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kneecaps
Last Post 06/18/2013 11:49 AM by carl x. 13 Replies.
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THE SKINNY

Posts:342

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06/14/2013 08:27 AM
after accessing all the aches and pains after 3 hard rides, the pain that seems to linger is achy kneecaps. it's not debilitating but i am aware of it. i tend to push a bigger gear rather than spin. could that be the problem?
How we spend our days is, of course, how we spend our lives.
Spud

Posts:181

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06/14/2013 08:40 AM
I know that cranking smaller gears has helped reduce those types of after ride aches for me. I also do the cross leg stretching before and after a ride. Hey, try it for awhile and see if it helps get rid of your pain.
THE SKINNY

Posts:342

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06/14/2013 09:15 AM
what do you mean by 'cross leg stretching'?
How we spend our days is, of course, how we spend our lives.
Spud

Posts:181

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06/14/2013 11:19 AM
Cross your left leg in front of your right and stretch as far as you can toward the floor then the right in fornt of the left. Those help more with my Iliotibial Bands.
zootracer

Posts:261

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06/14/2013 12:58 PM
Pushing a bigger gear is not good for the knees. For me, if my saddle is too low or too far forward, my knees will tell me. A couple of mm's make a big difference.

I went to a compact crank two years ago. My knees feel better, but my average speed dropped. However part of that is due to advancing age.
79pmooney

Posts:1018

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06/14/2013 02:03 PM
Skinny, I don't know if you are maybe seeing the beginning of chrondomalacia patellae (athlete's arthritis), but I will post what I wrote about it 10 years ago, I was diagnosed with it 35 years ago and have had to live with it since. What the doctor who diagnosed me told me was inf I have never seen all in one place since, so what I wrote is more comprehensive than anything I have laid eyes on.

What I wrote in 2001:

"Chrondomalacia patella. Yes, I can tell you a little about it. I was diagnosed in ’78 and given very good advice by the doctor (an orthopedic in sports medicine. He was also a novice bike racer, so he had more understanding of the cycling aspects of CP than most). I will do my best to pass on what he told me.

In CP, the kneecap is not aligned with the knee under it, hence there is chafing as the knee is moved. This causes wear, first to the cartilage, then to the bone under it. The wear accumulates with number of repetitions and pressure. At some point, the wear can cause permanent damage.

Some people are more prone to CP than others. It can be triggered by exercising in cold weather, exercising without adequate stretching of the hamstrings, i.e. touching your toes or less extreme stretches of the same tendons. It can be brought on by exercising without adequately strengthening the small quadriceps muscles just above the kneecap.

I brought on my CP by training to return my body to racing form after a very serious accident. (I was weak enough after my hospital stay that I was no match at 24 years old for any 7 yo. The accident was in November, and I returned to riding miles in March. I did nothing to keep my knees especially warm and did no stretching exercises (rationalizing that since my leg never extended to anywhere near straight, there was no chance of injury, hence no need to stretch). I was wearing just full tights and thermal underwear under them in Boston. The temperature was probably not much above 30. The ride that started it was 100+ miles on my racing bike, my first outdoor ride on that bike. It had 175 cranks. My trainer, with fixed gear and very low BB, had 168’s. After the ride I had a dull pain in my mid to upper knee in front. That Saturday was the first race of the season. I was forced to drop out, my knees hurt so much.

After that race, the race promoter introduced me to an orthopedic surgeon who diagnosed me in the back of a cold van. He laid out for me then and in later phone calls a plan that I will pass on here.

He first stressed that I had to stretch my hamstrings, touch toes or lean forward against a wall or post with one leg back and straight and stretch that hamstring or sit and touch toes. I now prefer the lean forward method. Very specific and hard to hurt yourself. (I am now a 48 yo, I damage if I am not careful.)

Second, he had me sit on the floor and do leg raises. He had me raise one leg at a time and hold it several inches off the floor for a while (I don’t remember the time, but 15 secs should work. Important – while the leg is raised, tense up your quads big time and tense up those little quads just above and beside the kneecap. Feel for them and get to know them. It is those little guys that keep you kneecap aligned. If you are in riding shape, you can do this with say 5 pounds on your ankles, but the tensing up is much more important than the resistance.

Third, KEEP YOUR KNEES WARM WHEN YOU RIDE!! For me, this is critical. I wear these dumb looking “knee warmers” for most of my rides, always below 70 degrees, often under tights. Since keeping the hamstrings loose is important, I had to stretch the elastic. To keep them from falling down, I sewed on garters that I clip onto my shorts.

Fourth, back off riding until you have been doing these two things long enough to make a difference. Keep up the exercises and especially the stretches after you resume riding. Build up your riding slowly. The doctor stressed this to me and it has been very true. My ability to come into real form and resilience on the bike is limited more by my knees than by my lungs/muscles.

