Kneecap Pain: answering @MonaLS85

Answering @MonaLS85 Physio for kneecap straightening from a physio.

Mona, from reading into your tweet, it would seem that you have knee pain that someone has told you is due to your kneecap not being well aligned with your femur (thigh bone), and that someone also told you to go and see a physio to help straighten it.

Well…  while not being precisely true about your kneecap somehow twising underneath your skin, it sounds like you have a condition called Patellofemoral Pain Syndrome (PFPS), which is very treatable by a physio.

Key things that are likely to be looked at (if this is indeed your problem – and always rely on your practitioner’s diagnosis, not some random dude’s translation of your 140 character message) will be the length and strength of your hip rotators and the control and strength you have in your VMO or inner kneecap thigh muscle.  With manual work from a physio, alongside potentially taping your knee, and most importantly a series of key exercises that you will have to do, this knee pain can be resolved quite well in the vast majority of cases.

I am on the road at the moment, but may get some video clips of the exercises I like for this problem up when I’m back.

Good luck with it!  And definitely go see a physio, and take heed of their advice before anything you’ve received from me.

Psoas release: Response to @MikePovey1

@MikePovey1 wrote “40 miles yesterday after months ill off bike and nothing but base turbo miles. Result! @tobydefrance any tips for tight psoas?”

Firstly Mike, nice work on punching out 60km on your first ride back! Chapeau.

Secondly, getting a good psoas release is best done with a partner. I’ll try to describe it below.

Start laying on your back with one leg bent, foot flat on the floor/bed.

Have your partner beside you on the bent leg side of your body.

Partner finds the approximate midpoint between your navel and your ASIS, which is the bony lump at the front of your hips, and presses down into this area with two or three straightened fingers.

Maintaining finger pressure, your partner rests their elbow on your thigh (of your bent leg) and you gently pull your knee into their elbow. This will make your psoas bulge up, and your partner will be able to exactly locate the psoas, and place three fingers on it.

Relax your leg, and while your partner maintains pressure on your psoas (I find it helps to brace the three fingers digging in with my other hand) you must slowly slide your heel away from your bottom, thus straightening your leg.  Then slide your heel back towards your bottom, causing your leg to bend again.  Repeat 3-5 times on each side, and you should feel a very nice release.

It hurts a bit (ok, it hurts a lot – heh), but I reckon it’s a good way to get your psoas to let go.

Enjoy!

DOMS in cyclists??

DOMS, or Delayed Onset Muscle Soreness is a common problem with certain types of exercise. The prevalent theory holds that with eccentric exercise (lengthening under load – like lowering a weight to the ground by bending your back) micro-damage occurs to the muscles. Despite no actual large tears existing in the muscle, the time during which the micro-tears are repairing is exemplified by the whole muscle being painful and stiff.

Common exercises that cause this include weights and running (especially downhill), but the effect is only for the first few bouts of the exercise, and then the body develops something of an “immunity” to this uncomfortable reaction. Thus when a person first does a weights training session or goes for a run for the first time in a long time, they are stiff and sore for a few days afterwards, but less so on subsequent runs, until they don’t feel DOMS unless they go harder or faster than previously.

The interesting point to note is that cycling is an exercise that normally does NOT cause this type of muscle damage. Cycling requires concentric contractions, meaning the muscles shorten to generate force. Mild stiffness after a hard day is normal, but for a cyclist to feel the pain of DOMS for several days, something odd has happened.

For one of our guys, that “something odd” was the descent down the Stockeau on the second stage of the Tour 2010. He crashed twice within seventy metres: not normal behaviour for a seasoned professional bike rider! The first time sliding on his side and taking off a lot of skin, but otherwise being ok. The second time he crashed on that hill (it was his 3rd crash for the day, but the 1st was much earlier) his front brake locked up unexpectedly as he tried to avoid another crash in front of him, and he was thrown over the handlebars, and slammed down onto his side on the verge of the road.

The immediate worry was the damage he did on hitting the road (he described his reaction after the fall as being like a little kid just laying still waiting for the pain to go away and to be able to take a breath in again), but the following day, and more so on the two or three days subsequent to that, his main concern was a “huge” amount of widespread pain in his legs.

