Conference noted::bicycle

	If three quacks say its foot position then there is at least a
30% chance that they are right.  Current conventional wisdom says to
get fit kitted, cleats aligned (if you use them) and stay with low
gears.  I mashed up both of my knees a long time ago, exercise has
helped a lot and every year they are affected less by the cold. 
Before I restarted riding I was seriously considering the knife, 
always reading about faster healing times and smaller scars with the 
new micro surgery stuff.  After about 10,000 miles the joints have 
tightened up a lot, I don't think I will need the operation now.

	Good Luck with this, I know how bad it can hurt !

	Reg

	If you want specific advice, you should be a bit more specific.
"Knee Problems" can mean lots of things, from simple inflammation to destroyed
tissues. Where is the pain? And how does it occur? How often? What was the
doctor's diagnosis?
	I am certainly not a doctor, but have a positional imbalance in my
feet like yourself. I've seen the doctors, before there was sports medicine
specialization, with similar results. Since then I've learned to keep a look-
out for the signs of worsening condition and act appropriately.
	Any doctor will tell you that the best preventative medicine for
joint problems is to strengthen the surrounding muscle to better support
the joint itself. Most of the knee pain I get is in the early or late season,
when stresses are high and conditioning is not up to snuff. During these
times, I take an anti-inflammatory (like aspirin or better yet, ibupropen)
a half hour before excersise. Most importantly, I "listen" to what my knees
are telling me, and if they say to back off, I do.
	In so far as riding is concerned, I strongly suggest the use of a
fixed gear rear wheel on your bike, with a low gear, under 70 inches. You
can have a cheap wheel built up for less than $50. I use a Pellissier track
hub, zinc spokes, Mavic Route rim, and a cheap cotton tubular. Total cost
was $26. I just replaced the tubular yesterday. The benefits to your knees
are great. It forces you to pedal in a complete circle, not in triangles
which can cause undue stress. It keeps you out of the big gears which can
be very damaging to weak joints. You have to pedal down hills, which
accomplishes two things. First, you put back resistance on the pedals to
help slow you down (my fixed gear bike is a track bike with only a front
brake) which excersises those hamstrings. Also, it encourages you to spin
fast, which is what you should be doing if you have knee problems. Finally,
it is gratifying to beat somebody up a hill or for a town line on a fixed
gear bike, if everyone has the same gear, then the best spinner wins!
	Also, don't forget to keep the knees as warm as possible during those
early rides. I've found that for temps under 65 degrees, I need some sort
of tights. I use this as a rough guide:

	below freezing		polypro longjohns, 2 layers wool tights

	32-40 degrees		polypro, wool tights with lycra tights over

	40-50 degrees		polypro, wool tights

	50-55 degrees		wool legwarmers

	55-65 degrees		lycra tights

	Variations in wind chill factor will have an effect on these choices.

	Finally (yeah!!) Fit Kits are great, but are not gospel. I've had
them done several times, and have wound up changeing the settings to my own
liking. If you've never found a position that feels perfect, then the Fit
Kit is the best place to start. Don't forget how the Fit Kit came about.
Bill Farrell spent two years measuring up all the racers he came in contact
with, and averaged the results. No black magic here. The RAD, the cleat 
positioning device is very good, although I've had to reset my cleats after-
ward. 
	Knee surgery for cyclists is almost a rarity these days. With proper
prevention and careful excersise you should be able to lick your problems
and enjoy healthy cycling.

CdH

 

	
	

	Those darned tab characters and Vnotes! Here's the chart I tried
to show in the last note:

        below freezing        polypro longjohns, 2 layers wool tights

        32-40 degrees         polypro, wool tights with lycra tights over

        40-50 degrees         polypro, wool tights

        50-55 degrees         wool leg warmers

        55-65 degrees         lycra tights


CdH

 Thanks much for the replys so far.

The pain is tough to be specific on since it varies.  It's mostly around
the right knee - either around the edge of the knee cap (sides) or the
muscle areas as tightness, stiffness, or fatigue.  Head winds seem to be
a bigger problem than hills but no cause has been consistent enough to
be even near sure (sometimes will have a problem on rides with little
wind and easy terrain).  I don't use cleats, do generally use clips.
Problem is year round (warm and cold weather).  Hope this info will be
helpful in triggering more thoughts. 

Would also be interested in hearing specifics of any leg/knee exercises
which have helped.  What, how many, how often, how much weight, how
increase, how long before effect noticed when in the saddle, etc. 

