Monday, April 02, 2007

Chain reaction

These adventures in knee recovery are becoming really boring. I need to find something else to write about ... anything ... maybe tomorrow.

I went to visit a physical therapist for the first time today. She had some interesting theories about the origin of my knee pain - including a misaligned hip and an atrophied VMO quad muscle. She gave credence to my posthole overextension theory, but emphasized that weak leg muscles won't support shock on a weakened knee. This injury has been building up since the dawn of my bicycling, she theorized, since I first sat down on a bicycle seat that I never bothered to measure on a bicycle I never bothered to check to make sure fit. I just bought these things online. A bicycle is a bicycle, right? Right? They're not precision instruments so specialized for body types that the slightest diversion leads to a chain reaction of deterioration and degeneration that can not be recovered? Right?

So now I'm doing my prescribed stretching/ITB band strengthening exercises and staring in bewilderment at my bikes. Did they really betray me? I liked it so much better when I was the idiot that injured myself.

And the bigger question ... if I do recover from all of this, can I trust them? How can I really know that it's not just going to start all over again? Will every mile I pedal be another notch in my inevitable decay? Is there a way to get my bicycles ... you know ... tested for this?

I'm feeling a bit flummoxed by all of this. But at least now I have an excuse to sit on the couch with a pillow between my knees and call it "exercising."

17 comments:

  1. Hey girl. The IT band thing is what nailed me on the hike of the Superstition Ridgeline and disabled me. I got on to a bike and cruised with that injury.

    Your memory of reality is not failing. You're the girl riding hundreds of miles on a bike in the snow. Most of us can't do that over a year or two -- if it was your bike it would have been last year.

    I think you need to find a real serious doctor.

    My daughter was injured last year -- an ankle injury -- and they misdiagnosed it. It healed badly. It ain't all that good. Get another opinion.

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  2. Anonymous2:26 AM

    Jill,

    Please do not be frightened by this bicycle fit information.

    I am 58 and have ridden bicycles all my life.

    I am coming to Alaska on May 20 and will be riding for 12 weeks over a distance of approximately 10,000 kilometres. For every one of those kilometres my left knee will be hurting.

    I ride to work every day approximately 15,000 kilometres per year and up to 200 kilometres every weekend and for every one of those kilometres my left knee hurts me.

    It is a matter of deciding whether you sit on a couch and watch TV or you get outside and enjoy yourself.

    I am lucky because I have reached the age where I know that no matter how much cycling I do I will not do my knee any more damage because it has been hurting for over 20 years. I do 10,000 kilometres tours every two years with it hurting.

    I do not complain I do not tell anyone I just look at the scenery and say wonderful.

    You just need to give up competition and decide that your cycling going to be like your walking and your swimming. When you were cycling every day and doing 800 kilometres per month you were riding empty.

    Then you put 15 kilograms on your bike and did 100 miles in the snow with inadequate rest. Your seat was probably too high and set too far back for the load you carried and you did not notice the pain in the excitement of the event.

    I carry at least 15 kilograms all the time whenever I ride and then when I load up with 25 - 30 kilograms my body and bike are adjusted for it.

    Please don't give up, your bikes can be adjusted perfectly.

    However while your knee hurts you can not tell what is good and what is bad so you must use a tape measure and a good bicycle mechanic.

    Find a nice bike mechanic and ask him to set you up on your bike, including your exercise bike so you fit properly, most good bike shops can help you.

    Keep swimming and walking and exercising until you can ride without pain. Then ride for the reasons you rode and wrote to us about, just the love of cycling. Not for some trophy or hat which has damaged you unnecessarily.

    Keep your chin up. Do not look forward to the day when you can be as strong and as fit as you were, forget that, look to see what you can do and how strong and fit you can be in the future.

    That person who was you has gone, there is now a new person there who has different abilities.

    Live the life the new Jill can live do not pang about that fit strong young stranger in the past she has gone.

    We all get older and our abilities and our bodies adjust.

    Please persist and don't give up.

    We want to see you back on your bike having a "FANG ON YOUR GRID". (Aussie for having a ride on your bike).

