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Bad knees.

Old 01-07-21, 10:01 PM
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Helderberg
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Bad knees.

Any advice as to a good exercise to help with a knee issue. It is good on the flats but have to be careful when climbing. Problem here is that everywhere is a hill and I have to down shift to keep the stress of my knee. I have changed the rear cogs to 11-36 to help with the hills. Have adjusted the seat height and front/back to where it feels good but if I twist my leg walking I can feel it in my knee. I am doing exercises that I have found on Youtube to strengthen it and have mounted a bike on a trainer so I do not have to deal with any hills but that is so boring. Want to get back out on the road but would like to hear if anyone has worked through a plan to strengthen their knee? I wear a compression brace when I ride but not day to day. Trying to allow the leg to get stronger and not depend on the brace. Any advice would be greatly appreciated.
Frank.
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Old 01-08-21, 05:21 AM
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There comes a time when seeking a Professional Diagnosis IS advisable. Been there, done it and found out why I have my issues. IMO, see an Ortho or 2 or 3. I've seen 5 Ortho's for my knees, shoulders, wrist and have chosen 2. One is a hand specialist and the other a knee, hip, shoulder guy. Had a total shoulder replacement and my guy had me back on my bike 3 days after a total right shoulder replacement.

BTW, both knees are at the point of medial joint bone on bone due to lifelong bowed legs

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Old 01-08-21, 09:47 AM
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Originally Posted by OldTryGuy View Post
There comes a time when seeking a Professional Diagnosis IS advisable. Been there, done it and found out why I have my issues. IMO, see an Ortho or 2 or 3. I've seen 5 Ortho's for my knees, shoulders, wrist and have chosen 2. One is a hand specialist and the other a knee, hip, shoulder guy. Had a total shoulder replacement and my guy had me back on my bike 3 days after a total right shoulder replacement.

BTW, both knees are at the point of medial joint bone on bone due to lifelong bowed legs
I was trying to avoid this but you make a lot of sense. Hoping for that magical do this or try that but at 72 I will have to face the music and probably hear the song I do not want to hear.
Thanks again, Frank.
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Old 01-08-21, 10:09 AM
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What is the knee issue you're dealing with? Arthritis? Damage? It's hard to suggest how to manage the issue if we don't know what the issue is.

I have one knee that is arthritic and taking glucosamine daily has worked well for me. It's relatively inexpensive and makes me forget about my knee enough so that I can focus on pains elsewhere It does take time to start working, however... like over a month and you have to stick with it.

Other "tips" would include making sure your at your ideal weight so as to not stress your knees for no reason, make sure your pedals and cleats are aligned in a way that's comfortable for your knees, and consider doing leg exercises off the bike to strengthen the muscles around the knees.
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Old 01-08-21, 10:24 AM
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Iím contemplating experimenting with cleat placement on an old pair of cycling shoes. Iíve got one bad knee (RIGHT) myself. Repaired torn meniscus. For me, just regular spinning isnít painful. Even climbing in the saddle isnít painful. But if I get out of the saddle...itís really too painful to do that. That increased pressure on the toe makes the pain worse at my knee. Seems like a lever-fulcrum situation going on. One day going up a hill on my commuter bike with flat pedals, I notice that if I put my heel on the pedal instead of the ball of my foot that I could get out of the saddle without pain at the knee. Consequently, I adjusted the cleats as far back as possible on my cycling shoes (shortened the lever). That diminished the pain some...but not completely. So...using a pair of old cycling shoes...Iím going to drill holes and try mounting cleats much farther aft and see how that works out. If done a little reading on it and found that there are some triathletes whoíve also made unorthodox cleat adjustments like this.
Dan
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Old 01-08-21, 11:03 AM
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I keep knees healthy by doing other exercises, not just cycling, to keep all areas of the musculoskeletal system in good shape, including running. We cyclists (and runners) primarily use our quads, since cycling/running is a quad-dominate exercise; this leads (over time) to muscular imbalances. I do all kinds of exercises with heavy weights and bodyweight, i.e. jumping. Deadlifts are one really good exercise for working your posterior chain. A lot of people do deadlifts incorrectly, mostly working their back muscles; however, when done correctly it's your glutes and hamstrings you'll feel it in.

I can do deadlifts with sore quads, so sore I can't do a single squat, but if I do the deadlift correctly, I will barely feel it in my quads.


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Old 01-08-21, 12:03 PM
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I've had knee pain (front lower patella, in both, but mostly the left) since 2017, probably due to 1,000+ watt sprint training. I went to an ortho specialist last year, got an MRI that was ~$700 out of pocket, had it reviewed, and was told "I don't see any problems in there. Here, wear this $200 silicone/velcro brace." Then went to PT, ice therapy, cold therapy, electrical muscle stimulation, dry needling acupuncture, etc... 2 days a week for 6 months and saw little to no effects, other than a lighter wallet.

