to most cyclists.

Seattle Forrest

I wanted to comment on this, just to share what little knowledge and experience I have with the group.

This stuff is legal here. I hurt my back in the gym this spring, an over-use injury. I bought a bottle of topical CBD cream from one of the pot shops. Somebody on the hiking forum said it was a miracle for his arthritis, it was only $20, and when putting your socks on is the worst part of your day, you'll try anything. It worked a charm. Really helped a lot. Didn't intoxicate me, just dulled the pain a lot. I got better and gave what's left to a friend, with bad knees. It didn't help him at all. So it seems like the stuff can be hit or miss, I don't know if it depends on the person or what's causing the pain or what. OP, it's probably worth trying if you have access to it.

canklecat

Yup, CBD seems to work very well for some folks. Heck, Floyd Landis started his own CBD company after discovering it helped with his chronic pain from years of racing, and he says it helped him to transition away from prescription opiate pain relievers.

Either I have an unusually high tolerance for CBD or it just doesn't work as well for me. I still end up needing ibuprofen at least once a day. And I use a topical pain cream, massaging and switching between hot/cold packs.

Right now a Utah research group is doing a study, to be published later on the NIH site, to get more data for the differences between THC, CBD and placebo in treating chronic pain.

That study may lead to federal or state governments permitting a higher concentration of THC in products sold as CBD with minimal psychoactive effects. Right now the THC component in CBD is so minimal that it has no psychoactive effect on most users and only minimal in some users. I've read a few cases of people claiming they had strong psychoactive effects from CBD, but without a study including a control placebo it's difficult to tell how much of that is psychosomatic.

There's a theory that the THC component is necessary for CBD to be effective for pain, and the amount of THC permitted in CBD now is so low that it may not help some users. That's one reason why patients with cancer or severe chronic pain prefer ordinary marijuana over the hemp and CBD products. And at least one study published on the NIH PubMed site indicates that most people who use marijuana to control pain eventually develop a tolerance and the cannabis products become less effective for pain. That study indicates CBD, THC, etc., won't replace opiates for severe pain.

Also, right now, CBD is very expensive, partly due to the expense of the extraction process. Ordinary complete marijuana doesn't require any special equipment. But economy of scale should drive down the cost of extracting CBD. Right now the lowest price with good quality is Green Mountain CBD in Vermont, at $30 per container of 30 doses of 20mg each -- whether in oil-filled capsule, oil bottle with dropper, or salve form. Every other brand I've checked or tried cost at least double that. But the prices will come down.

Ideally, once the FDA quits prevaricating, cannabis extracts would be manufactured and labeled like melatonin -- 1mg, 3mg, 5mg, 10gm, etc., so customers can choose the concentrations they prefer. If they need a slightly higher THC concentration they can use that. If it begins to impair them in any way, they can choose a lower concentration. People do that every day with many OTC meds and supplements.

Personally I think the government worries too much yet also inconsistently about physical and mental impairment from over the counter medications and herbal products. There are far more dangerous products than cannabis already available OTC. For example teenagers who can't buy alcohol can buy a bottle of generic Nyquil for a couple of bucks and swig it down to get some sort of high. Those multi-symptom cold/flu relievers contain multiple ingredients that have strong psycho-active effects, especially when combined -- notably at least three anti-cholinergics in the form of an antihistamine, a decongestant and a sleep inducer.

And melatonin and valerian root are readily available. Melatonin is produced naturally in the body but depends on a consistent diurnal activity/sleep cycle. The supplement can make some people very drowsy (which it's supposed to do) and I've heard several younger people say it gave them nightmares. I suspect that many young folks are unaccustomed to a diurnal sleep cycle with 8 hours or more of sleep and plenty of REM sleep. So anything that causes them to sleep soundly and longer may have effects that take some time to adapt to.

Valerian root has a long history of helping to relieve anxiety and to induce sleep, depending on dosage (and tolerance for the odor, which smells like musty gym socks to me). A handful of the capsules could conceivably make some people "high".

Same with diphenhydramine and many OTC meds, especially in the cold/allergy section of the store. And most of those carry far worse side effects, mentally and physically, compared with cannabis.

Anyone determined to get high could take a handful of melatonin, valerian root, Benadryl, etc., along with a handful of Sudafed or a six pack of energy drinks. Doesn't sound pleasant but some folks would try anything.