	Thanks, Mike

	Again, I'm not a doctor, but my first impression would be tendonitis
of the collateral ligaments, the ones running across the knee both inside
and outside. This could be caused by either general overstress of the joint
from lack of conditioning or a positioning problem, or from a trauma, like
a strain or sprain.
	I suggest you get a pair of cleats if you suspect a positioning problem.
Do you use touring shoes, or a similar shoe that has a stiff sole? Does your
right foot hurt too, especially underneath? If so, then your shoe is flexing
and twisting too much in the clips. Cleats will give you precise, repeatable
positioning, better form, and more power through the stroke. Don't be afraid
of them, you'll get over the "trapped" feeling real quick once you get used
to them.
	Several strengthening excersises would be appropriate for this cond-
ition. First, the leg extension. I assume you do not have a Nautilus club
available to you, and do have some free weights around. Sit on a chair, and
attach wieght to your ankle. Lift your leg to full extension, and slowly
back to the floor. DO NOT use a jerky motion, do it slow and easy. It hurts
more this way, but it is better for you. Do this 3 X 10 times, and on the
last lift of each set, hold your leg up as long as you can. This strengthens
your quads and patellar tendon, which surround the tendons you are having
trouble with. The next excersise is a calf lift. Put some extra weight on
your upper body (hold it in your hands, hold a wieght bar behind your neck,
put on a backpack filled with weight). Get a board, like a 2x4, and place
your toes on it, with your heels on the floor. Now raise yourself up on the
board and extend your calves as far as they will go, and slowly go back down.
Do this 3 X 10 times, again, holding the last raise until your calves are
on fire. This not only strengthens your calves, but the muscles in back of
your knee. Squats might be a bit dangerous for you with your problems, so
I'll save that one till you feel a bit better.
	Stretching before any excersise can help prevent injury as well as
properly prepare your body for effort. I personally do not do stretching
excersises before I ride, I warm up on the bike by riding at least 3 miles
in my smallest gear with very little effort. Maybe someone out there can
give us some good stretching excersises.

CdH

    You might find that a change in your pedaling technique will make
    a big difference.  You should be conscious of dragging your foot
    through the back and up stroke (unless you have always done this
    and it's become second nature).  If your foot doesn't feel as if
    it would lose the pedal if it weren't strapped in, then you should
    start paying attention to this.  Cleats will certainly make this
    easier, but I get by on just a stiff-soled touring shoe with
    molded ridges.  Plain sneakers even with toe clips and straps
    won't work very well.  The muscles at the back of your thigh will
    get tired doing this at first, but they get used to it pretty
    quick.  It takes a lot of the stress off the down stroke knee.
    
    				Julie
    

    My left knee makes a clicking sound on every revolution about
    20 degrees past top dead center.  It started doing that on a
    biking weekend last October, when I biked up Crawford Notch
    wearing shorts in cool weather.  I was wearing cleats that day,
    but the noise happens no matter what shoes I use.
    
    It has not caused me any pain at all while biking, but I can hear
    it.  Occaisionally it will feel sore that evening.
    
    What I would like to know is which of the following is true:
    	a.   This happens to all bikers by age 23; learn to live with it.
    	b.   See a doctor if it gets worse.
    	c.   Time to take up wind-surfing.

    Mine's done it since age 14 never has caused many problems but tends
    to be stiff at times without reason.

I had tick-tock knee for a while years back - it seems like the problem 
may have been caused/aggravated by lateral knee movement (in and away 
from the plane that the frame is in) at certain points in my pedal 
revolution, especially under high load conditions. I've since noticed 
this in a number of other riders; until that time, i hadn't even noticed 
I was doing it. When I learned to concentrate on an absolutely vertical
stroke, the problem lessened and eventually disappeared, and I got more 
power as a fringe benefit. May not be related to your problem, but check 
it out....
                                                      ken

I have notoriously bad knees. One has a plate in it since I was 21. I had
a lot of trouble with it until I got a bike with "Granny" gears. I baby
the hills now, and generally try to keep my cadence close to 80-95 at all
times. That seems to take the pressure off the joint, and onto the muscles
where it belongs. I still have that creaky noise when I stretch (you DO
stretch out good before you ride, right?), and the noise sometimes is
disconcerting when I'm riding a quiet lane, but, it seldom hurts anymore.
			<--------------------->
Of course I keep it well lubricated (Jack Daniels).
And I overhaul it every 2000 miles.
                                               ;^)

				=-=-=-=-=-=-=gary=-=-=-=-=-=-=
				past-50-and-still-rebuildable

    
    RE:  Knees clicking up Crawford Notch...
    
    Are you keeping the cadence high?  Should be up over 90, preferably
    around 100.  This will take pressure off the knees.
    
    Chuck
    
    

    HELLO MIKE ,I HAVE DISCOVERED NOTES.
    
    HAVE YOU TRIED GETTING A VERY EXPERIENCED CYCLIST TO CHECK YOUR
    POSITION ON THE BIKE. IN PARTICULAR ,THE POSITION OF YOUR FOOT IN
    THE TOE-CLIP AND THE SADDLE POSITION? BAD POSITION CAN CAUSE ALL
    SORTS OF WIERD PROBLEMS.
    
    REGARDS NOEL

Thanks to all for your sympathy and advice, and to Noel who reminded
me that I entered this note over 1 1/2 years ago.  After years of
knee problems I may have found the answer, at least based on some
hard riding over the past 2 or 3 months. 

I'd like to share what I learned, it may help some of you over time.

After seeing many sports doctors, doing exercises (especially 
extension leg lifts), and going to Sports Medicine for a program
(be careful of these people), I basically gave up on the 
"professional health/sports medicine" world.

My bike shop said that the Univega Specialissima was fine (yes, the
one I am selling), the fit kit said everything was kosher, and all
the adjustments I made to the bike never really improved anything. 