"Fool me once, shame on— shame on you. Fool me — you can't get fooled again." -George W. Bush

Now I just reduce my power and spin, and watch my power meter to be less than ~230 watts (any more and I'm just asking for a week of pain), and I also installed an eBike front wheel on my commuter to take the sting out of the steeper parts of my southern Denver commute (RT = 26 miles 1,500'), and I try not to take pain relievers (IB, Tylenol, etc) prior to a ride, since that seems to mask the pain while riding, thereby allowing me to push harder than I should be, causing more pain afterwards.

3,500 miles last year, with a trip up to the summit of Mt Evans 14,100' (highest auto road in the US, 3rd highest in the world). Slow and low, just below the threshold of pain, and I can go just about anywhere, with a 8% grade or less, 34/32 gearing.

But IF I could find another ortho that wouldn't charge me until the problem was fixed, I'd do it again. But I'm no longer willing to throw another $1,500 at it, without assurances.

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Old 01-08-21, 12:45 PM
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Knees are strong in the usual movements, front to back, of running or pedaling. They are much less strong in lateral movements. I have devised a series of lateral strengthening movements with ankle weights. If my knees begin to complain, I step up these exercises. I don't claim that these exercises are the ultimate. Looking around You Tube there are dozens of exercises that do the same thing. The link shows one such exercise. Poke around You Tube and pick several you can do at home with minimal equipment and do a bit every day and good luck.
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Old 01-08-21, 02:54 PM
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Originally Posted by _ForceD_ View Post
Iím contemplating experimenting with cleat placement on an old pair of cycling shoes. Iíve got one bad knee (RIGHT) myself. Repaired torn meniscus. For me, just regular spinning isnít painful. Even climbing in the saddle isnít painful. But if I get out of the saddle...itís really too painful to do that. That increased pressure on the toe makes the pain worse at my knee. Seems like a lever-fulcrum situation going on. One day going up a hill on my commuter bike with flat pedals, I notice that if I put my heel on the pedal instead of the ball of my foot that I could get out of the saddle without pain at the knee. Consequently, I adjusted the cleats as far back as possible on my cycling shoes (shortened the lever). That diminished the pain some...but not completely. So...using a pair of old cycling shoes...Iím going to drill holes and try mounting cleats much farther aft and see how that works out. If done a little reading on it and found that there are some triathletes whoíve also made unorthodox cleat adjustments like this.
Dan
This is interesting as I use flat pedals on my gravel bike and found that if I flatten my foot at the bottom of the stroke my knee hurts much less. Have been doing knee exercises for a while now and using my elliptical at a slow pace to try to gain mobility and strength. Walking doesn't seem to bother it as much as bearing down on the pedals climbing hills and at some point I run out of gears to go down to. Thanks for the input.
Frank.
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Old 01-08-21, 03:38 PM
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Exactly where in or around the knee does it hurt? What makes it hurt worst? Does it hurt walking down stairs? Up? Do one-legged calf raises on a stair hurt in that same place?
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Old 01-08-21, 03:42 PM
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Good. Experiment some more with raising the heel more or less and moving aft or forward on or off the saddle. If it hurts some now matter what machine you use and during a walk, try to see the doc as mentioned above. At least then you can plan for whatever might need to happen later. I'm determined to get my knees done while I'm still young. My dad waited too long and now surgery is not advised at his 85 years. He crashed about 6 years ago and the required hip surgery post op was not pretty.
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Old 01-08-21, 04:27 PM
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Originally Posted by Carbonfiberboy View Post
Exactly where in or around the knee does it hurt? What makes it hurt worst? Does it hurt walking down stairs? Up? Do one-legged calf raises on a stair hurt in that same place?
I will do some different exercises and keep track of what and where it causes pain. Thanks for the question and post.
Frank.
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Old 01-08-21, 06:26 PM
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Originally Posted by Helderberg View Post
I will do some different exercises and keep track of what and where it causes pain. Thanks for the question and post.
Frank.
Knee injuries/pain must be the commonest thing like that among cyclists, and "injury" is rather too broad a word. Sometimes it's just a swollen bursa or similar. Knees are complicated. The issue is sort of like this . . .yes, a sports orthopedist would be a fabulous resource here. Too had we don't have a poster like that, and too bad they're not easier to see and too bad knee issues are not easier to diagnose.
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Old 01-08-21, 06:49 PM
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Presuming the op does all the normal stuff like warming up before riding hard, maintaining a good cadence, controlling his weight, and had a proper professional bike fitting, then my suggestion is he see a good sport doctor.
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Old 01-08-21, 09:43 PM
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Besides the other advice, consider shorter crank arms if you're using 175 or even 172.5. My bike cranks range from 170 to 175 but with age I'm feeling some knee strain from the longer cranks.

