hillcrawler

I am 37. I used to have long and sometimes hilly rides with an awful bike fitting/cadence, no hydration, no cooling down, etc. because I didn't know about all this stuff when I started as an amateur. As I started to ride longer and harder, one night I had some swelling and terrible pain on my knees. Then those pains became persistent. I was having them after each and every ride. I was thinking what I was doing wrong, but I never figured it out or it was too late because the damage was so big. Weird thing is I was riding pain free but just after few hours I get back to home I was having these nasty pain around my knees which was lasting for few days. At some point I was having knee pain even when I was sitting, walking, lying on bed and many days I woke up with pain on my knees even though I had stopped riding completely. I thought it was going to stay with me for lifetime but one day I had a crash on my motorbike and broke a bone on my ankle. That was a shock on my system I guess and my body forgot about my knees completely. All the pains had gone for the good and I am still almost glad that I had that accident because my life was so miserable with those knee pain and I had no solution having seen so many doctors, physios, injections etc. Maybe it was the long resting period because I didn't even get out of the bed for about 3-4 months.

Now I want to ride again but it seems impossible because when I try to have a ride with the easiest gearing and only 2-3 km long I end up having these random kneecap pain on both knees but they disappear next day. I envy those people who rides competitively even in their 50's.

Is there anything that I can do to do
at least 5 to 10 kms rides pain free?

Btw I am so skinny that I have almost no muscles on my thighs and became weaker after the crash because I have some atrophy on my right leg.

FBinNY 

Impossible to offer any specific advice via the Internet, except that it warrants having a pro use his knowledge and tools to make a proper diagnosis and work with you toward a solution.

This stuff can often be resolved with therapy, or some drugs, or a brace, and sometimes with surgery, but that's a last resort. However, it can just about always be resolved.

FBOATSB

You are going to have to continue physical therapy. Tell them what your goals are so they can give you therapy that is correct for your situation. You might have arthritis, like I do, so your going have to get treatment from your doctor. I take arthritis medicine. Most knee problems from cycling are also caused by bike fit so make sure your bike is not too small.

79pmooney

I cannot diagnose you, but I have had decades of experience with chrondomalacia patellae; the chafing of the kneecap on the bone under. I have managed to lice with it and ride well over 100,000 miles since I was diagnosed, much of it on fix gears. But I do have to keep the advice of the good doc who diagnosed me squarely in mind, always. I wrote the following years ago for another bike forum. It is just my experience but it incorporates more than I have ever seen in one place. Give it a read. It might be useful.

" 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

BobbyG

Perhaps a bike with electric assist?

hillcrawler

Thanks a lot 79pmooney for sharing experiences. I am sure my problem is also CP and a bit of arthritis maybe because sometimes I feel a biting kind of pain right at the back of my knee and inside where femur and tibia intersects.

My hamstrings, calf and also quads are always tight for some reason. I should start stretching them every day and work out those quadriceps as you mentioned.

The summer is so hot here in Turkey so warming the knees is not an issue. In the cold winter there is no way to keep them warm so I should avoid going out if I can ride again.

Let me try these for few weeks and go for a 3-4 km ride and hope for the best.

Rowdy

I had the same experience. No knee pain while riding but a few hours afterwards I couldn't walk. The swelling was bad. I had to ice my knees before I could walk. I changed my pedals to Speedplay with unlimited float. I have never had that pain again.

79pmooney

I had made kneewarmers that look like basketball kneepads but with a velcro "garter" that goes around "D" rings I sew into my shorts. 2 layers of 300 wt windblock polar fleece. I usually wear regular cycling kneepads over them, then the usual stuff for that weather. I wear them anytime the weather is below mid 80s F (29C).

If that interests you, I could send you the patterns. They have been huge kneesavers for me (literally).

I also now grind my coffee by hand, 350 turns and stretch both achilles and lower hamstrings using a PT block I made from a 1X4 nailed to a 2X4. (Primarily for my achilles, but help with the ham stretches as well)

Ben

hillcrawler

I think some of my muscle groups are shortened because I was not stretching at all after my tours. I cannot do some certain stretching moves like touching to my butt with my wheels when lying face down. While sitting on the sofa and stretching one leg, I can’t touch to my kneecap with my chin. If I can stretch those muscles maybe I can sort the imbalance on my kneecaps

CliffordK

It looks like a couple of month gap. Any changes?

The one thing that I would say is to keep at it. Perhaps start easy. If you can ride 2 km, then do those 2 km rides until you can work up to 3 km.

I've had sore knees for a while, but have found that riding really doesn't bother them that much. In fact, the more I ride, the better the knees seem to be. In fact, I'm better off if I ride every day than if I take a couple of days off from riding.

I do believe in moderate impact exercise in moderation, so some jogging is probably good (only a couple days a week), but I can't seem to get the motivation. Maybe when it is wet and miserable this winter????

One thing I would encourage you to do is to occasionally check your knee and foot alignment. When you're walking, are you walking with the feet straight forward?

When you're riding on the bike, are the feet straight forward? Cleats and foot retention can help hold the feet where you want them on the pedals, but of course, there is the risk of crashing as one is learning. Some "float" is probably good in general, or make sure the cleats are perfect if you go with zero float.

A recumbent trike can't fall over, and is easy to stop and take a rest whenever you need it.

Of course, you can get ideas on the internet, but consult with your doctors, orthopedists, and etc. They know your issues better than anybody across the ocean does.

Machka 

Hi @hillcrawler ... welcome back. Have you gone to a bicycle shop to get the fit of your bicycle checked yet after all this time?