Osteoarthritis of the knees, – any tips?

Hi all,

Frustratingly after years of cycling (I’m 35), an MRI back in September revealed my left knee has ‘Minor chondrial irregularity and degneration in the patellofemoral joint‘.

Symptoms manifest with a deep ache within the front of the knee when cycling (putting power down, climbing & basically anything fun), with subsequent swelling/aching after riding. Have been dealing with this for a year now and understand it will worsen (already getting twangs in main joint line). The right is also exhibiting similar symptoms.

I only ride road and cross now, and whilst my racing days will cease as a result of this I would appreciate any tips from the STW community who may have dealt with similar?

Things have tried:

• 2 x MSK bods
• 3 different physios (including completing one and continuing with a programme that makes no difference at all)
• full bike fit (inc, custom insoles & already use cleat shims)
• fish oil & glucosamine tablets
• K-tape

Many thanks in advance!

Things I think have helped my knee osteoarthritis

Weight training, with a focus on “balancing” the muscles in the legs. I found years of cycling caused my thigh muscles to basically overpower my other leg muscles and put disproportionate forces into the knee joint. So while I start with squats and/or deadlifts, I also make sure I do nordic curls, romanian deadlifts, hamstring curls, calf raises and tibialis work (I actually bought a watson tibialis trainer because I couldn’t get on with the much more common tib bar). I think when I added some tibialis  work into my routine that has brought the biggest benefit in experiencing less knee aches and pains, although I suspect that is because it just the final piece in achieving the muscle balance.
I also think barefoot shoes have helped, I don’t think it should astonish anyone that raising your heel is putting you unnatural position as you walk and that puts unnatural stresses on your leg joints.
Fish oil & glucosamine tablets, did nothing for me at all.
I have found that I have to suffer a small amount of aching while riding or exercising because doing the exercise keeps down the every day pain and niggles. If I stop the exercise I end up in more pain. It’s just a matter of judging when to back of the intensity so that it doesn’t become inflamed, and I think only time and personal experience will find that level.
When you try something, give it time, whether supplements or exercise, it won’t work in a fortnight, give it at least 6 months.

And when you do experience pain or swelling, I have found diclofenac cream far more effective than taking tablets, maybe it is just the massaging it in that helps.

I’ve got severe bone on bone, diagnosed since 2015, supposed have a knee replacement but was cancelled many times.
Oddly I get no issues cycling only when I standup and peddle. Used to use ibuprofen but this only suppresses it.
Squats (with strapping) helps as does indoor cycling. Tried all the glucosamine and fish oil and makes no difference.
Ultimately a titanium implant will relieve it.

You have my sympathies. I’ve got it in my hip, luckily cycling is about the only thing I can do although it’s mostly road / gravel now as anything that can cause shock through my leg is not fun. Codeine and anti inflammatories seem to help 

I found exactly the same as MSP – too much cycling and nothing else makes for huge imbalance.  Follow the knees over toes program for serious strength gains – not sodding around with physio fooling around with rubber bands and endless doing silly glute exercises.

I also found the barefoot show thing helped counter intuitively.

I’ve had it since a bike off riding into town when my knee was the first part of me to impact the pavement. Other bits included elbow, shoulder, cheekbone and left side of my skull. Fortunately, I always wore a helmet. That was ten-twelve or more years ago, and I haven’t ridden since, but I do walk a lot, and I take Naproxen twice a day, which also helps with the work-induced wrist damage that is also arthritis in my thumb joints and the carpal tunnel issue caused by the inflammation that the arthritis induces. Naproxen doesn’t suit everyone, but it certainly helps me cope with the discomfort. I also have Zapain on prescription, but that’s only a backup if my knee or wrists flares up during the day – Naproxen is morning and evening only. I’m 70 this year, and fingers crossed I’m managing without surgery being suggested in the near future.

There is a new treatment being developed, but it’s early days and not in the U.K. yet. It involves a small pad of highly pressure resistant material bonded to a titanium disc inserted into the point where the natural cartilage has been damaged and worn. A very simple procedure, and highly promising.

Wall sits and leg extensions used to help with my pain (temporarily) and as prehab before my knee replacement, also single leg balance and single RDLs as prehab.

Naproxen didn’t really help my knee, but cortisone injections did. GP could do it there at a regular GP appointment.

