What does anybody do about knees?

Roger Davies

Philip Davis wrote:

I'm surprised nobody has mentioned exercise in relation to knees:

I've had two long conversations about knee injuries with different sports physios (both fully qualified, and in one case with a lot of experience with cyclists). Their view is that most knee injuries with cyclists arise not from cadence or badly fitting cleats, but from an imbalance caused by the nature of cycling - i.e. a constant stress on your 'spin' muscles, with little or no excercise for the opposite muscles.

They recommend two things: First, the obvious, which is regular stretching to release pressure on the knee (I actually pulled a kneecap out of position in a fall, caused, according to my physio, to the muscle being too tight).

Second, regular exercise to the unused muscle. My physio demonstrated two of these (apologies for having forgotten the names of the muscles):

1. Sit on a chair normally, with a cushion under your upper legs to raise them a little. Stretch out your legs horizontally (preferably with some light ankle weights). Do gentle leg presses, but don't drop the leg more than 15 degrees. This gives a gentle workout to the 'opposite' muscles to the normal pedalling action.

2. As above, but lock your knee out firmly, and twist your leg (so, for example, your right foot your toes are pointing at a 2 O'Clock position). Do leg raises (keeping your knee locked out), again, no more than about 15 degrees rise from the horizontal. You should feel a strain on the muscle that runs from your kneecap to groin.


Sorry if these are a bit confusing, hard to describeexercises like these without being able to demonstrate directly, but they are pretty logical when you do them. 2Kg ankle weights are best for starters. You don't have to do too much (according to my physio), its just a case of strengthening them enough to provide a balance against your pedalling muscles.

Oh, and also, I've personally found that keeping my knees warm all through the winter helps a lot - Swobo merino leg warmers are the best cycling investment I've made in a long while.

Hi Phil. Have you got a link for these: Swobo merino leg warmers.

Cheers
RD

SteveR_100Milers

[quote="Roger Davies
No apology needed MR. Frankly I'd be a bit embarrased at my age - 65 to wear 'proper' cycling clothing though I cycle with blokes every week and even older than me who always do. Also climbing in and out of it every trip just puts me off. But I guess if you're into preformance I can see why Lycra is a must. One thing though, dont take this personally, but whenever I see a cyclist coming the other way I always nod a greeting. 'Ordinary' cyclists like me nearly always nod back. Maybe one in hundred Lycra wearing cyclists do. I've always thought that strange. Just an observation.[/quote]

Didn't you know that Lycra is well known to cause a significant rise in heart rate and O2 consumption with no other discernible external symptoms, other than rapid leg hair loss. So on the outside you might see someone well within their comfort zone, in reality they are suffering like a rabid dog and are completely incapable of gasping more than half a ragged word at a time. Shaking or nodding ones head simply destroys the lamina airflow over the ears, and should therefore also be avoided...the only roadies that are friendly are the ones that don't win races

back to the OP, I have found that lateral cleat position has a huge influence on knee pain or not. When I have got it wrong in the past, even after only an hours riding in the "wrong" position, I found I couldn't ride for a week.afterwards my knees were that painful. I have found that pedals with a good level of lateral float are also conducive to protecting your knees.

McBain_v1

I couldn't agree more with SteveR's point about lateral float being critical to maintaining joint integrity. I'd never go for a zero-degree float pedal. However, I am still finding that positioning of the cleat on the shoe itself takes an inordinate amount of trial and error, particuarly when you don't have two pairs of shoes the same (perhaps that is where I am going wrong).

knedlicky

Philip Davis wrote:

I'm surprised nobody has mentioned exercise in relation to knees:

physios ... Their view is that most knee injuries with cyclists arise not from cadence or badly fitting cleats, but from an imbalance caused by the nature of cycling - i.e. a constant stress on your 'spin' muscles, with little or no excercise for the opposite muscles.

They recommend two things: First, the obvious, which is regular stretching
Second, regular exercise to the unused muscle.

