Knee cartlidge damage and cycling

So just back from my second physio visit. I thouht I had a hamstring problem but he is sure it is cartlidge damage. I went as walking is uncomfortable (not agony). This was 6 weeks ago and he said don’t worry about cyling just avoid impact. The damage seems localised to the inside rear of my left knee. Cycling does seem fine except on really steep climbs where hovering on the nose of the saddle isn’t good as it bends my knee too much. Today he was a little bit more circumpsect about cycling saying it was a matter finding my limits. I’m thinking about what to do next but most likely he will proscribe excercises to strength the muscles round the knee. The question being whether I should go via my GP for an MRI to check we know what we are dealing with first

So anyone OK cyling on a damaged cartlidge. I’m 53 and generally healthy. Fit by GP standards but not by the standards of this forum. Spending about 3 hours a week on my bike with a few rides upto 2.5 hours on my knee as it is. Oh and this leg lost alot of muscle last year when I had a now resolved bad back

I could do with a few happy cycling with poorly cartlidge stories. Failing that any other advice

I *think* I’m cycling with some mild damage on the inside front of my right knee, just overuse and/or poor knee cap tracking.

Going through the motions with physio although I think any form of squat style exercise aggravated it more.

Good news is that cycling seems OK, I’m trying to focus on higher cadence and smooth spinning, I think the higher cadence (for a given speed) is well accepted to reduce force across the knee. Also have an oval inner ring which feels good, can’t say much more than that.

Sorest it’s been for a while right now, combo of crawling around on floor chasing toddler and/or cat, rrrgh.

Mine is damaged and eventually I’ll end up with osteoarthritis. Oval ring is a must, makes a big difference. It definitely hurts more on very steep climbs so I jump off.
Ice and heat after riding help too.

At 55 I’d always run for fitness until about 2 years ago, when a knee injury stopped me. I’ve had an MRI which showed a fair bit of wear and tear to my knee cartilage and had lots of physio. Most of the time it’s OK with occaisonal aches or soreness but the motion of running really aggravates it within a hundred yards at most, causing pain. Frustratingly I’ve had to can the running completely because of this. The good news is that cycling is fine, it doesn’t cause any extra pain at all. Even downhill such as full days at BPW where you would imagine your knees would take a battering seem fine. Jog a short distance and it’s an excruciatingly different story however!

Do I get this right – yo haven’t a full diagnosis from a orthopod? If it were me I would be going down that road as the footballers “cartilage” ( which is not actually cartilage as such) responds very well to surgery

so yes – GP for a referral to an orthopaedic surgeon for me

You may benefit from having a proper bike-fit setup session. They can make sure your set-up is ideal so as to minimise stress on your knees, making sure that your knee is tracking vertically rather than kicking out to the side on each pedal stroke. I had / have knee issues from years of running, but they’re generally fine and as good as they’ve been for a long time on the bike now. That combined with knee exercises in the gym (definately NOT squats) and glucosamine supplements have all helped I think.
Definately keep away from the squats, a Bodypump class a few years ago spelled about six months off the bike and endless physio visits for me !

What exercises Wrong Trousers?

Frustratingly my (very) local gym doesn’t have any machines for working quads etc.

Physio had me doing single leg dips and weighted lunges. Not really sure what the alternatives are…

Thanks folks

TJagain

I think we might try the double approach of GP referal as a backup and then excercise to stabilise. The physio I went to as far as I can tell is as good as they get. He has seen me through frozen shoulder, mashed ankle and bad back. All on minimal appointments. I have about 10 colleagues who all rate him and have been helped through all manner of problems. He says they do alot less operating on knees now prefering to stabilise with strength work

The wrong Trousers

I think my gravel bike fits well. But lacks low gears. My hardtail I think is too slack and works less well but does have the lower gears. Problem is I’m off to Devon for a week on Saturday. I think I’ve left it too late to get the gearing lowered on my gravel bike by then. Years ago I had knee cap tracking problems. I’m failry sure my knee now tracks well. When my back stops getting more flexible I might try a bike fit. But ironically my back getting daily more flexible makes bike fit a moving goal post at the moment

Not enough time to buy a new chainring or two? If drivetrain not too worn could be a relatively simple swap

If he mentioned that he thought it was the posterior horn of the medial meniscus (made out of fibrocartilage), he tested everything thoroughly and you don’t have a large loss of knee flexion / it’s not locking then you should be fine with appropriate guidance from your physio. Surgery tends to have poorer outcomes in the above situation than rehab. Sometimes it’s as simple as a small pocket of swelling within the meniscus itself, it just takes a little while to settle. Hopefully your physio has / will give you advice about bike shoes / pedals (stickier isn’t always better), positioning, postures and activities to modify for a short period, not twisting on a fixed foot (getting out of cars, speaking over your shoulder etc) and appropriate rehab exercises. As long as you’ve been assessed properly and there aren’t other significant symptoms you’ve omitted, an MRI is unlikely to add much to your treatment plan…

