Knee rehab: Cycling specific strength exercises that don't stress knees

[Wayne77]

Looking for some suggestions on exercises that enhance pedal stroke, that don't put pressure on the knees. I'm pretty sure that means I can't work the lower leg muscle groups, so I'm looking for some exercises that work upper legs, hip flexors, etc. maybe some calf work (stand on ledge, flex feet up and down), keeping my legs straight would still keep pressure of my knees...

Earlier in the week I injured my right Vastus Medialus on a 50 mile ride, powering seated up a 300 yard climb. Bizarre injury, I've done several very intense 80-100 mile rides this year with no issues at all. It was very cold out so maybe the stiff tissues couldn't take the stress. In any case I have about 4 weeks of recovery ahead of me, but would like to minimize loss of muscle mass as much as I can during the recovery. What are some good exercises I can do each day to do that (that don't put undue pressure on my knees). Im convinced part of avoiding this in the future will be to develop a better spin...I think the mashing & torque on my knee is what caused it. Maybe some exercises that work contraction of hip flexors & quads? (Pulling up part of the pedal stroke). Maybe leg raises while lying on my back?

What else?

Sincerely appreciate any suggestions you have.

[Tickdoc]

Swim?

[JStonebarger]

That is a strange injury. Have you seen someone for it? What did they say?

[bjf]

Think about using a muscle stimulator. I once had my leg in a cast for 6 weeks, but had them make a window in the cast so I could use a stimulator. Much less loss of muscle mas than otherwise would have happened.

[Bentley]

Think about using a muscle stimulator. I once had my leg in a cast for 6 weeks, but had them make a window in the cast so I could use a stimulator. Much less loss of muscle mas than otherwise would have happened.

Are you referring to the "Russian" stim? In general I don't think a muscle stimulator will prevent muscle loss, I'm no Dr, but I've used one and other than the "Russian" does not really "work" the muscle. I have used a muscle stimulator during rehab, to help contract a weak muscle, but that is a bit different.

My 2 cents

[Wayne77]

That is a strange injury. Have you seen someone for it? What did they say?

I agree. It seemed odd once I localized it to that area. To clarify, its actually closer to where the VMO attaches to the patella area. When I touch there and the lower VMO area, it is very tender, and feel a sharp pain right there when pedaling. In any case, there is a guy on my team who is an orthopedic surgeon who agrees that's what was injured. I will be doing some PT, based on his recommendation...but looking for some general exercised I can do that won't stress my knees (ie, don't want to be doing any kind of squats)

[ultraman6970]

Walk in a swimming pool for 30 minutes, back a forth??

I got a dislocated knee and do this once a week accelerated the recovery a lot.

Swim?

[dgauthier]

(..) It was very cold out so maybe the stiff tissues couldn't take the stress. (...)

You can definitely injure yourself more easily if you don't keep your legs warm in cold weather. Were you wearing tights or knickers? If not, investing in some cold weather bibs might help you avoid a repeat just as much as smoothing your spin.

If maintaining muscle mass is that important to you, see a doctor specializing in sports medicine, and follow the doctor's instructions to the letter.

If you don't think a visit to the doctor is warranted, consider just resting until you're healed. You could try doing exercises that avoid extending the knee -- calf raises, hamstring curls, and hip extensions, for example -- but I think it would be hard to engage in all that activity in an unsupervised fashion without inadvertently re-injuring your quad. Sometimes you just have to rest.

Come to think of it, if leg muscle mass and strength is what you're after, aren't you doing these exercises already in addition to riding? If not, folding some gym work into your routine once you've recovered will pay off many times over on the bike, and make you forget all about whatever fitness you lost while your quad was healing.

[MattTuck]

No idea if this will help you, but I found it helpful.

For a long time, people had been telling me to do hip bridges to work the glutes.
https://media3.giphy.com/media/M4XovfOIOyp8s/giphy.gif
https://media3.giphy.com/media/M4XovfOIOyp8s/giphy.gif

I was finding that doing them was also activating accessory muscles like the hamstrings way too much. So now I do them in a way where the lower leg does not touch the ground. I put a foam roller, or other support about 2 inches above my knee, and this really helps keep the focus on the glutes and not on anything related to the knee.

[11.4]

I've seen a few of these injuries before. A number of things can bring them about: lack of hip flexibility or strength (which puts stress on the quads), dehydration, and a twisting or rotating action at the bottom of the pedal stroke that focuses the load on one small portion of the Vastus head.

