Bike Fit update — Cautiously Optimistic

See my extensive notes from a week ago in Bike Fit update.

After a week or so of riding:

• Power is at good levels.
• Knees and patella have some achiness but I deem this “adaptive discomfort”, a normal situation for changes to fit that stress the entire musculature differently; the internal pain has not manifested, a very hopeful sign. Patience for 6-8 weeks is required to “move through” such issues.
• The fit on the Look 595 Ultra seems just about perfect, but the fit on the Moots Vamoots RSL is just not quite right; the seat is not exactly the same and maybe the reach is too short— so I’m just going to ride the LOOK until the new SRM DuraAce crank comes in so I can be symmetric on the Moots setup also, then figure out if it is stem length or seat or whatever.
• All in all I feel hopeful that by riding as if it were January (steady aerobic mileage) that the kinks (knee issues) will work themselves out and I will end up better than ever!

—Lloyd

Bike Fit update

By sharing my own (frustrating) experience, I hope to help out others who might be having bike-fit issues, knee-pain, etc. I’ll follow up in an appropriate time once I see how I am progressing.

Background, see: The Left Knee Remains a “Project”: Little Progress, but some Insights and Advice.

I spent ~5 hours at 3DBikeFit.com two days ago, working with Kevin Bailey, who gets very precise and picky on the fit.

We used video extensively, checking on both knee tracking and centering of the body on the bike. The use of video (including before/after side-by-side video) is persuasive in showing the knees wobbling or diving in, etc (black stick-on dots help make this easy to see).

Findings

With before/after video recording, a 1mm change can be made can be made to say, pedal spaces, and then before/after compared: sometimes with no discernible difference and at other times surprisingly significant changes.

It turns out that stance width* and as little as 1mm offset on the pedals matters for me, as the video makes clear. With one change, the left knee just went dead-on stable with almost perfect vertical tracking.

We never did get the right knee tracking as well as the left, but it is quite good, and as the body untwists over time, it might improve.

The video shows that my body remains slightly twisted, the theory being that this twist was warped into it by 10K miles last year on that damned asymmetric crankset. With a symmetric crankset, this should work itself out.

Examining old video from 2012 (prior to any bike fit changes), I concluded “no way” on going back to a skewed and twisted and hunched-over position. Painful to look at.

We also found with careful measurement that the main bike had a 5mm narrower stance (Q-factor) in addition to being strongly asymmetric (5-6mm). By using a long-spindle (+4mm) DuraAce pedal plus a ~1mm pedal washer,

I decided not to attempt original 2012 fit: the pre-changes 2012 video shows a knee diving in, body way off center over the bike, hunched back, etc. Looking at it, I don’t know how I rode that way, but it’s clear that I had to contort and warp various body parts to make it work, which after a while surely had a “baked in” effect.

As an aside, I am also not so sure that the non-Shimano cranks are entirely circular (might have some wobble in the vertical plane around the ring side).

Stance width

The stance width / knee tracking finding provides a plausible explanation with visual evidence why riding my 2nd bike (the Look 595 Ultra) with its wider and symmetric crank** has felt better on my knees (well, almost symmetric: 1mm difference, which we perfected with a ~1mm pedal washer).

Knee tracking is mainly a function of:

• (1) being centered (symmetric) over the bike, and
• (2) a pedal spacing / Q-factor that is proper for one’s knees.
• (3) cleat position (centered and straight on the shoe generally)

Putting together on the bike feel and the video evidence, I make the following tentative conclusions:

• A symmetric crankset is essential to demystifying bike fit (compensating for asymmetry gets confusing). Check an actual installed crankset carefully for centering on your particular bike.
• As my mountain and cyclocross bikes have symmetric cranksets (and a wider Q-factor), it makes zero sense to do otherwise on my road bike.
• Q-factor and pedal spacing can be key. If something is working for you with excellent knee tracking, exercise extreme caution in changing a crankset or buying a new bike that might have a different Q-factor.

And if I went "back", I am changing the crankset in ~2 weeks anyway, which would essentially put me where I am now anyway.

So we determined that the old bike I mentioned had a wider stance by 4-5mm and this seems better. Using long-spindle pedal and a washer, we got the Moots within 2mm of that bike and the left knee tracks beautifully (which is no guarantee of no pain, but surely a wobble in/out cannot be a good thing).

