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Cycling hills with meniscus/ACL problems?(6 posts)

Cycling hills with meniscus/ACL problems?Dirik
Mar 12, 2001 3:45 PM
Here's a question for those of you who have knee problems, such as a torn ACL/meniscus and/or osteoarthritis.

I've had a torn ACL for as long as I can remember, and recently I had an arthroscopy to remove some torn meniscus. The doctor said my knee joint shows some initial signs of arthritis, and once you remove all or part of the meniscus, arthritis is inevitable. So obviously I'm pretty bummed about this, and wishing that I had taken care of this when I was younger (I'm 33). My only hope is to slow the progression of arthritis, and I can at least take solace in the fact that I'm absolutely addicted to cycling, which according to the literature, "is good for the knees".

I ride 100+ miles a week, either on my road bike (Trek 5200) or mountain bike (Santa Cruz Superlight XTR), and every ride that I do must have a lot of hills...or else I'm not satisfied. My knees don't hurt me (yet), but I'm anxious to prolong the onset of arthritis and don't want to do anything stupid.

My question is: I know that cycling is good for the knees, but what about lots of hills? Does hill riding put a lot of pressure on the meniscus? From a bio-mechanical perspective, which muscles/joints bear the brunt of work when climbing hills?

Thanks...
re: Cycling hills with meniscus/ACL problems?Akirasho
Mar 12, 2001 4:45 PM
... this is from a personal exprience/layperson POV. I'm not a doctor and would appreciate any constructive critique and addition to my post.

I've had two torn menisci repaired (both knees) over the past ten years...

The good news. Both repairs have held up well... 11 years ago on the right... last year on the left.

The bad news. Degenerative joints are a fact of life... for some, the effects come sooner than later. My left knee has an essentially normal and healthy amount of cartilage and since the surgery has improved over the last year. The right knee was diagnosed with degenerative changes way back when... (I was about 33 at the time) my last exam showed less than 1/8 of an inch of cartilage... bone on bone time.

So far, even the bad news has had little effect on cycling in general. I rarely experience pain in the joint that I attribute to cycling, however, there's a catch. I guard the joint... you rarely see me standing to stomp up hill. My current competitive focus has turned to TT's. It's not that you can't climb hills, it's that you use them gears you spent so much money on and spin up instead. To my credit... I get dropped on hills, but can often make it up (with a bit of wheezing) on the other side.

After my latest surgery, I used a recumbent bike (and still ride them) to aide in my rehab and recovery... I even did my first TT last year on one (just broke 20 mph)! Since you can't stand and stomp, the 'bent allowed me to concentrate on my spin better than I ever had before... and I believe that it's adaptations like this that will keep me (and perhaps you) in the saddle as long as possible.

Current recommendations suggest a total knee (right) in my future (my orthopod is a sports med specialist and a cyclist) though we'll delay that as long as possible. I'm hoping that bleeding edge developments in cartilage regeneration might make it a mute point... as long as the joint is there... there's hope.

Simply stated, I can't do things I did when I was younger... with respect to the knee, I've adapted... I can't predict the future, but like you I'm addicted to cycling. I don't believe that getting your proceedure done earlier would have offset the cummulative effects of arthritis... but they may have eased your pain a bit sooner (I waited 2 years before I had my first surgery... I felt 100% better 2 days after... kick kick)

Last year was a rebuilding year so my total milage was down a bit (about 3K) and likewise, the year before was the onset of my most recent surgical intervention. Before that I attained between 5 to 7 K being limited more by time than anything else. Of those miles, many were done on century (some rolling to hilly) or extended training rides (50+ miles). I've never been a super climber, so I don't let this "problem" get in my way.

While I have no first hand experience, I ridden with folks who've had the bilateral whammy... either knee or even hips... while their top speeds might have dropped a bit, and like me, they've adapted... the key is, THEY'RE STILL CYCLING!!!

When I asked my doc about causes for the tears, he smiled and said... "old age" such is life. I don't know enough about the bio mechanics of the joint to comment, but I'm sure your doc and physical therapist can or have given you exercises to strengthen appropriate muscle groups. Take their advice and build on it. Only you can.

