Any advice for avoiding knee injury

[TwoWheelsDC]

@LetsRide 121191 wrote:

I typically ride 50-100 miles a week to work and i have been doing this for a couple of years, but i am a fair weather rider (no winter or rainy days).
Two weeks ago, i rode my typical 10 mile ride home w/o any problems.
About an hour or so later, my right knee became really sore (as in drag the leg behind you…)
I spent the weekend recuperating (RICE and advil) and within a few days was mostly back to normal.
Ostepath xrayed it and said he saw nothing chronic.

I was told two things: make sure my bike is properly fit (seat at right height) and stay in low gears on steep hills (Custis!).

Any other sage words of advice?

thanks,

Ron

PS. i rode in today and knee is feeling fine!

Welcome! In addition to the correct seat height, the positioning of your feet on the pedals can affect your knees as well. For example, I recently switched pedal systems and afterwards started getting knee pain…but I realized that when I put new cleats on my shoes, I didn’t get the alignment quite right, so my knee was having to twist to compensate. Made a barely noticeable change to my cleat alignment and the pain went away immediately. This can also apply if you don’t use clipless pedals, particularly if you can’t keep consistent foot placement on your pedals and end up twisting/contorting your knees…or if your shoes aren’t providing adequate support.

[Emm]

Get a professional bike fit if you haven’t already. When you ride that often a proper fitting is really important. Cleat position, proper shoe insoles, what pedals are being used, seat height, handlebar positions and size are all part of a good fit. There’s alot of recommendations for fitters out there that you’ll see (Clovis @ freshbikes, Smiley, Retul @ Revolution cycles just to name a few).

Sometimes I get knee pain if I’m using too high a gear during long period of my ride. The only other times I’ve dealt with it is when the seat height isn’t quite right, or my cleat position is wrong.

[GovernorSilver]

I was getting knee tightness too, until the guys at Spokes noticed my seat was too low.

I also changed my pedaling technique on my coworker’s advice. I now try to pedal by pushing my heels down, which recruits more glute and hamstring than just the thighs, thus spreading the load more evenly among the legs’ muscle groups. It’s still a new thing to me so I have to think about it as I’m pedaling from time to time.

[Tania]

Great advice above – I’ll add that when my knees start to ache and I have to teeter going down stairs, it’s almost always because my quads (rectus femoris, specifically) are tight from a heavy week.

Good stretch for that here.
http://www.bozemanwellnesscenter.com/couch-stretch-hip-flexorquadriceps/

(I can’t get anywhere NEAR this upright of a position, but I try…)

[LetsRide]

Hey all,

Thanks for the advice!

I’m going to get fitted by ‘Tim’ at bicycleSpace.

[PotomacCyclist]

+ 1 on bike fit and also on using easy gears on hills (unless you have much more experience on hills and are doing specific training for hills).

Stretching helps a little, but it can’t compensate for muscle weaknesses and imbalances. Only strength work or bike-specific strength sessions develop strength. And only a smart and balanced strength program will develop balanced strength.

Don’t do too much, too soon either. One type of ride in a certain gear might be only a moderate ride for a very experienced and advanced cyclist. But that same hilly ride in a big gear could lead to immediate pain and injury for someone with much less experience and training. When you introduce hills and more mileage to your routine, do so gradually. Give your body a chance to adapt to the new stresses. Include some easier rides as active recovery. (Beginners might do better with a complete rest day.)

Nutrition helps too. If you aren’t eating enough of the key nutrients, your body won’t be able to repair itself or fight off inflammation. You don’t have to go super-heavy with protein, but make sure not to skimp on it either. Dark green vegetables and unsaturated fats have an anti-inflammatory effect. (Refined sugars are the opposite. They have an inflammatory effect in the body.) Drink plenty of water (without forcing yourself to keep to an artificial schedule). Include fiber for heart and GI health.

[dkel]

@PotomacCyclist 121457 wrote:

Only strength work or bike-specific strength sessions develop strength. And only a smart and balanced strength program will develop balanced strength.

Any recommendations on a cycling-specific, balanced strength training program? I’ve been arguing with my knees lately, and since I’ve been doing 100 miles a week for a couple of years now, I’m suspecting it’s a strength imbalance, since not much has changed on my bike in the last year. I have added stretching, and it’s great, though it doesn’t solve the problem altogether. I’m also looking into a bike fitting, just to make sure there’s no issue there.