    Morday
    bd78a@yahoo.com.au

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  3. Are you sure you're flummoxed? Perhaps just bamboozled. But certainly not stymied.

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  4. Yes, a correct bicycle fit is necessary for sure. Especially important as you get into the enduro nutt job field.

    Don't worry, we all make this mistake. I didn't get my fit until after my knee injury, DOH!

    I don't know much about Alaska, but make sure you get somebody who can do a "pro fit" just not an eyeball kind of thing.

    Peace

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  5. Most high end bike shops will have an adjustable contraption that looks like a stationary bike, which is used to fit you properly - seat & top tube length, stem length & angle, crank arm length, etc... Well worth a visit. Very small adjustments on a bike can make a HUGE difference in comfort and avoidance of pain, especially when you're riding a lot of miles. More a concern for road biking than MTBing.

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  6. Jill, don't believe everything any doctor tells you. They're human, they make mistakes and they make them all the time, especially when it comes to an injury such as yours and the possible causes. If you don't have Andy Pruitt's book, I would highly recommend it.

    Having said that, like all the others above, spare no expense on getting properly fitted--it will be the best money you've ever spent on cycling. Do your research. Not all shops take a passion on fitting or have the personnel trained to do it correctly, especially if your body is not completely symmetrical. I've got one leg 13mm shorter than the other and the difference is in my femur. Believe it or not, 170 cranks--no knee pain. 172, well, nothing I can do keeps my left knee from hurting (in the shorter leg). Lesson I learned? Have the shop fit you for both legs, not just one. See if there is a difference. If the difference is significant, then other measures will be needed for proper fit. May take some time, but fit on a bike is everything, especially when you ride the miles you ride. Off my soapbox now, ;-)

    All the best.

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  7. That diagnosis sounds bunk to me. Before Susitna- no knee problem. After-knee problem. bunk-bunk-bunk!

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  8. It's entirely possible (likely, actually) that you have some muscle imbalances - we all do to some extent. Cycling isn't exactly natural and uses some muscles a lot while ignoring others. A good PT can find those imbalances and help towards corrective exercises - sounds to me like you're on the right track.

    One thing I've done the past 3 years to stay balanced is a daily routine of core work ala Mark Verstegen - google will bring up a few books. There's one for endurance, and one called "core performance", I actually prefer the latter.

    Clearly, you did something to your leg on the posthole incident and then beat your knee to a pulp in the ensuing miles...but unless some hard tissue is torn, these things go away in time.

    Ya know what you have to do with lemons, right? I bet there's some stuff that's been put aside during the past year of enduro training ;)

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  9. I agree with Shawn and Juancho. Get another opinion.

    I also agree with Dave that bike riding can lead to muscle imbalances.

    But I don't believe any of it has to do with a specific bike. I think you're right - a bike is a bike. You don't need a laser-fitting. In the words of Grant Peterson, "you can be comfortable & efficient in more than one precise position. That's good, because different surfaces, conditions, loads, traffic, effort, & weather call for adjustments..." (Rivendell Reader #39)

    I'd venture there aren't many riders who know more than you do about riding a variety of surfaces, in a variety of conditions.

    The PT might be right about the imbalances but until you get the MRI they're all just guessing.

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  10. Anonymous8:33 AM

    Jill

    Have patience, get your bike fitted to you and let yourself heal. It's not much to go on but you are really inspiring to those of us who are not so dedicated nor so fit! The fit of the bike is really important and as somebody who had to give up on mountain bikes because he didn't pay attention to healing I really suggest that you take the time. For me I now ride a recumbent trike and only look longingly at your photographs!

    Have fun.

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  11. Flummoxed huh? Love that word. Just think, if you were not injured you probably would never get to say flummoxed. Flummoxing isn't it?

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  12. "Fit Kit" is one of the most common bikeshop methods. Keep in mind that it and other systems like it use averages of human anatomy. If you're unusually proportened it won't work properly.