What I believe has happened is that he contracted his leg muscles as hard as he possibly could in attempting to avoid crashing, and also to defy the laws of Newtonian physics (inertia and gravity and stuff: it’s complicated, but it’s my life), and as he’s been torn out of his saddle and then pedals, his muscles have been forced to lengthen.  A classic cause of DOMS, with his reaction exacerbated by the fact that he never partakes in exercises that normally cause this, so has no “immunity” to the phenomenon, and less experience of the feeling itself.  Thus he was more aware of it than one normally would be.

Treatment was directed at maintaining length, reassuring him that nothing was broken – just very very sore – and keeping things as mobile and loose as possible.

After a couple of days he was as sweet as apples.

Elbow Tendinopathy (answering @adventureisart)

From: @adventureisart
Sent: 19 Jul 2010 20:13

Any advice on continuing elbow pain? I’m pretty sure its tendinitis. I haven’t been riding for over a week now and its driving me insane!

sent via
On Twitter: http://twitter.com/adventureisart/status/1371970267

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Hey there @adventureisart, following is some basic advice. Your best bet is to see a physiotherapist or equivalent to help you out with your elbow pain! Rest isn’t all that effective for these issues a lot of the time.

NOTE: THE FOLLOWING ADVICE IS GENERAL ONLY. SEE A PROFESSIONAL IN YOUR LOCALE FOR SPECIFIC ADVICE!

The 1st question is when is the pain being felt?

If it’s while you’re riding that you first felt it, then look at your set up. Incorrect set up is the most common cause of pain from bike riding. Other than falling off!

If it’s not bike riding that causes the pain, your best bet for the tendon pain is low load, high repetitions of eccentric exercise. This is lengthening the tendon under tension.

HOWEVER! Don’t stretch the tendon too far!

Hypothetically if the pain is on the inside of your elbow then…

Start with forearm on a table, palm upwards.
Lift hand at the wrist (shortened position)

Put load on hand (a kilogram or 2pounds max)

Slowly lower back of hand to table (lengthening under load)

Take load into other hand, raise the sore hand to the first position and repeat. Aim for high numbers – up to 180 per day – but build up to this.

If the pain is on the outside of the elbow, do the same, but start with palm down, and lift the hand at the wrist from that position.

If it is elsewhere, you’ll need to be more specific with me!

If you do ride, and the pain is no worse, then there is no reason to NOT ride, provided you can control the bike properly.

Regards,
Toby

Toby Watson, Team Physiotherapist, Garmin Transitions Pro Cycling Team.

The Rude Return

So January was all sunshine and roses.

And then… KERTHUMP!  Along came Europe in winter in all of her furious unpredictability!  My first night in Girona was one of the very rare times that it snows in town.  We’re very close to the Pyrenees, so on clear days you can see snow on the mountaintops deep into May, but snow in town is rare.  I’d love to have photos to show, but I was too freakin cold to be worrying about such!  Not only was it super cold, but Mands and my central heating had drained of water while we’d been in Australia, and so there was not only no hot water, but also no heating.  Ohhh the joy!

And then for the final indignity.  Upon opening the fridge, I realised my schoolboy error in dutifully emptying and unplugging it, and then closing the door behind me.  A wonderful breeding ground for all kinds of bacteria and germs.  So I had the awesome task of cleaning the fridge and freezer out with boiled water while I awaited the central heating dude to come and rescue me.  Not my most triumphant return to business ever!

As for the team, we’ve been a little in the wars, as has most every Pro team at this time of year – sketchy road surfaces, high wind, cold hands and not yet being fully in the swing of things means that crashes happen a lot more regularly than any other part of the year.

One of our boys was so bad he had to get his shoulder fixed up at a guru surgeon up in Belgium, and I went up to make sure we were on the right page as far as rehab expectations, and also just to make sure that the poor bloke wasn’t stuck in a foreign airport a day after an operation and finding out the hard way that he in fact wasn’t ready to head back to the team base.  I DO have some photos of sunny Herentals, where the guru surgeon is based, and once I work out how to actually post and link to them (this modern technology business is a little hard, you know?)  They’ll be posted.

Until then.