As well as treating lots of patients with these kinds of problems, a childhood doing too much kick boxing and similar means I have something similar. It does mean I have to modify things on occasion and build my running up a lot more slowly, but it doesn’t really impede me. 🙂

This Radio 4 inside health programme seems to suggest knee arthroscopy is no more effective than a placebo in trials

https://www.bbc.co.uk/programmes/b062khlm

I’ve just had a knee arthroscopy on a torn medial meniscus. It’s early days but all seems to be going well. Cycling didn’t really hurt it but I walked with a limp. It can be a bit sore if I push it, though it soon feels normal. It took a while to get to the operation stage, MRIs and waiting for consultant appointments and so forth but you’ll have a better idea of what is going on if you set the ball rolling.

I’m just getting back on the bike after falling down a hole a chap conveniently left for me at work.
I’ve been off work since January with a diagnosed Meniscal tear or Medial ligament damage, I was given the all clear by the physio last week to start biking again as long as it wasn’t too strenuous. The knee has stood up well so far and I managed 7 miles of kirri black today . Listen to your knee, if it hurts too much, back off a bit .

I’ve torn my meniscus 3 times each time diagnosed by the physio. MRI is inconclusive.

I’ve always been encouraged to continue biking and swimming, only running has ever been stopped. It’s mainly been saddle based riding though and not stood up on a mtb.

Lots of gym rehab exercises to improve strength in certain areas and then I’ve generally been ok. Only to neglect the exercises and do damage a couple of years down the line…

I’m waiting to have surgery on mine, I’ve got a bucket handle tear of my meniscus and I have always been encouraged to keep cycling. I’ve waited a year so far and apart from the occasional locking or knee giving way it’s just about manageable. I cycle to work every day and do a couple of biggish rides a week. If its manageable I’d say just crack on.

What exercises Wrong Trousers?

Specifically, single leg raises with toes lent out to the side. In my case I had kneecap tracking problems and this is to strengthen the lower part of the quad, on the inside above, rather than outside or directly above my knee.
Also double leg-raises but with light weight, calf raises and some very light seated leg presses but definately without a deep squat. Also lunges were a big no-no for me.

You could possibly do those single-leg raises using one of those big rubber band things, sitting in a chair with the band tied around the chair leg perhaps, if your gym doesn’t have a leg extension machine.

The bike fit suggestion was to get your knee to move vertically in a straight line, this was done using specially made orthotic insoles in my shoes. It’s very common to see cyclists, when viewed from behind, with their knees kicking out to the side on each stroke becuase their feet aren’t supported properly leading to over-pronation, much like the problem runners often have.

My left one was cleaned out during my ligament op and my right cartilage was mushed during a nasty cycle crash (osteochondral lesion). Physio has helped me in the past , I try to keep them flexible & I do squats , but only crouching with my own body weight. That said , I played football with some 6 year old boys last week and I haven’t been able to crouch for four days! I do have to be careful & I can’t thrash a big gear any more but i can spin all day. I can see the time when I opt for plastic ones,knees that is!

A subject I know well…

I had one half of the cartilage in my left knee removed when I was 19 (so 25 years ago). Done via keyhole, but was a removal rather than the clean-ups/trims that tend to happen know. Rehab at the time was lots of what I’ve since learned to be very old-school single leg raises, holding for as long as possible.

Cycling is, generally, fine, with a good setup that gives me a good extension of the leg at the bottom of the stroke. I try to stretch quads/claves/hamstrings regularly (but don’t do it as much as I should).

Skiing, unsurprisingly, absolutely batters it, and I have a knee like a football by the end of the second day.

I also used to have real issues, when doing things like hiking or hillwalking, which I only ever do occasionally. Descending over steppy/rocky terrain for a sustained period would get really difficult, as my knee would begin to lose any stability and collapse as I stepped down. I’ve since started doing lunges, squats and split squats two or three times a week, using light weights (initially body weight, working up to 2*5kg dumb-bells) and it seems to be helping a lot.

I still can’t pull my heel to my bum though, I don’t think I ever will.

I had a motorbike accident 10 years ago (aged 27). Tore all the ligaments in my knee and lots of cartilage damage.