The (I hope this holds up over time) solution was simple, yet none 
of the pros suggested it.  It was a CRW friend who told me to:


	*** STRETCH ***

Yes, it seems that just periodically stretching to aid the upper leg 
has helped tremendously with my knee problems.  I do tend to be 
tight, and am more muscular than the "general" cyclist, so your 
mileage may vary.

But not having sore and stiff knees has sure helped my emotional
outlook.  Completing TOSRV-East was wonderful, in the past my right
knee would usually break down on the second day of such a 100+ mile
per day trip.

And it seems that the solution was much simpler that all that time
and money I spent on more "high-tech" techniques. 


	~Mike

    that's great Mike, we do get hung up on technology a bit
    too often.  It's good to be reminded of the human side of things.

< Note 13.15 by MISFIT::EPSTEINJ >
               -< What kind and how much stretching do you do? >-

Stretch your hamstrings...I remember reading that tight hams can cause 
symptoms similar to chondromalacia, i.e., pain under or around the kneecap.  I 
was once diagnosed as having that by one doctor (Sports Medicine at Haverhill) 
but another doctor said that I didn't, that I had a pronation problem (I'm 
also a marathon runner) and that orthotics might help.  (As opposed to 
strength therapy that didn't work, or artho surgery).  I went with the 
orthotics and I stretch a lot, exp my hams, and I've had little trouble the 
last couple of years.

Kevin

I have started cycling more seriously this year. I have had knee problems
in the past but have managed them through strenght work and stationary
biking. The first problem I had this year was pain around and behind the
knee cap. I read up on saddle height a little and found that my saddle
was a bit low. I raised it, about 1 cm every two weeks, for a total of
2 cm. Now, the pain is gone from the front of my knee, but I am having
a problem in the back of the same knee. Is this normal, in the sense
that I have changed the height and my knees need time to adjust?

Thanks,
Greg

    Aha... now the question is, "Are you hyperextending your leg/knee?"
    
    There are dangers from too high a saddle position.  It looks like
    you've been careful, and after all, 2cm. isn't a whole lot, but
    it would be worth having someone (cyclist?) check your riding
    position and leg extension as things now stand (or sit).
    
    -john
    
    PS: I had just the same problem as the one you solved when I 
    switched to Shimano clipless - the cleat was thicker, hence...

My wife has a minor problem.  Her legs are different length by ~1/2 - 3/4 of
an inch.  I fabricated a simple but removable spacer block for the excercycle 
which is adequate for that purpose.  However, I'm a little reluctant to 
fabricate anything for a street machine.  So my questions are:

	Are there any other riders in the forum with that situation?
	Has it affected your knees or riding?
	Is there any marketed devise to compensate?
	If such a devise, where and how much?

We live in Westford, Ma. which is very close to Nashua, N.H.

Regards
Frank

I suppose you could start with an insole for the shorter leg.

			Ken

> Now, the pain is gone from the front of my knee, but I am having
>a problem in the back of the same knee. Is this normal, in the sense
>that I have changed the height and my knees need time to adjust?

Assuming everything is correct with your position on the bike, take it easy.
I get a pain in the back of my knee when I push too hard early on in the
season. Are you grinding it out on the bike or are you spinning the cranks?
Your cadence should be around 80-90 pedal rev's per min. 

Hopefully it is this simple.

Tom

    	To go along with what Tom (13.21) mentioned, most people
    	say you shouldn't start pushing big gears (read: large
    	chainring) until you have at least 500 miles on the road.
    
    	Your mileage may vary.
    
    	Scott

Since I have only been riding for about 1 month this year and have only
ridden about 250 miles, I have been keeping my cadence up from 85-100. 
I have also been trying not to "pedal squares" and have been thinking
of "scraping mud off the bottom of my shoes" on the bottom of the stroke
(as I heard or read somewhere, possibly here). I think I will try to
ride with the current height, being really careful to keep my cadence 
high and sort of take it easy for a week or so before I push harder.
As far as hyperextending, according the the LeMond book and my own
feeling on the bike, I was planning on going up another half or whole
centimeter before I hit this problem. I think I'm still reasonable, but
I will have someone I know get a look at this. I have, however, been riding
on the large chainring--I'll stay on the small chainring for the next
month or so.

Thanks for the help, I'll give this a try.

Greg

re .19 and different leg lengths.....

T.A. (in Europe anyway) used to market pedals specially to overcome this, I
remember seeing them in the Ron Kitching (Harrogate, Yorkshire) catalogue.

    Don't forget toe clip size... Most bikes come with "medium" toe clips,
    only good up to size 9.5 shoes.  I found this out years ago when I
    first started using toe clips--  I had knee pain for a while, got the
    right (large) toe clips, and it has never returned.
                  --tom

    
    	Diamond Back Ascent EX 88/89 for sale $350.00
    Has Deore components, Farmer John tires, well maintained.
    Call-508-655-4632 Ask for Joe.
    
    	Roger
    DTN 297-2996

    Does the Diamondback Ascent EX cause knee problems??
    
    or
    
    Cure them???
    
    John