my worst enemy

[sundial]

I have a knee that's been described by my ortho as a knee of an 85 yr old. The medial compartment is gone. The knee cap likes to grind and pop. With that being said, I am cycling 2, sometimes 3 times a week but would like to be able to go longer or more frequently. Lately, I've been spinning more on the bike (85-95 rpm) but I've noticed my knee is alot stiffer off the bike--to the point that I want to wear an elastic support bandage post workout. It seems that the times I have the achiest knee is when I do steep hills or ride into a stout wind--and spinning while doing so. Is it possible that by spinning I'm actually making it worse? I know it's a silly question and forgive me for asking but I wonder if I'm better off doing a lower cadence? I really wish I could do more on the bike but my knee is a party pooper. It's so frustrating to know that I have the stamina to go further but I'm limited by the moodiness of my knee.

Sorry about the long rant. I guess I just needed to vent.

[ame]

I think pain is typically a good message that some adjustment is needed, and if a lower cadence keeps you pain free, then that's what you do. I'm two years post-op on a knee that was really put through the wringer (including cracking the patella in half). To be honest, cycling is the one thing that doesn't tend to give me problems UNLESS I slack with weight training (strong muscles around the knee compensate for the loss of my medial ligament; others were repaired or replaced with cadaver, yummy). That said, I can't use a spin bike at the gym b/c the fit is never right, and then I pay for it in pain later. However, it hurts BAD if I try and mash for too long, which has been a problem for me doing hills (I have to learn to stand more). If I keep my cadence upwards of 82+, I can go all day 100 mi+ no problem. However, 30 minutes at 70 rpm and I'm hurting the next day. So, I don't think your problem is spinning per se, but the extra pressure on your knee doing hill work. For me, body positioning when climbing is key. I try and think of my leg like a piston - if I'm sitting, I slide my butt back and try and make an imaginary straight line forward and when standing I stand forward and my leg makes a straight line going back somewhat towards the rear wheel. If I'm sloppy, the knee let's me know the next day and then some with a deep ache. Of course, at 30 my body is still in the range where I think I got fairly good injury recovery, considering. However, I didn't actually feel that way until the last year when I committed to dragging myself to the gym 2-3x per week (no less) for weight training . Up until then, I still had a noticeable limp.

And, might I add, knee pain SUCKS!

[OakLeaf]

Pardon me if we've already had this conversation - but how long are your crankarms? Shorter cranks mean a smaller range of motion for your knees. In particular less flexion at the top of the pedal stroke. That makes all the difference to me. With cranks that are too long, every pedal stroke irritates my knees, so spinning (more pedal strokes per a given distance) by definition is worse than mashing.

[sundial]

Oak, I believe I have 172.5 mm crank arms. I asked my ortho about this some time ago and he seemed ok with it (he's a cyclist as well). The thing is when I spin at a high rpm my R knee is so stiff right off the bike and I walk almost stiff legged for the next hour or so. (Remember Festus from Gunsmoke? ) I didn't have to do this at a cadence of 70-80. I did my first Spinerval of the season and when I finished I was at my dumb knee. I felt great otherwise. I found out I can spin with platform pedals.

[OakLeaf]

See, I can't even ride 167.5, it's 165 or shorter. It's unbelievable how much difference those few little millimeters make to my knees. I'm 5'3", but I think I have short femurs.

Can you borrow a bike with shorter cranks to see how it feels?

[Crankin]

+1 to 165 cranks.
My LBS pitched a fit when I told them to order them, after they had installed 172.5s. I could barely find a comfortable position with them and the one ride I did left my knees aching. I can spin like crazy with my little cranks!

[carolp]

you haven't said how old you are, but has your ortho talked to you about replacement? I had knee replacement four years ago and my only regret is that I didn't do it sooner. I'm 58 and my right knee is now starting to give me grief. Cycling actually helps, but I'm seriously thinking about getting the other one replaced.
If you do go that route, make sure your doc has done tons of them. The guy who did mine does nothing else.

[sarahspins]

I asked my ortho about this some time ago and he seemed ok with it (he's a cyclist as well).

Two problems with this statement.. your ortho really can't speak for what is comfortable for *you* on the bike, and just being a cyclist does not make him an expert on bike fit... especially because there's a fairly wide margin of what is "okay" on paper, but probably doesn't work in actual practice. 172.5 cranks may be fine for many.. it sounds like odds are good they're not fine for you.

I'd try shorter cranks.. because I think you'd know right away if that helps or not

[KnottedYet]

Oak, I believe I have 172.5 mm crank arms. I asked my ortho about this some time ago and he seemed ok with it (he's a cyclist as well). The thing is when I spin at a high rpm my R knee is so stiff right off the bike and I walk almost stiff legged for the next hour or so. (Remember Festus from Gunsmoke? ) I didn't have to do this at a cadence of 70-80. I did my first Spinerval of the season and when I finished I was at my dumb knee. I felt great otherwise. I found out I can spin with platform pedals.

Did the ortho have you bring your bike into his office?

Did he put you up in a trainer stand?

Did you spend several minutes spinning before he checked your fit?

Did he check your knee mechanics at several pedal positions?

Did he evaluate your cleat position?

