Spring Has Sprung and so has my Knee

Ah, spring -- when a middle-aged man's fancy turns to thoughts of old injuries.

It's becoming increasingly apparent that every spring is going to involve what Paul Fournel calls (and I'm paraphrasing here), "a revival of an old argument with a cantankerous knee." I successfully tried running through the whole winter at base/moderate levels, my cardiovascular capacity climbing while my legs retained some of their strength from last cycling season. But, for the fourth year in a row, once we hit March and April and I start adding intervals and hills, my left kneecap starts getting that lovely mortar-and-pestle feeling.

By now, fortunately, I know not to panic. Mostly.

If I stretch a lot, increase intensity slowly, and in the meantime just accept the aches and pains of an aging human body, I'll probably be strong and fit by May. (We'll see; moderation is still not my strong suit.) Even so, every year, it's a little annoying and worrisome.

Ah, the rites of spring.

The Last Word on Knees

I've become something of a connoisseur of articles on knees. You know -- that concatenation of bone, ligament, muscle and tendon that separates your shins from your thighs? Endurance athletes tend to have a lot of trouble with 'em. I'm certainly no exception, as Velophoriacs know too well from early posts here, detailing part of my odyssey with knee issues.

In my Firefox bookmarks folder, I must have over forty articles on knees: Physiology, strengthening, stretching, self-massage, blah, blah, blah. But ever since I recently bought a nice pair of running shoes and started fooling around with trying to run again, I've done a bunch of research on knees in the running literature. That's when I found this gem. I was surprised; I'm disappointed by Runner's World's tendency to print quickie sidebars entitled something like, "Five Tips for Joint Health." Useless. Nonetheless, this full-length piece is the best (and most enjoyable) summary of all the thinking, past, present and cutting edge, about knees I have read so far.

If you have any good ones yourself, feel free to post in the comments section.

Prescription from the Spin Doctor

Y'all will have to excuse the extended absences from the blog these days. As you know from previous posts, I've been wrestling with issues both existential and physiological.

This week, I've been testing the new fit on my bike and my shoe inserts, trying to see if they make enough difference that my re-injured knees will recuperate as I continue to ride. So far, the evidence is tenatively encouraging. Out of the two years I've been back on the bike, there've been many months when I've been mostly or completely out of commision. So, for right now, I'm just trying to keep the chin up and focus on what I can do, even if it seems worlds below what I stubbornly feel I could do.

And, in that vein, I had a great, one-hour jaunt this morning, shooting up and down rollers not far from my house. I'm trying to re-learn riding at a higher cadence (should help the knees), and I think alternating between flats and big rollers might be a great way to do so. It's really interesting how much less tired I am overall at the end of each ride when I spin more. I think I have a muscle-structure fairly well-suited to the roleur style, pushing tough gears and moving ever faster over ever-greater distances. In each of the last two years, I've ended up in that groove at some point mid-season. Muscularly, it works great, but apparently, my knees just will not take it. (They're built a little off-center.) Especially not on the much more serious hills out in Western Mass (compared to the Boston area, where we lived until a year ago).

At the beginning of each season, I've been a serious spinner, because I spend months on the rollers during the winter (and, yes, I like it!). I'll average around 90-95 rpm on the road early on, and will often go higher. But once the meat of the season rolls around and I've built up some serious quad-acity in the hills, I get lulled into pushing harder and harder. Before the knee stuff set in a few weeks ago, I probably had a cadence in the low 80s (but I was moving much faster). Let's face it: It's fun to feel the power in your legs rocketing you over hill and dale. You feel invincible!

Well, it seems my knees are very "vincible." I'm going to try teaching my body to spin a little more and push a little less; not a dramatic change, just maybe get up to somewhere in the low-to-mid-90s. I've never been able to do that when riding really fast; most of my leg-speed drills happen at lower speeds. So this will be interesting, trying to find the balance between muscle and grace.

On top of that, I'm considering buying a compact double chainring for the CAAD 8. The combination of going from a hill-flattening triple chainring to a standard double, and trying to surpass last season's feats while on some very serious altitude out here in the Western part of the state, contributed mightily to the Chondromalacia and ITBS resurgence.I bought the bike as NOS on eBay, so I didn't have many options about components. Also, I was lured by the full-Ultegra set-up. But I have a feeling that breaking up the Ultegra will be worth it. (I know Shimano makes an Ultegra compact double, but come on: $250?!)

