CYCLINGFORUM.COM - Where Cyclists Talk Tech --- Return To Home

 

    Register FAQ'sSearchProfileLog In / Log Out

 

****

cyclingforum.com ****

HOMECLUBS | SPONSORS | FEATURESPHOTO GALLERYTTF DONORS | SHOP FOR GEAR

Return to CyclingForum Home Page CYCLING TECH TALK FORUM
          View posts since last visit

Knee swelling/broken femur
 

Author Thread Post new topic Reply to topic
KerryIrons
Joined: 12 Jan 2004
Posts: 3234
Location: Midland, MI

3/17/18 9:55 AM

Knee swelling/broken femur

8 weeks ago tomorrow (Jan 21) while skiing I hit an obstacle (tree stump?) under the snow and broke my femur, right at the knee (2 cm displacement). Surgery that same day with 4 screws. The bone has healed "just fine" and I'm "full weight bearing" as of 7 weeks but I'm dealing with significant swelling in the knee that prevents enough range of motion (ROM) to ride a bike. I can ride with my arch on the pedal and just make it around the revolution of the cranks. 10 days ago I couldn't even do that.

I'm constantly "stretching" the knee but it really isn't a stretching issue because it is the swelling that prevents enough ROM. I have about 95 degrees of bend right now, up from 65 degrees at 4 weeks. The break was not casted; I had a brace that controlled ROM adjustably and they let me go to 60 degrees at 4 weeks, 90 at 6 weeks. I've been walking 2.5 miles per day on crutches, with nearly full weight bearing now, but the knee swells significantly after every walk. Swelling goes down over 4-5 hours. It doesn't seem to swell from riding (25 minutes on the rollers).

So does anybody have any suggestions on how to deal with this? I have the feeling that if I could just ride the bike I could get my ROM faster, but I can't get over the hump of being able to ride the bike normally. If I could then I could be exclusively cycling for rehab and avoid the daily swelling from walking.

It really is about time and I certainly am progressing, but if there any ideas that could help move this faster, I'd appreciate your input. My PT has been helpful but has no ideas about the swelling. My next doctor appointment is March 28 but at the last appointment the message was pretty much "it will take time."

 Reply to topic    

Sparky
Joined: 08 Dec 2003
Posts: 19068
Location: PDX

3/17/18 10:37 AM

Any MRI? Sounds like the ACL portion of my Tib/Fib of 2006. How low was your fracture?

First hearing of your injury, best fastest recovery to you.

 Reply to topic     Send e-mail

Rickk
Joined: 01 Jun 2004
Posts: 528
Location: Montreal

3/17/18 10:40 AM

Internet consults are never as good as live, but... here goes - at the risk of being completely off-target:

Depends on the cause or source of the knee swelling:

- As Sparky mentioned, are you sure there are no other intra-articular structures involved such as ligaments, or cartilage tears?

- Is it still swollen even after a night of sleep?

- It may simply be due to muscle weakness around the quads, hamstrings and calf muscles over the past 6-8 weeks (and their not providing enough "pumping" action and lymphatic 'return-assistance' when you are upright vertical with heart significantly above knee level and heart pumping lots of blood down to knee but blood return being limited - relatively to your other knee, because of lower leg muscle weakness on that side). In that case, one has to progressively and conservatively strengthen the knee muscles with isometrics and small arc movements (such as with swimming - crawl or backstroke).

- It can be due to residual intra-articular inflammation, if the fracture was inside the knee joint (vs outside the knee). If so, biking demands lots of movement and is relatively more weight-bearing vs, swimming, hence may be causing some added knee irritation/inflammation at this stage and causing your synovial membrane to produce more liquid.

- To decrease knee swelling due to muscle weakness, during your (conservative exercise) re-strengthening phase, use an elastic type knee-support upon awakening and take it off when napping/sleeping if knee and heart are at the same horizontal level.

- To decrease knee swelling due to irritation/inflammation of the synovial lining, stop full weight-bearing on it - go back to partial weight-bearing using one or two crutches, and increase weight-bearing progressively - according to how your knee reacts swelling-wise. You can also use the elastic wrap during non-sleepiing hours, when performing the isometric knee strengthening exs in non-weight-bearing positions.

