Arthritis, advice please...

In article <[email hidden]>,
"[email hidden]" <[email hidden]> writes:
|>
|> Well, for the past 6 weeks I've been off my bike because of knee pain.
|> I went to the doc. who diagnosed osteo-arthritis (SP?). I've been for
|> an Xray, and have a future appointment with the physio. I've also
|> started to take a vaiety of supplements (cod liver oil, glucosamine,
|> green lipped muscle).
|>
|> I'm desperate to get back on board, any ideas? (Any!)

I shall now get flamed :-)

If it really is osteo-arthritis, none of that flummery will help.
The X-ray and physiotherapist should be able to give decent advice.
But odds on the answer is a problem with your riding position.

In my experience, a huge proportion of inexperienced cyclists and
a significant proportion of experienced ones get knee pain when
attempting to ride in the currently favoured semi-crouched position
with a low saddle and high cadency. It is entirely unnatural,
requires considerable adaptation, and not all people can adapt to it.
Knee pain is only one of the problems it causes.

You could try a traditional upright position, with a much lower
cadency, and see if that helps. Alternatively, you could see if
walking UP a steepish hill (1:5 to 1:3) causes the problem, because
it is essentially equivalent; if that doesn't cause the pain, then
a traditional position and cadency (30-50) may help. Pity about
the windage and, if you are over 6' tall, you will have difficulty
getting a bicycle large enough, but ....

But, for God's sake, DON'T try that on your existing bicycle!
You really DO need the different position and higher saddle if you
are to use a high force, low cadency, technique. You can do serious
damage in 15 minutes by using one technique on a bicycle set up for
the other (I did it the other way round).

Regards,
Nick Maclaren.

Quoted message said:

Well, for the past 6 weeks I've been off my bike because of knee pain.
I went to the doc. who diagnosed osteo-arthritis (SP?). I've been for
an Xray, and have a future appointment with the physio. I've also
started to take a vaiety of supplements (cod liver oil, glucosamine,
green lipped muscle).

I'm desperate to get back on board, any ideas? (Any!)

Sorry to hear that.
(1) Your GP probably hasn't got a clue what's really the matter.
(2) The _cycling problem_ /may/ be the result of severe inflammation in the knee which
causes it to swell and tear the tendons. These take 6-ish weeks to recover.
(3) If you're on any serious medications find out EXACTLY how best to use them as
instructions are often patchy and vague. (Some work for a few hours there and then,
others over a longer period. Some treat symptoms, some causes. Some are meant to be
taken continuously others as-and-when.)
(4) If you get some positive prognosis then keep a diary to record ups-and-downs.
(5) Insist on seeing a specialist. By the time this eventually happens you'll have a load
of history and detail plus lots of questions such as "Is this the start of all my joints
rotting?" or "Will I ever be able to cycle again?"

I've just had a very similar experience(gout and F***ING abysmal doctor who amongst other
incompetencies says you don't get gout in knees!) and been off 7 weeks and just beginning
to do gentle 8 miles every day or other day but still can't dance.

Q:Anybody know if an evening-bike-ride-then-bed is a 'bad' thing for abused (but nearly
recovered) tendons compared with a daytime excursion? I seemed to suffer the other day as
a result but it may just have been one of those 'good day'-'bad day' things.

--
Peter Fox
Beer, dancing, cycling and lots more at www.eminent.demon.co.uk

(Nick Maclaren) said:

You could try a traditional upright position, with a much lower
cadency, and see if that helps.

I suffer from slight knee pain, never very serious, but it rarely goes
away completely. GP summarily diagnosed it as arthritis, told me to
stop running, which improved things. Swimming crawl makes it worse,
going for a 14 mile hilly walk got rid of it completely for a while,
so I'm not entirely convinced about the arthritis. Glucosamine did
nothing for me.

Can you explain the low cadency bit? I ride with saddle high enough to
more or less fully straighten my leg and this certainly helps. My
cadency is low (prob. 50 - 60 if I'm not consciously trying) and I've
been trying to increase it for a while, with moderate success, but am
getting the feeling that this makes my knees worse. I thought high
cadency was a Good Thing - more strokes, less power per stroke, less
damage.

BTW I'm 6' 2 and have no problem getting the saddle high enough.

