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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2017 round up

It’s the time for New Year’s Resolutions, goals, all that sort of stuff. But who actually looks at what they got up to last year? Surely planning goals is pointless if you don’t then think about if you achieved them…?

Winter climbing

My winter climbing objectives were modest in the extreme. They were something along the line of ‘do some nice routes and have some great days out’. How could I fail? The weather and one of the worst winter Scottish seasons in recent memory put paid to hopes of Styrofoam ice and blue skies, but I managed a couple of decent days out. The highlight was a day out with the Hiking Club taking a couple of guys out doing some easier winter climbs and generally doing a lot of miles on semi-technical terrain. We had fantastic weather the first day and good snow in the Nevis gullies. Other great days were had out on Kinder Scout – it was freezing, it might as well have been the moon for all the similarities to the normal ‘tame’ Peak District – the Aonach Eagach under blue skies, Munro bagging from a (very) remote Air B&B, and a fun day out in the Norries too. So, ‘tick’ on the fun Scottish winter season, despite the very mild winter.

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Blasting up and down Number 3 and Number 4 gully on the Ben.

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Kinder Scout on a seriously cold day.

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Classic gully action in the Cairngorms.

Cycling

I had a lot of cycling objectives for this year, a lot of which were pretty ambitious. I’d improved more as a cyclist in 2016 than I thought possible, and there was still tonnes of room for getting better.

The terrible winter cycling season was a big blessing for cycling as there were only a couple of nights where I couldn’t ride due to ice. It also meant the normal weight gain borne of winter climbing didn’t really materialise.

My big objectives were:

  • Find this year’s spring training camp a bit easier than last year. Don’t just get absolutely smashed every day.
  • Complete the Fred Whitton for Paul’s stag do and ride every single bit of it (no pushing).
  • Complete the Etape du Dales in under 7 hours (Gold).
  • Beat my PB on the local hilly TT course.
  • Compete in a local flat time trial.
  • Get a Strava KOM on a fairly decent local segment, not just some crap one.

From January onwards my cycling was getting better and better. I had an amazing reliability ride in Leeds where I felt like I could pull all day on the front and then when breaks went I kept reeling people back in. Only in the last five miles was I starting to tire. That was a good sign for the spring training camp.

The spring training camp was also great. Run by the absolute monster that is Pete Barusevicus at Arrivee Travel, I’d been on the camp last year in Spain and while it was hugely enjoyable and inspirational, it also mind-blowingly hard. Almost just too hard for me. This year I had more miles in the legs, more experience, a better bike, and better tactics. It was a brilliant week and I left it feeling super strong, as opposed to just completely wasted.

If you want to improve as a rider then I can think of no better way to progress, as well as getting a whole heap of inspiration.

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Not your typical bunch of overweight cyclists.

The Fred Whitton was a funny objective as until it was mentioned as a stag do idea I had no desire to ride it. However, on the day it was mega. I rode it with good mates and within myself.

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Paul at the top of Hardknott on a training recce.

Regarding gearing for the Fred, I’ve heard all sorts of weird things mentioned by various people…

 

Firstly, Hardknott is really hard. It’s an exceptionally difficult climb at the best of times, and with 100 miles in your legs it really is very tough.

It’s a totally difficult league to anything I’ve ridden in the Peak or even the Dales. On the day itself I rode it on 30×25, which is a gear I’ve never had trouble getting up anything with. However, that day was hard and I had to dig deep. However, it’s absolutely possible to ride Hardknott on a way bigger gear. On a training recce I rode it on 36×28 with 50 miles in the legs, and someone strong could ride it on 36×25 no problem. Some could ride it on 39×25 but that just sounds savage. So, for people who tell you 34×28 is minimum it’s just not true as long as you’re willing to suffer a bit and have the legs to back it up. I was pretty tired after the Fred but had 7 days to recover before the real deal…

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Going up Honister on the Fred. It had been cold first thing – overshoes – but by this point was getting pretty warm. Ideal conditions basically.

The Etape du Dales was my biggest objective of the year. It was, above all else, the thing I’d been training for. However, I almost totally screwed up on the day by getting my tactics wrong. As with many tough sportives, strong riders often set off late and then try to see how many parties they can catch on the way round the course. I got there a bit late and decided I’d just join the strong guys. Meeting Andy Cunningham (7th in national hill climbing champs, multiple hill climb records, all round animal) who I knew well from the Spring training camps was an ominous sign for what was about to go down. I set off a few minutes ahead of Andy and the Harrogate Nova guys who currently hold the course record, just to make sure I wasn’t racing hard out of the gate. About 20 minutes later I was caught by the Nova train and then immediately we were on to Fleet Moss, the first big climb of the day. I climbed alongside Andy, cresting the hill just behind him.

The big difference between us was that he was cruising, but I was absolutely dying behind my sunglasses.

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Trying to hold on to the flying Andy.

We screamed down the hill and while some guys stopped at the first checkpoint I kept rolling to try and recover from the onslaught a bit. I rode steadily up Buttertubs and down Swaledale but then the train was back and we were screaming out of Swaledale on one of the ‘unknown’ viscous climbs of the day.

I was hurting hard as we went through and off into a fearsome headwind, and soon I was missing my turns.