So if you see someone out there in a month or so, spinning fast on a bright red bike, it may well be me. Say "Hi"!

A Thanksgiving Cyclist's Prayer

Well, it’s the fourth Thursday in November, and while I can’t say I’m exactly grateful for what happened this morning on my ride, I am grateful for some of the insights it’s provided me. Somehow, I’ve managed to either injure or re-injure my left knee. Velophoriacs will know that I spent a good part of the last 12 months trying to shake a very nagging knee injury – actually, both knees, which have chondromalacia.

I have a bunch of theories about how I got it, how I usually am able to fix it, and why it cropped up again today, but I’ll bypass those right now.

I got in a perfectly horrible mood as the pain set in. It started right about when I got all the way “out” for my out-and-back route, and was about to turn “back”. The further I rode, the more it hurt, the slower I went, and the more I started bona fide, vile, base cursing at the top of my lungs. I was thinking about how many months total out of the last year I’ve actually been able to ride the way I wanted. Between knee injuries, overtraining, finishing grad school, moving, and so on, it wasn’t a good number. I was losing it.

Now, I’m back at the house. I’ve showered, had a bite, and some time to relax a bit and think. My usual thing is to take an injury or piece of bad luck and expand it into a disaster – very black and white. As a therapist, I know just how harmful this is to one’s mental health. Doesn’t stop me. I drag myself down into the pit of despair.

Yet today, for right now, I’m just chilling. I’m feeling more… factual about this injury. It’s not because “I’ve done this so many times, I can’t do it to myself again.” It’s not because I know that, every time I do this, it almost never turns out as bad as I think it will – even though I know it’s as possible I’ll feel better tomorrow as it is that I’ll be off the bike for a week or even much more.It’s a different reason this time.

It’s Thanksgiving, and I’m grateful. I came very close to having a bad car accident earlier this week, but God saw fit to make the whole thing pass in the blink of an eye, and I drove on – fully amazed. Not a scratch. It made me think; my life is so much better than I know it is. I was grateful that night, you better believe.

Probably the most important lesson I have to learn to make my life better is this: I have what I have. It’s as simple as that.

In my first year on the bike, which just ended a couple months ago, I pushed, pushed, PUSHED myself to be a faster, stronger rider. I wanted to be a great rider so badly, I could taste it. I thought about it day and night. Nearly drove my saintly wife crazy. Partly as a result of that, I spent much of the year injured or so exhausted I could barely function.

Slowly -- very, very slowly -- those “negative” results are teaching me that I often become obsessed with an idea that is not based in reality. Then I make myself miserable trying to realize it, no matter what it takes.

Like life itself, training can be very confusing: Sometimes we need to push harder, and sometimes we need to pull back – or walk away. When I get fixated on one idea, one goal, it becomes just about impossible for me to pull back. I tend to either want it all, or say “It’s not worth the frustration; I’m ditching the whole thing.”

Today, for Thanksgiving 2008, in addition to all the other wonderful things in my life – my loving and kind wife, my job and career, which I like, my relative good health, my nuclear family all alive and relatively okay, and so much more – I want to say a prayer of thanks for the GOOD rides I had this year. The ones where I really enjoyed myself, whether because of gorgeous scenery, incredible fitness that let me fly past previous limits, great company, or any of the other delightful things that can happen to me on two wheels. And a prayer of EQUAL thanks for the pure flame of desire that keeps me banging up against my shortcomings as a human, so I can learn to balance them out and be happier with what I already have.

Maybe, because of the built-in limits of my body and my life, maybe I’m not destined to be the rider I thought I could be. Or, maybe it won’t happen for a few years, while I work out the kinks as a beginning serious cyclist. Either way, I will live on. And that life is a gift much, much larger than any one goal, no matter how alluring.

Heal Already! Living With a Nagging Injury • iii

Third and Final Part. (Read Part One and Part Two.)

The second most annoying thing about nagging injuries: The variables.

Sometimes, I get to feeling a little better. I might even be able to do a hard ride and not suffer too much afterward. Was it the fish oil capsules a friend recommended to me? The glucosamine I started taking this week? The new stretch I’ve been trying? Or maybe it was just the cumulative effect of all the original stuff I’ve been doing for weeks and weeks – did I finally accrue enough benefit from the stuff the PT prescribed, so that I just now turned a corner?