Rob

In article <[email hidden]>,
[email hidden] writes:
|>
|> > You could try a traditional upright position, with a much lower
|> > cadency, and see if that helps.
|>
|> I suffer from slight knee pain, never very serious, but it rarely goes
|> away completely. GP summarily diagnosed it as arthritis, told me to
|> stop running, which improved things. Swimming crawl makes it worse,
|> going for a 14 mile hilly walk got rid of it completely for a while,
|> so I'm not entirely convinced about the arthritis. Glucosamine did
|> nothing for me.

Possibly cartilage damage, which is my problem. It is VERY common,
and is typically caused by abuse of the knees. In my case, it was
caused by the torture, sorry, PT and punishments at school - and,
MOST unusually, has got gradually better from age 20 to 60.

|> Can you explain the low cadency bit? I ride with saddle high enough to
|> more or less fully straighten my leg and this certainly helps. My
|> cadency is low (prob. 50 - 60 if I'm not consciously trying) and I've
|> been trying to increase it for a while, with moderate success, but am
|> getting the feeling that this makes my knees worse. I thought high
|> cadency was a Good Thing - more strokes, less power per stroke, less
|> damage.

You have been reading the racing propaganda! Yes, I have exactly the
same experience.

You need a high cadency to handle a racing crouch - for reasons that
I would rather skip. If you are riding traditionally, however, the
higher the cadency the more you are likely to 'jerk' - bad news. If
you look at walkers and runners, you will find that they use a cadency
of 30-60, and vary the stride length. This is what we have adapted to
over 3 million years of being an upright biped.

The matter of power per stroke is obvious [censored] (in an absolute sense),
if you consider a Sherpa or Para lifting a total of 150 Kg up a steep
hill. Even I, when hill walking, lift 100+ Kg. Knee damage isn't a
problem going UP, but the cadency is typically only 30 - and may be
less - and the walker straightens the knees every stroke.

|> BTW I'm 6' 2 and have no problem getting the saddle high enough.

'Tain't typically the saddle, but the handlebars. It you don't get
very close to upright, you can't straighten your leg because of
hamstring length issues. A semi-crouch also causes other problems,
which are irrelevant here.

Regards,
Nick Maclaren.

Quoted message said:

I'm desperate to get back on board, any ideas? (Any!)

Knees are complicated things, so it might be worth while finding out if the
doc has definately diagnosed it correctly. If the doctor has made a best
guess kind of diagnosis consider going private, where they throw your money
at the problem to find out what's really the problem.

In article <[email hidden]>,
Mark <pleasegivegenerously@warmail*turn_up_the_heat_to_reply*.com.invalid> writes:
|>
|> > I'm desperate to get back on board, any ideas? (Any!)
|>
|> Knees are complicated things, so it might be worth while finding out if the
|> doc has definately diagnosed it correctly. If the doctor has made a best
|> guess kind of diagnosis consider going private, where they throw your money
|> at the problem to find out what's really the problem.

Most physiotherapists are private nowadays, like dentists. One that
deals with active people (e.g. 'sports' injuries) will probably give
excellent advice and cost under 50 quid a session. It's worth it!

Regards,
Nick Maclaren.

Quoted message said:

Well, for the past 6 weeks I've been off my bike because of knee pain.
I went to the doc. who diagnosed osteo-arthritis (SP?). I've been for
an Xray, and have a future appointment with the physio. I've also
started to take a vaiety of supplements (cod liver oil, glucosamine,
green lipped muscle).

I'm desperate to get back on board, any ideas? (Any!)

Many knee problems on a bike are caused by an imbalance of the muscles
pulling the joints out of alignment, e.g. iliotibial band syndrome. If
this is the case stretches and exercises will help.

I wouldn't presume to diagnose your particular problem but I would
recommend that you see a specialist. In my experience GPs say the first
thing that comes into their head and don't correctly factor in abnormal
activity such as cycling 100km a week.

Nick Maclaren said:

In article <[email hidden]>,

Quoted message said:

Quoted message said:

> You could try a traditional upright position, with a much lower
> cadency, and see if that helps.

Quoted message said:

Quoted message said:

Quoted message said:

Can you explain the low cadency bit?

You have been reading the racing propaganda! Yes, I have exactly the
same experience.