Walking gets sore but only after a lot of steps (i.e. >8 miles)
Running was a real no no, until I got some proper trainers. Have done a half marathon since.
I didn’t cycle much before the accident, but do loads now. It never really hurts now, though it did after the accident.
Was back at docs the other day – got an x-ray which shows osteoarthritis. This was expected, but the progression is much slower than expected – will need a new knee in 30 years, not 10.

The key to all of this is just to do a LOT of cycling. Build up your leg muscles to support the joint and keep your weight off. Things like cortisone injections or keyhole surgeries to trim the cartilage don’t really do anything.

So glad I started this thread. Lots of encouragment cheers guys. I’ll take a more detailed look later and come back with specific sugestionget anck with questions if needed

I think the botch for next week will be take my hard tail and slicks. Then add a longer seat post with less lay back to match the seat height and seat angle of the gravel bike. Then maybe a longer stem. Should be under £30

Dropping the gearing on the gravel bike really needs a new chainset which I think will be from SPA cycles. I can’t see any fast delivery options.

I had an arthroscopy 18 months ago on torn medial meniscus. Knee was locking up and I was limping heavily and not even able to turn a pedal.

Had a trim (surgeon says 10-15%). It look over a year for swelling to dissapear but could ride hard on it after 4 months. not sure I’ll ever run on it again but generally 90% recovered with occasional twinges. Have skied hard and biked even harder for over year now.

long term im sure it will be arthritic but better to enjoy it now.

Then add a longer seat post with less lay back to match the seat height

I tend to find I need a layback post, if I’m ‘over’ the BB on an inline post I can feel it in my knee, as per:

really steep climbs where hovering on the nose of the saddle isn’t good as it bends my knee too much.

Interesting to read diverging opinions on squats – some folk saying they can’t go near them, whereas they’re core to rehab for other folk. I have a pretty mild condition with my knees after CX season (sparked by a course with a couple of hard uphill runups in deep mud) and my physio was all about the squats – Bulgarians, Romanians deadlifts, the works. I’m pretty sure I don’t have any acute injury, though, it’s more overworking. [tbh I’m impressed they’ve lasted me into my 40s with no problems – they’re putting a decent shift in ferrying my carcass around the place].

Low intensity, but long, stuff like Hiking seems to do the most damage for me, like IHN mentions above. Did Crinkle crags a few weeks ago and 20 mins in realised I’d left the walking sticks in the car. Decided to just go ahead with it – won’t be making that mistake again. Knees were absolutely pummelled by the end of it.

I have Osteoarthritis in my left knee, I broke my tibial plateau 15 years ago, which mashed up the lower articulating surface of the knee. The surgeons rebuilt it with bits of my hip and metal work. I was told I’d get arthritis but thought that would be when I was older (42 now). A year ago it really started to hurt following two hard rides and playing football with kids. I had an X-ray (MRI wont work due to the metal) and it confirmed moderate degenerate changes in all 3 knee compartments, moderate is the level below severe and severe is bone grinding on bone. So there is not much cartilage left in my knee.

I was struggling to walk and stand so had a cortisone injection and physio. I’m not sure what worked but it was much better in a few weeks. I had stopped cycling, the physio told me to get back on the bike, he also spent a long time trying to get my knee to go straight again. I had lots of exercises to do, these started off focused on straightening the knee, then moved to strengthening it with squats and lunges and then moved into the gym doing leg press and leg raises. I suppose I know that its not going to get better so I might as well use it and put up with a bit of pain and discomfort. It looks as though everyone varies so find out what works for you and keep doing it…..don’t let the muscles waste away – it takes longer to get the strength back.

Ah i forgot – I need a new chainring for the MTB so I want to try an oval one, if I currently have a 30 tooth should I go 30 tooth oval? I think I do as spinning is so much better for my knee than mashing.

I’ve had cartilage problems with one of my knees for ~10 years now, pretty much given up on MTB as the constant change of foot position / twisting & turning (brake bumps especially) were doing me in – I dare say I could manage light xc no problem as I can happily sit on the road bike all day, but any lateral movement in the joint just leads to grief – recurring advice from various consultants & physios was “if it hurts, stop it”

Keeping the strength up in the surrounding muscle groups helps support the joint & that worked wonders for me – one physio that was pretty helpful recommended squatting & keeping my lower legs perpendicular to the floor, not taking the knee joint past 90 degrees – it takes a bit of getting used to shifting your balance but once you get used to the movement, you can start putting some weight on there.