    Not everyone agrees on proper bike fit:

    http://www.sheldonbrown.com/frame-sizing.html

    http://www.peterwhitecycles.com/fitting.htm

    It really isn't an exact science. You should get your physio to explain exactly what she thinks is wrong with the way you sit on your bike. Something I can't imagine she could do without actually seeing you on the bike.

    I'm sure she's right that you have an imbalance but it might be unrealistic to expect that imbalance to be corrected by riding. It might be something you just have to work on off the bike.

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  13. Hey Jill! Long time reader, first time commenter, etc. etc.

    I tweaked my knee a couple of years ago training for a marathon, and had a tough time finding a physical therapist that could put it back together.

    I found that when therapists don't really know what's wrong, they fall back on the basics: stretching, muscle imbalance, ice massage. None of this stuff ever helped me, and I'm willing to guess it won't help you: you have an acute injury traceable to a single trauma. Treating it like an overuse injury probably won't help.

    So: Get a second opinion. And a third, if necessary. Keep going until you feel you have a good picture of your condition and your treatment options.

    Also, I found that I'm the best judge of what's working. Endurance athletes know their bodies extremely well, and know the difference between good pain and bad pain. So the best therapist out there may be YOU. Listen to your body, and find what works for you.

    Above all, be patient. Connective tissue takes a long time to heal. As long as you feel better today than yesterday, you're on the right track. Stick with it. And know when to back off. Recognize when you're leaving "active recovery" territory and heading back into "overdoing it." Stop there. That's the sweet spot where you'll heal the fastest.

    The toughest part of injury isn't the physical, it's the mental. I sink into a wicked funk when I can't work out, and you seem to be battling that too. Find something, anything, that will get you good and tired once a day. I have a sprained ankle, so I'm back in the weight room doing core and upper body work, and making my ankle do stabilizing work. Find something, anything, that works for you. Maybe it's swimming. Maybe it's stuff like core, hip, and shoulder work that will complement your cardio and leg strength and make you a stronger rider. Maybe it's cross-country skiing. Having something like this will kill that feeling of losing ground every day, and satisfy your need for a physical test each day.

    Anyway, sorry to ramble. Keep your chin up! This just one more cycle in your training, and it couldn't come at a better time-- right after a huge endurance race, when you can really use the recovery time!

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  14. Anonymous12:41 PM

    That second long winded post was a bit overkill. Jesus, you're in your 20's and have pleanty of happy cartlige left!
    Any athlete is going have injuries. Its just that now you've pushed things up a few notches and the bike fit has becomore more and more important. There is likely alot of truth involved that long term bike bio-mechanics have been a problem for a while, its only that during the SU did they make themselves known.

    It sounds like you have inflamation from pateller femoral pain, likely a tracking problem,your PT is saying your VMO is weak compared to the lateral part of your quad, and pulling the knee cap laterally, combined with tight IT bands... its really common. My injury has stumped everybody becasue with me its actually the other way around, with an overdeveloped VMO, the 1% case.


    The tricky thing about bike fit with an injury like this is that you've been loading parts of your knees for a long time, and its been bothering them. When you make fit changes its going to take some time for the "underloaded" parts of the joint to adjust to the new stresses of biking which they havent seen yet. So it might not feel all happy from the get go.

    Anyway, just give it time, the races will always be there.
    Eric P, off to the pool

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  15. Follow the money. Complex diagnosis means repeat visits, $$$. Cynical aren't I?

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  16. Agree with DH; do this right and you'll be stronger than before. Just takes a bit of patience. Maybe get a kayak once the ice melts? I can't stand the gym.

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  17. Bike fitting is among the biggest rackets out there. If you go out and pay $100 or more for a MTB fit, they'll measure the length of your legs with a crude instrument and multiply the number by some overly precise factor (3 decimal places!) that is supposed to be your ideal saddle height. They'll tell you that it's a "starting point" and that you should fine tune the saddle height as you ride. (as was suggested above, road bike fitting is more involved, but it's still a racket)

    The fact that you don't use clipless pedals allows your feet to float around on the pedals until you find the spot that is natural. It's all subliminable.

    That said, in my experience, often shorter cranks will make all the difference. A saddle that is 1/2" too low causes me discomfort within 2 miles.

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