You need a high cadency to handle a racing crouch - for reasons that
I would rather skip. ..................

Quoted message said:

Quoted message said:

Quoted message said:

BTW I'm 6' 2 and have no problem getting the saddle high enough.

'Tain't typically the saddle, but the handlebars. It you don't get
very close to upright, you can't straighten your leg because of
hamstring length issues. A semi-crouch also causes other problems,
which are irrelevant here.

As I understand Nick's views, the bike needs to have a seat-handlebar
relationship shown on things like the Pashley Roadster or the Pedersen. You
can't do this easily with most "drop touring" machines, as bringing the bars
back and up that far just doesn't work, even with extra stems, bars, etc..

Pashley here:
http://www.pashley.co.uk/products/roadster-classic.html
Though I suspect the chap in the top left picture has the bars lower than
Nick would advocate.

Pedersen here:
http://www.pedersenbicycles.com/ergonomics.htm
http://www.pedersen-bike.dk/
http://www.dursley-pedersen.net/

I've ridden a Pedersen with its very upright position, bars close to body,
hammock saddle, etc. .
Its a totally different riding experience to a "racing crouch" as Nick
describes it. Very stately, encourages the slower cadence Nick is
advocating.
I didn't ride it far enough to know how my legs would feel, or to get an
impression of how much slower it was over real journeys than my usual
dropped touring bar arrangement (obviously wind frontal area is much larger,
so that alone would make flat cruising speed lower).

- Nigel

--
Nigel Cliffe,
Webmaster at http://www.2mm.org.uk/

In article <[email hidden]>,
"Nigel Cliffe" <[email hidden]> writes:
|>
|> As I understand Nick's views, the bike needs to have a seat-handlebar
|> relationship shown on things like the Pashley Roadster or the Pedersen. You
|> can't do this easily with most "drop touring" machines, as bringing the bars
|> back and up that far just doesn't work, even with extra stems, bars, etc..

Right. But you can't do it even on a Pashley for someone of over 6',
though the largest Pashley is probably ridable.

And it's not just MY views - they are the views of many people from
the heyday of cycling (the 1920s).

|> Its a totally different riding experience to a "racing crouch" as Nick
|> describes it. Very stately, encourages the slower cadence Nick is
|> advocating.

Precisely. Thugh you can shove down damn hard, which isn't precisely
stately :-)

|> I didn't ride it far enough to know how my legs would feel, or to get an
|> impression of how much slower it was over real journeys than my usual
|> dropped touring bar arrangement (obviously wind frontal area is much larger,
|> so that alone would make flat cruising speed lower).

10-14% slower, due to the windage. Unless you are one of the people
who find it ergonomically more efficient, when it may be faster.

Regards,
Nick Maclaren.

Quoted message said:

Can you explain the low cadency bit? I ride with saddle high enough to
more or less fully straighten my leg and this certainly helps. My
cadency is low (prob. 50 - 60 if I'm not consciously trying) and I've
been trying to increase it for a while, with moderate success, but am
getting the feeling that this makes my knees worse. I thought high
cadency was a Good Thing - more strokes, less power per stroke, less
damage.

I can't explain it: I occasionally get pain just above my knees (more
of an ache) when pedalling hard e.g. in the highest gear I can
manage. My ex had problems with her knees but always rode in top gear
saying it hurt less because there were fewer strokes despite having to
pedal very hard.
You could possibly try different sorts of bike to see if some are more
comfortable - my new folding bike is more like running on the spot to
pedal but my mountain bike feels more like pushing backwards against a
block.

I was having pain in my feet, mainly while walking, and the doctor
suggested arthritis but did a blood test which came back negative.
After 6 months of puzzling and seeing other doctors at the same place
I was referred to a specialist who watched me walk, felt my legs and
instantly diagnosed me with some condition which tightens muscles. I
was prescribed some stretches and even if the diagnosis was wrong it's
certainly worked! If you're lucky a specialist might find something
equally simple to sort your knees out.

peter

Nick Maclaren said:

You could try a traditional upright position, with a much lower
cadency, and see if that helps. Alternatively, you could see if
walking UP a steepish hill (1:5 to 1:3) causes the problem, because
it is essentially equivalent; if that doesn't cause the pain, then
a traditional position and cadency (30-50) may help.

