Knee round 2: rehab

The Physiotherapy practice I am seeing, sixphysio.com, have a slightly unusual setup in that their staff either specialise in remedial & manipulation, or in exercise & rehab. So today I had my second physio appointment today, this time with a rehab specialist.

After another short consultation, with a bit more time spent talking about bike setup and possible theories of what might have triggered my pain a fortnight ago, I did a bit of balancing on one foot and so forth, and immediately all sorts of ingrained problems in my posture, balance, and general being became very apparent. It turns out to stand on my right leg I twist my pelvis, throw my left foot across behind me, twist on my knee and all sorts. As soon as she mentioned all this it triggered other recollections: when skiing I have more difficulty carving to the left - where more weight is on the right foot - and I can never sustain one-footed skiing on my right foot whereas I have a tolerable ability for this on the left foot.

Having determined how my right leg is generally disagreeable in performance, all quite explainable by the lazy Vastus Medialis muscle (VMO) as identified on Friday, I was started on the road to correcting it. First step was a round of electric-shock therapy. I had had the misfortune of doing some google searches for lazy VMO prior to the consultation, and come across some youtube videos of a chap putting himself through this - using some sort of homebrew kit, crocodile clips and all! Fortunately my treatment was considerably more clinical, but still a rather curious experience.

Once it was activated, I was put through various other exercises to help train this muscle into responding to normal activity. The most difficult bit of this was overpowering my subconcious tendency to twist feet and hips in strange ways, as much as anything because I'm trying to avoid making knees click -- a destructive feedback loop between symptom and cause that has no doubt deepened this issue over the years. I now have a routine of daily exercise to go along side the post-exercise stretches I was issued on Friday.

Cycling home I made a very conscious effort to keep my knees aligned over my pedals, rather than letting them bow inward toward the frame as I now see they do (the Physio had already guessed so much just by seeing the way I sat in the chair with my feet splayed toes outwards). What I had considered as my knees knocking outward at the top of the pedal stroke is infact them knocking inward throughout the entirety of the rest of the revolution.
On the way into work this morning I'd worn a knee compression bandage; this had seemed to prevent the worst of the clunking, but I still arrived with some mild tenderness. (A bad sign as this is only an 8 mile ride so easy to see how it would be worse scaled up to say 400km!)
Coming home, I had no knee bandage but the joint effect of keeping my legs better aligned and trying to clench my quads, and in particular my newly activated VMO, appeared to have a very noticeable result: not only was there no knee-clunking, but no knee pain either.
So now all I need to do is get my own portable electric shock machine to take on my next randonee.

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More practically, I'm also going to look into change the pedals on my commuting bike from SPDs to something with more lateral rotational float. I don't believe I need more float per-se, but I do think a freer pedal (such as the speedplays I use on my road bike) would give my more ongoing reminders keep these factors in mind. A lot of people recommend Time ATACs as a good MTB-style pedal with increased float, but I think I'm as much interested to have free float without the spring return that they have; without trying some it's hard to know. So I may just go for Speedplay's "frog" pedal - which frustratingly they've been previewing a replacement for called the SYZR for several years, but has never actually made it to retail. Feels wrong to be spending more on a pair of pedals than many people spend on an entire bike (or BSO), when you know it's already obsolete!