Good news for crunchy knees (and 3 bike Fit Experts you should know)
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| A-fitting we will go... |
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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.
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| The ass-ometer measures, well... |
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. Later, I managed to snag an appointment with Andy Pruitt while bicycle evangelizing in Boulder, Colorado. Here's what went down...
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| Avery, an expert bike fitter at Boulder Center for Sports Medicine, tweaks my seat |
KNEE GURU #1: MARK 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. In fact, I felt a bit guilty sitting among people with some serious orthopedic problems.
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.
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| Those are my KNEES you're looking at, OK? |
"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 - so... I got one done, with...
KNEE GURU #2: ANDY PRUITT
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.
Rather than deluge you with words, Here's the blow-by-blow video playlist of the consult and fitting and check out these photos.
And here's the short write-up which may still be available on the internet archive.
Enjoy!
FIT GURU: MIKE SHERRY
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 ...+++
In summary ...
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. Here's an exchange I had with him this year which might help those with the same experiences:
Hi Andy,
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.
Lynette
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
303-544-5700
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 ...
More gossip from the Gal
Comments
I have had three knee surgeries: two cartilage surgeries and one ACL reconstruction. My first major knee surgery was over 20 years ago, before sophisticated arthroscopic surgery became popular. They opened up my knee, removed a bunch of cartilage and now I have almost a bone to bone situation. The surgery hungry orthopedic surgeons would love to give me a titanium knee, I'll keep investing in the titanium on bike for as long as I can! I am hoping that technology will advance so as to be able to regrow cartilage and give my knee new life.
Good news is that I can barely run, long walks even hurt but I can still ride! I am convinced that my legs were made to spin more than anything else. Cycling is the one activity that really does not bother my knees (unless I ride in really hard gears for two long). Classic cross country skiing and swimming also feel great. Yoga gives some great stretches but I have to be careful not to hyper-extend my knees. It's too bad for my kids who would like to see mom do stunts but to protect my knees and my ego, I don't really participate in sports that have side cutting movements like soccer, tennis, sliding to second or rugby :)).
For the past 15 years I have been a huge fan of getting a custom fit onto my road bikes. For my latest road bike, a Serotta NOVE, I had the bike custom made for my small frame. My local bike shop, Belmont Wheelworks, they took about one hour getting all my measurements, talking to me about my riding style, understanding my knee issues and watching me spin. It fits me like a gem. For my commuter bikes and other around town or occasional two-wheelers, I usually just adjust the seat based on feel.
I tend to spin really easy gears and am never too proud to go into my triple. Certainly taking some Advil before a long ride can help prevent the swelling that can cause pain.
GOOD LUCK!
Lauren Hefferon
Director and Founder, Ciclismo Classico
"Transforming Lives through Bicycle Travel since 1988"
30 Marathon St
Arlington, MA 02474
1-800-866-7314 x 10
Cell 617-640-4837
http://www.ciclismoclassico.com
Check out my new blog: http://laurenhefferon.blogspot.com/
'Probably 'cuz I'm one of them-- ;)
I like to think that I'm "non-denominational."
Many modern shoe-pedal systems with angular "float" still resist ankle rotation. Speedplay is a notable exception. I have to rotate Shimano SPD cleats to the limit for toe-out to avoid knee strain, and position the cleats as close as possible to the big-toe side of the shoe sole, so my ankles don't strike the cranks of some of my bicycles -- even though I don't toe out as much as many people do. Most modern cranks are angled so as to increase ankle clearance, but some people may need "knee saver" pedal axle extenders.
I first learned about cleat adjustment in a professional Fit Kit fitting, but it is possible to make the adjustment by observing the angle at which your feet naturally rest when unconstrained on plain pedals, and perhaps have a friend mark the angle on the soles of your shoes as you sit on the bicycle.
I also mount the cleats farther back then usual, in order to avoid another bout of Achilles tendinitis.
With toe clips and straps, select wide pedals and mount the toe clips outboard of their usual location so the toes can rotate outward and ankles inward. I use long toeclips even though I have only size 9 1/2 (USA) or 44 (Euro) feet. Beware, toe clip sizing is not consistent -- I found Japanese long to be the same as Christophe medium. People with very large feet may have to space each toe clip away from the pedal with stacks of washers.
Many modern shoe-pedal systems with angular "float" still resist ankle rotation. Speedplay is a notable exception. I have to rotate Shimano SPD cleats to the limit for toe-out to avoid knee strain, and position the cleats as close as possible to the big-toe side of the shoe sole, so my ankles don't strike the cranks of some of my bicycles -- even though I don't toe out as much as many people do. Most modern cranks are angled so as to increase ankle clearance, but some people may need "knee saver" pedal axle extenders.
I first learned about cleat adjustment in a professional Fit Kit fitting, but it is possible to make the adjustment by observing the angle at which your feet naturally rest when unconstrained on plain pedals, and perhaps have a friend mark the angle on the soles of your shoes as you sit on the bicycle.
I also mount the cleats farther back then usual, in order to avoid another bout of Achilles tendinitis.
With toe clips and straps, select wide pedals and mount the toe clips outboard of their usual location so the toes can rotate outward and ankles inward. I use long toeclips even though I have only size 9 1/2 (USA) or 44 (Euro) feet. Beware, toe clip sizing is not consistent -- I found Japanese long to be the same as Christophe medium. People with very large feet may have to space each toe clip away from the pedal with stacks of washers.