[PotomacCyclist]

The basic principles of a balanced strength training program are total body exercises and free weight and/or body weight exercises.

The basic exercises are some type of squat (bodyweight for beginners, barbell squats), a hamstring-specific exercise (deadlift, one-leg deadlift) and a push (push-up variant) and pull (pull-ups, rows or similar exercises). Always warm up before doing ST. By definition, it is more intense than a casual recovery ride or run. Whenever you do anything intense (ST, tough hills, tempo or speedwork), you need to start off with a good warm-up. Depends on the air temperature, your age (us middle-aged folk seem to take a little longer to get warmed up for tough workouts) and other factors. Sometimes I do the ST right after a moderate bike or run, so I’m already warmed up.

Single-leg work is good too. That hits the small stabilizer muscles like the gluteus medius, which is a problem area for many people. (Sitting causes a lot of the problems. Many of us are stuck with sitting for much of the day because of work or school.) Single-leg work can include pistol squats (single-leg squat), step-ups, lunges, single-leg deadlift, et al. Always work on the form before adding weight. Doing a strength exercise incorrectly will cause more problems than it solves.

You don’t have to do all of these every time. I might only do barbell squats for a month or two in mid-winter, when I can afford the extra recovery time. If I’m doing harder bike or run training in the spring, I can’t afford to get my legs wiped out every week by a tough squat session. In the spring, I might focus more on pistol squats, which work more on coordination and small stabilizer muscles than on building a lot of strength.

Some people split up legs and upper-body into separate days. Depends on your goals. Bodybuilders might overload the legs or upper body so much that they don’t have the energy to do the other exercises in that session. Endurance athletes can scale back the total workload a bit. Maybe not as many sets or exercises, so you can fit everything in on the same day.

How often do you need to do this? Endurance athletes don’t need to do ST too often. Ideally, I try to do ST every 5-10 days, but it doesn’t always work out.

You can do a lot of it with no equipment at all, except a pull-up bar. This is why I post occasionally about places in the DC area with outdoor pull-up bars. I can head there at the end of a bike or run and add some outdoor strength exercises. The hardest part is the hamstrings if you don’t have weights. You can do single-leg deadlifts without weight, but for an experienced athlete, those aren’t really challenging enough. But they do work on those important stabilizer muscles. I also try to bump up the intensity by going slow on the way down and moving back up a little faster. Or adding more reps. People say that higher reps work muscular endurance only. But I barely did any ST this winter while doing a lot of swim paddle sets and my upper-body got a lot stronger. So much so that I was finally able to do one-arm push-ups, even though I had only been doing ST once every 2 or 3 weeks at that point. You don’t build much strength from one strength workout every 3 weeks. It had to have been the swim pull sets.

I’ve found pull-up bars at Seaton Park (just south of the Air and Space Museum), an impromptu bar at the foot of the Exorcist Steps (your feet are only a foot off the ground, and only a couple inches from the metal step so it’s safe), a new one on the Main Line Blvd. trail in Potomac Yard and maybe a couple others. I don’t remember if there is a pull-up bar in the small park at Crystal Drive & 26th St. (near the beach volleyball courts). The bar at the Exorcist Steps is kind of grimy though. I’d recommend wearing gloves. (For other bars, I try not to wear gloves. Mostly because of my other fitness goals, like American Ninja Warrior. Not that I’m competitive in that but I’m using that as a general guideline for my strength and agility work. For ANW, you need to be able to grab and hold onto bars without wearing gloves.)

You can do push-ups anywhere. (If you can do one-arm push-ups, then you can match the intensity of the pull-ups. But I recognize that one-arm push-ups are very difficult. It took me about six years of on-and-off trying before I was finally able to do them. You can do a progression though. If regular push-ups are easy, try a one-handed bench push-up. Bench push-ups are easier, but not if you only use one arm. Be careful with the rotator cuff though. This will put a lot of stress on the shoulder. Try a static hold first. Try a higher bench to make it easier at first. Once you can do 10 reps or so for a few sets, it’s time to start at a slightly lower point. Keep going like that, not too quickly.)

You can do pistol squats anywhere.

