Physical Therapy

[benb]

I had posted about my knee last week and the doctor recommending surgery..

I got a second opinion and the second doctor sent me to PT.

I've only gone twice but there is already a difference.. I don't know what was up with the first doctor.

They said I had the following from years of cycling and not knowing the right stretches and/or exercises to balance out cycling.

- Very stiff hips, especially tight hip flexors, but also in the twisting motions
- Very stiff IT bands (injured leg much worse then good knee)
- Balance issue in my quadriceps on that leg (weaker vastus medialis)

Because my joints are really flexible apparenty rather then getting IT band syndrome it instead pulls my kneecap slightly out of alignment. Working on the IT band seems to already be helping. The muscle strengthening stuff will of course take longer. Pretty interesting as I had loads of strength in most of the stuff but clear weaknesses in a few specific exercises they're having me do that involve motions nothing like cycling.

There are clearly some things in my fit & cleat alignment that should never have been done too.. my right foot points out on my bike, and has been the entire time, and it's clearly the IT band that has been causing it all this time. I think I will be able to correct that over time. I wouldn't be surprised if that contributed to the muscle imbalance as well from riding with my foot pointed out. But I guess fitters must have to tread very lightly here as I'm sure lots of folks want the bike adjustment as a quick fix rather then being told they need to fix body issues.

I'm pretty excited to see how this benefits my cycling if I can make some improvements. I feel like for the cost it is something I should just start doing for "checkups" once or twice a year even when I'm not hurt... kind of like seeing a coach or a fitter.

[dekindy]

It is good to hear that the different advice seems to be working.

[cmg]

cool to hear that stretching and exercise can help. what exercises are you doing?

[rpm]

Physical therapists are my favorite medical practitioners. They've helped me immensely. The syndromes that your PT identified are all definite causes of pain, and if you work on the prescribed exercises, you'll get better. Surgery is always a last resort. I'm curious, though, what kind of surgery was suggested? Unless you have something torn in there, I can't see how it would help.

[veloduffer]

I think some doctors only looking at fixing the pain, but not look at the underlying cause. Sounds like you're on the path to being well again. :beer:

[KeithS]

I am a big believer in PT too. Had a great therapist work with me to relieve in short order, years of pain. I brought my bike to therapy. No she didn't try to help us work out our issues but she did do some very slight repositioning - after lots of measurements and even video. I have sent two of my riding friends to my therapist and they were helped too. She compliments and complements my fitter.

My PT is also a triathelete. She really knows her stuff.

[benb]

My kneecap is shifted a bit to the outside of my leg.

The surgery the first doctor wanted to do was to graft a piece of tissue on the inner portion of my knee to tighten the ligament in that direction. From my own research it sounds like this is a typical surgery for people who have dislocated their kneecap... (not something I've ever done)

The second doc + PT are saying the tight IT band + weaker VMO in that leg are the root cause. The muscles on the side of that leg that you would use for ice skating, etc.. are also weaker then the other leg. Stuff you never notice in cycling since you don't have to move sideways.

One of the less obvious things the PT is having me do is use a foam roller to break up the knots in my IT band.. It was only $20 and seems to do a better job then "the stick" and similar products.

[RADaines]

tight IT band + weaker VMO in that leg are the root cause.

Any idea what has caused the weaker VMO in that leg? PT may help, but if the underlying cause is not corrected, the fix may be temporary. In my case, it seems that my right knee was not tracking properly during the pedal stroke. A couple a cleat wedges have improved the tracking and I have been able to maintain good symmetry in my VMO between the left and right leg. Before this, the right VMO was almost nonexistent.

[benb]

I don't know. I don't think cycling was the cause, but my fit has probably evolved to take this into account, and that may have made a feedback cycle that made the problem worse over years.

I think I probably had both issues before I started cycling. Probably from having flat feet.

I've always had my right foot try to "duck foot" on the pedals, now that I know what is going on I suspect that is from the IT band.

If this resolves through PT I'm going to go have my cleats looked at, etc.. in case it changes something in my fit.

[rpm]

I don't know. I don't think cycling was the cause, but my fit has probably evolved to take this into account, and that may have made a feedback cycle that made the problem worse over years.

I think I probably had both issues before I started cycling. Probably from having flat feet.

I've always had my right foot try to "duck foot" on the pedals, now that I know what is going on I suspect that is from the IT band.

If this resolves through PT I'm going to go have my cleats looked at, etc.. in case it changes something in my fit.

Your mention of flat feet and duck foot sound familiar--I have the same issues. When I had intractable pain, I got a little help locally, but then decided not to screw around any more, and went to see Andy Pruitt. He changed my shoes, pedals, and saddle positions and added wedges to my cleats. That was 9 years ago, and I've been fine ever since. The consultation and trip to Boulder cost me about $1000, but it was absolutely the best cycling money I've ever spent.

[benb]

The thing with treating this as a cycling issue is it's never bugged me cycling. I think cycling may make it worse, but all the pain occurs in other activities.

I have orthotics in my cycling shoes (which are some of the specialized ones that Pruitt designed) and that has seemed to work over the years.

It is great that Pruitt is that one guy who can put everything together but I'm not prepared (nor wealthy enough) to travel out there to see him. I settled for reading his book. :)