Ice application is over-rated btw; however, it will certainly help temporarily mask or numb pain, if that is an issue.

Hope this helps to start your "trouble-shooting" process. Good luck, and if necessary, perhaps change physio for a more evidence-based and experienced professional?

 Reply to topic    

dan emery
Joined: 11 Jan 2004
Posts: 6884
Location: Maine

3/17/18 11:11 AM

I had similar

I busted my femur a year ago January, though my break was higher. At first I had real range of motion issues cycling, as I could barely get the leg over the top of the stroke - I would get a sharp pain right above the knee. There was some swelling at the knee, and a "knot" on the inside of the leg just above the knee. Usually after a few minutes pedaling it would loosen up and be OK.

I think this is not unusual. Right after the break, a PT friend said "your problem will be getting back the range of motion of the knee."

Not what you want to hear, but "it went away over time." I had a lot of PT exercises which I did religiously, and a lot of them involved bending the knee (such as l lying on my back and pulling the knee to the chest). These helped, and I think riding helped.

The swelling went down over time, and the knot dissipated. Even the Doc was not sure what the knot was, he thought it might simply be blood. Anyway, it went down with time and I ride fine now.

Good luck. Things happen slowly. Even over a year after the break, I still notice some things improving.

You say you hit an obstacle under the snow. Recently a friend's son, a professional snowboarder, died snowboarding backcountry at Telluride. They thought his board hit a rock under the snow, he was thrown, and he hit a log under the snow. Careful out there.


Last edited by dan emery on 3/17/18 12:19 PM; edited 1 time in total

 Reply to topic    

Sparky
Joined: 08 Dec 2003
Posts: 19068
Location: PDX

3/17/18 12:15 PM

Similarly to Dan, my knee was a slow component participant to getting back to cycling. In fact, in my case it took compact gearing to get and stay on the bike without post ride pain/swelling. This after a few seasons of swelling and prescribed scope exploratory as next. MRI having been inconclusive etc.

Are you embellishing the diet/protein consumption post workout? Aot of atrophied cells you are freshly tearing up that have been stagnant for the interim etc.

Assume you are diligently ice/heat applying post spinning. Anti inflammatory provisions (Motrin et al)?

 Reply to topic     Send e-mail

KerryIrons
Joined: 12 Jan 2004
Posts: 3234
Location: Midland, MI

3/18/18 5:55 AM

Answers

According to the surgeon, no collateral damage. Unfortunately, the surgeon is in CO and I am in MI so I don't have the opportunity for follow up questions, but I did ask him specifically about it after the surgery.

Knee swelling recedes at night but is still significant upon awakening. I ride first thing in the morning before any added swelling from activity. I also ride in the afternoon roughly 5 hours after my "crutch walk" and the knee is tighter, but not a lot tighter.

Been doing quad sets and leg lifts for over 7 weeks but the leg certainly is weaker. That's why I want to ride the bike as much/soon as possible.

Riding does not seem to increase swelling nearly as much as walking.

I have one of those neoprene knee "braces" which I have used on occasion but the compression didn't seem to help a lot. I will try it again now that things are in a different place. I do apply a heating pad for a couple of hours per day - it helps with the stretching efforts. Ice packs have not seem to help.

Thanks for all the ideas and thoughts.

 Reply to topic    

Brian Nystrom
Joined: 26 Jan 2004
Posts: 5096
Location: Nashua, NH

3/18/18 7:21 AM

This may be too simplistic...

...but have you tried elevating your leg after exercise? That should help to prevent any fluid pooling.

If the swelling is caused by inflammation, that's another matter. If you're not already, you may want to try taking Naproxen pre-exercise to see what effect it has post-exercise. If nothing else, it may help to narrow down the cause of the swelling.


Last edited by Brian Nystrom on 3/20/18 5:42 AM; edited 1 time in total

 Reply to topic    

dan emery
Joined: 11 Jan 2004
Posts: 6884
Location: Maine

3/18/18 8:32 AM

Relative timing

Thinking back on my experience, I think 8 weeks is still pretty early. I took a trip to Mallorca (pre-booked) 3 months after the break, and I was still having trouble getting the knee around for the first few minutes of cycling, trouble getting the leg over the bike, etc. I just got cleared to ride outside a week before. I had been on "toe touch" weightbearing for 6 weeks (basically impossible if you actually try to do anything:).

