SBR Utopia - OPEN (Page 118)

Nicole, sorry you are feeling down and I understand the frustration of unresolved pain/injuries. Realizing that there's a lot of history to your injuries/ issues I'll offer a couple thoughts on the above: Not all pain is created equal but if it limits your ability to do certain activities then it bears paying attention. The knee is just one complicated joint in a long chain of interdependent body parts (spine to foot), the root issue could be somewhere else entirely. As an example, my herniated/ruptured lumbar discs never caused back pain but rather manifest pain in my hips. It took time, countless diagnostic tests and a few incorrect dx to get to the core issue and ultimately treat it properly.  Sometimes simple things can make a huge difference, so don't give up on adjusting bike fit etc.

So I would just encourage you to listen to your body, don't give up, and if you're not seeing really good docs/pt's/etc with endurance sports experience try to find them.  Good luck. Hopefully others in the group will have more to offer. 

I would start eliminating (well... taking a break from) things one at a time until you start noticing improvement.

Does it hurt all the time or just when you're exercising?  And where does it hurt?  If it's behind your knee, I'd suspect the biking.  Removing the shim is equivalent to raising your saddle height and your leg might be extending too much now.  You could try lowing the saddle a tad or post some photos / video on here and folks can help you.

If it isn't behind your knee, then running is more suspect.  If that's the cause you might want to just cut out running completely for 4-6 weeks and see if you notice an improvement.  If it's the outside of your knee it might be ITBS.  If you had a scope and no problems then I assume there's no cartilage damage.

Those are my best guesses... I've had 3 knee surgeries myself.

Edit: you also might look into having a running specialty store evaluate your gait.  They might see something in your stride that's off and causing irritation in the knee... and they can probably put you in a shoe to help deal with it.

A little history on my knee pain: In July 2012, I got hit while on a training ride and was thrown off my bike, landing on the outside of my left knee.  X-rays and MRI's are clean, but after five months of dealing with pain, my ortho suggested (again) that we scope it and clean it out. 

The pain I feel is mostly on the inside of my knee (though I landed on the outside), "under/behind" my kneecap, and in the patellar tendon.  It hurts all the time, with certain things being more painful than others....cycling had never bothered it until this past weekend after we'd tweaked the fit (which included lowering the saddle a significant amount, putting on a smaller crank, moving the saddle forward, dropping the bars, and removing the shims). 

I can't kneel down (any position that requires my butt to be near my ankle really exacerbates the pain).  I even notice it walking....and often feel that running provides a bit more shock impact (I'm naturally a forefoot runner, so landing on the forefoot while running seems to aggravate it a little less than stepping onto my heel when walking).

I've also had my gait analyzed twice in the past (though it was before the accident) and both times they said the same thing -- I have very high arches, I have a forefoot strike, and a neutral shoe is recommended. 

Since July, I've done very minimal running (I attempted for five -- sporadic/inconsistent -- weeks between Thanksgiving and New Years, and then started with a run/walk program again a couple weeks ago).  Unfortunately, at this point, I don't think taking time off running is going to solve it.  And as much as I think it might kill me or at least drive me insane, maybe the answer is to drop the running and the biking??

I'm looking for suggestions for a new doctor / ortho with a running background.  Granted, my current ortho generally treats football player knee injuries, so he should know athlete's knees....but obviously something is missing.  Maybe another set of eyes on it is the way to go (though it would be a fourth opinion...).  Now it's just a matter of finding someone I feel is worth trusting.  Like I said, I really don't want to give up, but I'm exhausted....it doesn't seem like it should take 8+ months to diagnose a knee injury, but maybe the problem is elsewhere and the pain is just showing up in the knee, as Kim suggested.

Wish I had some words of wisdom, but I think at minimum you need to go back to the fitter and explain what the new fit has done to your knee.  I also wouldn't run through any pain, but definitely look for a 2d, 3d 4th opinion, whatever.

I was told by one esteemed doc I should never run again in 2009 or so.  They're not always right, nor as you have found do they always know what the proper diagnosis is.

This is quite a high possibility, which is the crazy part.  I would find a highly recommended sports PT clinic.  I have a great one I go to here in AZ but that is probably too far for you.  I have been amazed at their knowledge every time I go and how they are just so aware of how one thing that you'd never think could be related would impact what your issue might be. 

I'll start with the disclaimer that I'm not a doctor... so these are just ideas for you to discuss with your physician(s).  The problems you described with the patella sound like the best place to start.  That initial impact could've move the kneecap enough to cause injury.

My first knee surgery ~15 years ago was an ACL reconstruction using a patellar graft.  To this day I still can't kneel down like you described, because of the piece they cut out of there.  Yours is still intact but maybe there's some inflammation going on.

For starters I'd avoid low cadence / standing / climbing on the bike.  Avoid running or even walking downhill or down stairs whenever possible.  Any type of motion where you're slowing yourself down against gravity puts strain on that area.

I'd be inclined to speak with a physical therapist at this point.  Sports medicine doctors look through the lens of "what can we fix via surgery" but you've already ruled out some of those possibilities with the scope.  A PT might be able to see what you're doing that still aggravates it.

Another gait analysis might not hurt either, since you haven't done it since the injury.  When we get hurt, we subconsciously change little things to protect ourselves against the pain.  They might notice something that you aren't even realizing.  I wouldn't tell them about the injury up front.  See how much they notice without any prompting, then explain to them afterwards.