And there's no advantage to longer cranks for me -- I'm 5'11", 33" inseam, and technically I can ride 175 cranks, but the only reason I have 'em is because a couple of bikes came with those cranks. For awhile they felt okay, but now I'm feeling knee twinges.

As soon as I switch to my bikes with 170 and 172.5 cranks, the knee strain clears up. I might even try 165 cranks if I can find a set for my older steel bike.

FWIW, I've had a full body skeletal diagnostics since I was hit by a car a few years ago and my doc later discovered I have osteopenia -- not osteoporosis, which does run in the family, just the early warning signs. The scan revealed several old healed fractures above the waist, but no problems with my knees. So the pain is just age, muscle strain, usually exacerbated by sudden weather changes -- I can feel barometric pressure shifts in my joints now. I used to laugh when my grandparents said that. I'm not laughing now.

I also do a lot of physical therapy stuff at home, after visiting a PT clinic 2-3 times a week for a few months in 2019. A lot of my perceived joint pain turned out to be referred pain from adjacent muscles. So I do stretching, massage, use a percussion massager, topical analgesics, hot soaks in a tub with Epsom salts, etc. Keeping my quads, lower back muscles, hips, etc., in shape helped reduce the perception of joint pain in the knees and hips.
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Old 01-09-21, 08:44 AM
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Thank you all for taking the time to add to my post. At this point I am trying to make an accurate record of what I feel, where and what I have been doing at the time. I have a yoga based routine I do 5-6 days a week that I do because of herniated discs and back surgery due to paralysis of my left leg back in 2001. I am now adding specific work for my legs and knees that I started before I made this post, it has only been about 3 weeks now, and has seemed to have made some improvement. Again thanks so much for the information and I will add I have also gained some weight over the past Holiday period that I have to drop.
Frank.
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Old 01-09-21, 01:44 PM
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Stairs

Best exercise I have found for my knees is walking up and down stairs. Perfectly balanced workout.
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Old 01-09-21, 07:37 PM
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Yep, seek proper medical expertise from an Ortho. Your knee may not be tracking correctly. Have them also watch your cycling pedal stroke. If you are riding 'bow legged' - that is with your knees pointed slightly outward, that will cause all sorts of problems!!!
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Old 01-12-21, 12:43 AM
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Physical therapy. Those peeps can give you some great exercises and body mechanics tips. Thatís been my experience.
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Old 01-13-21, 09:58 AM
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Hydration also plays a small part in joint pain. Be sure you are always well hydrated.

Anytime on a bike that I felt any inkling of a pain in my knees, I'd be sure to drink more as well as shift to an easier gear. For a while I was working as a machinist and stood for eight and a half hours a day. Anytime I felt a back ache coming on I'd guzzle down a bottle of water. The pain was gone before it ever became an issue.
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Old 01-17-21, 09:37 AM
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My knees have bothered me now and then since I was 20 years old. I put up with it forever. My knees always hurt climbing or descending stairs. I could tell when i overdid it the previous day if coming down stairs in the morning hurt more than usual. 10 years or so ago, my wife went whole-foods-plant-based (vegan) to successfully deal with some health issues and I gradually joined her. Guess What!? I have been coming down the stairs each morning for the last several years without pain. I am not easy on my knees, had a couple meniscus repairs, bowlegged, pronate, flat footed. My understanding is that animal products cause inflammation.
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Old 01-21-21, 10:03 AM
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Originally Posted by OldTryGuy View Post
There comes a time when seeking a Professional Diagnosis IS advisable. Been there, done it and found out why I have my issues. IMO, see an Ortho or 2 or 3. I've seen 5 Ortho's for my knees, shoulders, wrist and have chosen 2. One is a hand specialist and the other a knee, hip, shoulder guy. Had a total shoulder replacement and my guy had me back on my bike 3 days after a total right shoulder replacement.

BTW, both knees are at the point of medial joint bone on bone due to lifelong bowed legs
I certainly second this advice, find the best surgeon you and your insurance can afford. I'm lucky that my knee guy is local to me, as opposed to my ankle and hand guys, which are 45 minutes away. You want the one that does HUNDREDS each year. And be just as picky with PT after any procedure. My knee doc did my left knee just over 10 years ago, and my right knee just over 3 months ago. My left ankle is being evaluated for replacement or fusion by the guy that fixes others mistakes.
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