Knee injury: assistance on training plan

Training
#1

Hi all,

I’m struggling with some injuries and would like to know your approach(es) towards specific recovery training.

It all started with me switching from SPD to Favero Assioma’s on my race bike. I had never done a bike fit and had adjusted the spd’s all by myself along the way. No physical complaints, happy me. Then came the Assioma’s, which I fitted ‘on sight’. Few weeks later, I had issues with both achilles tendons (cleats were placed too high up), and decided to do a proper bike fit. That went well up to a certain point. The new cleat position induced a torsion in my right knee. That was corrected in a follow session with the specialist, but I suffer from a slight discomfort up to today.
Fast forward a few weeks: I just returned from my osteopath. He confirmed no signs of remainder of achilles problem, but he saw that there’s a slight swelling on the knee. Further inspection, we noticed that just below the knee cap, the quadriceps tendon (if that is the correct term) is aching. Note that I only feel this pain when the tendon is manualy manipulated. I doesn’t ache when I walk, do stairs,… Normal activities like walking, driving car (manual) just gives me an uncomfortable feeling as if the knee is still torned.
He suggested ice packs to decrease swelling.
Upon me asking what I can do on the trainer, he confirmed only low intensity for 3 to 4 weeks, ice pack after each session, and evaluate end November, beginning of December.

I’d love to have some insights from you all on what I can do on the trainer in the meantime (yoga, strength, pure easy spinning?).

I don’t do any other sports and moreover covid19 closed all swimming pools etc. So I have my trainer only to assist me in recovery.

Thanks for the input

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#2

Ooft. This sounds like a right pest !!
It sounds like the advice is already there I’m afraid. If the consultant is saying limited low intensity for 3-4w then that sounds like a sensible plan.

As far as non trainer stuff goes, I guess it’s avoiding anything that stresses that joint in the same way?
So doing yoga without any of the ones that load up that joint in that side?

Injuries are so frustrating.
Got any outdoor swimming options? Even if it’s just minutes at a time (all depends on your geography of course)

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#3

Appreciate the reply. I’ll see what options I can figure out wrt the swimming.

As for the trainer part: any specific sessions you can advise apart from the main recovery no vid?

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#4

Hello Santiago, good to hear you have the cleat placement and injuries have been sorted and you have a course of action to get you back to training. The biggest concern when you have an injury is to truly listen to your body and Osteo so that you do not prolong the injury. I know you want to get back to training as soon as possible but doing more now will see you prolong doing more later. Incorporating light yoga and stretching with icing after will be beneficial for you. I would suggest continuing with the Open 30 at an easy intensity until you have been cleared by your Osteo. Use this time to invest in yourself and make yourself strong for the training to come. All the best for your healing and happy training to come!

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#5

Take time off and figure out your injuries before dialing back into training. If you want to bike, keep it super easy and see how you feel while you make tweaks to your fit if necessary.

If you dive right back into the training without healing, you’re going to end up with a chronic issue. Adding a bunch of intensity with a training program with an angry joint/injury is a bad idea.

Given that you have made a significant change to your fit, you need to ride easy (i.e. <75% MHR) for 2-3 weeks till you have the fit dialed in before you dive into something more structured with intensity. Your body needs to figure out the fit before you throw intensity into the mix.

I would not do strength workouts till things calm down either. You may feel okay, but adding weight etc has the chance of making everything flare up again.

Out of curiosity, did you take things easy after the fit prior to this knee aggravation or did you jump right back into intensity with structured training?

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#6

Appreciate the input. Thanks

Thanks for the feedback.
I foolishly jumped in too quickly I reckon now.
I’ve been injured before and never really been able to temper my enthousiasm, but it’s never been with the lenghty recovery periods which I’m facing now (achilles, knee, what next). I still need to master the skill of patience I guess… :slight_smile:

#7

I had to stop racing/cycling in college because I started having knee issues and just didn’t know how to quit so I kept trying things till my right knee felt like it was on fire all the time and just got really burnt out and frustrating. Didn’t ride again seriously for more than 10 years.

That’s certainly an extreme example, but it just goes to show that you can start dreading and hating something you know you love by refusing to take a step back and making the entire experience miserable (instead of sufferable!).

I’ve had the same knee issue pop up again and I started working with a fitter right away. We did a few things and it didn’t get better so I saw a sports med doc and kept making changes with the fitter. Eventually made a pretty drastic fit change (kind of went to the extreme with what the fitter recommended). I’ve lost some power due to the change, but have been able to keep riding without pain, at the end of the day that’s a worthwhile tradeoff, especially while I get the issues sorted out!

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#8

Update:
I did open30/45 for 3 weeks, but didn’t really feel any better OFF the bike. The uncomfortable feeling remained. On the bike, no problem, as long as my cadence was around 90-95 rpm, outputting between 100 and 130W.
Since I didn’t see any progression with the injury, I went to physio this Wednesday. In the end, they introduced me to ‘dry needling’ and… Incredible. I have only mild pain remaining. Coming Monday is session 2. I hope that’ll be the end of it.

I was totally new to this technique. After all these months of frustration, this really is magic to me now.
I hope to have 1 more recovery week, tops, before I can be worthy in the eyes of GvA once more.

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#9

I would caution you to return more gradually to hard activity. Also figure out why your knee was freaking out to begin with!

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#10

Thanks for your reply @ridethecliche.
Sadly enough, session 3 with the physio brought me back to square one. Somehow somewhere I’m still overcharging my leg/heel/knee. My physio advised me to renew my insoles (regular use, I don’t use insoles for cycling); they’re arriving this Wednesday.
I hope that my body adjusts in the coming weeks so that I can build up my volume again without pain.

@abicarver, I’m looking at your specific videos for knee pain. Which exercises would you advise to start with and is frequency of much importance at the beginning. What should I focus on?
I’m also struggling a lot with the following: should recovery hurt (a bit)? When is pain too much? Where is the line between uncomfortable feeling (which is still beneficial to recovery) and when does it turn adverse?
As you see, I’m confused about this and don’t know how to properly listen to my body (which sadly enough is also the origin of my injury…).

edit: I also got some inspiration from Vegan Cyclist yesterday: using bands.

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#11

Great question about the line between an uncomfortable feeling and adverse pain. For me personally the latter tends to be a sharper kind of pain that really grabs my attention and tells me to back right off. Quite different from general muscle or joint soreness due to fatigue, which tends to sit more in the background and slowly builds up as I keep on pushing. I also find that non harmful soreness soon disappears with rest and doesn’t grab my conscious attention in daily life.

Interesting that you say that you don’t use insoles for cycling. I find insoles with extra foot arch support really helpful for knee stability when pedalling hard. But I don’t use insoles in my normal walking shoes. Opposite to you!

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#12

@SantiagoB
Have you had a professional fit?

I really do recommend against being concerned about volume right now. If you make the injury worse by overdoing things too soon, you’re going to require way more time away from activity.

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#13

Hi Santiago. The yoga in the app is, of course, no replacement for physio but there are exercises that can help to strengthen your knee and keep your lower body moving well. Bridge is the gentlest pose, then Runners Lunge, High Lunge and Chair. (You can find free tutorials for all of these on my website: yoga15.com). Yoga should never hurt. You’re absolutely right that the line between pain and discomfort is not always obvious and I also empathise with the feeling of over-riding the signals that your body is giving you, even to the point of harm. So take it easy, be as patient as you can—gently strengthen and mobilise to the extent that does not hurt.

Here are some articles that I have written about interoception or body awareness that you might find helpful. Good luck.


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