Not sure about your cadence figures. A brisk walk covers 100m in 1
minute. A double stride might be 1.7 metres. Divide one by the other
and you get a cadence of about 59, or about 62 with a 1.6m double
stride. That's slower than generally recommended for cycling, but well
above your 30-50.

Colin McKenzie

--
No-one has ever proved that cycle helmets make cycling any safer at
the population level, and anyway cycling is about as safe per mile as
walking.
Make an informed choice - visit www.cyclehelmets.org.

Nigel Cliffe said:

I've ridden a Pedersen with its very upright position, bars close to body,
hammock saddle, etc. .
Its a totally different riding experience to a "racing crouch" as Nick
describes it. Very stately, encourages the slower cadence Nick is
advocating.

I like upright positions (being only 5'8" I can get one on my Brom, and
I like the Dutch roadsters I've rented in NL), but I also prefer higher
cadences. In fact, I find shoving down hard at low cadence tends to
trouble my knees, and it's been adopting a higher cadence approach (I
used to be a shocking masher) that has actually done a lot of good for
my knees and my ability to get about on them (on foot and on wheel) in
comfort. They're considerably better now than they were in the mid 90s.

Pete.
--
Peter Clinch Medical Physics IT Officer
Tel 44 1382 660111 ext. 33637 Univ. of Dundee, Ninewells Hospital
Fax 44 1382 640177 Dundee DD1 9SY Scotland UK
net [email hidden] http://www.dundee.ac.uk/~pjclinch/

Peter Clinch said:

Nigel Cliffe wrote:

Quoted message said:

Quoted message said:

I've ridden a Pedersen with its very upright position, bars close to body,
hammock saddle, etc. .
Its a totally different riding experience to a "racing crouch" as Nick
describes it. Very stately, encourages the slower cadence Nick is
advocating.

Quoted message said:

I like upright positions (being only 5'8" I can get one on my Brom, and
I like the Dutch roadsters I've rented in NL), but I also prefer higher
cadences. In fact, I find shoving down hard at low cadence tends to
trouble my knees, and it's been adopting a higher cadence approach (I
used to be a shocking masher) that has actually done a lot of good for
my knees and my ability to get about on them (on foot and on wheel) in
comfort. They're considerably better now than they were in the mid 90s.

I like a low cadence when I'm coasting - so not shoving down hard.
Works better in a flat country with good tarmac: once you are up to
(slow basic) speed it doesn't take much force to maintain that. A bit like
a leisurely walk.

Roos

In article <[email hidden]>,
Colin McKenzie <[email hidden]> writes:
|>
|> > You could try a traditional upright position, with a much lower
|> > cadency, and see if that helps. Alternatively, you could see if
|> > walking UP a steepish hill (1:5 to 1:3) causes the problem, because
|> > it is essentially equivalent; if that doesn't cause the pain, then
|> > a traditional position and cadency (30-50) may help.
|>
|> Not sure about your cadence figures. A brisk walk covers 100m in 1
|> minute. A double stride might be 1.7 metres. Divide one by the other
|> and you get a cadence of about 59, or about 62 with a 1.6m double
|> stride. That's slower than generally recommended for cycling, but well
|> above your 30-50.

At that speed, a double stride might also be 2 metres! Mine is, and
I am only 6'2". But that's not the point. I agree that fast walkers
and runners use a cadency of about 60 - which is a damn sight closer
to 50 than it is to the 90+ one sees recommended for cycling. And
some may be a bit faster, too.

However, a more serious point is that you are considering walking on
the flat. I pointed out that traditional cycling is equivalent to
walking up a steepish hill - NOT on the flat - and you will find that
people drop their cadency CONSIDERABLY when doing that! 10-20 isn't
rare.

Regards,
Nick Maclaren.

Nick Maclaren said:

At that speed, a double stride might also be 2 metres! Mine is, and
I am only 6'2". But that's not the point. I agree that fast walkers
and runners use a cadency of about 60 - which is a damn sight closer
to 50 than it is to the 90+ one sees recommended for cycling.

The point of 90+ is that given the leverages involved and assuming a
fair turn of speed, that will typically keep you above an aerobic
threshold where stamping down harder at a lower cadence doesn't. But
the "fair turn of speed" is an important part of that: if you're barely
ticking over then the aerobic threshold thing is a moot point.

