my worst enemy

[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.

[sundial]

Ultimately that contributed to problems with my calves and Achilles, but it spared my knees.

I experienced that too, Oak. Funny how the slightest change can significantly affect things over a distance. I did get a professional fitting back when I had the Roubaix. Besides adjusting the saddle fore/aft/height, they adjusted my cleats and checked the alignment of my knees during the pedal stroke. I did have to add a spacer on the left pedal so that my knee would track right. Seemed to get things pretty much squared away.

During the off season, I noticed that my mtb platform pedals gave me less grief than the SPDs so I put platforms on my road bike and seemed to clear up issues with my achilles and knee(s). Interestingly enough, my mtb has 175mm cranks. Go figure.

Now that I've changed from less mashing to more spinning, my knee seems to be protesting more. I'm doing exercises to try and build up the muscle groups around the knee in hopes of making it happier. Maybe that's what it needs. I'm hoping anyway.

[Cataboo]

Sundial - what type of cranks do you need? triple or double or compact double?

I've got a few spare 165 mm cranks and a 170 mm or so.

I'm 5'1, maybe a 29 inch inseam and use 165's (I can manage with 170s, but like 165's better) - BF is 5'7 with a 33 inch inseam, he uses 170's

Mountain bikes typically have longer cranks than road bikes.

[texascampgal]

I've been taking Lubrisyn for about 6 weeks now. My knees no longer grind and pop. My boss recommended this stuff to me.

www dot lubrisyn dot com

[sundial]

I've been off the bike for about 6 weeks and when the symptoms persisted I decided to pay a visit to the OS. Turns out my pain was due in part to the muscle catching on a bone spur. I opted for a big ol' cortisone shot--my first. I was instructed to not spin at a higher cadence and discussed treatment options, including Synvisc One therapy, for joint pain relief. Anyone have experience with Synvisc?

[Zen]

Try this exercise first http://cyclingphysio.com/?p=132

That guy just wanted to take his shirt off and show us his ill-fitting pants.
This is why I have stopped cycling for a while and am concentrating on walking, it allows more extension and the dogs like it too.

[sundial]

Zen, lol. I bet your doggies are really enjoying your attention.