Ironically, right leg does not track as well, but it has not been an issue.

I am persuaded that the old fit just had my body all twisted... and it remains slightly so as the current video shows; this will have to work out over time, but I think it's best for the long term.

So I'm going to ride my "daily" and just give it some time and assume it will work its way out.

* Stance width is the distance between the pedal. It is actually more than just “Q Factor” (crank-arm width) since it includes the shoes and cleat position.

** Some care is needed when measuring pedal offset because one cannot assume centering of bolt holes in the frame, or even symmetric tubing (especially with carbon fiber frames near the crank area). Also, do NOT assume that quoted nominal Q-factor is accurate to the mm.

Matching the stance width

We found with careful measurement that the main bike (Moots Vamoots RSL + Cannondale Hollowgram) had a ~5mm narrower stance (Q-factor) in addition to being strongly asymmetric (5-6mm).

By using a long-spindle (+4mm) DuraAce pedal plus a ~1mm pedal washer on the left side, it was possible to closely match the stance width and symmetry to the DuraAce crankset on the 2nd bike (Look 595 Ultra, the one that felt better on my left knee).

The two bikes are now both symmetric for pedals as well as within 2mm of stance width. Note that stance width on mountain bikes is on the order of ~15mm wider, so the +2mm difference on the Vamoots RSL is presumably favorable.

With this change, the knee tracking is so close that it’s hard to clearly say that one is better than the other.

Measurements here are to specific places on the pedal (for ease of measurement) which might be slightly different than official from/to figures for Q-factor.

Vamoots RSL with Cannondale Hollowgram SRM crankset:

145mm stance width
    +4mm longer pedal spindle
    + 1.5mm left washer
     = 150.5mm

Look 595 Ultra with Shimano DuraAce SRM crankset

147.4mm stance width
    + 1mm left washer
     = 148.4

Will this setup help resolve the knee-pain issue? It had better, because what can one go on other than seeing fluidity of movement through a range of motion. But I have to keep my training levels low (for me) as such things still take time for the body to adapt, to “untwist”, etc. My fingers are crossed.

The Left Knee Remains a “Project”: Little Progress, but some Insights and Advice

See The Left Knee Persists in Griping.

I have some advice to share: if you’re over 40, proceed with extreme caution in making bike fit changes. Start slow, change slowly!

The “correct” fit might not agree with subtleties of your body, let alone years of adaptation and “wear in” joint changes. Make small changes!

The discomfort is primarily internal to the joint. And here there is cause for speculation: with use, that joint “grooves in”. For someone in the 20's or 30's (I’m almost 50), bike-fit changes might be no big deal; the body will heal and adapt quickly. But for someone almost 50 (me), the knee after so many miles has shaped itself just-so, an so a bike fit change can be a lot more problematic if it makes the knee joint move in a different way. This is what I think is going on.

Little has changed since then, but I have concluded the following.

• Psychologically, I’ve gone from “lost training won’t be competitive” to “won’t be in good enough shape even to compete” to “will I ever be able to ride like I used to?”. It’s a bummer.
• Two more radiologists and a cardiologist agree that the ganglion cyst in my left knee as shown by the MRI is very unlikely to be the cause of the pain. Also, that the knee is generally healthy with good tissue, though it does have some sub-patella roughness (but this is not the issue either).
• If I push on a harder ride for two days, the right knee develops some discomfort afterwards, but not the internal ache of the left knee. Some discomfort with an increase in training (“spring knee”) does not particularly concern me.
• Various bike seat changes and pedal offset changes have been inconclusive other than showing that some combinations are definitely worse. It simply takes a long time to make any sense of a change; only the changes that are definitely worse (outright pain on a ride) are easily rejected.
• The mountain bikes and the cyclocross bike and the Look 595 Ultra seemingly bother the knee somewhat less than the main road bike.
• Irritants: I hate being 10 pounds heavier than last year; I feel overweight and it’s definitely slower. But it’s really hard to force down weight fast when I am limited to burning ~1100 calories per day at most (because of knee irritation).

