Knees knees knees

[betagirl]

Ok, so I have bad knees (thanks dad!). When I was 14, I had to have surgery on my left knee for a chronically dislocating kneecap. Probably some of the worst pain in my life. It went out on me 5 times before I got it fixed. I was on the same course as my father, who had surgery at 16 on the left and 35 on his right. Well, I hit 30 this year and my right knee is starting to show signs of the same crap I had before.

Apparently the technical term for what I have is Chondromalacia, where basically my kneecap doesn't track properly. Currently if I'm in too big of a gear, I feel the pain behind my kneecap as it rubs incorrectly in the joint. It's nothing horrible, but I'm slightly concerned about RAGBRAI this year. The route is about 18,000 feet of climb over the week. Basically lots of rolling hills. Considering my knee is bothering me on the Chicago flats sometimes, I can't wait to see what hills do to it. It's currently slightly swollen, which my boyfriend pointed out to me tonight. Swell.

I'm not sure what to do about it. I've read what the physical therapy is for it - basically strengthening your quads and such. One of the exercises recommended is riding a stationary bike I suppose I could strengthen the muscles more than they already are, but I'm not sure what good that would do.

Does anyone else have this problem? Apparently it's pretty common in us girls. If so, what do you do? Part of me says get the dang thing fixed in the winter like I did with the left. I'm secretly mortified of having it dislocate on me.

Thanks!

oh and I do take celebrex for longer rides. I'm not really keen on wearing one of those braces on the bike either. I can't imagine how sweaty and uncomfortable that would get!

[salsabike]

Yes, I have had it ever since my ballet days. Best exercise: what they call short-arc extensions. I sit on the floor with a soccer ball under my knee to raise it up, and four pounds of weights on my ankle, and raise and lower my lower leg. They call them short-arc extensions because you are really only raising and lowering your lower leg the last 20 degrees or so of the 90 degree arc you have when your knee is completely bent (like when you're sitting upright in your chair).

Link to an excellent article: http://www.youtube.com/watch?v=_pGtY6e3fVI

[Lise]

Sorry to hear about it, beta. I think SK has the same thing, and had a number of surgeries for it.

[Kathi]

I have it too. My x-rays are showing signs of cartiledge wear.

It's the reason I started cycling.

Correct crankarm length is very important as well as saddle height. I spin my gears, no mashing. I use Speedplay pedals, my ortho recommends them and they keep my knees happy.

I was also told by my PT not to do the same activity the same day in a row, ie. riding the bike. I do not jog or do high impact activities. My drs. told me not to do lunges and squats. One told me, this was in 1994, to quit exercising.

Fast forward to today. I tore my ACL in Jan. and had surgery in late Feb. Just about everything I've been told is out the window!

I do lunges and squats almost on a daily basis, I'm working on muscle endurance and will eventually back off. I do leg raises and bridging on my fit ball. I'm now doing plyometrics.

My physical therapy exercises incorporate quad, glute, hip, hamstring and core strength. Many things I do for strength are on the Pilates reformer.

Currently, I'm riding 100+ miles a week and have 3 tours scheduled for later this summer.

Before I tore my ACL I did a weight routine that included lunges, squats or leg press, leg lifts, step ups and calf raises with 12-20 weights.

Anyway, I recommend that you find a PT that knows how to work with this issue and get on a good program for strengthening the quads so the pain doesn't get worse.

[Trekhawk]

Ooohh we have quite the club going. I have Chondromalacia in both knees and have just finished PT. Make sure you ice your knee after riding. I recommend you buy Andy Pruitt's Complete Medical Guide for Cyclists. I know Im always raving over this book but it really is jammed full of great info. It has a section on Chondromalacia and a section of stretches to help the condition especially strengthening the Vastus Medialis.

Avoid pushing big gears and until you get the condition under control avoid lots of climbing.

Hope this helps and GET ANDY'S BOOK.

[Kathi]

For me, the Vastus Medialus is the one muscle that has not come back yet. My therapist says its the last muscle to come back and it takes a long time.

The uninjured leg looks great but the injured one, I shouldn't complain, it's come a long way since March.

[KnottedYet]

A good PT can teach you to strenthen your hip external rotators (to stabilize the femur) and the vastus medialis obliquus (to keep the kneecap tracking properly). They can also get you stretching the tight stuff and teach you how to do myofascial release to your ITB and the retinaculum around your knee. And will be able to tell if insoles/orthotics will help on the bike or walking.

Tibial tubercle transfers and lateral releases are really last resorts. And you do have time before RAGBRAI to make a difference. PT could tell you how to keep things happier on the ride, too.

[TxRider]

I'm cursed with bad knees as well. Same thing - chronic dislocations and I agree, some of the worst pain you have ever experienced. I had surgery on the right knee for the first time while in college (tried the conservative routes up until then) and ended up having it repeated about 5 years later when it started dislocating again (last time at work - how embarassing!). Fortunately, the left one never went out as often, so I've been able to avoid surgery on it. However, not sure if I overcompensate with it, but I experience problems with the IT Band from time to time.

