About Matt Fuller

I am an experienced hill walker, keen mountaineer, and terrible rock climber with a love of all things gear. I spent too long at University and now work in the outdoor industry. This blog is my thoughts on the science behind gear, some gear reviews, and some stories of adventures I've been on.

Knee bother. Part 1 of 2.

If you’re a keen cyclist, runner or mountaineer then your knees are a ticking time bomb. You’ll forget they’re there until one day they begin to hurt. What happens then? You carry on and ignore them, stop doing what you enjoy, or you do something about it. If you’re a Scot, “knee bother” doesn’t sound too bad, but for everyone else it’s a right royal pain. Here’s the first of two posts on how I solved my knee injury.

My story

If this were a TV drama the music at this point would be really dramatic and melancholic, probably self-indulgently so. I live in Manchester, UK, so suggest you put on The Smiths’ I know it’s over to read this bit.

About 18 months ago I had some knee pain in one leg. It came on slowly, a dull nagging ache under the kneecap which occasionally presented lower down my shin, and it wasn’t long before the knee ached all the time. I mean all the time: sat at my desk, standing up, walking about, driving… whatever. Running and cycling for fun were impossible (why would you want to go out to do a knee-intensive exercise if just wandering about aches, and you know it makes it worse?).

I went from doing about 10 hours of aerobic exercise a week to 0.

I did some crying, saw four different physios all over the country, spent hours reading books and watching Youtube to try and solve the problem, and spent literally hundreds of hours doing physio exercises. On more than one occasion I didn’t think I’d ever run or ride a bike pain-free again and started looking into knee replacement surgeries, which at age 30 is pretty depressing, and it’s the longest period in my life where I’ve felt down.

I’ve had plenty of injuries in the past from broken bones to snapped ligaments but this was the hardest to deal with because there seemed to be no way to fix it.

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Strava’s recordings leading up to my injury: on paper it’s nothing unusual, but it doesn’t measure intensity: was too much intense exercise a factor?

But, wind forwards a few months and I seem to be on the road to recovery. I’m just back from a 10 mile fell run, I rode 60 miles on my bike yesterday, and my knee hasn’t ached in weeks. If you’re suffering from knee pain I understand how frustrating it is – it can be a total nightmare – but in the majority of cases there will be a solution, so don’t lose hope. Replace The Smiths with something with some tally-ho.

Disclaimer

This isn’t the sort of post I usually write, but it’s something I feel pretty passionately about. However, I have no medical qualifications and no medical training. Any advice presented here is what worked for me; it might not work for you. I did a lot of research myself but I’m not an expert and I’m only going to cover one of the million different types of knee pain. If your knees hurt then you should see a doctor or a physio, preferably a specialist, and if you’re still struggling then you might be desperate enough to read my thoughts on it. For anyone reading this who does have a medical background, I am sorry for the doubtless mistakes in my descriptions of physiology – this is how I think of it and hopefully it’s not that far off the truth. For the physios who’ve helped me, thank you very much.

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Following one of the country’s best hill climbers on the Etape du Dales: the last good ride I did before it went to pot. Coincidence?

The knee

The knee is a slave joint: it does what muscles tell it to do. That means unless you have structural problems with your knees (ligament damage, etc.) then the pain in your knee is probably not because of your knee but it’s because something else isn’t working correctly. Those things are likely to be your glutes, hips, thighs, ankles, or feet. So, to fix your knee you probably need to fix a muscle or two somewhere else, and that will align the knee better or make the patella (kneecap) move more smoothly, etc..

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Descending the Nadelhorn. This is a 2500m descent and the guidebook describes it as a “knee destroyer”. If you’re going to try it you better have strong knees…

Patellafemoral pain

Patellafemoral pain is what I had. It was pain under the kneecap felt in the front of the knee and sometimes slightly lower down in the pes anserine bursa (a meeting point for bits of your hamstrings and adductors (inner thighs)). It was never really painful, it was just a dull throb, maybe 3 out of 10 on the pain scale, but it was constant. It moved about a bit too, never quite in the same place and seemingly not linked directly to activity level. It was worse if I kept my leg in one place for a while (e.g. driving, watching tv, sat on a plane) or if I did repetitive knee-based exercise, such as road running or cycling. Running downhill made it much worse; hiking downhill was okay but only with a lot of weight on trekking poles. The pain originates from the kneecap being pulled out of its groove and grinding a bit on the side of the knee.

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Back on the bike: a good feeling. Copyright Liz.