Best of luck with it!

how do you get this condition – from general wear and tear with cycling? can you avoid it?

thanks

I tend to find I need a layback post, if I’m ‘over’ the BB on an inline post I can feel it in my knee, as per:

I suppose it’s personal. I’ll put the two bikes next to each other in a minute and compare. It might be saddle height. But the gravel bike is 74 degree seat tube with a short lay back post. The ancient hard tail is definitely slacker with more lay back in the post. I suppose I’m just trying to replicate what works

I did mine jumping out of a window.

I believe that age plays a major factor in relation to the type tear that you might get and whether repair is appropriate or feasible. The younger you are the more likely you will have tissue that can be worked with i.e. arthroscopically. Over 50 and the meniscus can become paper thin, so it’s not suitable for repair. They even called mine a degenerative tear :(. On MRI my meniscus looks like ‘crackle glaze’. Physio is the best plan for most, but if you are active then you probably have this base covered. I was encouraged to cycle and it seems that this is fine. Sitting for long periods then standing cripples me. Then I get going and its OK.

Ah i forgot – I need a new chainring for the MTB so I want to try an oval one, if I currently have a 30 tooth should I go 30 tooth oval?

Yes, stick with 30 tooth. I think the benefits of oval rings are very subtle (maybe no benefit at all depending on your strength and pedal stroke) but if you do experience a benefit it is because the flat parts of the oval are basically a very slightly lower gear at the top and bottom of the pedal stroke, reducing force across the knee joint.

If you fitted a bigger oval ring then that ‘very slightly lower gear’ probably wouldn’t be any lower than your existing round 30 tooth.

Years of playing football on hard surfaces (indoor & outdoor) did it for me, cycling (and swimming) is probably the best low impact exercise you can do to improve muscle strength & cardio fitness

I’m 35 and have a long(ish) history of knee problems starting in 2004 with a broken ACL in my left knee. Had surgery on it in 2006 which has been unsuccessful and failed in 2010. After the surgery I was told by my physio that cycling was the best thing for me so I started doing a bit (cycling to work, short local off road loops etc). I stopped cycling in early 2017, was working a stupid amount and just didn’t have the time for it. I then switched jobs and moved away and the cycling still went undone.

Fast forward to June 2018 and I was on holiday in Italy, my first trip abroad in a number of years and on the first day my knee gave way, to the point where I couldn’t walk. I came back to the UK and went to my GP who referred me to a specialist who put it down to cartilage damage. They didn’t do an MRI, just an X-ray. The specialist didn’t think an MRI would be worth doing.

My physio got me doing some leg lift exercises and after 4 weeks she got me cycling on the turbo. This gradually increased with me doing stronger leg exercises including lots of balance work and even more cycling. I was discharged from physio in December and told to keep up the cycling, which I have (I do a minimum of 6 hours a week on zwift, a mix of group rides and races). I’ve got it lucky that I now work two part time jobs so I can fit a lot of cycling in to my life now which I couldn’t the last few years.

I haven’t done any mountain biking yet (although I really want to get back into it I am a little unsure and lacking in confidence, especially regarding the knee). I wasn’t into any technical gnarcore stuff, more want to enjoy some XC type rides and bikepacking over a couple of days.

~2 years ago, I was riding my 29ered Wazoo fatbike with a n/w 34T chainring and 11-30 cassette. Never had a problem with my knees, able to pick a suitable gear to get up any of the local inclines until I discovered Dell Rd, just off Witts Hill. It peaks at ~20% and as much as I could just about ride up it in 34/30 back then, my knees were in agony after the first few days of visiting Dell Rd.

Took the n/w ring off and replaced it with the default 38T ring, which then meant I could use the inner 24T ring again, knees recovered in a week a so and then gradually increased the gear combo to winch myself up “the wall.”

I’ve just had a knee arthroscopy on a torn medial meniscus. It’s early days but all seems to be going well. Cycling didn’t really hurt it but I walked with a limp. It can be a bit sore if I push it, though it soon feels normal. It took a while to get to the operation stage, MRIs and waiting for consultant appointments and so forth but you’ll have a better idea of what is going on if you set the ball rolling.

This is almost me except I’m having mine done this Saturday. I can pedal all day but walking any distance gives me grief. The worst part for me is waking up at 3am with knee pain. (I’m 62 1/2)

how do you get this condition – from general wear and tear with cycling? can you avoid it?

thanks

I put mine down to years of kneeling working on vehicles, knees bent & turned inward & sitting on my feet. Along with playing a bit of rec ice hockey & having some eejit who couldn’t skate fall on my knee from the side. That smarted.

First open water swim of the year has chered me up no end

Plus your stories…..

Had a tear and my ACL is non existent, still ride and occasionally run. It does sometimes feel a bit weak but trying to build it up to compensate.