For me, the dislocations occurred primarily when I was kneeling/squatting down or sitting with my leg(s) folded beneath me, so I've learned to be careful when doing either. And, I also got to where I could tell when it was going to happen ... I'd feel that pull and immediately I'd try to straighten it back out to prevent it from happening. Didn't always work, but certainly kept it from happening more often.

I second the opinions others have expressed ... find a knowledgeable PT that can help you strengthen the quad muscles and try to avoid that surgery for as long as possible. I do appreciate the fact that it has given me another 6 years without too much constant fear of dislocations, but I also know that I gave up some strength in that leg as well as some stability.

[SadieKate]

Yikes! Lunges and squats! No way, Jose. Not for me. Let me say that again.

Prescription orthotics. Worn them since 1976 for chronic chondromalacia and I don't leave home without 'em.

In 1980, I managed to fall straight through a snowbank with a fully loaded backpack and my right knee had nowhere to go. What was chronic was now acute with a big, old gigantic tear. Fortunately, I could walk out of the backcountry and I have a strong as an ox brother who doubled-packed everything out. I carried the fishing rods.

After an arthroscopic scraping didn't work because the gouge was just too big(I got to watch the little lawn mower rotor rooter around in there!), my right knee was re-aligned with a Macquet Maneuver (tibial tubercle elevation) which I understand is no longer performed. The Los Angeles Rams' orthopod did mine which may have been why it has been successful for me (he had lots of really big knees to practice on first). The lower attachment point for the patellar tendon is actually excised from your tibia and bolted to another spot. Bye-bye competitive volleyball (I'm too short anyway); hello, cycling (and a handsome hubby/riding partner).

My chronic chondromalacia is caused by a number of things, pronation being part of it. The orthotic rolls my foot outward so that my tibia tracks in a straight line in the patellar groove as I bend my knee. So, it does solve my chronic issues but, of course, couldn't protect against acute injury.

I'm hoping one of these days to get some new prescription insoles as mine are not as low volume as are used for cyclists these days. I've been very interested in eSoles which TsPoet bought. http://www.esoles.com

I did short arc extensions until I was blue in the face when I was recuperating. Yoga, cycling and orthotics for me. And, no hiking downhill. Let me add a few more on that one.

Adding one last thing: no extra weight. Easier said than done or I would be the indulgent dorky dough girl, but somebody has to keep those peppermint mochas from escaping.

[salsabike]

Andy Pruitt's book IS great, and I got it on Trekhawk's recommendation.

My understanding is that anyone with anterior knee pain should avoid squats, lunges, and any weight-bearing knee bend that places your kneecap beyond your toes. And, by the way, I changed my crank arms to 165 mm.--the ones that came with my first bike were 175s!

[SadieKate]

Ditto on Pruitt.

BTW, TrekHawk, what's up with the mtb cranks?

[DrBee]

I had knee problems in both knees from my ballet days as well. I had my right knee dislocate 5 times in one afternoon of riding horses when I was 15. That was pretty much the end of my ballet days. I had surgery (lateral release) on both knees when I was an undergrad and it cured me. I have had no problems since. My knees will "talk" to me a bit when I start running, but by 5-10 minutes into it, they are fine. I haven't run into any problems on the bike. Strengthing the quads is not always the solution - that is what caused my problems. It's the other muscle on the inside of your leg (name escapes me at the moment). In women, the quad wraps across your leg above the knee. Over-strengthening of that will cause improper tracking. The jumping and other movements done in ballet accentuate this. Hence, the problem in women, especially dancers. When they did my lateral release, the doc said that he could see the patella pop back to where it was supposed to be.

[Nanci]

Beta, I'm sorry to hear about the knee problems. I think your only hope is to move to Florida. The brevet series here is much gentler and kinder, too.

Nanci

[betagirl]

Wow, thanks guys for all the tips. I've been mulling over seeing an orthopedic dude who I hope would refer me to a good PT. The surgery (lateral release) I had at 14 worked phenomenonally well (knock on wood). So I'm tempted to just have it done again. I know it sounds crazy to say that the surgery is the "easy" way out of this. But I tried the exercises when I was young. Grant it I probably wasn't that dedicated to doing them, so their efficacy was probably less than it could have been.

I did a pretty fast ride today, and had no problems. I was spinning a lot, no mashing, so I definitely think that's a big part of it. So I'll try to keep the cadence up. I've been better about that this year. I'll also check out that book.

Nanci - if they'd just do the Brevet's in Illinois, I'd be happy. I think the chicago area competes with FL for flatness. But noooooooooooo, we need to go to WI for them. RAGBRAI this year starts near Sioux City, and goes through some area called the Loess Hills. That should be painful. Guess Terry the triple will see a lot of action

[KnottedYet]

Fishdr- that's the VMO, vastus medialis obliquus. It's on the medial side of the whole quad complex and acts to pull the kneecap so that it stays centered in the groove. In those of us of a feminine persuasion, it gets inhibited and weak so it needs extra love. It acts to help straighten the knee in the last 10 or 15 degrees which is why everyone is running around doing short arc extensions. There are better ways to strengthen the VMO. If the VMO is already weak the larger quads can substitute in a short arc, so you end up in the same muscle imbalance you started with.

(i'm thinking externally rotated straight leg raises with feedback from just resting your fingers on the VMO, and functional activities like step-downs in front of a mirror and posture work)