Advice for improving patellofemoral pain in everyday life

First thing is to try and work out what makes it worse and stop doing it. When driving, cruise control might be a massive help, and avoid driving straight after exercise as it’ll cause your legs to stiffen up. Move around whenever you can and avoid getting stuck at your desk. Bend your legs regularly. Do regular gentle stretching. Try to forget about it and don’t let it get you down. It will, but don’t worry about it. Some part of the injury might be psychosomatic and once you notice it the pain won’t go away. Instead, distract yourself doing something else. Don’t go mad and try to do a massive bike ride, but do some light exercise. I found rock climbing helped me because it moves your knee lots, has no impacts (hopefully) and increases strength. Yoga, also, was very beneficial. Write a knee pain diary to track what helps and what doesn’t.

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Rock climbing was pain free, but more importantly was a massive confidence boost for someone frustrated by not being able to run or ride a bike.

Get clued up yourself. Visit various physios and do what they say, but ultimately you have to fix it, so being knowledgeable will help.

Books, online articles and Youtube are amazing resources. The internet has made knowledge transfer so much easier and there’s no excuse not to learn stuff.

If you’re frustrated enough by your knee pain that you are reading this guff then by now you will know that your knee isn’t fixing itself: without you doing something different why would it get better? The most important thing, then, is to do some physio exercises which will encourage it to improve. My next post on this will go through these things.

Advice for cyclists

You’re a cyclist and your knee has been hurting for ages. This is not good; you are probably going insane. The first thing is to work out whether it’s the bike or you, or both. ‘Get a bike fit’ is what people might say but in my experience bike fits are pretty hit and miss, and coming out of a bike fit with a saddle 30mm higher than what you’re used to is a sure fire way to injure anyone, and it was a factor in why I got injured in the first place. Instead, unless you’re really desperate for a one-stop-fix, slowly tweak stuff yourself and see if it helps. Some things to try:

  • Seat height. ‘Raise the seat to rid pain in the front of the knee’ is the classic advice. I bet you’ve tried that. I bet your seat is now too high. If you have a seat that’s too high your hips will rock and your knees will be ‘windswept’ to make up for it. That will not be good for you. Check to ensure your legs both track in the same position relative to the top tube; if they don’t, or if you notice uneven pressure on your saddle, lower your saddle.
  • Seat fore/aft. ‘Put your seat backwards to remove knee pain’ is more classic advice. Maybe, but only to a point. Don’t make yourself overreach, but if you’ve knee pain you probably don’t want a setup with your knee at the top of the pedal stroke tracking way forwards.
  • Shorter cranks might help. I went from 175mm to 172.5mm on one of my bikes and it might have helped. Not sure, but it certainly didn’t make it worse.
  • Move the cleats backwards. Cleats that are too far forward make the knee angle at the top of the pedal stroke more extreme and increases the length of your lever which increases ‘wobble’. You might lose 5 watts. Who cares, if you’re pain free? I moved mine back 5mm on all my shoes and it helped a lot. Try cleats with more float if you like, but that might not help. It didn’t help me.
  • Make certain your cleats aren’t worn out. If you ever ride SPDs then replace the cleats and replace the pedals. The pedals’ bearings might be fine but if the contact surfaces are shot then your foot wobbles all over the place. That’s a sure-fire way to wreck your knees. That was the best £20 I spent in my rehab.

If your pedals look like this (look at the worn contact points) then it’s just another thing wobbling about and upsetting your knee. Spend the money and replace them.

  • Multiple bikes. If you’re lucky enough to have multiple bikes and/or shoes then ride with one bike and one set of shoes for a while. That removes loads of complicated scenarios like ‘ooh was it this bike that hurt me?’ stuff. I had to ride my prize Bianchi through one of the coldest winters in recent years because it removed the complexity of wondering which bike was causing what pain.
  • If you’re taking measurements of your bikes at home with a tape measure and then transferring those numbers between bikes then realise the limitations with this: it’s not very accurate. If your pro-level bike fit is set up whereby a saddle going up a few more mm throws out your hips then that’s madness: be more conservative with your bike fit.
  • Reduce the intensity of your riding. I didn’t use the big ring for 9 months, which I can tell you now is really frustrating, but it removes the temptation to grind or to put down big power and make your knee hurt. Ride at 90-100 rpm and don’t sprint out from traffic lights.
  • Keep riding your bike; don’t stop altogether. But, don’t go mad and do a century with a painful knee.
  • Watch the Bikefitadvisor channel on Youtube. John is an absolute legend and some of the stuff in his videos really helped me. It’s an exceptional resource.
  • Do the physio exercises. Accept that it might not be the bike and it might be you: this might take you months to come to terms with but it is really important.
  • Accept that you will lose a lot of fitness, but it’s better to come back pain-free than repeatedly get injured after a couple of weeks. My FTP dropped from about 310 W to about 200 W. Despite being really slow, coming back to the bike feels amazing.

