Anyone else have ACL trouble?

[Flatlander]

I have a dicey ACL--partially torn, what the ortho calls "stretched."

It's been this way for years, and aside from occasionally "going out" on me when I'm walking, it only bothers me when I turn my bike into the wind. After a couple of miles, I'm hurting.

Oddly, it never bothers me when I run or swim; just when I ride.

I've tried several positions with my cleats, moving the saddle up, down, forward, back. It still bothers me.

I'd like to ride bigger mileage, but I seem to top out at around thirty miles, sooner if it is at all windy (I live on the PLains, so this is common). I've only been riding seriously for about about six months, so maybe this is something that will take care of itself as I build up a base, but right now it is frustrating to feel limited. I'dlike to increase my mileage to fifty miles in a single ride, but I can't see that happening anytime soon.

I've googled ACL and cycling, but all I get is stuff that says cycling is good for ACL rehab . Nice to know, but not especially helpful in telling me why I keep having problems.

I was wondering if anyone else had this problem, and if so, have you been able to find a solution?

[Kathi]

I had ACL surgery in late Feb. I tore it skiing so I didn't have any problems before I tore it.

I've been slowly increasing my mileage and it's not happy. There could be several causes but one thing is that my saddle, because of my healing knee, was in a half a dozen positions. We think I just have not adjusted to one consistent positon. I've been mostly doing 25-30 mile rides but jumped to a 50 miler and my knee has been talking to me ever since.

Anyway, if your sure your saddle height and position is correct my only suggestion is to be sure you have built a good mileage base early season and increase your mileage slowly. What pedals are you using? Speedplay pedals have kept my knees happy over the years.

Do you have physical therapy to strengthen the muscles. If you do are you doing it on a consistent basis? I backed off mine for a few weeks to ride more, that's another reason the knee could be talking to me, and are you stretching?

I got over confident, thinking I was healed and started ignoring my knee. Well, it told me in no uncertain terms it wasn't healed and I need to pay attention to it. So, I'm back to icing, stretching and strengthening.

[Kathi]

Also, make sure you're spinning in easy gears. I know its harder to do in the wind but a higher cadence is less stress on the knees.

Another thought, crankarm length. Are your using the correct length? I use 165mm on my road bikes and had 170's on my mtn bike. I noticed irritation with my knees with the longer cranks (I also have chrondomalicia) so I put 165's on my mtn bikes.

[KnottedYet]

The ACL is so important for controlling the shear forces at the knee, stabilizing the knee. When it poops out the hamstrings have a huge role to play taking over the shear/stability job as much as they can.

Is it possible that your quad/hammie force is out of balance for you on the bike?

Keep doing all your hammie exercises, so that at the very least they will help your knee by virtue of sheer bulk; but also ask your PT to check you on the bike and help you adjust things so you kick in the hammies more if that is needed. (and this is something a PT should do, since a bike shop will be aiming for a different standard which isn't going to be the same as needed for a stretched or torn ACL)

You might want to take a peek at "Andy Pruitt's Complete Medical Guide for Cyclists" Velopress 2006.

[Kathi]

The ACL is so important for controlling the shear forces at the knee, stabilizing the knee. When it poops out the hamstrings have a huge role to play taking over the shear/stability job as much as they can.

Is it possible that your quad/hammie force is out of balance for you on the bike?

Keep doing all your hammie exercises, so that at the very least they will help your knee by virtue of sheer bulk; but also ask your PT to check you on the bike and help you adjust things so you kick in the hammies more if that is needed. (and this is something a PT should do, since a bike shop will be aiming for a different standard which isn't going to be the same as needed for a stretched or torn ACL)

You might want to take a peek at "Andy Pruitt's Complete Medical Guide for Cyclists" Velopress 2006.

I know my quad is still weak, the toes on my injured leg point slightly down so I started doing single legged pedaling to help retrain my pedaling stroke. After 3 sets my injured quad was really tired. I wonder if other muscles are trying to compensate for the weakness.

[KnottedYet]

Quads are a two-joint muscle group. They flex the hip and extend the knee. There are other critters who can subtitute or compensate.

Downward toes sounds like a substitution of ankle plantarflexion for part of what should be knee extension. (just another way to push the pedal. your body doesn't care what joints or muscles it uses, as long as it gets the pedal to go around)

Pedalling with one foot is a cool way to work the muscles. (and it strengthens those all important hamstrings in the back of your leg!)

Be sure to keep doing both the open chain (like standing hamstring curls) and closed chain (like hamstring bridges) exercises your PT gave you. Hammies are your friends!

[Kathi]

Knotted Yet,

Thanks for the hammie advice. I was working them pretty much then backed off. Looks like I need to pay more attention to them.

My LBS fitter says a saddle that is to far forward can cause shearing too but the set up on my new bike is right on. Actually, he said I had my saddle just right on my old bike too.

My therapist thought that since I was biking so much I didn't need to focus as much on the pt. Interesting, my bike fitter didn't think the cycling was a good substitute for the pt.

