Knees knees knees

[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

[Kathi]

[QUOTE=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.


I also wear prescription orthotics, shoes, ski boots, cycling.

And yes, squats and lunges. My first bout (when the ortho told me to quit exercising) with this the therapy was mostly straight leg raises with ankle weights. I did them until I was "blue in the face". But, I still had pain. I had been doing step aerobics, which I gave up, but had an instructor who was very strict about proper form (knee over toe) when doing squats and lunges.

One day, I decided my knees were going to hurt anyway so I started doing squats and lunges again. My knees felt so much better! A year or 2 later I tore my rotator cuff and for some reason got off the leg training. During that time I went hiking and jumped down an embankment and that started the right knee off again.

The ortho I saw said "no lunges or squats" but my therapist disagreed, most of my therapy was straight leg raises, again to ad nausum, weight machines and lunges and squats. To make a long story short I ended up working with an athletic trainer at my gym who set up a program using the weight machines. I followed her program for quite a long time.

When I moved here to the Denver area I didn't have a gym membership so, for ski conditioning, I started doing lunges and squats again. No problems. After I joined a gym I mixed the weight machines with lunges and squats.

Then every skiers fear, the dreaded ACL tear. Before my 1st therapy session for my torn acl/mcl I thought I was so smart because I just knew I'd have to do zillions of straight leg raises. Initially there were leg raises but the protocol is so different from what I did before. Strengthening was done on the pilates reformer, all leg muscles ( hip, core, etc.) were included. Many floor exercises were pilates based. Around 4 weeks I started doing single leg squats. Then I had acl surgery and started the protocol all over again. Around 6 weeks post op I began lunges, walking, sumo and side to side,l squats against a wall or fit ball. I also do the step down in front of a mirror that knottedyet spoke of.

The therapy this time around is much more "whole body" based and functional. Every exercise I do incorporates a variety of muscles, including my upper body. When I finish formal PT next week, I will start a "maintance program" at the physical therapist office, so there will be continual guidance with the knees.

I still have a lot of work to do to bring back the muscles in the injured leg but I've learned so much about keeping my knees strong. I guess that's the positive side of this acl tear.

[run it, ride it]

Oh boy, so I crashed my bike early Sunday morning. Aside from a monstrous black bruise on my thigh, I was fine--I did 75 minutes on the elliptical at its highest ramp setting later that day, and spent a good ten minutes crouched down brushing mud off my horse's legs after that. No problem.

Skip to Monday afternoon; my right knee is tracking a little funny. Monday night, if I try to straighten it after it's been bent more than ninety degrees it sticks, sticks, sticks, CRACKS into place and sets me off cursing in pain.

Tuesday morning, the whole inside of the knee is tender where I must have hit it in the crash, and any un-bending procedure involves me relaxing the leg completely and carefully manually manipulating the patella to minimize that jolt of pain.

I have bad knee genetics--shallow patellofemoral grooves, pronation. I took an impact to the other knee when I was fourteen and it never recovered. I've seen every sort of specialist and heard everything from "patellofemoral syndrome" to "bone bruise" to "huh.. pretty crunchy cartiledge there, eh? (to the nurse) FEEL this!" to "it would have happened on its own later anyway." I was advised to use orthotics in all my shoes (not just my running trainers), and to wear a brace for any activity.

Of course, the brace didn't last long. I preferred to build up my muscle and NOT have a weaker, more dependent leg. When it gets sore, rather than favour it I push it harder, push it through, and most of the time I work through the pain. I've managed the injury well, but its unpredictable incapacitating moments are what ultimately ended my running career and got me into cycling.

Well, now my old injury seems a walk in the park compared to what my right knee is up to! I just tossed the ole brace on it and already feel a difference, but UGH, what an awful feeling when it grinds out of place.

In less than an hour I have an opportunity to go mountain biking for the first time EVER. I can scarcely walk on my right leg, but I'm brought back to track races where I was too injured to walk and still got the adrenaline up enough for something resembling a dynamic warmup, staggered to the line and waited for the gun not knowing if my legs would support me. They miraculously worked every time.

So um... here's hoping that technique works again! I've got the ice pack handy, and the guy taking me on this trip has already insisted we're not going to do more than a few roots given the state I'm in (says he just can't stand the thought of the extra weight of the spatula he'd have to bring along to scrape me off the trail otherwise). YAY MTBING!

[run it, ride it]

w00 still in one piece! Knee started tracking fine once I was on the bike. I have switched over to the dark side and am in love with MTBing.

[surgtech1956]

I have patella chondromalacia, grade III(right knee). Mine is from a fall at work - May 2006, my OS said it is like a 'dashboard injury' and can take up to 2 years for the pain to go away. My real job is standing 99.9% of the time, I've been on 'seated work restrictions' since the injury. I just had a scope done in January now in PT(my 3rd time since 5/06). I'm still not working. I see my OS on 4/30. My OS is talking about a possible Faulkerson's Procedure or Patella Femoral Joint Replacement. Anyone been through either or these procedures????? My pain is anterior - behind the patella and medial pain. The pain is definitely getting old. I just bought a new bike - to try to get in shape. I have the seat up. Biking is suppose to be good - building up the quads too. I'm not suppose to do any kneeling, no squats. I can relate.

[run it, ride it]

Okay, day three and this tracking thing is not letting up. If I brace the patella in tight and go through some pain it will track alright on the bike, but I can't bend it to walk up stairs, and lord knows without the brace I'm no good on a bicycle either (I just pedaled up the big hill to school -on one leg,- and you know I was really hurtin' 'cause I was late for a final and still couldn't push the injury!)

Has anyone had trouble tracking after an impact to the inside of the knee, and will it really go away in a few days like I've been led to believe? Ahh well, at least my 'bad' knee is getting some serious muscle built compensating, but I'm tired of the embarassment of trying to walk up a flight of stairs in public and yelling out in pain, falling against the railing and cursing up a storm when my kneecap CRACKS into place!