Walking was still very painful as was just sitting or trying to sleep, but cycling (not competitive) was fine and I was bike packing just a week before my replacement.

My other knee is going the same way now, but not bad enough to warrant an op.

Broke my Patella into umpteen bits years ago, might be a placebo but Marine collagen supplements seem to make a difference and when I’m taking creatine it does seem to feel better too.

I have a very very knackered knee and Ben Patrick’s ATG program allows me to ride anything I want pain free and I’m back training MMA. It focuses on the stuff people above are recommended but in a very well structured and laid out way

I have been plagued with Arthritis in both my knee joints, The surgeon told me that My tendons/ligaments and cartilage are all in perfect health and there was nowt he can do for me at this time but eventually I will need knee replacements….. it was really painful for me when out on the MTB , I was struggling to keep up with riding buddies and to be honest it was just no fun anymore due to the pain….I had resisted numerous suggestions about getting an ebike…. and I held off for a s long as I could…. to be honest my mental health was at an all time low.It was last September when the owner of the LBS offered me a FREE ebike hire…… what a difference it made to my biking…. for the first time in ages I was biking pain free….. I went and bought an ebike at the beginning of October last year…and to be honest I have not looked back….no pain and longer routes have been opened up to me……best thing I have done so far…..loving my biking once again…

I have this in my right knee, just had my left hip replaced due to it destroying that joint over the last 7 years, the knee will need replacing at some point, but the advice about physio exercises is good, as always with arthritis, motion is lotion, but with the caveat that it’s doing it the right way.

Speak to your GP and hopefully they can set up the physio, my place did this and they even have an app you can use for exercises.

Unfortunately (my wife suffers badly – 2 new hips and 2 fused knuckles) there is little treatment for Osteo. If it was Rheumatoid, then I believe there are more treatments available

Thanks for the replies everyone, most appreciated – definitely got some bits to research in the interim.

Despite my optimism, I’m aware that it is a downhill slope. Still, someone will at least benefit when I sell all the bikes + kit! Just sad that this will come sooner than later.

Cheers

Naproxen doesn’t suit everyone, but it certainly helps me cope with the discomfort.

As a long term answer isn’t that too hard on one’s stomach?

I’ve been taking it, along with the stomach liners – but thought it was only a temp solution for a month or so.

Watching this thread with interest after a partial menisectomy has left me with a shite right knee.

I stopped taking naproxen a while back with the hip, had to take lansoprazole as well, add on if you’re other stuff and it gets a bit OTT.

Think the reality is if you’re having bad pain, see if you can get an injection, or if there’s some type of arthroscopy to clean up any loose particles, etc that may reduce the pain, i’d definitely keep going and not give up biking just yet.

As a long term answer isn’t that too hard on one’s stomach?

You have to take it with other medication too. Anti-inflammatory in general screw your stomach over time. I cant take them now for my hips as they upset my stomach.

OP – is the intervention all through private stuff you have arranged or through the GP?

If not through the GP I would be seeing one personally. Hips and knees have very long waiting lists these days so its good to get in the system

Yip, Osteo in my left knee. Actually started feeling the pain when cycling back in 2019, but I’m pretty much pain free on my bikes now. I also visited 3 different physios but only one of them gave me the exercises that helped. Strengthen those knees, lots of single leg stuff. Also wokring on my hamstrings and quads 3 times a week. I still have issues and pain and it does really get me down, but I’m not done yet.

Despite my optimism, I’m aware that it is a downhill slope. Still, someone will at least benefit when I sell all the bikes + kit! Just sad that this will come sooner than later.

A knee replacement or hip replacement isn’t the end of cycling. You may not even need an eeb!

I had my knee replaced 5.5 years ago (at 48) and have done some centuries since without an eeb. I use an eeb now largely for other health issues I have.

I also know a few with hip replacements still riding well.

I’m not saying you need a replacement, but don’t give up hope if a fun active life. For me I’d suffered for so long at home and with my job waiting for a knee replacement it was a relief to get it, and I’m in much less pain generally now and when cycling I just have to avoid high torque blasts and spin.

I’m 62 and had a lot of issues with my knees over the years, including arthoscopys in both knees 30 and 20 years ago.  At one point 2006 ish I was diagnosed with osteoarthritis and told my left knee was almost bone on bone.  At that point I gave up running and took up mtb, which made a great improvement to pain/issues and Ive pretty much managed it since then.  Been taking Fish oil for 12 years, Glucosomine for 8 years, but upped that 2 years ago to include chondroitin and currently my knees are feeling strong.  I play golf carrying my bag, do long walks and fingers crossed they stay like this.