At present, my tentative theory is the following:

• I doubt that even the exact-same old setup will resolve the issue.
• My suspicion is that the stance width (Q factor) is too narrow on the main road bike: 141mm for the Cannondale Hollowgram SRM crankset, 146mm for the Shimano DuraAce on the Look 595 Ultra and the cyclocross bike. And even more on the mountain bikes (possibly 165mm). All of which seem to bother the knee less. In short, the narrowest stance (Q factor) is on the main road bike crankset, by far. To be changed asap with a new crankset.

My working theory is that I am going to have to find a setup that is (a) symmetric pedal offset for both legs, (b) looks good for knee tracking. And that I’ll need to allow six months to adapt to the new position, with discomfort along the way and no ability to train hard.

Accordingly, I have a tentative plan:

• Continue the stretching and start some inline skating (I used to speed skate extensively). Add stability strengthening exercises (skating counts too); this might stabilize the knee in beneficial ways.
• As a reference point, change the Vamoots RSL (main road bike) back to exactly last year’s setup. I don’t expect satisfaction by so doing, but It cannot be ruled out. Also, if not it plays a psychological role: to acept the fact that no particular setup is just going to instantly cure the problem, not even the same one I had in 2012.
• Continue to ride the Look 595 Ultra for its symmetric pedal spacing (crankset) and its wider Q-factor since this seems to bother the left knee less.
• When the new DuraAce SRM crankset arrives and the Chris King PressFit 30 bottom bracket become available, install those onto the Vamoots RSL (main road bike), yielding a conventional symmetric pedal spacing with conventinoal Shimano Q-factor.

Chris M writes:

I'm not nearly as good a runner as you are a biker, but I I can share a story.

I was a long time runner who made a shoe change. I felt I did it for the correct reasons(I did), but when I made the change I started adding mileage much too quickly to my training because for the first time in a long time I hadn't had achilles pain. Instead of gaining mileage slowing I and my body was reminded of how it was to run when I was in the 20s and early 30s. Pain free. I was enjoying running so much again that I just kept going longer. I concur with your assessment that this is the wrong method for those in our 40s. I'm closer to 50 than 40 now. It took 2 years of trips to the doctor and finally finding out that my severe calf pain was caused by excessive training and that if I just built mileage slowly I wouldn't have these issues. I gained 20lbs and had to take up bike riding in order to keep exercising in some way. :) I now don't ever do over 10% mileage increase than the week before and I have been pain free for almost a year. My point was to let you know, it sucks where you are at now, but it does get better, unfortunately it just takes time.

WIND: Sounds eerily similar. Ouch.

Popliteus Muscle and Knee Pain

My left knee issue does not involve and behind-the-knee pain, but this note from reader John S was so interesting and well writen that I thought I’d share it with readers.

John S writes:

Interesting what you describe is very similar to an injury that I had.

About 30 years ago, I blew my ACL. Faithful care and wearing of a knee brace during athletics meant that I was able to preserve the integrity of my knee, meniscus etc… This was the only choice since ACL repair was not very good back in the day.

Two years ago, while eating at an outdoor restaurant on a sunny day, I went inside and stepped off of a step that I was not able to see since my eyes had not adapted well to the dim light. I landed with a stiff leg and instantly knew I had hurt something in my knee. From that time on, walking and other activities caused as snap and pop in my knee that was really uncomfortable. I thought I had torn the meniscus or done something else.

Two trips to sports medicine docs showed led to treatments that were not effective. An MRI reviewed by my ace ortho surgeon showed a knee and meniscus that were "pristine" to use her words (other than the vanished ACL). I was told to come back in several months if no change.

Finally I went back to my family practice doc (also a friend) and told him I wanted to see the very best knee PT that they had. He asked around and set me up with just such a person. She looked at my knee, examined it and told me to come back in a week after she had done some research.

Turns out the pain in my knee was the popliteus muscle- a little known muscle that helps the knee to twist and helps stabilize my knee . What I had apparently done was to stretch the iliotibital band (ligament) which was being compensated for by the popliteus muscle which subsequently was getting over used and was becoming quite painful. This injury is one that could only have come about in a patient without an ACL but other intact structures in the knee - unusual. It can be fixed by surgery, but it has a low success rate.

