The knee is an amazing joint. Think about how much weight goes through it when you walk, more when you run, or go down the stairs and what about running down the stairs. I broke my knee cap 13 weeks ago and I meant to write about my recovery on this blog but I haven’t written as much as intended. I emailed someone last week with some advice on knees and I thought I would turn that email into a post.
I have spent half a century abusing and then repairing my knees. Most of the damage has been caused by running, hill walking and skiing. However, in the last year, I have hurt both of my knees cycling.
A brief history of my knee problems from the age of 25 onwards
- Initially caused by running – probably because I increased my training load too quickly (I went from 0 to 80 miles a week in very little time), then pushed through some knee pain when I came back after a break and didn’t wear the right sort of shoes or change them frequently enough.
- I carried on getting knee pain when hillwalking especially descending, probably made worse by a more sedentary lifestyle, as I went from being a student to working in London.
- In my early 30s I was diagnosed with slight tears in the cartilage (this was after an MRI scan and exploratory keyhole surgery on one knee).
- After extensive Physiotherapy, a podiatrist making custom insoles and stopping running my knees were as good as new. I think doing more frequent exercise, initially going to the gym and then rediscovering cycling in my early 40s really helped.
- My only knee pain cycling was from badly adjusted cleats when I first started going on longer rides.
- Last summer I was hit by a car on my right knee and it swelled up horribly. After a few weeks on crutches, it was still swollen but I was able to walk fairly normally (including in the alps) and when I started cycling again I had no pain and the swelling went down totally.
- Thankfully my right knee was fully recovered before I broke my left knee cap and only time will tell if I make a complete recovery. Initial signs are good, especially now that I am no longer using crutches and have started (indoor) cycling.
The things that I have found most helpful are:
- Podiatrist prescribed orthotics. This made a big difference to me as I have high arches, leading to my feet leaning inwards and effectively making me knock kneed. I have walked with orthotics for about 20 years now and also ski and sometimes cycle with them.
- Leg length discrepancy. It was only a second podiatrist, a few years after the first, who noticed that one leg is 1cm longer than the other (possibly due to breaking one of my legs when I was about 20) and she added a rise to the orthotic for my shorter leg. Again I now use this for walking, skiing and cycling longer distances.
- I have greatly benefited from numerous physios over the years. I would really recommend https://www.amazon.co.uk/Sports-Injuries-Self-Help-Vivian-Grisogono/dp/1905367287/ref=dp_ob_title_bk both for helping to diagnose and understand what is wrong and also for providing exercises to help strengthen the right muscles.
- Glucosamine/Chondroitin/MSM – the evidence is weak but it seems to help me and many other people, especially as we get older. A friend of mine said that the thing that convinced him of the benefits was seeing the improvement in an arthritic dog, who obviously wouldn’t know it was meant to help.
The thing that you might find hardest to believe is that cycling can actually help your knee recover from an injury. As I have been told recently you have to “let pain be your guide”. Cycling has the advantage of being non weight-bearing. The movement is also meant to help lubricate the cartilage and help the swelling go down. My current physio has told me that studies show that even 5ml of excess fluid in the joint can reduce the quadriceps’ function by 40%. So its easy to get into a vicious cycle where swelling stops you moving the knee and the muscles become weaker so you can’t move it and are more likely to injure it (one of the reasons a brace, which I wore 24/7 for 6 weeks after breaking my knee cap, is so important). So cycling can help break this pattern, by getting the knee moving without tiring it by putting weight through it and thereby strengthen the muscles and also reduce the swelling.