Ferdinand NYC

Hi. I usually post in the Northeast forum.

I have been bicycling on a daily basis (excepting rain and snow) for the past five years. I lost more than 60 pounds back then, and have kept it off. I am a few weeks shy of my 51st birthday and in the best shape of my life, doing things that I couldn't have done when I was 30. For instance, I rode from New York to Washington this past July, and I have twice gone to Philadelphia. In the past three full years, I have ridden 5800, 6400, and 6800 miles; and I hit 1000 miles in the month for the past four Julys.

And then I had an injury. It wasn't a crash or anything that I could pinpoint. One day last month I just couldn't ride because of pain in my knee. This was a shock because in the previous two days I had ridden 42 and 53 miles with no problem; and I was in the midst of a typically good summer, averaging well over 200 miles per week during the previous two months of the summer.

An orthopedist initially guessed that it was a meniscus or tendon problem. But, after I had an MRI, he diagnosed it as a subchondral insufficiency fracture. I gather from reading that this is a type of stress fracture that occurs at the end of a bone, in my case at the bottom of the femur.

I have now not ridden for more than three weeks; and I will have to spend at least another three or four weeks off the bike while this thing heals. Of course what I fear is that I will never be able to get back to riding, that the problem will just recur when I try to ride again.

My question is: has anyone here had a similar injury? After such an injury, is it possible to return to daily riding, and to even do 100-mile days and 1000-mile months?

deacon mark

I am a runner and have had 2 stress fractures that I know of over 20 years ago pelvic ring. Could not run on the first one for 10 days and returned to running able to keep training. This was only diagnosed later when it showed up healed on an X-ray. I ask the ortho surgeon and he said that it was possible to run throught it after the 10 days given the pelvis is a double ring. You runners are something was his comment.

Two years later had on on other side of pelvis and did not run for at least 12 weeks. I both cases I could ride a bike and did but I was careful and keep the power light spinning more. Note I was 23 years younger.

Moving to 9 months ago I fell on my hip riding broke it in the neck. Was non-displaced fx was lucky 3 screws and back on trainer in 5 days only
Easy spinning. Started back running in 11 weeks no real loss of aerobic fitness and at my usual 30 mile weeks on about a month.

I mention this because cycling generally is not something associated with stress fx s due to low impact nature. I would quizz the doctor more about this and see what he says. You should be able to spin in it does not hurt to turn cranks. Also once a stress fx has healed and nothing unusual going on it should be fine. Frankly a stress fx can be a better injury to get over than some soft tissue problems that can last for months and even years.

Please note the Deacon is not a doctor take my
Advice with care.

Ferdinand NYC

Thanks for the response.

I am aware that it is more likely for a runner than a bicyclist to suffer a stress fracture. I guess that I am an unusual case, because I never run.

The doctor was pretty firm that it was indeed a subchondral insufficiency fracture. He said that the outer layer of the bone was collapsing at the lower tip of the femur.

To have my daily regimen of riding come to a screeching halt has been extremely frustrating. But if, after the injury heals, I can eventually get back to normal riding, I would be pleased. I only wish that I could be confident of that.

MinnMan

I don't have any experience with this particular injury, but much of your experience rings true - i.e.,seven years ago, in middle age, I became a dedicated cyclist and I ride mileage similar to yours (4600 miles so far this year) and feel great when I am healthy.

But I also have had several significant injuries that have kept me off the bike for long periods of time. And each time I fear that maybe this means I'll never come back to riding at the same level - that this is the injury that ends it all.

but so far I have come back from all of them. Maybe one day I'll encounter that problem that really does end my road riding days. I hope that I won't, but it certainly seems possible.

Best wishes for a swift and permanent recovery from your fracture.

Ferdinand NYC

I am sorry for your string of injuries. But reading that you have come back from all of them is most encouraging. Thanks.

John E

One way to protect yourself is to supplement bicycling with load-bearing exercises. We have all heard stories about 40-year-old bicyclists with 20-year-old hearts and 60-year-old bones.

Ferdinand NYC

What sort of exercises are you referring to?

MinnMan

And it's probably a good idea to have your vitamin D checked.

Bmach

Weight lifting is one load bearing activity.

baron von trail 

I have this pain in the knee of a surgically repaired femur (4 pins in the upper head) The pain radiates down from the the hip joint, but it is most severe in the knee. It's worst on chilly days while I am still wearing shorts. It's less a problem on warm days or when I am wearing leggings. I attribute the pain to a combination of cold, the surgery and pushing too hard on the pedals. I never considered this subchondral insufficiency fracture thing.