What she did note - and what you might find very useful, is that due to all my cycling, there was a misbalance in the muscles in the front of my leg compared to the muscles in the back of my leg (hamstrings). She set me on a regime of strengthening the hamstrings and other muscles in the rear to help stabilize and better balance the knee. After about 4 weeks of this, the pain suddenly decreased and after another two weeks all the clicking and clunking stopped. I'm wondering if with all your cycling, if you are not suffering from a similar problem (misbalance). Mine was brought on by the injury and then exacerbated by the cycling (pre and post injury, it seems). Now I'm wondering if had I balanced the groups better, I might have avoided the injury entirely.

Your clicking problem sounds like mine. Your MRI is similar to mine (no problem). So I'm wondering if you might not want to take the path I did with the PT and have them look at similar clues to mine. It's also worthy to note that the pain from my popliteus muscle was really quite debilitating and, interestingly, non specific. My whole knee felt quite sore and tender not just at the site of the muscle. I attribute this to the fact that it's so deeply buried. My doc found it by using his iPad anatomy app, asking me to point at where it hurt and then peeling back "layers" in his software until it's clear that that was the only thing there.

WIND: maybe I should resume my inline speed skating and Olympus squats.

The Left Knee Persists in Griping

My left knee continues to be unhappy; some ache that I cannot even localize and after hard rides (next day) increased crepitation and even a small click. Yet the February MRI showed only mild inflammation in otherwise healthy knee tissues.

As it is, there is no h0pe of training hard enough for any event; the knee can’t accept the training load. My plan at present is to continue training in the hope that the issue slowly improves. Which might be a good plan or a terrible one—I don’t know.

I made an adjustment to road bike cleats and I’d have to say that my knees are tracking vertically as well as ever, and probably better. It doesn’t seem to fix anything. I rode my mountain bike for two (fairly hard) days. That setup has not changed, but my left knee tells me that it is just as unhappy. So more and more I am not thinking this is a fit issue, with the caveat that healing in connective tissue is very slow and thus very hard to say without an extended period of trial.

Pedal offset

The left leg pedal offset is different now: most of 2012 I rode the Cannondale Hollowgram SL crankset, and it had and has a 6mm asymmetry which twisted me up after 10K miles of riding, see Make Sure Pedals are Symmetric!.

That left/right leg asymmetry has been addressed by using the long spindle Shimano DuraAce pedal on the left side; together with appropriate cleat placement so that my left and right feet and knees now have the same offset. This can be seen and the knee tracking is very vertically confined, showing good positioning (really minimal “looping” of the knee).

Unfortunately, James A might be on to something.

James A writes:

Is it correct that the knee issues stem from the bike fit in the city late last year? I know it improved your power output but the joint memory of many years of cycling is what MAY be causing the pain.

It is doubtful from a medical standpoint that continued use will fix the problem. There can be subtle grooving etc. in any mechanical system that is now out of alignment however slightly. Is it an option to go back on one of your older bikes that was set up during your pain free period and train on it. If the pain improves the diagnosis is made and the added power of the new setup may need to be sacrificed for a long term painless ride. Just my thoughts.

Lloyd: At this point I am reluctant to blame the fit because my mountain bikes (setup unchanged) don’t seem to make my left knee any happier, and I also see excellent knee tracking on the road bike. Of course it could be just a different angle to the pedal as well as loading of the knee as well as offset: it’s tricky.

However, the point James A makes is a troublesome one if true: if I have to go back to the 2012 setup, I don’t really want to build in that 6mm asymmetry (seems like a bad long term idea if nothing else), and it is also a problem for any future crankset change, which I plan to make in June/July. As well, all my other bikes have a symmetric crankset. So I could “go back” but this not be strictly speaking the same with a symmetric crankset arrangement.

A Brief Update: Shoulder, Training, etc

Thanks to the well wishers who emailed me about my shoulder: it is doing great, the shoulder surgery was a success and it is working with 90-95% range and no pain.

On the cycling front, the left knee is still giving me problems, so I am going to abandon the blue Shimano road shoe cleats (very little float) and put the yellow cleats back on. And I still cannot feel that comfortable in the new fit, even though the power numbers are higher. This has been a frustrating season, psychologically more difficult than any race, pretty much a goner as far as anything competetive: I cannot make up 2 months of base training and I feel like a porker on the bike (6 pounds heavier than last year at this time).