Advice for runners

I’m not really a proper runner but I miss it if I can’t do it when I want to. Mentally, knee pain for runners is just as bad as for cyclists, but try to keep yourself occupied with other things that you can do.

  • Try running on different surfaces. Running on the road is very repetitive and running off road might be that much better.
  • Avoid blasting down hills. Walk down them if it makes it feel better.
  • Don’t run up hills fast. Steady is okay but I found that running up them hard made my knee hurt.
  • Are your shoes worn out? Wear shoes that work with your style of running.
  • Try to keep running, but pare down the intensity and the length of the runs.
  • Do the physio exercises. Accept that it might not be running that’s doing it – it might just be you that’s broken and you need to fix yourself. That is hard to accept. This was the key to me getting better.

Advice for hikers and mountaineers

Carrying big packs up and down hills hurts loads of people’s knees and it’s a constant gripe among hikers. I found my knee pain was never too bad while hiking, even on really big days, but I always used trekking poles and have been walking up hills as long as I can remember: if I can’t do that anymore then I must be really buggered! I found big days out in Scotland last winter extremely beneficial for various reasons: they stopped me going insane because I was doing some exercise; they made me feel worthwhile and that I could still do stuff; and they made my legs stronger.

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Scotland’s winter season made my legs stronger but also reminded me that I could have amazing days out, even if my knees wouldn’t let me cycle or run. (Photo Copyright Paul.)

A physio joked that prescribing his knee patients ten hour days on Ben Nevis with a 15 kg pack might not go down too well, but it helped me.

Most hikers and mountaineers aren’t out every week. If you’ve not climbed a mountain for six months then try to hike every day for a week is it any wonder your knees ache? You wouldn’t try to run 100 km in a week having not run in six months: don’t do the same thing with hiking. Build up slowly and do other exercises when you’re not in the hills to maintain fitness. Also, do the physio exercises: they really do work. They’re coming up in the next blog post. Stay tuned.

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Serious motivation: watching BMC ripping it up on the way to Greg Van Avermaet winning the Tour de Yorkshire 2018.

 

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Scottish winter 2018

As I write this it’s 25 °C in Manchester, Northern England. It’s wall-to-wall sunshine, a Wonderwall of sunsh-ee-iiine (there’s some local music for you). This is freak weather. It is bizarre, not usual, out of the ordinary. And this winter was the same, bringing prolonged amazing climbing conditions. Here’s some of the highlights of what I got up to this winter.

January

Liz and I snuck in a quick ascent of Pinnacle Ridge and Sharp Edge in the Lakes in early January. Blue skies all round and good snow: quality.

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Sharp Edge

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Blencathra.

 

I was then whisked off to the USA with work and the bizarre Ouray Ice Festival. It’s amazing, scary and brilliant in equal measure. Real ice, but man-made with sprinklers, and top-rope lines everywhere.

It’s a great way to practice ice climbing and to get pumped out of your mind in relative safety, as long as you keep an eye on potential falling ice as you belay!

Ice climbing comps and watching heroes like Will Gadd was a great bonus.

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Will Gadd tops out on the comp route.

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An amazing sand/snow mountain thing on the way from Ouray to Denver.

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Ouray ice festival in fresh snow.

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Me getting seriously pumped on a long and steep WI6.

 

Back to Scotland

Next, a backpack and Munro-bag of the five Lochnagar Munros was on the cards, staying at the Glas-Allt-Shiel bothy. The weather was dank, it was warm, but we marched round and were rewarded with great views as we neared the Stuic.

 

One of the highlights of the winter was climbing Crowberry Gully in perfect conditions.

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Into the bowels of Crowberry Gully: amazing atmosphere.

Loads of people climbed it this winter but Ross and I got lucky and we were the only people on the route. The weather was mixed but it wasn’t too bad and the perfect neve more than made up for it. Tim Neill had told us we only needed one ice screw: we thought that maybe he did, but we probably needed two. However, he was right and conditions were so good we only placed about 6 pieces of gear on the whole route. The descent was a little complex as a cornice prevented access into the normal descent gully, but the rib to the north was okay, though some windslab was about.