So in terms of avoiding a repeat, I'd suggest finding a really good fit specialist (not your basic Retul or similar fitter) who can identify how you're rotating ankle and hip to place stress near your knee. I'd also do a lot of rolling work on the glutes, abductors, adductors, and upper quads. The tear comes down low but the problem tends to originate up high.

As for any kind of electrostimulation, that work prevents muscle loss but doesn't preserve muscle strength well. I wouldn't think too much of it. I'd also be careful of any physical therapist who has you do seated knee extensions; those have little place in modern sports therapy and can complicate your problem. However, what I would suggest is that you build that musculature a bit more. For starters work with kettlebells at low rates and then increase the weights as you recover. You have to be very disciplined about not overdoing the injury or it'll recur, but exercising carefully during recovery will speed healing. I'd also do low-gear spinning; you can still get a good FTP workout in a low gear if you're spinning fast. Stop all cycling if you're getting a resumption of pain in the vastus because it can indicate you're resurfacing that twisting action that brings this about.

[Wayne77]

Guys, this is incredibly helpful advice! Sincerely appreciated. I do have an appointment with my PT but he is booked out several weeks, so I thought Id do some research ahead of time.

One thing I didn't mention. For the last 6 months or so I very often get a cold sensation in my lower right leg...But it's not cold to the touch. Sometimes it's a cold/hot swnsation...like I put Icy Hot on it. Perhaps there could be some sort of nerve issues going on. Not sure if that changes anyone's thoughts, but just throwing it out there...

[Ralph]

I'm an old guy who sometimes has knee pain, and some of mine may be due to just age and wear........but.....I notice than anytime my saddle is as little as 1-2 MM low (which is not a lot), or my foot placement on pedal is a MM or so back from where it needs to be (and I run my left cleat further back than my right to compensate for slight leg length difference) ....whenever I change bikes (or mess with saddle in some way) and don't get all this just right.....I get some knee injury after a big effort...climbing or pulling hard in a big gear. Like knee is a "pivot" point, and it is strained. Point is....don't overlook fit. Over simplification I know.....but when fronts of my knee hurts....I know my saddle is too low or my cleat is too far forward on that leg.

[batman1425]

The VMO is an underdeveloped and weaker muscle in many cyclists as it is responsible for only the last few degrees of extension of the knee. Most (seated) pedaling doesn't recruit the VMO effectively, so it gets underdeveloped compared to the lateral quad muscles. Short intense activity - especially out of the saddle where full leg extension is reached can cause injury as a result of the imbalance. Others experience problems as patellar tracking issues - as the stronger lateral quads pull the patella laterally with more force than the VMO can support - effectively pulling the patella out of its groove - end result PFPS.

I'm not a PT/Orthopod but have dealt with VMO injuries very similar to this, at the attachment point with the patella. IMO the key to recovery will be allowing the injury to heal, then building strength and flexibility in the VMO with targeted exercises. It can be a difficult muscle to isolate, again due to it's role in only a small part of leg extension. There are good resources online for specific exercises, but healing is the first thing on the docket. You may have put a small rip in the ligament which won't respond well to continued stress.

In theory you could do limited mobility strengthening to isolate the lateral quads in the mean time, but IMO, that will be counter productive as you are furthering the imbalance issue.

[Wayne77]

Extremely helpful! - thanks for taking the time to share your thoughts.

The VMO is an underdeveloped and weaker muscle in many cyclists as it is responsible for only the last few degrees of extension of the knee. Most (seated) pedaling doesn't recruit the VMO effectively, so it gets underdeveloped compared to the lateral quad muscles. Short intense activity - especially out of the saddle where full leg extension is reached can cause injury as a result of the imbalance. Others experience problems as patellar tracking issues - as the stronger lateral quads pull the patella laterally with more force than the VMO can support - effectively pulling the patella out of its groove - end result PFPS.

I'm not a PT/Orthopod but have dealt with VMO injuries very similar to this, at the attachment point with the patella. IMO the key to recovery will be allowing the injury to heal, then building strength and flexibility in the VMO with targeted exercises. It can be a difficult muscle to isolate, again due to it's role in only a small part of leg extension. There are good resources online for specific exercises, but healing is the first thing on the docket. You may have put a small rip in the ligament which won't respond well to continued stress.

In theory you could do limited mobility strengthening to isolate the lateral quads in the mean time, but IMO, that will be counter productive as you are furthering the imbalance issue.