Makes me think.

berner

I can't say too much on the causes of your stress fracture but certain causes are known to cause reduced bone density. An obvious one is good nutrition. I'm not hiking very much these days but have hiked quite a bit up to several years ago. I noticed then in packpacking journals that stress fractures were common to long trail thru packpackers, These folks have difficulty getting enough good nutrition. In fact, my reading about nutrition indicates that an important part of maintaining good training practice is the nutritional aspect.

It is also known that weight training will also effect bone density. I suggest you poke around on google a bit to see what pros have to say about this.

CrankyOne

Cause? Osteonecrosis?

work4bike

Basically, all forms of strength training, i.e. weightlifting. We start losing muscle mass at age 30, even active people, that's why you see so many old people that have a tough time getting around and have problems with breaking hips. After developing a base thru weight training in your musculoskeletal system you might want to also participate in some forms of plyometrics https://en.wikipedia.org/wiki/Plyometrics

Too much emphasis is placed on cardio health, but not enough on the musculoskeletal system. Cardio health is easy to work on, compared to building the rest of the body, muscles, bones, connective tissues...

Some very good exercises to start off with are the basics, such as bench press, squats, deadlifts...

Ferdinand NYC

I do pushups, 100 in the morning and 100 at night. But I figured that, for the legs, the very act of pedalling amounts to exercise for the muscles and bones down there.


I spoke to the doctor again and asked him if he suggests any supplements (calcium, vitamins, etc.) or any dietary changes to address bone density. He said no, affirming that rest is the only thing to do. He said that he showed the MRI pictures to another doctor at the hospital, who confirmed that the cause was just the use.

While it's nice to know that there is nothing serious wrong in there, the doubt remains about whether the condition will recur when I eventually start riding again. To this question, the doctor said that many times a bone heals stronger than before. He said that, if I let it heal completely, and if I ramp back up slowly, then I have a chance of that bone being fine going forward.

work4bike

No, cycling is not enough to exercise the legs. This is a common misconception among not just cyclists but also runners. Also cycling doesn't do much for other parts of your musculoskeletal system, especially your back – which deadlifts are great for.

The problem is that cycling is very repetitive and while certain parts of your musculoskeletal system are being worked, other parts are not so much, so this creates imbalances. Furthermore, we cyclists tend to get into a routine and routines leads to plateauing, which is very bad for us older folks, remember we start losing muscle mass after age 30.

Some interesting reading: Strength training builds more than muscles - Harvard Health

Guide to Cycling Muscle Function | Bicycling

Just remember that these nutrients do very little on their own. To get the most out of them, you need to break down the muscle, something that cardio does very little of, especially after you get into a routine and it does nothing for many parts of your body.

Last ride 76 

+1

I'm outdoors a lot, love milk and other dairy products, and after my recent blood test was told that I am vitamin D deficient. Maybe has something to do with age and/or type 2 diabetes. Worth checking.

Hope you can get back on the bike soon!

Best Regards, Eric

Falchoon

I had a similar injury after a fall at work in February and was able to ride on the wind trainer about a week after getting out of hospital and back riding on the road a few days after that.

I have backed off the kms a fair bit (~500 down to <300), not really to do with the injury, just decided as I wasn't racing anymore I didn't need to train/ride as much. Plus I hate getting up at 4.30am to do bunch rides in the dark before work (was also paranoid post-injury of crashing and re-injuring my leg/hip).

I am probably 90% as fit as I was pre-injury and the fewer kms is keeping me fresher and actually sometimes faster than before. I ride 6 - 7 days depending on weather, usually not in the rain and just tolerate the frost.

Still can't run though, not that I was a runner before, but sometimes it would be handy to run to cross the road urgently if a car suddenly appeared or just for fitness when I couldn't be bothered dragging all my cycling kit out and making sure the bike is in rideable condition.

TCR Rider

I think that as long as you are able to maintain a positive attitude and treat your rehab like your life(style) depended on it you can come back from significant injuries and return to a high level of fitness. It may require some modifications in your activities but you can generally find a work around.
I was primarily a runner when I had achillies reconstructive surgery in 2011 at the age of 59. While I was recovering from that I had a cycling accident and fractured my hip. I had a total hip replacement which ended my days as a runner. At first I felt like I lost my best friend not being able to run but I found road cycling and made peace with it. Last year I rode over 9000 miles and generally ride between 150 and 200 miles a week with a fair amount of intensity.
I've had heart issues with ventricular tacycardia that I've had 2 ablations to correct and am still on the bike. Last June I had surgery to realign a fractured pelvis and a revision of the hip replacement. I'm still recovering from that mess but I am back on the bike and last week I rode about 185 miles with a long ride of 56 miles.
With each of these injuries I initially felt that I wouldn't be able to get back to riding at a level that would scratch my itch. It really amazes me what the human body can recover from if you really work at it and don't try and force your recovery. The body will recover on it's own time table not yours and you really have to abide by that.
Good luck