But now my Anquetil - like pedal stroke is back. :)

 Reply to topic    

Sparky
Joined: 08 Dec 2003
Posts: 19068
Location: PDX

3/18/18 8:34 AM

Maybe lower saddle for a bit and/or shorter crank arm. If right leg maybe longer left arm and lower saddle...

 Reply to topic     Send e-mail

KerryIrons
Joined: 12 Jan 2004
Posts: 3234
Location: Midland, MI

3/18/18 10:26 AM

Lower and shorter

Lowering the saddle would make it worse (more knee angle required to get over the top). A shorter crank would be an idea but I don't have one lying around. As of now I have a flat pedal on that side and am riding with a tennis shoe so I can put my foot as far back on the pedal as possible.

 Reply to topic    

Sparky
Joined: 08 Dec 2003
Posts: 19068
Location: PDX

3/18/18 12:33 PM

What crank. what length, and which is your broke peg side?

 Reply to topic     Send e-mail

April
Joined: 13 Dec 2003
Posts: 6593
Location: Westchester/NYC

3/18/18 9:24 PM

With everyone skiing in the trees, injures related to hitting obstacles naturally goes up.

According to my PT, (whom I almost worship like god because she seems to know my symptoms without my telling her) every broken bone will have massive soft tissue damage at the time of the injury. If the break is displaced, muscle and blood vessels will be affected too. By the time the bone mended, most of those would have mended but formed scar tissues. Once you start moving your joint, those scar tissues need to tear and remold to let the joint move. The swelling is just a symptom of that soft tissue healing process.

Keep doing your exercise, it will improve. My own experience (shoulder, not knee) is the body has its own timing. It felt as though no progress for weeks. Then within a week, the swelling came down and the associated symptoms are largely gone.

In the mean time, to try to reduce the swelling. Try the RICE treatment. Some people respond to one element better than others. Find what your body wants. You can also walk less, and if that prevents swelling and give you enough ROI to ride, you’ll be ahead.

 Reply to topic     Send e-mail

KerryIrons
Joined: 12 Jan 2004
Posts: 3234
Location: Midland, MI

3/19/18 1:06 PM

Swelling

It's like there are two types of swelling in my knee. The "daily swelling" is what I get from working the knee, primarily walking. Riding doesn't seem to cause "any" swelling as the knee feels just as flexible after 25 minutes on the rollers as it did before. Not so with 25 minutes of walking. But that swelling goes down over a few hours and overnight. It's the "permanent" swelling that is at issue. No amount of ice, compression, or elevation affects it. This is slowly receding with time but I'm looking for ways to speed it up.

As to crank length, I have 175s on the roller bike right now with an ISO BB (Campy). I've thought about going to a local bike shop and asking them to look in their junk bin for a 170 or even 165 left crank, but then I would be out of balance and that might present it's own issues. It's quite possible that I'll be able to get a full revolution within the next week, and at that point I can really start working on my recovery. But who knows. The body is working on its own schedule.


Last edited by KerryIrons on 3/20/18 10:55 AM; edited 1 time in total

 Reply to topic    

Brian Nystrom
Joined: 26 Jan 2004
Posts: 5096
Location: Nashua, NH

3/20/18 5:46 AM

I had the same issue with my hip

I just had to be patient and keep working on flexibility off the bike. You're correct that once it comes around, you'll be good to go.

 Reply to topic    


Return to CyclingForum Home Page CYCLING TECH TALK FORUM
           View New Threads Since My Last Visit VIEW THREADS SINCE MY LAST VISIT
           Start a New Thread

 Display posts from previous:   


  
Last Thread | Next Thread  >  

  
  

 


If you enjoy this site, please consider pledging your support

cyclingforum.com - where cyclists talk tech
Cycling TTF Rides Throughout The World

Cyclingforum is powered by SYNCRONICITY.NET in Denver, Colorado -

Powered by phpBB: Copyright 2006 phpBB Group | Custom phpCF Template by Syncronicity