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Pete gets stuck into the second pitch

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I took this from the floor because I’d already been blown off my feet. Windy.

A savage day climbing in the Norries a few days later was had on the Seam. Very strong winds, loads of spindrift, thick rime, and plummeting temperatures (this was Beast from the East time) meant getting out of there as quickly as possible. I’m not sure whether it was the weather or the conditions or both, but it felt more like grade V, 6 than IV, 5, and Pete who’d had the debatable pleasure of leading the top pitch agreed.

Back up North

Long-suffering partner Paul and I found ourselves in Scotland on a weekend where conditions were difficult: avalanche conditions were relatively high and yet the weather forecast was good, and climbing conditions were difficult to interpret with little info online and a lot of aspects unsuitable due to the amount of snow about. Following endless discussions we got on Scabbard Chimney.

The walk-in (wade-in) to Stob Coire nan Lochan had taken us an hour longer than usual, and I was very glad that Paul was very fit and very keen to wade up to his waist to reach the climb itself. I walked behind in his footprints/bodyprints, pretending it was hard for me too.

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A very white Stob Coire nan Lochan.

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Paul gets established on the first/second pitch.

The first pitch was largely buried so Paul got stuck into pitch 2 and made quick work of it – just as well as it wasn’t the place for hanging about. He got pounded by spindrift on his ascent, completely disappearing for minutes at a time. It was a good lead.

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Me on the crux corner (Photo Copyright Paul).

I had the next pitch, somehow being lumped with the crux. I took my time, teetering up on poor feet but with generally good hooks. The clearing was exhausting, though, and it took forever: about six inches of rime covered everything. It was probably a 90 minute lead for 25 metres.

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Me still battling and digging (Photo Copyright Paul).

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The brilliant upper ridge: if the weather’s good I’d highly recommend making the effort to top out on Stob Coire nan Lochan – it’s a great day out.

Being mountaineers and not climbers we opted to finish the route and we were so glad we did: the weather cleared and the upper gully and then the upper alpine-style ridge rewarded us with stunning skies. Perhaps my favourite climb of the winter, on a long and tiring day.

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Summit shot.

The next day we tackled Eastern Slant near Stob Coire nan Lochan (good option if lots of snow about and it’s cold: relies on frozen turf) the next day we headed to Ben Nevis for a short day. I led the first pitch of Vanishing Gully before Paul – a few minutes after saying he struggles placing ice screws one-handed – made quick work of despatching the crux second pitch. It’s a great route and the second pitch is plump-vertical for the first few metres, it’s the steepest bit of ice I’ve climbed in Scotland. We abseiled off and made our way to the cave belay for the second abseil – a far better proposition than abseiling off the peg belay.

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Vanishing Gully second pitch.

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The cave belay.

Late season

Later in the season the conditions were still great and along with Comb Gully in frankly ridiculous spindrift – the worst I’ve ever experienced – Scott, Ross and I climbed the CIC icefall. What an amazing piece of ice! It was dripping as we climbed it and we probably got it on the last few days of which it was climbable. A great low-level option on the Ben.

 

Liz and I climbed Twisting Gully in Glencoe on a great low-stress day where the only real difficulties were found at the cornice, which with a lot of digging by me got taken care of. The next day was one of the best I’d ever had: on an Easter with a good forecast Scotland was busy, but we headed to a deserted Glen Sheil to tackle the Forcan Ridge.

In terms of aesthetics and classical Alpine-style ridges, I think it’s superior to any of the Great Ridges on Ben Nevis, better than the Aonach Eagach: it’s just stunning.

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The first part of the Forcan Ridge.

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Like Castor or Pollux, but without the faff of altitude.

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Views of Skye and Rum.

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The Forcan Ridge goes on for a long while, it just keeps coming. We carried and used a ~40 metre half-rope for moving together, but we weren’t sure it would be long enough for the abseil once we reached it. However, there is a route down on the left (facing towards the summit of the Saddle) which, while quite tricky and a bit loose, wasn’t too bad and looked more tempting than the technical down-climb on the right hand side.

Excluding the top-rope lines in America I climbed 16 graded winter climbs this year (8 of which were grade IV or above) and bagged plenty of Munros too. That’s a record for me, in a winter which broke plenty of records.

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Even when the weather’s grim there’s light ahead. You might just have to wait a while.