But today I had a wonderful ride on my Moots MootoX RSL mountain bike up to Black Mountain, the first good ride on it since last fall. Wow! With the tubeless Furious Fred tires, the thing is incredibly responsive and fast.

Weight loss has not happened. With a caloric deficit for 10 days now, I’ve gained 2 pounds. Well, I’ve probably lost some fat, the the heavier training seems to have my body retaining water or food or both. Damned hard pyschologically, so I’ll just have to keep at it. But that damned left knee has to get happy to make it possible.

With all this, I am totally intimidated by the idea of doing the Alta Alpine 8-Pass Challenge this year, which is only 7 weeks away. Last year I romped through it (first one to finish for the day, but 2nd place) and was rather pleased with my effort. This year I doubt I could finish. It’s hard to underperform past levels.

Sony DSC-RX100: Perfect Cycling Camera?

Putting my recent post of Form Factor and Camera Appeal to a real-world trial, I stuffed the diminutive Sony RX100 into my jersey pocket and headed out for a multi-hour mountain bike ride on my Moots Mooto X YBB 29er. I also have the handy Richard Franiec stick-on grip on mine.

The Sony RX100 had impressed me last fall, but it did so all over again: small and light so that I scarcely notice it in a jersey pocket, the most natural fill flash I have found in any camera at any price (set to -1.7 slow sync), excellent exposure accuracy, very pleasing color, bitingly sharp centrally at close range at the 28mm setting.

The RX100 just gets the job done fast and without any of the size/weight hassles of larger cameras: no excuse for not taking it, no excuses for not getting highly satisfactory images. Its a real winner in my book for its combination of features for this type of use. Which is what any successful camera is about. Well, I do wish there were an EVF option, but its rear LCD is excellent even in bright sun.

This image is cropped down to ~12 megapixels. Note the perfect exposure in aperture priority mode, along with flash that is so natural one wouldn’t even know it had been used except for the catch-lights in the eyes.

Alpine Road (Dirt) is Blocked 2/3 Up

Update April 29, 2013: the barriers are still there, but nicely parted, no problem getting through.

I use Alpine Road on a regular basis to get to and from Skyline drive and El Monte Open Space.

But the county has put up barriers about 1/5 of the way down and 2/3 of the way up. I hear that there is absolutely no issue with the “road” (which is after all a trail), which makes this closure rather irritating.

The detour is a slog up a steep and poorly maintained (rutted) Coal Mine Ridge trail.

Sometimes Good Surprises Happen

Mastering one’s own psychology is an ongoing challenge for any athletic goal.

As I wrote in Training Restarts as the Virus Retreats, I have to be realistic about what losing nearly three months of base miles means for competitiveness in the Everest Challenge (or even being able to complete a double century anytime soon). It’s especially hard (for me at least) to come down from the “high” (last fall’s extreme fitness).

Then there are those unexpected bonus days in which everything “works”.

Like today when after being almost sedentary for six weeks (shoulder surgery and a 2+ week virus assault following weeks having to back-off from a knee irritation). So today I rode my most enjoyable ride of the year; it just felt easy and fluid and everything that it ought to feel like when things are working optimally. Well, my legs did feel it by the end (endurance down), but dang it felt good, which was a much needed pyschological boost after several challenging months in multiple ways. This kind of positive result helps reestablish a sense of normalcy when too many disruptions have occured.

Surely the new bike fit helped in delivering the respectable 254 watts for 75 minutes (though it remains to untrain my body from its asymmetric twist from the former asymmetric-crank mistake). The pouring rain did not dissuade me in the least as I was feeling relaxed on the bike.

My heart rate was ~17 beats higher than a similar workout last fall (155 = 88% of my max of 175), and that is too high for this power output, but such HR behavior is always true early in the season and/or when detraining occurs and/or if not fully hydrated (I wasn’t). That should drop with miles on the bike, so I have no concern there, and one ride does not establish a baseline. Besides, my small airways remain somewhat impaired and reactive from the virus, and that definitely raises heart rate by reducing oxygen uptake.

