|Getting the full knee-down from bike fit guru Andy Pruitt, knee guy to the cycling stars (including the US Cycling Federation). Watch videos|
TODAY I received some good news - and in this recession, any news is good news.
My knees, which were starting to sound like I was hiking through granola when descending a stairs, are not falling apart after all. I merely have a relatively benign form of crepitus. Wiki it and you'll see it's a term for anything that leads to innoisy knees. In my case, no bones or diminished cartilege seems to be involved - just fluid.
I consulted RoadBikeRider.com's Ed Pavelka on this last year, who wrote: Lynette -- you need to see a cycling medical specialist. The best in the business is Andy Pruitt at the Boulder Center for Sports Medicine. If you can't go to Colorado maybe he can recommend someone in your area. Generally, pain behind the knee indicates a saddle that's too high. But there can be alot more to it than that. Good luck. -- Ed
Since I was in NYC, I decided to go local at first. At the suggestion of Mike Sherry, coach for the NY Empire Cycling Team, I made an appointment with NYC knee guru Dr Andrew Feldman.
My pink tikit caused a bit of a sensation when I wheeled it into the waiting room where it took its place among the parked crutches and walking frames. I felt a bit guilty sitting among people with some serious orthopedic problems.
KNEE GURU #1: MARK FELDMAN
Feldman's intern, a David Hasslehoff-lookalike who bore all the markings of a roadie cyclist (short hair, clean shaven, body like a beanpole) stared at me disbelievingly when I told him my employer also made folding bikes that were ridden by bike racers. "What, a FOLDING bike can RACE?"
In fact, he continued to flip through the Bike Friday catalog I brought along (to prove I wasn't merely a couch potato wasting a sports medico's time) during the entire consult.
"Stop riding a bike," joked Feldman as he entered the room. Then more seriously, "Yes if you stopped riding, your knees would get better. But my job is to keep people doing their sport - i.e. manage without damage."
He looked at the x-rays and I sat there dreading the result - a friend had told me about his ex, a mogul skier, who had to have bone fragments sucked out from under her kneecaps to be able to walk again.
But the x-rays were "clean". Apparently, that cacophany in my knees is merely fluid rather than bone-on-bone, resulting from my occupational hazard - riding a bike.
"Over time, with repetition, your knees can start to track incorrectly, creating inflammation too," he said.
I was given two knee braces with donuts cut out for the kneecaps to use "when exercising", a script for Voltaren, a physiotherapy prescription for strengthening the area, and instructions to get a proper bike fit done. Now, my Bike Friday does fit me well, it's just that I'm always riding different models and demos without doing much finely tuned fitting, and this can play havoc with your knees. Plus, I confess I've never had a professional bike fit done, in the same way I've never had a facial or colonic irrigation done. It's just one of those things you tend to never get done!
KNEE GURU #2: ANDY PRUITT (full playlist)
I'd already consulted on email with Andy Pruitt, Bike Friday owner and cycling doc to the stars, as well as the Bike Friday owners and cycling gurus Ed and Fred at www.roadbikerider.com, and even RAAM legend Lon Haldeman who, despite crossing the country in 9 days on a bike has silent knees.
As if by divine providence, I found myself in Colorado on bike business and was able to get a consult with Andy Pruitt.
Here's the blow-by-blow video playlist. And here's the short write-up on the internet archive. Enjoy!
Mike Sherry, Empire Cycling Team (Manhattan) coach and owner of Performance Labs HC, does professional bike fitting to prevent crunchy knees. Despite his reputation for expertly coaching a gung-ho cycling team he happily posed with my pink Bike Friday commuter, the tikit, and his more usual Cervelo. Por que? He's surprisingly egalitarian when it comes to bikes. "I'm actually into extracycles and bikes that carry load," he says. Not too loudly of course ...
THREE BIKE FIT EXPERTS TO KNOW ABOUT
Mike Sherry, Performance Labs HC and coach for the Empire Cycling Team, NY. I met Mike by accident when I answered his Craigslist post selling a Blackberry Pearl. Serendipitous for sure! If he can coach a winning team like Empire he must know something we don't ... fee runs around $250 for a complete fit.
Bob Olsen, WheelWerksBikes, Crystal Lakes, Illinois: I met Bob 'The Fit Guy' Olsen Haldeman's Wisconsin Camp 2006 (he's the 6th photo down on that report), and wish I'd had the presence of mind to get a bike fit done then. I've been trying to catch him coming or going during Arizona Camp but so far, no good! Bob expressed some interest in being a dealer for BIke Friday, a bike which, of course, can be made to fit the most hard-to-fit people including petite women. How about it Bob? Fitting fees start from $100.
Dr Andy Pruitt at the Boulder Center for Sports Medicine, Boulder, Colorado: he's the doc to the stars like Lance; read his ultracycling creds here. He apparently owns a Bike Friday, which is why he appears on our Famous Fridays page, but I've not yet been able to locate one as proof. Here's an exchange I had with him this year which might help those with the same experiences:
Lynette Chiang from Bike Friday here. I haven't met you yet, but I've certainly put you on our Famous Fridays page under "those in the know"! Ed Pavelka kindly sent me to you ... I've been developing a bit of a sore left knee. There's pressure diagonally to the right of the kneecap, and then pain behind in the crook of the knee. Sometimes that leg feels like it's going to give out if I stand up. I often sit cross legged like meditation - largeoly because I am short and chairs don't cater to us. Also, my knees crunch when I walk downstairs although there's no pain, just a squelching cartilage sound rather than bone on bone. On the inner ankle bone protrusion of the same leg there is also moderate sharp pain. I get the feeling you've heard all this before, and wondering if you can suggest anything. Attached is a pic of me on my bike last week - I tend to wear my cleats really loose and yes, I wear 'spinning class' SPD shoes. If you can tell me what you charge, if you take insurance etc, it would really help. Maybe I could wrangle a trip to visit the Bike Friday Club of Boulder this year if absolutely necessary.
I received this nice reply:
Lynette, yes I have heard that before. Sounds like you have chondromalacia of the patella, with some structural contributors. Medical grade bike fit (including orthopedic evaluation) is crucial for you. For the moment, stop sitting in the meditation position, avoid stairs and keep your cycling mellow. I would be happy to see you. I have cc Avery Marzulla on this email, so she can contact you about the possibility of coming to Boulder. good luck and I hope to see you soon. Andy
Andrew Pruitt, EdD
Boulder Center for Sports Medicine
311 Mapleton Ave
Boulder, Co 80304 USA
As at Feb 2008 I was given this info by his office:
The full cost of the appointment as a self-pay patient (if insurance covers nothing) is $550. The evaluation is $212, functional activity is $63 per unit (usually bill 4 units) and computer motion analysis is $273. If you have to pay for any of these on your own a 40% self-pay discount is applied to the functional activity and computer motion analysis, and a 15% discount on the evaluation. The most common situation is that insurance will pick up Dr. Pruitt's charges from the evaluation and functional activity, but not the computer motion analysis. In that case we would bill the medical charges to your insurance and you could pay for the computer motion analysis, which comes out to be about $165 with the discount ...
I hope this post helps those with crunchy knees ...
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