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

See The Left Knee Persists in Griping.

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.

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