From: laforce@xenon.arc.nasa.gov (Soren LaForce)
Subject: Re: Knee problem
News-Software: VAX/VMS VNEWS 1.41    
Organization: NASA Ames Res. Ctr. Mtn Vw CA 94035
Date: Thu, 1 Oct 1992 16:20:00 GMT

In article <16872BF5E.RONEAL@lexmark.com>, RONEAL@lexmark.com (Randy O'Neal) writes...
>In article <4065.2739219031@kiwi.gen.nz>
>rabbi@kiwi.gen.nz (Rabbi Bajzheet) writes:
> 
>>
>>About a month ago, during a medium length (60ish km) hard ride, I managed to do
>>something to my right knee. It feels fine under all circumstances, *except*
>>when I'm pushing on a downstroke. Then I feel a chronic ache, under my kneecap.
>>Nothing else I do (running, walking, poking at it with my fingers) seems to
>>hurt it.
>>
>>Saw a doctor, he said I'd bruised the cartilage under my kneecap. Since
>>cartilage doesn't have a very good blood supply, it doesn't tend to heal very
>>fast. He prescribed complete rest from cycling for six weeks (gasp!), and then
>>gradually build up strength, keep spinning and don't overdo it. He said if I
>>didn't do this, it wouldn't heal for several months, perhaps never if I keep
>>cycling.
>>
> 
>Speaking from experience, either listen to your doctor, get a second opinion
>if you don't like the first, or get ready to limp - maybe for a loooooong
>time.  I didn't listen to my orthopedic surgeon and went dirt biking when
>he told me to take it easy... I ended up with a second more radical
>operation and now I can't run, jog, etc.  Fortunately, I *can* ride, though
>I can't ride standing up for too long.  Believe me, if your doctor told you
>to lay off, that's *exactly* what you ought to do.  Good luck...
> 


I would definately stop riding (for now), but I'm not sure the doctor
is correct.

My experience is that this kind of injury does not heal
**ever**.  The condition is called condramalasia of the patella (could
be a spelling error there...), at least MY condition is called that.

What I have is not bruising of the cartilage, it is roughening of the 
cartilage.  This is not something that shows up on an x-ray, so it is
dificult for me to see how the doctor could diaganose is exactly, of
course I should warn you that I have a, uh, poor, yeah, poor!, opinion
of doctors (guess I've been told "gee that's too bad, why don't you 
try to learn to live with it - that will be $100 - " a few too many 
times).

I've been living with this condition for about 11 years now.  Here's 
what works for me:  Physical therapy.  Low gears.  Warming up slowly.

Based on my own experience, and I did keep riding for a while with
minor pain - I don't know how much this contributed to my condition,
what I would do is:

1)	See a physical therapist.  These people work magic.  On thing
**really** insidious about this condition is that when you stop riding,
you get weaker.  When you're weak, it's easier to aggrevate the problem.
The therapist can show you how to strengthen the quads to support the 
kneecap.  I would do this almost regardless of cost, if you damage 
your knee IT WILL NOT EVER HEAL.  I saw a sports medicine surgeon
at one point.  He told me that my problem was not severe enough to 
warrent surgery, and that he would consider surgery a sucess if the
paitent was in my condition at the end of surgery!  The surgery is
to put you in good engough condition to bennefit from the PT!

2)	Be sure you have low enough gears on your bike and that you 
maintain a cadence of 90 to 110 whenever possible and never go below 
60 or 70 without standing up.  For me, standing up is nowhere as bad
as sitting down (less leg flex).  I ride the mountain bike a lot more
now due to the lower gears (anyway the road bike is apart undergoing
a triple chainring conversion to give me lower gears).  I have never
had knee pain with the mountain bike.

3)	Warm up for about 10 miles.  High cadence, low gears, minimal
hills, etc.  This is what did me in.  I kept a high cadence (about 100),
but was riding to work at 7 am and it was cold out.  So I rode hard and
fast to get warm.  Bad move.  Don't do it.

Here's some weird stuff:  The very worst thing for me to do is play 
tennis, bicycling is bad but managable with the PT, but running 
causes me no knee pain at all!  Skiing is okay, but I have to be 
careful if I ski a lot of bumps.  These days I run a lot, which helps
keep the quads strong, which helps the riding!

Another trick is that when I know I'm going to be doing something the 
knee won't like, I do the PT for a few days in advance, and to do it
just before the activity (skiing!).

Anyway, I hope this long rambling disertation helps.  In your place
I would see a sports orthopedist and a physical therapist,  'cause
if you do prang it, you will live with the problem for life.



--Soren            laforce@xenon.arc.nasa.gov
Newsgroups: rec.bicycles.misc