KraneXL

Depends on the injury or extent of the condition. The pain is caused by the inflammation so control that and control the pain. But the inflammation is a response to something else, not the cause. Have you tried weighted stretching for mobility and Voltaren gel (diclofenac sodium topical gel) 1% for the pain? Neither is a cure, but I have been getting positive results from both.

canklecat

Oh, yeah. I've been doing my own physical therapy at home. My ortho doc reviewed my exercise routine and said I'm already doing everything the PT clinic would do, and probably more.

Even before the shoulder injury I was doing some kettlebell type exercises (I use plastic jugs filled with water), for range of motion strengthening. For a couple of weeks I've been using the lighter jugs for gentle traction on the shoulders and some careful lifting, including weighted shrugs, etc.

After my early August ortho followup I may try the PT clinic since they have weight equipment and apparatus I don't have at home.

As a matter of fact I had a diclofenac prescription from my nurse practitioner (we don't often see the "geriatric" doctor in my routine health care clinic -- it's mostly handled by NPs). But after three unsuccessful visits to the health network's pharmacy I gave up and tried various OTC analgesics.

I was skeptical about diclofenac because unless it contains a transdermal carrier it won't be any more effective than the many tubes of topical analgesics I already have.

Most of the relief from typical OTC balms comes from the massaging. But with two dislocated shoulders (the left, my weak arm, is a very low grade dislocation; the right is Grade 4), it's very difficult to effectively apply any topical stuff. I've rigged up a helper using a bamboo back scratcher with a sponge. There's no massaging effect that improves circulation, relieves tense muscles, etc., so any relief is up to the topical material itself. If it doesn't work, it doesn't work, there's no massaging involved to blur the issue of efficacy.

I did a search and couldn't find any indication of a transdermal carrier in any of the lists of ingredients for diclofenac. But those lists may be incomplete. Often the transdermal carrier is not listed as an active ingredient, which is a mistake. And in the case of fentanyl and other patches the transdermal carrier is actually integral to the adhesive, so it may not be listed if the manufacturer considers it a trade secret.

I remembered my grandparents' generation of folks swearing by DMSO, which they bought from livestock feed stores and farm/ranch suppliers as horse liniment. I ordered some roll-on DMSO gel from Amazon and tried it for a week with various topical analgesics I already had: salicylates, menthol, camphor, eucalyptus, capsaicin. I couldn't tell there was any relief. By itself the DMSO caused some minor tingling and itching. Combined with capsaicin it produced some fairly uncomfortable burning, redness and blistering -- about like a bad sunburn. Fortunately I had some sunburn relief topical lidocaine, which relieved that discomfort.

So, I wasn't very impressed with the DMSO trick.

I saw an ad on Facebook for Ted's Pain Cream -- probably because I've posted a few times to friends about my recovery efforts from the shoulder injury, since some of those folks saw me in the ER back in May and have asked for followups. I don't mind that kind of targeted advertising on Facebook or via Google. I only object to irrelevant ads. If I was concerned about privacy I wouldn't discuss that stuff on social media.

Anyway, Ted's Pain Cream was developed by Dr. Ted Price, a neuro-scientist with UT-Dallas. So he had the bona fides and credibility. His balm contains fairly common ingredients -- a salicylate in the form of wintergreen, and resveratrol. The tricky bit is the transdermal carrier -- his balm uses MSM rather than DMSO, which is clever. It doesn't have the garlicky odor of DMSO or the tingling, itchy side effect. But MSM is a less aggressive transdermal carrier so he recommends using it for a week to evaluate the efficacy. It's been a week today and I'd say it does seem to be more effective than other topical analgesics I've tried. It costs $19, about the same as my copay for diclofenac, and cheaper than some other topical analgesics marketed to athletes. More expensive than a tube of generic balm from the dollar store, of course, but those aren't really very effective on anything other than skin disorders -- salicylate cream is actually useful for some skin rashes, even if it doesn't penetrate to the muscles and joints.

So I'd recommend Ted's Pain Cream with some minor reservations. It's not a miracle balm. It knocks down my worst shoulder and neck pain from a level of 6-8 on a scale of 10 to around a 4-5, tolerable but still there. I can function with pain level 5. At 6 it becomes intrusive. Above that it's difficult to get anything done. So anything that tones down the pain to a 5 is good enough for my purposes. Especially if it doesn't involve meds that make me drowsy or affect my balance.

Also, unlike DMSO, sun and heat exposure don't have adverse effects with Ted's Pain Cream. I rode in 107 degree heat Thursday for 3 hours and didn't experience any skin rash, burning, stinging, etc. In contrast I got pretty uncomfortable burning from capsaicin alone when outdoors, and much worse when combined with DMSO.

