Sunday, May 15, 2011

Thing1 knee 1

This week I finally got myself organised and saw a Physiotherapist on Friday, to have a look at my knee.

It's a fortnight now since the pain first started in it, on the way to Wales, and which caused us to pack the Brevet Cymru 400km just 30km in on the following day. I had thought it was improving so we drove to Ilminster last weekend to ride the Old Roads 300km, but overnight the pain returned and so we didn't even start. Something had to be done.

The Physio was a little confused by the long story I had to tell about my knee. It's been a bit "clunky" for about 10 years, but rarely painful so I never put much thought to it. I found that within half a minute of starting cycling, if it was clunking, I would unclip my right leg and kick it out a couple of times, and the knee would click the tension be released and this would stop the clunking for many hours or even days.
In short, the problem of the last fortnight is I can no longer click out my leg and so it is continuously clunking.

At the moment, it is looking hopeful the problem is one of patella tracking disorder, rather than more serious meniscus / cartilage damage.

One observation that seems to support this was quite late in the consultation my Physio asked me to clench my quads on either leg, and noticed that the Vastus Medialis muscle on my right leg was "lazy"; slow to contract only doing so in the final stages of squeezing the Vastus Lateralis muscle. In contrast on my left leg these fire about the same time as is desirable.

She made the observation that my quads and ITB are extremely tight, and I need to take up exercises and stretches to address this. She was quite surprised when I replied in the affirmative to a question of whether I own a foam roller! This is particularly good for loosing these areas, it turns out. I'm used to being made aware about how tight my hamstrings are, first time I'd really been made aware of this problem elsewhere.

The one thing she could explain is why, when walking up stairs, my knee clunk is far more pronounced when I make tall ankle extensions with each step. Most likely theory is extending the ankle through calve muscle contraction causes some other quad muscle activity to stablise the leg, having this side effect.

The final experiment of the session was to try taping my knee cap for a day. At first I found this to be rather uncomfortable, partly just from the stickiness pulling on skin and the lack of motion it allows. Cycling on to work it was initially giving a very disconcerting clunk, but eventually it settled and over the 24 hours it became much smoother feeling. Eventually I was surprised how I'd carefully stand up from sitting for a while, moving carefully in anticipation of a knee clunk that never occurred. This more than anything has given me hope that surgery is not going to be required, and I just need to sort out the kneecap stabilising muscles to cure the issue.

The time line for this is hard to predict though. Exercises to rebalance muscles could take a while to get full effect. Hopefully binding it will prove reliable enough to keep it in check in the interim, I will need to test this out on the daily commute and build up to longer distances with it.
The remaining pain and inflammation feeling needs to be given chance to recover as fully as possible before I take on any more long distances, and then I should also be prepared with a regime of ice packs to ward of any final niggles.

With these sorts of issues it seems often recommended runners take up cycling, cyclists take up swimming, for another source of exercise. I never learnt to swim with any real ability, maybe now is the chance? I started investiging some adult swimming lessons in London, and found the Art of Swimming which looks interesting. Would be interested to hear if anyone else has recommendations on this.