Training Restarts as the Virus Retreats

Aside from one aborted “raw lungs with coughing fits and wiped out afterward” ride back on March 22, today is the first day back on the bike since a virus made its way into my lungs. A two week lapse.

But let me digress first: about 10 years ago I had a case of viral pneumonia (“a lung full of pus” according to my doctor. Pulse oximeter down to the low 90's, minor exertions being major efforts. Took three months to recover and the left lung had some presumed scarring.

So now when a bad virus gets into my lungs, where does it head? Straight into the left lung with its damaged tissue. I can feel it set up shop with each and every pulmonary infection. These are infrequent, and my body usually kills it off quickly. But virii just love hanging out there and sticking it to me, and this latest nasty bugger started whole body first, then finally set up shop in the lungs. It is a definite physiological weak area in which my body clearly has a hard time killing off the intruder. A real risk with the wrong virus—I suspect that I have an increased risk of mortality from pneumonia later in life due to this weak area. But we all have our issues, don’t we? :)

So I’ve been mending slowly over the past week, and I felt well enough to ride today. Small airways perhaps at 60-70% of my usual function (my own estimate based on pulmonary tests over the years), with noticeable impairment so that any effort over ~240 watts couldn’t last very long without inducing asthma-coughing (yes I am treating with an inhaler every day). I expect that it will take 2-3 weeks for the lungs to perform without griping, as the inflammation recedes.

The good news is that I completed a 80 minute ride at decent wattage (210 watts), the legs felt OK and I wasn’t worn out by the effort. With the weather lovely and balmy, what a treat.

The disappointing angle is that as far as the 2013 Everest Challenge, it is pretty much impossible to make up missing the three solid months of base miles and double centuries that I had done by this time last year. But if all goes well I should be able to complete it, even if not realistically aiming for top-5.

James T writes:

I had my first case of viral pneumonia back in 1970 after riding a motorcycle across the U.S. - almost nonstop. Spent a week in the hospital. Now I get it pretty easily. My first year of teaching elementary I "caught it" thrice. Boy, talk about sick.

Fortunately the bicycling seems to have strengthen the lungs although I've got plenty of scar tissue (which my doc keeps an eye on . . . just in case). My doctor is an avid bicycle rider – to from work daily – and does as many centuries as he can find time for.

Since you've already experienced the joys of pulmonary issues I won't say more. Let's just say I was delighted to hear you're back on the bike and working on getting back "up to speed."

DIGLLOYD: I agree on both counts:

• A prior pneumonia damages lung tissue with internal trauma resulting in overly sensitive and not entirely happy lung tissue, and possible scarring.
• Vigorous physical exercise strengthens lungs in general; over the past two years of vigorous cycling my lung function as tested at a pulmonary specialist shows small and large airway function to be at a 20-year peak.

So I suppose that one could argue that cycling or any form of regular vigorous excercise is a preventive measure against lung problems in general. Not a guarantee, but at least moving the odds in a favorable direction.

Back on the Bike — And Back Off

Well, I was a little optimistic five days ago about being back on the bike. It seems that this year is throwing me a lot of curve balls.

After a few hearty days of riding, I picked up some kind of achy virus thing four days ago. It wasn’t so bad in general, but Saturday night my entire lower back hurt so intensely that I was practically hyperventilating with the pain (I could feel a throb of sharp pain with every heartbeat). Not particular to any position or motion at all (in short not a disc thing or something structural). It was worse than my post-surgical pain, and I have a high pain tolerance. I was literally just about ready to head to the ER, thinking maybe caution was in order (e.g. infection of spinal area), but finally around 2 AM it settled down and I was able to sleep and besides I had no signs of any issues with lower body neuromuscular control. Still feeling weak today, but the back pain has gone away entirely. It’s a puzzling rapid onset thing, but I feel a rawness in my lungs too and some overall lingering achiness, so it almost certainly has to be an infection. Puzzling thing is I had a 3-4 day bout of something like this two weeks ago, which disappeared prior to resuming riding. Maybe resuming riding weakened me just enough for it to resurge.

Anyway, my 2013 season is shaping up to be a total loss in racing terms. I guess that’s the way it goes when summer weather arrives in March.