I’ve also done some “cheating” hand-stand push-ups. They aren’t quite hand-stand push-ups, which are very difficult. I keep my legs against a wall for balance. This is like doing an overhead press, but with a balance component thrown in. Plus you don’t need to bring a dumbbell with you. Just find a wall and a flat, clean section of ground or sidewalk for your hands.

Sprint work is supposed to be good for the legs and even for the core. Don’t overdo it, but since you’re an experienced cyclist, you could throw in some of these. Maybe at the end of an easier ride. Find a nice empty street where you can sprint for 8-10 seconds safely, with no risk of a driver, cyclist or pedestrian entering the street from the side. Then take a long recovery, maybe 1-2 min. of easy pedaling before the next rep. Try 4 reps then a cool down. Add a rep every few weeks if you’re feeling good. I don’t usually do more than 6-10 reps of sprints/strides. Sometimes I might do a second set, after a longer recovery in between the sets.

[DismalScientist]

@dkel 121459 wrote:

Any recommendations on a cycling-specific, balanced strength training program?

I’m a fan of the 12 ounce curls. It balances my excessive quad strength with upper body strength. After doing enough curls, I can’t feel my knees at all.

[Tania]

@dkel 121459 wrote:

Any recommendations on a cycling-specific, balanced strength training program? I’ve been arguing with my knees lately, and since I’ve been doing 100 miles a week for a couple of years now, I’m suspecting it’s a strength imbalance, since not much has changed on my bike in the last year. I have added stretching, and it’s great, though it doesn’t solve the problem altogether. I’m also looking into a bike fitting, just to make sure there’s no issue there.

Find a qualified PT and get a professional assessment. You get what you pay for on the internet.

[dkel]

@Tania 121469 wrote:

Find a qualified PT and get a professional assessment.

How do you do that? Is this the kind of thing that requires evaluation by an MD and a prescription to see a PT?

[jabberwocky]

For me, I find knee soreness is mostly a flexibility issue. It pops up more when I run, but sometimes is an issue riding as well. For me, 5 minutes of stretching a few times a day helps a lot. My main issue is tightness in my hips that cause me to run or pedal slightly weird.

I’ll add the caveat that my body is used and abused. I work around a lot of old injuries. Your body is different, so getting a professional opinion might be a good idea.

Obviously this assumes you’ve covered the main stuff like bike fit and nothing is injured and all that.

[dkel]

@PotomacCyclist 121466 wrote:

The basic exercises are….

This is all great stuff! I particularly like the idea of bodyweight exercises, because I don’t want to accumulate stuff, or to have the whole ST thing to use up any of my cycling bandwidth.

[Tania]

@dkel 121470 wrote:

How do you do that? Is this the kind of thing that requires evaluation by an MD and a prescription to see a PT?

Guessing that would depend on your insurance (if you’re using it).

The thing is, your issues (and the OP’s) could be caused by any myriad of issues: stability, mobility, an underlying gait disorder (as applied to pedaling), an underlying medical issue, etc etc etc. Or it could be just that you’re getting old and creaky (that’s my excuse anyway). There’s no way for anyone online to say “this is how you fix it!” because there’s no way to know what “it” is without a detailed, in-person, hands-on assessment. You can spend some time following internet advice and maybe it works, or maybe there’s no amelioration of symptoms and after a few months you go to a doctor. I hope in both your instances the fix is simple! Aches and pains that impact your daily life are never fun.

All I can say for SURE, is that when MY knees hurt, it’s because I’ve been neglecting to stretch. That and I rode just under 100 miles last week and thought I was going to die.

[PotomacCyclist]

I posted about strength training. Nowhere did I claim to know the specific causes of dkel’s issue. I mentioned some problems that are very common among modern American adults, but again, I am not saying definitively that is causing whatever is going on with him. I don’t even know what is going on with him in detail. There are several different knee problems, some of which can appear similar.

I also know, at least with running, that I’ve heard many people get flawed advice about physical ailments. I’ve heard many people say that when they went to a doctor about a knee or lower leg problem, the first thing the doctor said was to stop running, because “it’s bad for your knees.” While some people certainly can overdo it with running, and not build in enough recovery, or use horrible form or whatnot, the limited data tends to indicate that running, on average, tends to be better for the knees. It might be bad for some individuals, but it tends to be better for more of them. On the other hand, far more people develop knee and other ailments because of sedentary lifestyles and junk food diets, which these doctors don’t always seem to address (partly because some of them have terrible diets themselves).