[sundial]

Knotted, I have not done any of the things you have inquired. (I'm riding on platform pedals because I found that riding clipped in made my problem worse.) I'm wondering if I have chondromalacia. I'd like to try some exercises and see if that helps.

Sarah, Crankin and Oak, I'm 5'6" with an inseam of 31". I don't know how shorter cranks will feel for my height. I do know that it doesn't feel like my knee is too bent at the top of the pedal stroke with my current set up. But then again it might feel even better with shorter cranks.

Carolp, a total knee is the only option at this point but I'm young enough (40+ Club ) that the docs don't want to do it unless I really want it--which I don't.

Thank you all for your suggestions. I'm going to rummage around the garage and see if I can find some shorter cranks to try.

[sundial]

No luck with finding a shorter crank so I will give my LBS a call and see if they have a gently used part that I can try. I also found out that I do have "severe chondromalacia" per the doc's diagnosis. I guess then I probably won't be able to ride relatively pain free on the bike then? Even with quad/hamstring/glut exercises?

[KnottedYet]

No luck with finding a shorter crank so I will give my LBS a call and see if they have a gently used part that I can try. I also found out that I do have "severe chondromalacia" per the doc's diagnosis. I guess then I probably won't be able to ride relatively pain free on the bike then? Even with quad/hamstring/glut exercises?

Chondromalacia is always a symptom of something else.

Something is out of whack with your body mechanics or posture or habits, and that causes the cartilage on the back of your kneecap to get wolloped.

Just like having sores in your mouth is a symptom of something else (say, eating sharp tortilla chips) which will go away if you fix the cause (taking smaller bites of chip and chewing more carefully); so is chondromalacia.

Randomly strengthening leg muscles isn't guaranteed to fix your mechanical problem. (what if your chondromalacia is caused by excess tibial torsion from an overly-strong medial hamstring? Strengthening your hammie won't help then!) Ask the doc to figure out what caused the chondromalacia in the first place, then work with a PT or trainer or whatever to address the actual cause of the problem, it will be much less frustrating that way.

If your medial weightbearing surface of the knee is truly "gone", then you are a candidate for replacement. Perhaps a hemiarthroplasty would be appropriate. Depending on the issue, synvisc might be appropriate. There are a lot of options, but first ask just what he means by "gone." There are lots of folks running around on bone-on-bone knees, so leaving it alone and working on proper mechanics and supportive muscles might be an option, too.

Whatever imbalance or mechanical problem caused the damage to the medial surfaces is probably the same thing that is causing the chewing up the backside of the kneecap. Two birds with one stone if you can narrow it down!

(and if your doc didn't actually look at you on the longer cranks on your particular bike, I'm not sure I'd take his word that the longer cranks are fine.)

[cyclingphysio]

I agree that chondromalasia is a reflection of a problem, but at this point it sounds advanced, so the game plan is different. What it sounds like is a force production problem, a technique issue where you are doing too little hip extension to turn the cranks and therefore using too much knee extension.

This is the most common error I see. The solution is to improve the coordination in glut max so you can better turn the pedals from the hips, less withthe knees. Easier said than done. What is interesting is that most people with this problem have an easier time when grinding, I think because it is easier to push from the gluts when your legs are moving slower. The problem there is as everyone will tell you, it shreds your knees after a while.

The best solution is as I said, try exercises that improve your ability to fire your gluts first, as you improve your control you'll feel an improved ability to use them on the bike. Try this exercise first http://cyclingphysio.com/?p=132

This

[sundial]

Whatever imbalance or mechanical problem caused the damage to the medial surfaces is probably the same thing that is causing the chewing up the backside of the kneecap. Two birds with one stone if you can narrow it down!

You're right, Knott. The post-op pt that has been prescribed in times past always addressed chodromalacia with strengthening exercises for both the quads and hamstrings and gradually increasing the flexion of the affected knee. When I wasn't due for spring cleaning of the knee, seems like I've had to meet with the ortho during the high point of my cycling season for pain around the kneecap, stiffness, and occasional swelling.

What it sounds like is a force production problem, a technique issue where you are doing too little hip extension to turn the cranks and therefore using too much knee extension.

Cyclingphysio, I've wondered if I haven't been using enough of my gluts. I have a tendency of raising my seat post a little higher--but not to the point that I'm rocking in the saddle. Maybe that causes me to use more of my quads than gluts? I had my saddle a little higher when I was using SPDs but now that I've switched to platforms, I've lowered my saddle about 3-5mm and I am able to keep my heel down as I pedal.

[OakLeaf]

Mmmmmmm.....

What I used to do before I had a road bike with 165s (and what I still do on my little commuter, which I almost never ride more than ten miles at a time) was to set my saddle height too high so that my knees didn't flex excessively at the top of the pedal stroke. Ultimately that contributed to problems with my calves and Achilles, but it spared my knees.

Basically, too-long cranks create a situation where your seat height is simultaneously too high (at the bottom of the pedal stroke, where your knees are excessively extended) and too low (at the top of the pedal stroke, where they're excessively flexed). A good fit will check your knee angle throughout the pedal stroke, not just at the bottom.

That you too have compensated by setting your seat height too high is suspicious, IMO.