On a more cosmetic or convenience level, Ted's Pain Cream is made with great attention to detail. It's like a fine skin cream -- not excessively greasy, doesn't seem to stain clothing, seems tenacious yet also washes off my hands easily under tap water. I've ruined some t-shirts with other topical balms so this is a big deal for some folks, especially if they have to wear good clothing for work or social occasions. I'd suggest wearing a white t-shirt or comparable base layer, but Ted's Pain Cream shouldn't cause problems for most clothing.

KraneXL

This formula doesn't seem to need it, but is most effective on joints near the skin. If you use it frequently, there maybe some redness near the sight of application.Its not the best at penetration, so its advised to use on area near the skin that covers bone i.e. knees. Nevertheless, I do find so level of pain relief on my should/back. I also use it on my knees, but the greatest effect comes with my lower back where the pain reduction is near 100%.

I typically use it at night or before a workout so the clothing issue for me is inconsequential. Still, its a greaseless, odorless formula (after you rub it in) so at least I have that additional benefit to be thankful for. Its the only cream I've used that truly stops the pain, and is not just a temporary cover of heat.

canklecat

Incidentally, I just got back from some errands and checked the local pharmacies for topical analgesic rubs. Only two had any transdermal carrier, MSM (methylsulfonylmethane) in both cases: Blue Emu and a variation of the same thing by another company. Both were pricey, $20-$33. In both topicals MSM was among the primary ingredients, which may account for the higher price.

Again, some versions of diclofenac topical balm may contain a transdermal carrier to improve effectiveness. There are other transdermal carriers besides DMSO and MSM, but those are the two I'm familiar with.

For example, Topical Edge claims its PR Lotion can penetrate the skin with sodium bicarbonate to reduce lactic acid and improve muscle recovery. Sounds like voodoo to me and they wouldn't explain how they did it without a transdermal carrier. I'm skeptical. But some users swear it works. I suspect it works because users are massaging their muscles while applying the ointment. It's possible they'd do just as well using foam rollers or simply massaging their muscles with any lotion or massage fluid.

hexron

Wow thanks for the advice here everyone! I decided after talking to the doc and looking at MRIs to just rest and wait for my bike fit appointment which is about 3 weeks away anyway. I don't want to get a shot and then bike fit - cause then I'll just drive myself nuts wondering if the fit helped the problem. I need a rest probably anyway. Lots of other family/life stress as well. Might also get on a short Ambien run here just to power sleep for a couple weeks.

DaveLeeNC

I have osteo-arthritis in both knees (DOB 1949). After a period of time inflammation becomes a real issue. And the treatment (beyond all the ice that I can stand kind of all the time) is a steroid injection, and then a series of 3 hyaluronic acid shots. These don't work for everyone but they work for me. I end up needing to do this roughly every 9 months and it keeps me riding with minimal pain. But new knees are probably in my future.

dave

KraneXL

Have you tried weight training? I know, it seems counterproductive but in fact its actually just what the doctor ordered. I have the same disability and weight training has been a godsend not just for my knees, but my back as well. Its not a perfect cure, but it has set back the clock 10 years. Just start off slow and light. No pills or potions necessary.

DaveLeeNC

You and my doctor would agree. He believes that my high level of activity (150 to 200 miles per week) is the reason that I am still functional. From my doc "I have seen x-rays like yours on people who could barely walk with a cane". I don't know if more/different would be helpful or not.

dave

canklecat

BTW, since my July post here I've had an anti-inflammatory injection for my fractured and separated shoulder. The injury occurred in early May but was still causing a lot of constant pain. So during my last ortho appointment the doc did it on the spot rather than referring me to my health network's "pain management clinic". (More like pain misanthropy clinic. They have a three month waiting list, a crappy attitude and basically do nothing for up to six months even after your first visit.)

Took a couple of days to notice any difference but I'm having less chronic pain, although there's still bouts of sudden severe pain if I move carelessly.

And I'm still using a lot of topical analgesics (same stuff I mentioned above, primarily Stopain roll-on and Ted's Pain Cream).

But I'd definitely recommend the anti-inflammatory injection to jump start your recovery.

Especially if the pain is interfering enough with sleep to need Ambien. No way I'd take Ambien. I've seen too many problems with it in my own family. I'm sure it helps some folks but I won't take it.

KraneXL

I have chronic insomnia with problems falling asleep and staying asleep. I use Trazadone on occasion. Lately, I've been using a supplement call DIM and it works better than all the pharmaceuticals combined. The fact that it makes me drowsy was pure happenstance. I bought it as a remedy for hormonal balance.