Oh, and also, I've personally found that keeping my knees warm all through the winter helps a lot

The muscle often deficient is the one on the inside of the lower thigh. Cross training (swimming, best on your back, and climbing in particular) and stretching definitely help, the latter best as part of a regular allround fitness cross-training session in the gym. Failing that even doing a few mins appropriate stretching exercises within an hour of a long ride still helps. But how often do you see a cyclist stretch after a ride?

Other variations on your exercises include (10-20 repeats, 2-3 sets):
- lie sideways on the ground, say on your right. Bend your left leg over the right leg, which should be straight, and rest the left leg's knee on the ground, though not its foot. Then lift your right leg off the ground slightly, bend the knee slightly and then return it to straight, before replacing it on the ground. Make sure the hip stays on the ground and the right leg faces forward, that it doesn't turn. Also pull in the toes of the right leg.

- sit on the ground, putting legs straight out and apart, keeping back straight, if needed with arms supporting just behind hips.
Lift one leg, say the right one, the toes pointing upwards to the right, and move it so it crosses the other leg with a few cm to spare. Then move the leg back again to its original position.

Keeping the knees warm is always the best - unless it's actually inflamed, when cold is best.

Roger Davies

'Didn't you know that Lycra is well known to cause a significant rise in heart rate and O2 consumption with no other discernible external symptoms, other than rapid leg hair loss. So on the outside you might see someone well within their comfort zone, in reality they are suffering like a rabid dog and are completely incapable of gasping more than half a ragged word at a time. Shaking or nodding ones head simply destroys the lamina airflow over the ears, and should therefore also be avoided...the only roadies that are friendly are the ones that don't win races'

Nice one

Ok you got me. What is and are 'lateral float pedals'????

Roger Davies

Hi knedlicky. I can see how that helps muscles but how does it help a knee?

paulswilliams2

Yellow Cliff wrote:

paulswilliams2 wrote:

Is it worth taking Glucosamine and Chondroitin as a preventative at the age of 30? I have recently had a 2nd arthroscopy which solved my 'impinged fat pad'. Although the joints are fine and show little cartilage wear, I would like to protect mine in future as much as I can.

Was this a Hoffa impingement (a haemorrhage on the fat pad)? I had an arthroscopy 3 months ago and my surgeon found and removed this. He said it was caused by repeated bending of the knee - well there isn't much you can do to prevent that if you are a cyclist!

Have you managed to discover a different reason for yours?

Yeah, think it was a Hoffa impingement. I don't know for sure as I only learnt this term via Dr Google since my first post-op consultation. I will check in a couple of weeks. My consultant advised me that the likely cause was poor patella tracking, which can cause the fat pad to swell, and sometimes get caught in the main load bearing joint.

The fat pad was trimmed back, and the patella tracking will hopefully be resolved by physio.

Many people have been discussing increasing the frontal inside thigh muscles - well my main current exercise is to sit up high on a desk for example, and do leg extensions whilst holding a football between my ankles. The inward force to hold the ball means the inner thigh muscles work harder than if you just do normal knee extensions. It was also surprisingly difficult at first, with my knees getting the shakes after only 20 reps

paulswilliams2

Roger Davies wrote:

Hi knedlicky. I can see how that helps muscles but how does it help a knee?

Bone and joint problems can be caused by an imbalance of muscles. Unnatural forces on the bones can cause misalignment, and in my case poor tracking of the knee cap. This can result on bone rubbing bone etc. Therefore, the root cause of muscle imbalance must be fixed for long term resolution.

Philip Davis

Roger, you can get the Swobo knee warmers at stif.co.uk:

http://www.stif.co.uk/gear/select_optio ... uctid=3939

Super comfy, but maybe not so necessary now spring is nearly here (I hope).

BTW, my understanding is the same as Pauls re: exercises. An imbalance in muscle strength and stiffness literally pulls the knee out of alignment. I found this out the hard way when a fall on my hip literally pulled my kneecap out of position - my physio said my cycling muscles were far too tight from not doing stretching.

Roger Davies

Philip Davis wrote:

Roger, you can get the Swobo knee warmers at stif.co.uk:

http://www.stif.co.uk/gear/select_optio ... uctid=3939

Super comfy, but maybe not so necessary now spring is nearly here (I hope).