Two years ago, I tweaked my knee at home, an hour befor doing a 20mile mtb ride and despite feeling nothing during the ride, the next day it was badly swollen and utter agony.  Was diagnosed with psuedo gout (look it up) for which there is no treatment apart from naproxen, so just hobbled around in pain, until it inexplicably cleared up complete 8 months later.  I reckon my knee slowly ground up the crystals until they were gone.

So, I appreciate we are all different, but wanted to post that to show that knee pain isn’t necessarily the beginning of the end.

Thanks for the recent replies on this, I really do appreciate it.

It shows the diversity of things and I’m pleased that everyone has remained on two wheels!

I have been thinking about splashing out on one of these.

https://kineon.io/pages/red-light-therapy-device

Red light therapy does seem to have some research behind it, although I am not that grounded in the science to tell the difference between the quality peer reviewed science and the bullshit.

On the one hand it is a lot of money to throw away if it has no impact, but if it does alleviate some of the aches and pain then it is very much a price I am willing to pay, of course there is also the thought of, am I really the kind of person who will strap that to my knee for 15 minutes a day per knee every day for the rest of my life, even if it does work.

10 keys to unlocking knee pain (ebook by Catherine Holland)

Eat fermented foods like Sauer kraut

Take 1/2 tsp MSM flakes in water on empty stomach in morning

Near infra red light Therapy.

Also take 3mg boron every day

Naproxen doesn’t suit everyone, but it certainly helps me cope with the discomfort.
As a long term answer isn’t that too hard on one’s stomach?

I take a bunch of different things, mostly supplements but statins as well as the Naproxen, and I take Omeprazol (?), I think that’s the stuff, anyway I seem to be one of the lucky ones who doesn’t seem to suffer significant side affects with it, but I know plenty who do, and can’t touch the stuff. Taking two, morning and night certainly help my knee and my wrists, and very occasionally I might have to take a couple of Zapain, but maybe once or twice a month or so. 🤞🏼I can carry on as I am, my wrists are now my major issue, I do struggle with things like writing, tying things like boot/shoe laces and even things like shirt buttons, because I haven’t got the fine movements like I used to have, gripping things is more of a problem now as well. That’s work-related, unlike my knee.

Oh well, shit happens. 🤷🏼

I developed a similar (pain over the kneecap when pedalling) a few years ago, and got a similar diagnosis. Obviously, everyone is different but the biggest single thing that helped me was moving to short cranks – I’m 183cm and using 160mm. I think that having the leg slightly straighter during the power stroke is what makes the difference.

Counter-intuitively, taking up running also helped by strengthening the muscles around the knee (I think it’s been mentioned above that over-doing one exercise relative to others can cause an imbalance). Running also encouraged me to drop some of my excess weight, which also helps of course!

Yeah, I run shorter cranks now as well, I think the smaller range of movement it creates on the knee helps, and frankly I haven’t noticed any downside.

Sorry to hear that OP.

But it shouldn’t mean the end of cycling for you. I had a partial knee replacement 7 months ago, after six months of bone on bone. On Zwift, I’m about 80% of where I was a couple of years ago and I’m cycling roads with no pain.

All the best.

I was diagnosed with minor osteo arthritis in my right knee in my early 40s, a couple of years after being hit by a van while on my bike. While the pain has gradually worsened over the ensuing 20 years, it generally only affects me significantly when I’m walking downhill. I don’t take any medication, apart from the occasional paracetamol to minimise discomfort. I can still cycle, ski with minimal discomfort, although hillwalking can be pretty uncomfortable by the end of a long day.
Management of the knee has involved strength and flexibility work, along with weight management to minimise loading on the knee. Getting decent sports physio input from the get go was really helpful, and I work with a fitness coach periodically to change up the exercise routine. A lot of the initial strengthening was done with isometric exercises then working on range of movement etc. It’s definitely worth spending the money to get good professional advice on managing your knee, and get into the mindset that managing it will be a lifelong process.
Hope that gives some optimism that having osteoarthritis doesn’t neccessarily signal the end of your active days!

