Went to my sports doc to discuss doing the 508 on a fixed gear, and get a general assessment of my knee health. The doc looked a lot, felt the knees while bending, then did xrays.
I got sort of a quick education on knee health, at least the part relevant for cycling. Assuming the joints are otherwise healthy, the cartilage (meniscus) between your femur and tibia tends to break down over time and use, with several stages of disrepair. It starts with a lack of lubrication and then cumulative softening, then splitting, then tearing of the cartilage. This can happen with trauma, like doing a really heavy leg press, all at once, or cumulatively over the years of excessive stress on the joints. He said that my knees (at 43 years old and having run marathons since age 15 and plenty of cycling the last 8 years), are about 1/3 of the way long that cumulative degeneration continuum, such that I need to start being careful, but there is no immediate concern.
Keeping everything inside the joints aligned so that the parts meet up where they should is critical. If you have weak muscles that affect the alignment, then injury can be hastened. This is a critical fact. In cycling, we don't tend to strenthen the muscles that affect this alignment, because we exercise the legs with fairly limited ranges of motion, and really don't (at least I don't) exercise the leg to full extension (mine are always slightly bent at "full" extension). Also, the more fatigued you get as you ride, the less able the muscles are to maintain proper alignment. Xrays showed the alignment to be excellent right now, though.
So, apparently while my quads are fairly strong (well, for perspective, I can ride a fixed gear at 25 rpms up 10 % grades for 8 miles standing continuously), the muscle just above the knee cap on the inside of the thigh (vastus medialis), which typically buldges a bit is relatively weak. This muscle plays a major role in maintaining alignment, but is largely exercised when the leg is near full extension (straight). So, he told me to do some limited range knee extensions at near full extension, and some other exercises, to build these muscles to help out. If misalignment is part of the problem, then stregthening can either cure or lessen the risk. This is good.
What was also interesting is that the pain I've experienced when over doing it on the fixed gear is not the cartilage (can't feel pain there), and likely not ligaments or tendons, but probably the bone itself, either from friction or pressure for the extreme number of repetitions involved in the fixed gear climbing. He said typically you won't feel pain there during the exercise, but a day or two later. Yup.
While the injury can be cumulative, and you don't really heal the cartilage once it's damaged (the bone is better at healing), he noted that largely if there is no pain involved, either during or after the riding, then things are probably ok, or at least at acceptable risk levels. However, if there is pain, that's very bad, and a sure indication that you should stop doing what you're doing. (He did say, though, from a strictly medical perspective the best thing would be to stop riding altogether, but then I would not be talking to him if that were an option. He said that cycling is much better than running, too.)
He also said that glucosamine/chondrotin/MSM complex is very good. He recommended it wholeheartedly, but cautioned that it can take several months of consuming the recommended dosage to see results. I'm maxing out on the stuff.
He said that spinning at extreme rpms down the hills is likely not a problem at all, unless there is unusual loading. I told him that there is almost zero load, it's simply a matter of making the legs keep up. I brake down hills, if necessary, and don't use the legs to slow the bike much at all.
While his preference would be not to do this type of event at all, he said that to minimize the risk of long term injury, do the exercises, then use pain as a guide. Experiment with lower gearing, then test by riding up similar slope hills for longer and longer durations. If there is no pain, then I should probably be ok during the event. However, if I can't ride 100 miles of similar hills without pain after a few months, then give it up.
Does that appear to be sound advice? Thanks.
I got sort of a quick education on knee health, at least the part relevant for cycling. Assuming the joints are otherwise healthy, the cartilage (meniscus) between your femur and tibia tends to break down over time and use, with several stages of disrepair. It starts with a lack of lubrication and then cumulative softening, then splitting, then tearing of the cartilage. This can happen with trauma, like doing a really heavy leg press, all at once, or cumulatively over the years of excessive stress on the joints. He said that my knees (at 43 years old and having run marathons since age 15 and plenty of cycling the last 8 years), are about 1/3 of the way long that cumulative degeneration continuum, such that I need to start being careful, but there is no immediate concern.
Keeping everything inside the joints aligned so that the parts meet up where they should is critical. If you have weak muscles that affect the alignment, then injury can be hastened. This is a critical fact. In cycling, we don't tend to strenthen the muscles that affect this alignment, because we exercise the legs with fairly limited ranges of motion, and really don't (at least I don't) exercise the leg to full extension (mine are always slightly bent at "full" extension). Also, the more fatigued you get as you ride, the less able the muscles are to maintain proper alignment. Xrays showed the alignment to be excellent right now, though.
So, apparently while my quads are fairly strong (well, for perspective, I can ride a fixed gear at 25 rpms up 10 % grades for 8 miles standing continuously), the muscle just above the knee cap on the inside of the thigh (vastus medialis), which typically buldges a bit is relatively weak. This muscle plays a major role in maintaining alignment, but is largely exercised when the leg is near full extension (straight). So, he told me to do some limited range knee extensions at near full extension, and some other exercises, to build these muscles to help out. If misalignment is part of the problem, then stregthening can either cure or lessen the risk. This is good.
What was also interesting is that the pain I've experienced when over doing it on the fixed gear is not the cartilage (can't feel pain there), and likely not ligaments or tendons, but probably the bone itself, either from friction or pressure for the extreme number of repetitions involved in the fixed gear climbing. He said typically you won't feel pain there during the exercise, but a day or two later. Yup.
While the injury can be cumulative, and you don't really heal the cartilage once it's damaged (the bone is better at healing), he noted that largely if there is no pain involved, either during or after the riding, then things are probably ok, or at least at acceptable risk levels. However, if there is pain, that's very bad, and a sure indication that you should stop doing what you're doing. (He did say, though, from a strictly medical perspective the best thing would be to stop riding altogether, but then I would not be talking to him if that were an option. He said that cycling is much better than running, too.)
He also said that glucosamine/chondrotin/MSM complex is very good. He recommended it wholeheartedly, but cautioned that it can take several months of consuming the recommended dosage to see results. I'm maxing out on the stuff.
He said that spinning at extreme rpms down the hills is likely not a problem at all, unless there is unusual loading. I told him that there is almost zero load, it's simply a matter of making the legs keep up. I brake down hills, if necessary, and don't use the legs to slow the bike much at all.
While his preference would be not to do this type of event at all, he said that to minimize the risk of long term injury, do the exercises, then use pain as a guide. Experiment with lower gearing, then test by riding up similar slope hills for longer and longer durations. If there is no pain, then I should probably be ok during the event. However, if I can't ride 100 miles of similar hills without pain after a few months, then give it up.
Does that appear to be sound advice? Thanks.