Miles of headwind followed and I was dropped from the group. This was where the problems started. My big issue was that no one who we’d caught could work for me, basically nobody was going quick enough for me to still finish in under 7 hours. So I worked like a dog into the wind, feeling sick and with no one coming through and a growing group of people following my wheel as I picked up riders ahead. At the next check point I was in trouble but I ate a lot, drank a lot, and didn’t rush. Then I was back on the road, still riding effectively solo. About an hour later though and I got a good partnership going with a strong rider, and we each worked hard to the final checkpoint, which I rode straight past. I had an hour for the last 20 miles, and by now I had a tailwind. It was still possible to make the time gap, but it would be balls out. I rode as hard as I could for the last hour, now completely on my own, and screamed into the finish knowing it’d be super close. I’d managed it with a minute to spare. I was delighted. It was the hardest ride I’d ever done given how I’d had to ride it: as hard as I could basically all day.­­

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The Etape du Dales. A hard day out.

Following the training camp I managed to get a KOM without too much difficulty. I found a great segment locally that favoured me – hilly but requiring multiple efforts with a bit of recovery between them – and which had no big hitters who’d yet ridden it hard. I rode at 180 bpm for 7 minutes and got the KOM. Another tick in the box!

I rode the flat TT – a pretty simple objective completed – but rode it badly so wasn’t particularly satisfied. As for the other TT, well that effectively marked the end of my cycling for the year. Overloaded and possibly with a bad bike setup I was in a bad way as I rode the TT and despite putting in a time on the way out which would have smashed my previous best my knee felt bad on the way back and so I abandoned. More on that below…

Running

For running I had two objectives: beat my long-standing 5k PB, and to do that bit better in some local fell races. I managed both of these, but not through doing any training! My fitness from all the cycling translated well into fell running fitness and I placed 12th, 14th, and 14th in the three races I did. I was very pleased with that and it was a big improvement over the top 25 finishes I’d been getting in previous years. My 5k PB fell when I came back from the Alps: I thought two weeks of altitude would have done my running fitness no harm, and so I set off to try and break 19.08. On an unfamiliar but flat Parkrun course I furiously tried to stay with the strong woman ahead of me, but she eventually pulled away. However, nearing the final bend I looked at my watch and could barely believe the time: I was going to do it! 18.53 was the official result, 15 seconds off my previous best. That was a good Saturday morning.

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Liz on a sunny training run round Langdale.

As an aside, back in Feburuary I managed to find a suitably niche event that I could do fairly well at. It was a duathlon which combined cross country running with a punchy bike course, and it was all over in just over an hour which is perfect for me. I was fourth in both running legs but third on the bike and so came second overall. The winner was super strong, being fastest on the bike (he was a Cat 2 rider) and second quickest runner too. That was my best ever position in a solo race, so I was psyched.

Climbing

My climbing objectives were pretty poorly defined. However, I’ve had the best climbing year I can remember, so that turned out to be no bad thing. I’m never going to be a good climber, partly because – unlike with cycling and running – I’m not particularly driven by pure performance and am more into it for good times. The other reason is I don’t train properly and am a big wuss.

However, I’ve had a lot of fun climbing this year, which definitely counts for something.

I’ve climbed amazing routes all over the UK and some spectacular routes in the Alps too. A day bouldering with good mates at Burbage, climbing 400 metres of bolted granite in the Alps in under 3 hours, Northumberland rock, loads of gritstone, Pembroke… it’s been awesome. I’ve also done a lot more plastic pulling than in previous years, and for the first time ever have learnt to enjoy indoor leading. I’ve always enjoyed indoor bouldering, but indoor leading makes you a lot fitter, rather than just stronger. That’s definitely helped on longer routes.

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The Cobbler. A fantastic mountain in a fantastic setting.

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Climbing at Peel Crag and Crag Lough: totally fantastic and yet deserted!

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Belay duty for Ross in the Alps.

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Liz gets to work on a pretty steep Pembroke VS.

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Dave Macleod: inspiration personified.

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That moment when you’re trying really hard but your spotters don’t seem to care.

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The end of a great day out.

Injuries

The above list reads like a huge line of successes, and I suppose it has been. I’ve ticked every objective that I had for the year with one major exception. My first objective was ‘don’t get injured’. It’s always my first objective, it’s always impossible, but this year’s been worse than most. In January I had a back injury but that’s now cleared up thanks to some excellent physio, a lot of core exercises to turn off my previously inactive deep abdominals, a lot of hamstring stretching, and a bit of fiddling over the bike setup. However, the big one which I’ve now had since about May-time is in my right knee. Broadly speaking it’s patellofemoral pain, and it’s a pain in the arse. Knee. I’ve not ridden my bike apart from to work for over 6 months now, and haven’t run save for the odd jog for the same time. However, it doesn’t affect climbing or hill walking one bit, which is partly why they’ve prospered. A lot of physio, two professional bike fits, and literally hundreds of hours of stretching haven’t fixed it yet, but it is slowly, oh so slowly, getting better. I think a combination of factors including overload and bad bike setup caused it, but it’s been a massive downer for the second half of the year. Objective for 2018? Simple: fix my knee.

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A bonus winter day: a great way to finish the year’s big days out was a day out on North Buttress on Buachaille Etive Mor. A long day, but a good one.