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^^
Should say: Pain at the front of the knee is the most common presentation (but then if you've been to see me you probably know that already)

Bike Blog

http://www.guardian.co.uk/environment/bike-blog/2010/dec/03/cycling-fitness

Thanks for your emails.

Been there, done that.
It's recorded and broadcast live. I think the podcast is edited.

Swimming should be ok. Breaststroke kicking can sometimes irritate degenerative / meniscal problems but should be fine for you. Also try not to hyperextend the knees.

I went to the physio today and she told me that I have wear and tear on the kneecap. Riding will make it worse, and I should back off. I don't want to.

So what so I do? Ride and end up hobbling around at 50, or stop riding and get fat and go bonkers?

Don't be so pessimistic. You may have 'wear and tear' (very non-specific) but there may be a number of contributing biomechanical factors, many of which may be correctable and could promote many years of happy / happier cycling.

The therapists appear to be soft tissue therapists and not medical doctors or Physios. The info. on their website sounds fine and the printout seems like a progressive pilates based exercise programme. I'd prefer to be assessed before undertaking a rehab. programme. Quite often recurrent hamstring injuries persist due to neurological factors that often go untreated.

It sounds like you were managing things in the past so try to get back on track with self management. If that fails please feel free to get in touch.

Michael.

Perhaps - if you are loading them in hyperflexed and rotated positions - for your type of presentation rotating your foot inwards would tighten the ITB. Climbing can involve prolonged static loading of the knee which can cause ischaemic symptoms.

Within my clinic I combine cycle-specific Physiotherapy assessment and treatment with own-bike biomechanical assessment and fitting.

See link for more info:
http://www.complete-physio.co.uk/clinics/kentish-town-la/services/cycleclinic

I also see patients without bikes.

You're making me sound lonely. People seem to be getting more private with their health needs and questions so my inbox is busy. Post or PM, I won't take it personally.

Have quite good availability at peak time this Thursday. Take advantage of this rarity if needed.

Although not advertised on the Cycle Clinic link (http://www.complete-physio.co.uk/clinics/kentish-town-la/services/cycleclinic) routine Physiotherapy appointments are also available (45 min / 30 min). I will see patients with and without their bikes as required and not necessarily in a one hour Bike Fit.

I've been asked about Kinesiotape (the bright elastic tape you see gracing the knees of many pro-riders). It's one of many treatments I use in the management of patients. It provides a fascial release to soft tissue optimising recovery and improving muscle function.

I'm not a fan of promoting the big chains but Evans have specialized BG footbeds on sale (limited sizes). These are a useful off the peg product for addressing foot pronation.

http://www.evanscycles.com/products/specialized/high-performance-body-geometry-footbed-ec023331?query=bg

many thanks, regards.

No problem. Let me know your experiences if you do start supplements.

thanks michael, would you take them, or try something else, knowing you are going to do 150 miles pw regular ?

My honest impartial opinion: If you feel better taking them then continue. In 20 years will your joints be in a better condition? Answer unknown. Anyone who tells you differently is simply giving their personal opinion. If I started to develop joint pains then I'd probably try supplements but this may be purely to satisfy a psychological need.

The problem with searching for info online is that you will absorb the information that you want to, subconsciously or otherwise, and then make an informed decision.

Glucosamine and Chondroitin, two common supplements for joint nutrition, have little empirical evidence to support their use. A recent study found no benefit in the management of osteoarthritis but many patients report good responses to supplementation. Better outcomes seem to occur over long periods of use. I wouldn't say you must take them but you may find them useful. They are generally inexpensive with few side effects.

I've just finished up my sessions with Michael, cant go on Thursdays any more due to a change in working hours. He's friendly, extremely knowledgable, and is excellent with the physio massage and acupuncture. I highly recommend him to anyone here.

Thanks Kevin. Good luck with the rehab.

I've now set up links with sports scientists if anyone is interested in performance and physiological testing (VO2max, Anaerobic Threshold testing etc.). Please contact me for more information.

Sorry not being clear again. Do you ever see pts with ITB and groin pain (ie true hip pain)?

I haven't seen this clinically.

There is a bit published but poor quality. My question was poorly put though. What I meant to say was do you treat TFL as well. So ta for that! Have you ever come across ITB and hip pain together bearing in mind the ITB's deeper firbers blend into the lateral aspect of teh hip capsule?

True hip joint pain most commonly presents as groin and medial thigh pain whereas a large number of patients with ITB symptoms will complain of diffuse aching in the buttocks and upper thigh (and sometimes lumbar spine) due to overuse / relative weakness in the lateral hip stabilisers.

What's your opinion re TFL and Glute Med/Min imbalance ie TFL rolling the ITB over the Lat Epicondyle as TFL overpowers those glutes hence causing that 'friction' type pain?

I don't know of any published evidence to suggest that this happens. It is true that many patients compensate for gluteal weakness with increased TFL use but I don't think this would have a significant effect on increasing ITB friction over the lateral epicondyle. Clinically I find a combination of increased ITB flexibility and increased gluteal strength yield excellent outcomes. To compliment this I may target the TFL to reduce it's activity and tension with trigger point treatment such as acupuncture.

I have some peak time (5-8) availability this Thursday.

Call us: 0207 482 3875
Online-booking is also now active: www.complete-physio.co.uk
Or PM me

Michael

Too high a saddle leading to excessive knee extension or climbing out of the saddle will have similar effects.

This topic has sparked good debate.

I wouldn't spend too much time looking at your Gluteus Minimus. It is not a hugely powerful abductor or internal rotator and in hip flexion it doesn't do much at all. It does however contribute to hip joint stability.

ITB syndrome and anterior knee pain are the most common clinical presentations I see in the Cycle Clinic and have similar contributing factors. It's more common in runners due to the greater lateral loading, ground reaction forces and greater range of knee extension which tightens the ITB.

ITBFS is an umbrella term but it's imprtant to identify the cause(s).

Possibilities are weak / tight gluteals (buttock muslces) / saddle height / tight ITB / foot-pedal position to name a few. It's generally a biomechanical issue which is correctable but you should get a professional assessment to work out what needs to be addressed.

PM if you have any further queries.

3 runs on the Rollers last night at LMNH and now my quads need some attention. The Irony!