As for being bummed... I concur. Last year started on a good note (had the surgery on February 4 thinking that I'd be back in the saddle for most of the season) but then reality set in... recovery was gonna be long and painful... but at least it was recovery. I had the support of other riders who hung with me on those days when 12 to 13 mph were as good as it was gonna get... (one day, it took about 50 minutes to do 2 miles)! To them, I tip my helmet!

And, my goals, while simple, started to haunt me. I wanted to participate in our local
... note... too long a response gets truncatedAkirasho
Mar 12, 2001 5:04 PM
And, my goals, while simple, started to haunt me. I wanted to participate in our local TT series and do a few organized rides, but as the first race drew near, self doubt welled up. When that day came... something funny happened.

While out on a warmup loop (on the 'bent) another rider hit me... ran right up my right shoulder. I landed face down in the roadway and thought "wow, that's odd"... then I thought of my knee... it had made first contact. Surely something awful had just happened. As we both dusted ourselves off, I took time to sit in the middle of the road and gather my wits. Other riders were now on the scene to make sure both of us were ok. In a few minutes, the pain subsided and I decided to head back to the start line, thinking my day is done. The accident had knocked the boom on my bike out of alignment making it impossible to ride... so I had to walk back. Slowly at first, I soon realized that it was more scare than true injury and tried to hurry my hobbling pace... If I could repair the bike, I'd still ride the route at whatever speed I could muster.

Well, the bike was repairable, and I felt better when my start time rolled up. As I mentioned above, I met goal #1 of the season... I did the TT and just broke 20 mph... suddenly, my mood changed... and stayed that way for the rest of the season. Indeed, at the end of last year's season, while not posting any PR's I won "Most Improved" for my improvement over the entire series! That meant a lot and has fueled my goals for this year. And, over my last organized ride of the year (two 50 mile days) I was affectionately known as "That fast guy" since I was no worse than 4th (and at best 2nd) into our destination each day (hilly on the first day).

ACL repair is a bit more extensive but I feel that with a good attitude, motivation and support, there's no reason to retire from cycling. I love this sport!

Again, this is my POV, but I hope it shed some light on what might be possible for you.

Be the bike.
... note... too long a response gets truncatedDirik
Mar 12, 2001 8:32 PM
Wow, I wasn't expecting such a long reply!

I'm still recovering from my arthroscopy (it's been 2 weeks) and I'm not quite ready to get back on my bike, although I've been using a trainer a little bit...but nothing compares with biking outside, climbing hills. Reading your reply really makes me feel a lot better. I'll be doing the AIDS Vaccine ride in Montana this summer and I'll definitely use your experience as motivation.

Thanks, and good luck avoiding the total knee replacement!
re: Cycling hills with meniscus/ACL problems?mike
Mar 12, 2001 5:32 PM
Over the past 15 years, I have had 3 surgerys on my left knee. Two were for meniscus repair (arthroscopic) and one was a total ACL reconstruction. I too share your worries about the inevitable arthritis and this past year even had to resort to some anti-inflamitory medication to help me through some swelling. The good news is that cycling will be benificial to a knee that is lacking an ACL because the strengthened muscles will aid in supporting the internally weak knee joint. I haven't really found it necessary to change my hill climbing tecnique on the road, but I definitly spin more when climbing in the dirt and I've given up competetive mountain biking. What has helped me the most is to not alter the amount of climbing (heck, it's the only thing I'm good at!)but rather to make sure I get quality rest between rides. In other words, riding every-other-day is more benificial to me than taking it easy on the climbs. Above all, listen to your joints and gauge your riding accordingly. They will let you know when you've been over doing it. If they don't complain.....put the HAMMER DOWN!
re: Cycling hills with meniscus/ACL problems?Dirik
Mar 12, 2001 8:36 PM
Mike,
Glad to hear that climbing is no problem for you. Hope that your knees keep doing well...thanks for the inspiration.