[Flatlander]

Thanks, y;all! This has given me some hope that I can work through this thing.

I'm going to take a week off from cycling to get the ACL calmed down. In the meantime, I'm going to keep doing the weight work, but stick to closed chain stuff (no more quad extensions!).

When I do get back on the bike, I'll make sure to spin in those easy gears (no mashing!), and take my time to build up a base. I'm training for a sprint tri in September, so there's not really any need for me to do more than 20 miles or so in training right now. I think I need to wrap my mind around building my base for a solid year to get up to longer distances, instead of trying to do it this year...Plus a year of building the hammies can only help, right?

I'll also start looking around for some help with bike fit/sports PT. I'm not sure I'll be able to find this in my town, but it doesn't hurt to look! In the meantime, I'll order that book you recommended, Knotted.

At least I have a plan now!

[Flatlander]

Hi Kathi and KnottedYet!

I thought I'd give you an update on my ACL trouble. I went for a ride on Sunday and did fine for about 20 miles or so, until I turned into the wind. The ACL started acting up almost immediately--so much so that I worried about making it home. I was contemplating the DHwhen I had to stop and get off my bike to walk through some construction. I noticed that the ACL didn't hurt at all when I was walking. FOr some reaosn, I decided that what this suggested was that my seat needed to be higher. I adjusted it (I had already moved it forward a day or two earlier) and noticed immediatley relief--almost 85-90% better. It was so much better, in fact, that I went one to ride a few extra miles before going home.

Yesterday I went into an LBS and asked about bike fit if one has an ACL problem. The solution that was suggested to me was to move the seat forward and higher (!).

Anwyay, I took it out again today, and again the wind came up. However, no ACL pain *at all*.

Meanwhile, not content to trust the seat position as a total solution, I've also added hamstring curls and squats to my regular routine. I've also ordered the book by Andy Pruitt that was suggested. Hopefully, he'll have some things to say about this...

I'm really pleased, and hope that these "fixes" do the job. Thanks for all your help!

[KnottedYet]

Hooray!!

Glad you found the way to ACL happiness! Now, keep those hammies strong and flexible, and call for help from a PT/ortho if you need a tune-up.

[kaybee]

Flatlander, glad to hear you solved your problem. I had an ACL reconstruction six years ago using a hamstring tendon, and have found that I absolutely HAVE to do the weight workouts for the quads and hamstrings, even after all this time. Like you, running has never bothered me, but cycling sure did point out that that hamstring was not and probably never will be as strong as the other one, since the tendon is being used elsewhere. No matter what they say, it ain't the same as originial equiqment! Anyway, I just wanted to let you know that you are not alone.

KB

[xeney]

My husband is about to have his fourth knee surgery after he tore his ACL about eight years ago. Don't be scared by the four surgeries, only the first two were directly related to the original skiing injury; he then fell while rock climbing and broke off the top part of his tibia at the spot where the bolt from the first surgery had weakened the bone. The next surgery is to remove a bolt from the third surgery, because it's causing pain and coming through the skin. Don't go falling off any rocks and you should not have these problems!

Anyway, it took him a while after the initial reconstruction to be able to ride like he used to ride, but he still considers cycling the one thing he can still do as well as he did before the injury. He did a ton of PT after each surgery, and spent some time on a stationary bike, and then for almost a year rode only a mountain bike with slicks, because avoiding falls is so important after ACL surgery and he wanted extra stability. (Don't ask me how he got from that level of caution to climbing rocks without a harness ... I am not in charge of his brain. ) The falling issue is something to worry about, unfortunately -- when he broke his leg, he also damaged the 'new' rebuilt ACL, but at this point there is nothing they can do about that, because they can't build him another one given the other damage to the leg. He's looking at knee replacement in another ten years or so, because of the subsequent damage. (He's 34.)

But he did get back on the road bike after about a year following the ACL surgery, and it wasn't even that long after the broken leg, and it is his primary exercise. He does do weighted squats and other exercises that he got from PT, but he is more likely to have pain from those exercises than from cycling. He can't do any kind of leg extension exercises: his doctors forbid them, and he says they cause instant severe pain. And it took him over a year after each of the two majory surgeries to get his leg muscles to "match" again.

He has had trouble recently with pain and he is having a lot more problems with bike fit than he had before. And he's mostly given up mountain biking, because he found that after years of using clipless pedals, and using them just fine on a road bike, he's lost the range of motion in his knee that he needs to reliably unclip on his mountain bike when the pedals are all gunked up with mud. (He found that out the hard, painful, falling-on-rocks way. Since he didn't get hurt, it was a little funny to watch.)

I just bought Speedplay Frogs for myself but I am going to have him try them out because I think that pedals with float would be a very good idea for him. Are you using pedals with float? I've seen them recommended, here and elsewhere, for knee problems, but he is worried that he'll have problems unclipping if he has too much float.