After rides, take aspirin or Ibuprofen to speed recovery. I personally think aspirin is better, that my knees recover more with it. I disagree with the ice. I have always felt that moving my knees when they are cold is causing the damage I am trying to avoid. Perhaps ice speeds recovery, but I feel it also continues the damage (at least in my knees).

Big gears are the enemy of CP knees. I love to climb hills standing. I love to ride hilly country on fix-gears. It is a fact of my life that I can only ride certain not-so-steep hills on my commuter and that I have to have and use a granny ring on my custom. It is a fact that there are days, weeks and months when I have to let whippersnappers blow by me on hills where I know I can humble them.

Lastly, what you did not want to hear, but again what the doctor told me. Get used to the idea of CP. If you are at all like me, it will be a fact of your cycling life for a long time. 23 years later for me and I am feeling my knees now because of a very easy ride I did in street clothes without knee warmers at noon today.

Sorry to be the bearer of bad news, but you can still do a lot of riding. I raced that season (I already knew it was my last) and have done 60,000 (?) miles since. I still commute, but only on alternate days. (But for the first 7 years with CP, I did not own a car and rode everywhere.)

I took the time to spell all this out because in the 23 years I have had CP, I have never seen all of this in one place. In fact, I have only heard about the importance of keeping the knees warm from that one doctor. That is the single most important aspect of the program for me. Thank you Dr. Kish, wherever you are. I will probably ultimately need those carbon fiber knees, but by following the regime, I figure I can wait until a) the product improves, b) the price comes down and c) I’m old enough that my cycling level will be within the abilities of those knees. I hope to delay another 10 years.

Since I wrote this a year plus ago, my physician has recommended that I take glucosamine. He was very specific, that I should take 3000 mg/day in the form of glucosamine sulfate or glucosamine hydroxide, but to avoid chrondroitin. This I did faithfully for 9 months. Between riding steadily starting two years ago and the glucosamine, my knees never felt better than they did last summer. I was passing whippersnappers uphill. Then my riding tapered off, I tapered down on the glucosamine and got sick so my riding and conditioning dropped. Thanksgiving I rode 50 miles with 2500’ of climbing on a cool day. My knees hurt. How many of those rules outlined above did I break?

Ben"

My CP is still there. Since I wrote that, I have had custom kneewarmers made that I wear 95" of the time, often under standard kneewarmers. My customs cover just the front and sides of my knees (roughly 6" by 8") with 2 light elastic straps behind my knees and a non-stretch strap with velcro that runs through a "D" rind sewn to my shorts hem. They consist of 2 layers of 600 weight windfront Polartech. So they cover just my knees. They do not warm me, just my patellae. I can climb mountains when the temps are high 80s with them and while they look goofy, they do not slow me down and are there to keep my knees warn for the much cooler descent and ensuing climb.

Ben
RobertMitchum

Posts:21

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06/14/2013 02:03 PM
"i tend to push a bigger gear rather than spin. could that be the problem?" Yes. Of course. Have you changed anything lately? Seat position? Stem/handlebar position? Pedals/shoes/cleats/Odor Eaters? The miles yer doing gone up dramatically recently? Riding with studlier people lately? Lots of possible variables.
Pin0Q0

Posts:229

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06/14/2013 04:22 PM
I experience the same and I also usually ride the big gears, but the pain usually dissipates after a good night sleep. Someone told me once that the core (the wood) of a pineapple is good to eat fresh as it dissolves acid build up in the joints that eventually cause arthritis. I crush it in a blender and make smoothies, it also lubricates your joints......Wooooo...easy!
I’ve yet to make a habit of buying it regularly, but this summer I think I will.
longslowdistance

Posts:586

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06/14/2013 05:24 PM
2cents to add to Ben's timeless advice: seat higher and further forward and shorter cranks reduce patellofemoral shear stress.
Consider seeing a non-ortho pod sports medicine doc to look at your biomechanics. Strengthening the vastus medialis is good medicine for some.
longslowdistance

Posts:586

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06/14/2013 05:27 PM
PS
Stay away from Tony Soprano. Save those kneecaps.
Entheo

Posts:315

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06/15/2013 10:04 AM
thanks for that post ben; i've developed a popping in my right knee (slight pain but not too bad) and i think it may be due to riding in cool chicago spring conditions without knee warmers.
vtguy

Posts:222

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06/15/2013 03:12 PM
Great post, Ben. Thanks. It confirmed my suspicion about keeping my knees covered even in moderate temps. I just ordered another pair of knickers.
lochness

Posts:47

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06/18/2013 11:28 AM
Addition to "keeping knees warm": embrocation has worked wonders for me. Whether it's just the endorphin effect of having my skin go nuclear, or whether it really is the capsaicin penetrating to the joints, mad alchemy medium has really helped my chronic knee pain. I also keep the knee warmers on until late in the spring.
THE SKINNY

Posts:342

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06/18/2013 11:49 AM
i was just riding to big a gear. i pushed less and spun (spinned?) more. no issues today.
How we spend our days is, of course, how we spend our lives.
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