There are specific issues with some people, such as a traumatic tear or a leg-length disparity or something like that. But there are also common issues that affect millions of adults, which is why certain problems occur so frequently in modern America. It doesn’t hurt to discuss them. If a problem is serious, then yes, by all means, see a qualified professional. But not all qualified professionals are helpful in all situations. I don’t know if it’s the case as much with cycling as it is with running. Some doctors may believe that no one should be cycling except on separated trails because “cycling is dangerous!” which sounds like the “running is bad for your knees” statement that some doctors put out there.

I will say that once you have a proper bike fit, that running does pose more stress and more of a risk for the knees. That’s where I’ve had the most experience with knee issues, in running. I had a bad time of it in my first year to 18 months. Partly because I had aerobic endurance (from a few years of swimming) so I wouldn’t get tired. But I didn’t have the leg durability, proper form or muscle balance to handle that mileage so early in my running program. (Beginners who don’t have much aerobic endurance find it much harder to run so much where they put that much stress on their knees. They get tired and cut their workouts off sooner.)

I ramped up my running far too quickly that first month or two. My knee started clicking. Eventually the pain became excruciating, to the point that I couldn’t even flex the knee without feeling searing pain. But I found out just as quickly that it was a muscle imbalance problem with me. (Other studies have shown that core weakness and imbalances are a major contributor to perhaps the majority of running knee injuries, and maybe with many cycling knee problems, although bike fit is an important consideration too.) After just a couple strength workouts with step-ups and squats, the clicking disappeared completely. Just like that. Fixing the muscle weakness (probably the VMO toward the lower inner part of the quads) got my kneecap to start tracking properly, instead of scraping against the sides of the groove where it slides through.

But the ST didn’t fix the existing damage. Only time could heal that. So no running for a few months. I might have done too much swimming at that time and continued to irritate the cartilage. When I started running again, I quickly developed lower back tightness and ITB tightness. Another break from running, this time just a couple weeks.

I got more serious about balanced strength training. The knee problems went away a few months later and have never returned. So it had nothing to do with age (because obviously I’m several years older and much more injury-resistant, at least with the knees). I’ve never had another overuse problem with my knees. (I did slip once on a treadmill while wearing shoes that were wet from walking outside in the snow. I fell, then grabbed onto the railing while my knee was on the tread. It grinded a huge wound onto both of my knees. But that had nothing to do with overuse problems and everything to being careless about wet soles.)

I developed extreme shin tightness later in that 1st year of running. Exercise-induced compartment syndrome. While traumatic compartment syndrome can be life-threatening if not treated, the exercise-induced version isn’t quite as bad, but you don’t want to ignore it. It would happen at the start of almost every run. But then I started adding some lower-leg specific exercises (toe raises, bent-knee calf raises, straight-leg calf raises). Within a few weeks, the problem disappeared permanently. I’ve never had any issues with shin splints or tightness again.

I’ve had minor issue pop up here and there, again mostly while running. I think this can be helpful on a cycling forum because the extra stress of running reveals flaws in the body sooner than it would in cycling (assuming you have a good bike fit). On some of my long runs, I would start to develop ITB tightness again. (For those who don’t know, the IT band runs along the outer side of your thigh, from the hip to the knee. When it gets tight or inflamed, it creates a lot of pain and discomfort on the outside of the knee. It’s one of the most common ailments among runners.) I had started reading that ITBS is associated with core weakness or imbalances. So in the middle of these long runs, when the IT band would act up, I would consciously tighten up my abs and deeper core muscles. Every time I did this, the ITB tightness would disappear immediately. No exaggeration.

But clenching your core muscles consciously is not a good long-term solution. The real solution is to strength and balance out the muscles so there is good muscle tone and strength, without having to put conscious effort into it. I don’t think I’ve had any ITB issues in several years either. I really don’t remember the last time it happened.

I wasn’t naturally “injury-free.” I was one of the most injured runners I knew. I thought that it was because I had been sedentary for too long and my time for being active was up. That was very wrong. The sedentary years did play a role, in the muscle weakness and imbalances. But unless there is some serious medical condition, muscle weakness and imbalances can be addressed in all able-bodied adults. It doesn’t take too much time, but don’t expect 2 minutes a week to suffice.

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