11/8/13 3:16 PM

Saw the Doc today after MRI. Functionally, now the knee feels normal and I can ride normally.

The MRI showed some cartilage arthritis in the area I was having pain, so he thinks that got aggravated/inflamed, causing the pain. Nothing surgical, but to lessen the chances of it recurring I will have some PT to strengthen muscles to keep things in alignment better, and I can get evaluated by a bike fit specialist they have.

So considering the alternatives, I consider this pretty good.

11/8/13 3:41 PM

That's good news!

(Any pain that eventually goes away by itself is always good news anyway)

quote:

---

my first treatment modality (wait a few days and hope it goes away) failed

---

11/8/13 7:54 PM

Good news on the knee. I went through something similar and am now a full time convert to doing PT. I do at least 4 days a week (not on days where I'm riding 60 or more miles) and it makes a huge difference. I see it as part of my life from now on. Watching TV is a great time to do PT and it costs you zero minutes per day.

11/9/13 7:24 AM

Completely agree on the PT. I will go to see a PT, but I suspect I will get patellofemoral exercises (kneecap tracking), which I've done before, so I'm starting those up. At his point I think it will be permanent knee maintenance.

One thing you learn quickly, a problem with a knee can totally mess up your riding.

11/9/13 8:04 AM

to keep you occupied during the downeaster wintahs.....Just watch out for those two four legged hooligans from dragging you around on the snow and ice....:)

11/9/13 10:43 AM

"a problem with a knee can totally mess up your riding"

Tell me about it. 3 years after my ski accident I still was getting pain after riding. It was not until I went to the 34/50 Compact gearing and a 30 tooth bail out up top on my cassette i was able to stay on the bike.

The Scott and Paramount this year are the first 39/53 I have ridden since late 2009.

11/26/13 4:44 AM

Saw the PT, got quite a regimen of exercises. I expected mostly strengthening, but these also include a lot of stretching, particularly the IT band, and also the ever popular tight hamstring as well as other leg muscles. I ordered a medieval torture device known as a roller, kind of a rolling pin for leg muscles/ligaments.

These are pretty time consuming, some of them twice per day, but I'm all in. Can't ride right with even a small knee glitch, and riding right is important.

11/26/13 11:44 AM

Hope you get good response to the PT. I am sure the cold is not helping either. My right knee [tib/fib leg] still gets stiff/achy if I ride without tights under 60^ first.

11/26/13 12:12 PM

IT band rolling can do wonders for knee issues. Can hurt like hell but at least you can do it while watching TV.

Hope you got the orange Grid roller, lesser foam rollers are not as effective/durable.

11/26/13 12:28 PM

Looked up the IT band, forgot what it was/did. The hip bone connected to the shin bone. I did not know connective muscles/tenons crossed two bones like that. Although I never really thought about it. ;)

Without reading all your posts, how did you aggrivate the IT band originally. Or is this just complete PT and not your source of issue?

11/26/13 1:09 PM

Don't know that I really agravated it, but it was tight (like pretty much all my muscles). The PT also found some small irregularities, knots or whatever. What I have is a bit of patellofemoral syndrome, which means the kneecap is pulled to the outside of the knee and doesn't track correctly. A tight IT pulls it that way, so the treatment is to stretch the IT and strengthen the muscles on the inside of the thigh. He thought that over time riding, particularly with a narrow tread, might cause the IT to tighten. Rolling the IT is kind of like "ironing" it.

@ sanrensho: I got a white "soft" roller, which the PT recommended. It's not really all that soft. I tried a black one they had and it was excruciating. The PT said he didn't even like the black one because it hurt too much. But he said it was good for obsessive bikers/runners who didn't think anything was happening unless it hurt :)

11/26/13 1:20 PM

Maybe you could benefit form a wide Q factor on your crank/pedal system ?

Pedals with longer spindles, longer spindles for your current pedals, a triple [gasp] setup for the winter ??

Could also slam your current cleats to the inside, maybe some dremel coaxing...

Or cleat shimming to tilt outward if this theory hold any weight you might consider ??

Or maybe just a never mind on my Q theology altogether. ;) Or in true definition of the word Theology some prayer, you may have tried that. ;O

11/26/13 2:18 PM

I've also had a few bouts of patellofemoral syndrome. Particularly when I briefly played soccer.

Dan: I started with a blue foam roller and it soon became deformed.

