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.

[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.

[Flatlander]

Knotted--are you a PT? My ortho didn't refer me to pt; he just gave me a big brace and a little booklet. The exercises in the booklet involved ankle weights and not much else. I didn't find the brace or the ankle weight exercises particularly useful (the exercises were very minimal, and seemed designed for people who were either not very active to begin with or coming back from surgery), and at the time I was only running, so I didn't have too much trouble w/the ACL. as a consequence, I slacked off on the exercises (and quit wearing the brace).

Since, at the time, I had only gone to see the ortho to find out why my knee kept "going out" when I walked, and he didn't seem to think that it was a problem for me to keep running if it wasn't bothering me during that activity, and since I wasn't cycling at the time, we mutually decided not to pursueit farther. (Plus, he probably assumed I'd continue with my exercises.) Now I wish I'd been a little more proactive.

About two weeks ago I decided to do some weight training to see if it would help. I started doing hamstring curls, quad extensions, and squats. Are you saying that the hamstring curls are the best thing for the ACL? Should I concentrate mainly on those? Are the quad extensions or squats detrimental?

Also, should I position my seat so that I am using more of my hamstrings, or less?

It is interesting to note that the the hamstring on the "bad" leg is noticeably smaller than on the "good" leg...Could this be related?

[KnottedYet]

"I'm not a PT, I just play one on television."

It might be a good idea for you (Flatlander) to get a referral and a script for PT.

Open chain quad work is pretty much not the best choice (watch me dance around to avoid saying "fer gawdsakes, don't do that!") for post-ACL. Open chain is when you are firing off your quads in a non-weightbearing situation. (straightening your knee with ankle weights on, doing quad extensions on a quad machine)

Closed chain quad work is peachy. (leg press machine, squats) That's where you are using your quads while putting weight through the soles of your feet. Just don't bend the knee more than 90 degrees while weightbearing, at least until you get the all-clear from a PT.

For the hamstrings you want to do both open and closed chain work, and you can bend more than 90 degrees with that.

You really need someone to look at your firing pattern before you start adjusting your bike.

It's probably not the best sign in the world that your "bad" hammie is smaller than your "good" hammie. You need those hammies!

Doesn't matter how long ago you had your incident, PT now is cool. Depending on the laws in your state and your insurance, you may be able to go to PT without seeing the doc again. Try calling the ortho's office and ask if they can fax a script to a PT clinic. (ask around to choose a clinic) Sports therapy/ sports PT might be the best choice, if you have a good sports therapy clinic near you. They will have a good handle on the running and biking part.

[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