Whilst strengthening all muscles to ensure balanced forces on the knee is a good idea, be careful with exercises that put a lot of strain on the knee. Some of those suggested will do that.

Thanks for the additional responses in this, do appreciate it.

I had (another!) bike fit yesterday, saddle has gone up ~ 20mm amongst other more minor tweaks. One area that has been noted (and that I did know about) is my ingrained “pedalling toes pointed down” action regardless of bike set up – This apparently does drive force through the knees and the fitter wants to hear how I get on after riding over the next few months.

I’m trying to to remain optimistic but walking with a limp (now from the other knee!) at 35 makes me feel very old already.

Cheers

Update: Opted to book in with a surgeon to discuss options next month – will see how it goes. It’ll just be for an (expensive) but hopefully valuable conversation.

I cannot continue being in pain knowing that this will continue for the rest of my life. eBikes or not!

Spoke too soon about my other OEM knee, ended up at the GP a week ago on Monday after it blew up massively and it’s still stopping much walking and stopping sleep. Had x-rays and waiting to see the result that while icing and on naproxen.

With my first knee I paid for a private consultation after getting fed up waiting for the NHS. I think £400 including x-rays. It confirmed my fears, but I couldn’t afford iro £12k for the private op. The consultant was really nice though and wrote to my GP said how needed it was for me to keep in work, with a family etc and the ball got rolling quickly after that (could be coincidence?), including being referred for a unloading brace prior to the op. I deemed it money well spent.

If I win the lottery I’ll get mine done. Been waiting since 2015.

And there’s me thinking 2 years was bad enough when I got my first one done! 🤯

Ahh knee pain. I bet ive had more than most. Probably into double figures for operations and even had to learn to walk again after one injury. Eventually after nearly becoming an alcoholic to mask the pain so i could sleep and then breaking down in front of my consultant who had put my right knee back together when the patella tendon completely snapped i got the solution.

Basically i have knock knees. I had a full lower body xray and both my knees go inside the line from hip to foot. Due to the injury i had on my right knee and the subsequent ops this is less pronounced and the issue, weirdly isn’t as bad. But because i used my bike to try to rehab the right leg, what i ended up doing in reality was 5000 miles on the left leg that year. It wore out what was already a bad knee. I had pain from the right knee from the rebuild and the left knee from arthritis.

So i am sat in front of a consultant who is offering me a new knee. He said due to the knock knees i was pretty my putting my weight through 25% of the knee and when he showed me the pictures it was like scrambled egg and then polished marble. He said if I let him straighten the leg this would ‘possibly’ solve the arthritic pain but also set me up better for a new knee if it doesn’t improve.

I had a distal femoral osteotomy which sounds worse than it is. Its just a surgical break and reset and took about 6 weeks of discomfort.

If i told you that 100% of the arthritic pain disappeared overnight in that joint i wouldn’t be exaggerating. It was amazing. My knees are still rubbish and i don’t cycle or run anymore but that’s more down to the other knee which doesn’t work properly anymore and has left me with co-ordination issues. I took up weights instead and I can squat and deadlift double my bodyweight and more importantly i can go to sleep knowing i havent got to mask any knee pain.

Edit…If it could happen at a good time then mine was it.  When my tendon snapped i was on the operating theatre within 4 hours and they had some special band taxi from Leeds to fit into that knee.  I was seen every 2 week for an entire year with the right knee.  Due to complications in putting it back together i had 2 more ops to try to make it work properly and when the left one flared up i was already in front of the consultant who wanted to do the operation.  I had zero wait for the osteotomy and am forever thankful of the NHS.  I am over 10 years down the line now and have no arthritic pain.

I’m off for an MRI in the morning to have a look at my knee. It’s always been a bit dicky, not helped by a good proportion of the cartilage being removed when I was 19 (I’m now 49). It’s now pretty much constantly achey and swollen, the consultant reckons it’s probably arthritis so the scan is to find out exactly what the score is

From there the options are probably a brace, osteotomy, or knee replacement. ‘Triffic…

Bookmarked.

For what it’s worth IHN I don’t regret knee replacement at all. It’s not perfect but it’s sooo much better than the pain and suffering before it.

Also bookmarked. Mine hurt on the eeb as well now. Just started taping them for patella alignment as apparently that is the issue, too early to tell if it will help though

I take MSM powder daily. It has worked well for me. I had pain from years of skateboarding.