Anyone else have ACL trouble?

[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.

[KnottedYet]

I would listen to the bike fitter.

did the PT actually LOOK at how you ride? Figure out what muscles fire at what time during the revolution? Hook you up to a biofeedback machine to monitor co-contractions of the hams and quads?

(knee issue folks in particular will need co-contractions so the hams can stabilize the knee joint itself during the quad contraction as you push the pedal down, unless you have massive hams that can do it just by bulk. we've had patients who did exactly that. overdeveloped hams can only help someone with ACL/PCL/LCL/MCL issues, never hinder) (mind you, that's overdeveloped, not overtight. gotta stretch and strengthen)

[Kathi]

No, this developed, withing the last 2 weeks, right after I finished PT. They do have the capability to do that now but the therapist who is trained is on vacation.

They have a maintance program that I can sign up for but I'm leaving next week for 2.5 weeks. I plan to do that when I return.

I had a lot going on that could have contributed to it. I rode with my saddle to low for awhile, including a 40 miler. I quit wearing my orthodics in favor of my sandals, and I cut down on my pt and stretching for a couple of weeks. My bike fit guy thinks I should work on my pt, stretch and ice and let things settle down.

Unfortunately, we're doing a bike tour in 2 weeks so I don't know how well things will settle down.

Since none of this has affected my strong leg, it appears that my injured leg needs more strengthening.

I may stop by the pt office tomorrow and if she has time I'll mention it to her.