Since the forces involved are rather different I don't really see that a
direct comparison of cadence alone will tell you much. On a bike the
high cadence is compensated for linearly with low gearing, but with legs
positioned in the same way. With walking there is a far more natural
"gear" determined by the length of one's legs which you can't change
mechanically in a simple way like you can with a bike's gears.

Bottom line is whether one's particular problem will be made worse by
frequent flexing, or by direct strain on the joint. In /my/ case the
latter is the problem, the OP may (or may not) be different.

Pete.
--
Peter Clinch Medical Physics IT Officer
Tel 44 1382 660111 ext. 33637 Univ. of Dundee, Ninewells Hospital
Fax 44 1382 640177 Dundee DD1 9SY Scotland UK
net [email hidden] http://www.dundee.ac.uk/~pjclinch/

In article <[email hidden]>,
Peter Clinch <[email hidden]> writes:
|>
|> > At that speed, a double stride might also be 2 metres! Mine is, and
|> > I am only 6'2". But that's not the point. I agree that fast walkers
|> > and runners use a cadency of about 60 - which is a damn sight closer
|> > to 50 than it is to the 90+ one sees recommended for cycling.
|>
|> The point of 90+ is that given the leverages involved and assuming a
|> fair turn of speed, that will typically keep you above an aerobic
|> threshold where stamping down harder at a lower cadence doesn't. But
|> the "fair turn of speed" is an important part of that: if you're barely
|> ticking over then the aerobic threshold thing is a moot point.

Eh? Surely YOU aren't one of the psychlists who believe that the laws
of phsyics don't apply! X pounds at a cadence of 100 and 2X at a cadence
of 50 produce exactly the same power, and therefore have exactly the same
effect on the aerobic threshold. End of story.

I used to ride at 18 MPH at a cadence of 60 and, with a higher gear and
better lungs, could have done 25 at the same cadence.

|> Since the forces involved are rather different I don't really see that a
|> direct comparison of cadence alone will tell you much. On a bike the
|> high cadence is compensated for linearly with low gearing, but with legs
|> positioned in the same way. With walking there is a far more natural
|> "gear" determined by the length of one's legs which you can't change
|> mechanically in a simple way like you can with a bike's gears.

No, no, no! The legs are positioned VERY differently for a semi-crouch
and high cadence and for an upright position and low one.

|> Bottom line is whether one's particular problem will be made worse by
|> frequent flexing, or by direct strain on the joint. In /my/ case the
|> latter is the problem, the OP may (or may not) be different.

It's not just the frequent flexing, but the associated crouch and
always-bent knees. Almost all the problems that cyclists have with
direct strain on the knee joint are caused by the position in which
they do it. In a strictly upright position, it is entirely comparable
to walking uphill and few people have trouble with that (downhill is
different).

However, you are right that it may not help, and might even make things
worse. But, IF it does, THEN the person will ALSO have trouble walking
up hills and stairs. If the person DOESN'T have trouble doing those
but DOES on a bicycle, then their position is wrong for the technique.

Regards,
Nick Maclaren.

Nick Maclaren said:

In article <[email hidden]>,
Peter Clinch <[email hidden]> writes:
|>
|> > At that speed, a double stride might also be 2 metres! Mine is, and
|> > I am only 6'2". But that's not the point. I agree that fast walkers
|> > and runners use a cadency of about 60 - which is a damn sight closer
|> > to 50 than it is to the 90+ one sees recommended for cycling.
|>
|> The point of 90+ is that given the leverages involved and assuming a
|> fair turn of speed, that will typically keep you above an aerobic
|> threshold where stamping down harder at a lower cadence doesn't. But
|> the "fair turn of speed" is an important part of that: if you're barely
|> ticking over then the aerobic threshold thing is a moot point.

Eh? Surely YOU aren't one of the psychlists who believe that the laws
of phsyics don't apply! X pounds at a cadence of 100 and 2X at a cadence
of 50 produce exactly the same power, and therefore have exactly the same
effect on the aerobic threshold. End of story.

What about the mass of the leg, the friction etc, chemical efficiency of
the muscles. Law of physics indeed!