BTW, my understanding is the same as Pauls re: exercises. An imbalance in muscle strength and stiffness literally pulls the knee out of alignment. I found this out the hard way when a fall on my hip literally pulled my kneecap out of position - my physio said my cycling muscles were far too tight from not doing stretching.

Cheers Phil. I learned something to.

knedlicky

Roger Davies wrote:

Hi knedlicky. I can see how that helps muscles but how does it help a knee?

Paul and Philip have answered before me, or even for me!
My only comments on top are that it's not the knee which is pulled out of alignment by the muscular imbalance, as Philip wrote, but the knee cap (usually towards the outside of the knee), and it isn't usually bone rubbing bone as Paul wrote, but the knee cap (over)squeezing the cartilage against the bottom of the thigh bone. It's called patellar subluxation.

Although muscular misbalance is recognised as a cause of knee pain in cyclists, I suspect that improper saddle position (esp. too low) or wrong cleat adjustment are more common causes, or forcing it too hard (too high a gear) when there's already a knee problem due to other causes, like over-pronation or damage from twisting the knee when playing tennis or football or skiing.

Roger Davies

knedlicky wrote:

Roger Davies wrote:

Hi knedlicky. I can see how that helps muscles but how does it help a knee?

Paul and Philip have answered before me, or even for me!
My only comments on top are that it's not the knee which is pulled out of alignment by the muscular imbalance, as Philip wrote, but the knee cap (usually towards the outside of the knee), and it isn't usually bone rubbing bone as Paul wrote, but the knee cap (over)squeezing the cartilage against the bottom of the thigh bone. It's called patellar subluxation.

Although muscular misbalance is recognised as a cause of knee pain in cyclists, I suspect that improper saddle position (esp. too low) or wrong cleat adjustment are more common causes, or forcing it too hard (too high a gear) when there's already a knee problem due to other causes, like over-pronation or damage from twisting the knee when playing tennis or football or skiing.

Interesting knedlicky. This has been a useful thread for an amatuer like me. One more questions if you wouldent mind. How do you work out what your correct cycling position should be in relation to saddle, pedals and handlebars? Thanks

Roger

knedlicky

Roger Davies wrote:

Interesting knedlicky. This has been a useful thread for an amatuer like me. One more questions if you wouldent mind. How do you work out what your correct cycling position should be in relation to saddle, pedals and handlebars? Thanks

You should be able to find guidance about setting up your bike in books covering the technical side of cycling or in websites covering the same. Of course the frame size should be about right to start with, then come all the rules like …

saddle height based on crotch distance x 1.09 or heel on pedal when sitting on saddle, nose of saddle 4-6 cm behind crank vertical axis or aligning with small ring on a 2-ring crank or so that kneecap in same vertical plane as pedal axis when pedals are on same horizontal plane, nose of saddle to handlebar stem about same length elbow to fingertip, saddle 5-6 cm higher than handlebars, body angle on bike about 90 degrees, etc.

You’ll end up making compromises if you try to follow all the rules, and then slight adjustments (max ¼“ at a time) based on comfort or the type of riding you’ll be doing.

milese

Panter wrote:

If you have bad knees the doctor can prescribe Glucosamine on the NHS because there are studies that show it to be effective to some extent.

Is that a fairly new thing then? when I saw my doctor about my knees he recommended it but said it wasn't available on prescription.
That was nearly 2 Years ago now though, I'll look into it.

Saying that, I get mine at ASDA. I forget the cost but its a hell of a lot cheaper than at Holland&Barrets and may be chepaer than prescription if you only get a months worth from the doc in one go.

I've been taking it regularly for a few moths now and my knees do seem a bit better, but then I'm doing a lot more cycling now which may be strengthening them too.

cheers

Chris

I've got the Plymouth area joint formulary, which is basically a book of the drugs that can be prescribed in the region, and it does not list Glucosamine. But then given its cost its probably cheaper to buy from tesco.

Moving from shorts to 3/4 lengths definately helped my knees in cold weather.

Making sure your shoes (or practically your insoles) put your foot at the right angle is also very important. This will be different from shoe to shoe though. I've got insoles that I got for running that I use in one pair of spd shoes, but I dont need them with a different pair that I also use.