The orange Grid rollers are much sturdier and more versatile IMO. As far as the pain level (pressure), that can be adjusted by supporting yourself and applying less weight. The pain level can vary quit a bit at different spots on the IT band.

As your PT says, IT band tightness can pull the kneecap out, so the roller is the first thing I reach for now when I experience knee pain. Thankfully not recently.

One thing you can try is cold rolling, using a plastic bottle filled with water and kept in the freezer until hard ice. Although one PT I spoke with expressed doubts about simultaneously cooling and stretching muscle/fascia.

11/26/13 2:28 PM

So is the associated tightness medial ? And at the knee or the hip ??

11/26/13 4:39 PM

If you are running, ditch your traditional running shoes and go minimal.

I have found it to work wonders for joint issues because it makes you run as you evolved to run. Heal striking is horrible for your knees.

11/26/13 6:24 PM

Just finished my set of rolling exercises, I rate them pretty challenging. I think sanrensho is correct, the key to avoiding agony is to maintain support over the length of the roll. I have not mastered that yet, but should improve with practice. Sort of like starting to ride a bike and having too much weight on your hands or butt or whatever, and not being able to unweight. When you do lose support, yeeeeowwwww.

@Sparky, can't really respond. The tightness is not something I feel, it's indicated by range of motion. Plus I don't know what "medial" means...:)

@Erik, I haven't run in years. I think I have minor knee issues because I am 63 and have taxed them my whole life (including years of basketball), plus I have tight muscles.

11/26/13 6:50 PM

medial= toward middle or inside. As opposed to outside/lateral.

11/26/13 7:44 PM

Dan: You probably already know this, but the IT band inserts just below the knee joint. So make sure you roll past the knee.

12/7/13 6:09 PM

Update provided FWIW in case anyone has a similar issue.

I've had 2 PT appointments and have been doing exercises twice per day for nearly 2 weeks. The exercises are basically to strengthen the VMO muscle (inside the thigh), stretch the IT Band, stretch the hamstring, quad and calf muscles, and "iron" the IT Band and other muscles with the roller.

Results have been great. Pain is gone, I can hammer on the bike as much as I want. Plus the leg feels great, noticeably looser than before, which I'm sure will enhance my Souplesse (hack, cough). I have one more PT, then I think I'll continue the exercises at some level as maintenance.

At first the exercises seemed to bring on the pain slightly, but the PT said that was normal, to do the stretching you have to stir things up a bit.

With better balance and mechanics, the roller exercises are kind of fun and not agonizing.

Glad I went thought this process, as it took an MRI, a good ortho and good PT to sort this out.

You kind of take your knees for granted until you have to favor one, then you realize you can't ride for sh*t that way.

12/7/13 6:16 PM

"You kind of take your knees for granted until you have to favor one, then you realize you can't ride for sh*t that way."


Right was always my dominant. After TiB/Fib recovery and with time my left became dominant. Then the right again by second year after.

Then Femoral nerve damage, right a TG last year, left again for a while, now about 50/50. The Computrainer spin scan still shows a slight flat spot on the right leg I never used to have. It is 1-3:00 just after TDC. I don't really notice it riding, as I am so slow anyway anymore..

12/7/13 6:46 PM

quote:

---

"iron" the IT Band and other muscles with the roller

---

12/7/13 7:17 PM

Hip flexor and glute at the top is where the IT band connect. As well as to the pelvis, looking at pics.

Are we saying rolling the hip flexor? Or some quads around/under the band ?

12/7/13 7:40 PM

The main rolling exercise I do is the IT Band, which I am trying to stretch and loosen. Rolling was described to me like ironing, perhaps it could be visualized as a rolling pin flattening and stretching dough. You are supposed to pause at tender points so there may be a massage like quality.

The sheet I have also has roller exercises for the quads, hamstrings, calf and glutes, which are more optional but I do sometimes. The roller is on the floor and you roll your body over it, so your body weight is pressing down on the roller. If you lose your other bases of support so your whole weight is on the roller, it hurts like hell - it takes some practice to maintain the support while rolling.

Maybe if I look at the instructional CD I'll know more of the theory...:)

12/7/13 7:49 PM

Does one flex/tighten or specifically not flex the leg muscles, quads etc whilst rolling ?

12/7/13 8:10 PM

You just keep the muscles relaxed - the leg being rolled is straight (except for the glute exercise where the legs are bent, but still relaxed).