Quoted message said:

I used to ride at 18 MPH at a cadence of 60 and, with a higher gear and
better lungs, could have done 25 at the same cadence.

|> Since the forces involved are rather different I don't really see that a
|> direct comparison of cadence alone will tell you much. On a bike the
|> high cadence is compensated for linearly with low gearing, but with legs
|> positioned in the same way. With walking there is a far more natural
|> "gear" determined by the length of one's legs which you can't change
|> mechanically in a simple way like you can with a bike's gears.

No, no, no! The legs are positioned VERY differently for a semi-crouch
and high cadence and for an upright position and low one.

|> Bottom line is whether one's particular problem will be made worse by
|> frequent flexing, or by direct strain on the joint. In /my/ case the
|> latter is the problem, the OP may (or may not) be different.

It's not just the frequent flexing, but the associated crouch and
always-bent knees. Almost all the problems that cyclists have with
direct strain on the knee joint are caused by the position in which
they do it.

I would like to see a ref for this. I believe a lot of knee problems are
caused by tracking problems caused by muscle imbalance. I don't believe
this can be entirely avoided by any normal riding position.

Roos Eisma said:

Peter Clinch said:

Nigel Cliffe wrote:

Quoted message said:

Quoted message said:

I've ridden a Pedersen with its very upright position, bars close to body,
hammock saddle, etc. .
Its a totally different riding experience to a "racing crouch" as Nick
describes it. Very stately, encourages the slower cadence Nick is
advocating.

Quoted message said:

I like upright positions (being only 5'8" I can get one on my Brom, and
I like the Dutch roadsters I've rented in NL), but I also prefer higher
cadences. In fact, I find shoving down hard at low cadence tends to
trouble my knees, and it's been adopting a higher cadence approach (I
used to be a shocking masher) that has actually done a lot of good for
my knees and my ability to get about on them (on foot and on wheel) in
comfort. They're considerably better now than they were in the mid 90s.

I like a low cadence when I'm coasting - so not shoving down hard.
Works better in a flat country with good tarmac: once you are up to
(slow basic) speed it doesn't take much force to maintain that. A bit like
a leisurely walk.

Roos

yup for pootering though parks that works well.

roger
--
www.rogermerriman.com

Nick Maclaren said:

Eh? Surely YOU aren't one of the psychlists who believe that the laws
of phsyics don't apply! X pounds at a cadence of 100 and 2X at a cadence
of 50 produce exactly the same power, and therefore have exactly the same
effect on the aerobic threshold. End of story.

I believe in empirical evidence. That tells me that if I go for a long
ride at speed mashing all the way then my legs stop working well quite
dramatically, where if I spin lower gears then I can come back with much
more speed and much less pain.

It's the laws of physics as applied at molecular chemistry level in the
way muscles work, not a very plain force times distance. Otherwise, why
exactly do we need gears at all?

Quoted message said:

No, no, no! The legs are positioned VERY differently for a semi-crouch
and high cadence and for an upright position and low one.

Quoted message said:

It's not just the frequent flexing, but the associated crouch and
always-bent knees. Almost all the problems that cyclists have with
direct strain on the knee joint are caused by the position in which
they do it.

But where did I say anything about being in a semi-crouch? I just said
I prefer higher cadences even when in a relatively upright position, as
on my Brompton.

Quoted message said:

However, you are right that it may not help, and might even make things
worse. But, IF it does, THEN the person will ALSO have trouble walking
up hills and stairs.

Sorry to break natural laws again on your watch, but I have no trouble
walking up hills and stairs (quite the opposite, I'm remarkably good at
both), but dislike and find uncomfortable low cadences with big effort
on bikes, even with upright pedalling positions. Perhaps my nerve
endings need better education?

Quoted message said:

If the person DOESN'T have trouble doing those
but DOES on a bicycle, then their position is wrong for the technique.

Yet if I adopt a different technique and that gets me about fine and
doesn't hurt, then I'm still "wrong"?

Pete.
--
Peter Clinch Medical Physics IT Officer
Tel 44 1382 660111 ext. 33637 Univ. of Dundee, Ninewells Hospital
Fax 44 1382 640177 Dundee DD1 9SY Scotland UK
net [email hidden] http://www.dundee.ac.uk/~pjclinch/