Maybe it’s even some maddening, nebulous combination of the above. Probably is, actually.

Finding what I call “the end of the knot” (so I can pull on it and finally unravel the problem) can be really, truly, infuriatingly hard. Sometimes it seems foolish to even try; by tomorrow, I’ll probably just have another guess as to what caused my improvement. It takes a vast amount of will to keep at the project of figuring out what will help. I admit to three separate days when I was nearly in tears, wondering if I really cared for this sport enough to keep at this whole through the looking glass experience. I was barely a breath away from burying my bike under a bunch of junk in the back of my garage and resigning myself to long walks for exercise. Grim times.

And just going to the “expert” doesn’t usually dispel the darkness. Sure, I always walk out with hope springing eternal that the new diagnosis or exercise they’ve given me is finally the end of this. However, as I’ve said, doctors can be a bit glib about getting to the very bottom of a problem. Well, to be honest, it’s not very efficient for them to sit with me, digging endlessly through the layers of complication. So, I try to strike a balance: I do a little research on my own. I try out some stuff friends recommend. And when I get completely mired in the variables I’ve introduced by myself, I go back to the physical therapist (who is a great guy), do a brain-dump of the whole thing, and see if maybe I have managed to introduce some tiny new wrinkle that will help him finally solve this thing.

Now, here's where I admit that he actually seems to have done just that, about ten days ago. I went back to him after a long stretch of trying to solve it myself, and did one of those brain-dumps. I just blurted out, with no small relief, all the ups and downs and each and every desperate measure I've tried. He actually listened very carefully (you can't imagine how good that feels after weeks of obsession), and then he started trying a little of this and a little of that, all the while explaining some new levels of skeletal detail.

While he was chatting away explaining stuff, he almost off-handedly tried something that felt really different to me. I made him show it to me, went home and expanded on it, and voila – nearly instant and apparently reliable improvement. I won’t bore you with the fine points; if you have chondromalacia or ileotibial band issues, feel free to post a comment here and I’ll be glad to give details. The point is, I think… for today… that I’m out of the woods. Like the twelve-step people say: “One day at a time.” Fingers crossed!

And maybe that’s the upside of all that maddening confusion: You just never know when the next stinkin’ thing you try is actually going to be the end of all your worries.

Heal, Already! Living with a Nagging Injury (ii)

Part Two (Part One can be found here.)

So I actually did manage to be patient and follow the physical therapist’s strengthening and stretching regimen pretty religiously for a few months. And slowly -- very, very slowly -- I got better. It was very much two steps forward, one step back, but at least it wasn’t the other way around.

By March, I was riding a little harder and longer, and by April, I had almost forgotten I’d been injured. I’d been promising myself for months that, once I got to May and the insanity of my final semester of a multi-year grad school program was done, I would reward myself by riding as much and as hard as I wanted. I was salivating for this. Seriously.

By early May, I had gotten confident, strong and very happy. I was riding a little more intensely each week. I was building up carefully. I got to the point where I was doing climbing repeats on the steepest hill in town, and loving them to death (when I wasn’t heaving pieces of my lungs onto the blacktop.) It was going to be a great spring, after all. I was going to be at the front of the pack. I was going to shine.

And then one day I did one extra repeat on that hill, and felt a little twinge in my knee.

What? Did you expect a happy ending? Come on.

Now, the number one very most annoying thing about a nagging injury is that it’s impossible to tell the difference between healthily pushing the limits, and dangerously aggravating it. Often, I’ve pushed a little beyond my safety zone, felt a little ache here and there, and found out the next day that I had done a good thing. Instead of more discomfort, I would actually feel stronger. Then the next week, I might push it exactly as hard (or so it seems), and that night feel the hot irritation that signals the beginnings of re-injury. Then I have to pull back, and maybe even lose weeks of progress.

It was just that way on the very day of my last class in graduate school. I felt great after repeat number two, and so went for number three for the first time. That’s when I re-injured myself, and pretty good, too. It’s now seven weeks later and I’m still in the throes of recovery, progressing, backsliding, angsting over Web research, calling my PT. Yay!

Next: Repeat After Me: "My Knees Are My Teacher"