So this is weird.  When I went compact on my road bike last year, I could have sworn the shop sold me an 11-28.  I was going to have that swapped to my HED3s for racing this year, and went and looked and it's an 12-30.  Didn't even know they made that, but looks like it came out last year.  So it's either swap that one out, or stick with 12-27 for climbing.  I have doing most of my traning rides in the 27 (and sometimes with a 12-25), so not quite sure what to do for racing.

Courses this year for the most part are considered somewhat hilly, but not crazy hilly - Oceanside, Wildflower and IM Canada.  Done Oceanside and WF before with the 27 (but heavier).  Thoughts?

For me personally, with a compact up front, I'd likely use a 11-28 for a hilly long course tri.  I'd probably train in a 11-26 though...but I'd rather have the 28 as a bail out in case I was in danger of overcooking the bike on the climbs.

If you're comfortable training with a 12-25, I'd opt for the 12-27 on race day.  If you're training with the 12-27, and find yourself using the 27 a lot...then you might want to go with a 11-28 or the 12-30.  I had no idea they made such a cassette though.

Me neither, but a google search says it's new as of last year.....   

I'm sorry you're going through this - I wish I could offer some suggestions, but I can only empathize, and hope that with the other suggestions from the group you are able to find a remedy and get back to enjoying your training without constantly worrying about your knee.

^^^ I am also sorry I have no advice to give. Just sympathy and wishes for healing.

http://forum.slowtwitch.com/gforum.cgi?post=4481044;sb=post_latest_reply;so=ASC;forum_view=forum_view_collapsed;;page=unread#unread

Posted this in ST.  Looking for advice on how to test the difference between two power meters.

I'm so sorry and although I'm not a doctor, I do know a lot about knees. You and I ijured our knees in a very similar way...forgive me if I have told the story before..I crashed my bike in 2011 and had so much road rash, broken ribs etc that I didn't even know how badly I had injured my knee until I tried to run again. I landed on the outside of my right knee and it was bruised and swollen for a long time. After the bruising went away, I was left with some pain outside of my knee that just didn't go away. I went to a highly recommended practice of Orthopedic doctors. We tried the usual: RICE, PT and X rays. Nothing showed up. After a period of several weeks, my knee got worse. I am on my feet a lot at work and it felt like it was locking up, weak and unstable. I was following up with the ortho regularly and he ordered an MRI. The MRI showed a "bone bruise", now this was months after the crash but he said it was possible to still have a deep bone bruise. Fast forward a few months, my knee completely locked up at school after I had to run down a child who was running from us, I couldn't straighten it out and it swelled up like a balloon. I went to the ortho the next day who did nothing! He barely even touched my knee. I was so frustrated. I had a PT appt the next day and my wonderful PT suggested I go see an Ortho friend of hers because she couldn't even do PT with me, my knee hurt so badly. I drove to the other side of town with my xrays and MRI and met with the most wonderful Ortho. He brought in his partner (a surgeon) to review the test results and said we needed a higher resolution MRI because he thought he saw a loose body on the Xrays. Long story short....better MRI showed a large loose body stuck behind my knee and large area (15mm) of articular cartilage was missing. I had surgery a few weeks later, they removed the large loose body which was 15mm (same size as the hole in my knee) and did a general clean up. My knee is in good shape, meniscus is great etc but I now have a large chondral defect. After surgery, we went over my options...the first being microfracture, then possible cartilage replacement techniques. I opted to wait it out, had lubrication shots in my knee, did PT and got back ont he bike. I can now run again, minimally, because I am conservative.

In other words, get a second opinion. There is most definitely something going on. My only other suggestion would be to rest it out for longer. It seems to me that you have done so much rehab and returned very quickly after surgery, sometimes you can go too hard at rehab...which is very typical for us tri types  You need to think long term, Vineman and all the other races will still be there next year and you will enjoy them a lot more when you can train with confidence. 

Hang in there and vent away. Just about al of us now what it's like to be injured and that the emotional side of it is worse than the physical most of the time! 

Same here. Wishing you quick and simple recovery.

Hmm, I'm not sure exactly what you are asking.  Do you mean how significant is saving 5.6 watts at 40 km/hr?

At that speed on flat road / no wind, I'd probably be around 250-270 watts.  So 5.6 watts is about 2% for me.  That'll vary a bit depending on the rider but not by a lot.

If you're looking at how much a particular aero upgrade helps you - say, a wheelset, keep in mind nothing by itself will be a huge gain.  It's the sum of the parts.  Position, helmet, wheels, clothing, etc.

I plugged it into anyalytic cycling, and using the defaults, it would take 243 watts to go 24.85 mph (40km/hr).  If you increased to 248.6 watts (increase of 5.6), then you would go 25.08 mph or 40.45 km/hr.

ETA: Notice that a 2.3% increase in power, only resulted in a 0.93 % increase in speed.

I agree with Mark that while one adjustment of 5.6 watts may not seem like much...but if you can make 4-5 adjustments of 5.6 watts each, it really starts to add up.

Can you link which page you used their defaults on?

I was trying this page:

http://analyticcycling.com/ForcesPower_Page.html

If you plug in 11.11 m/s for the speed, which equals 40km/h, and leave everything else at the default, the power it states is high.

I think those defaults are bad (my CdA is way below 0.5) but I'm curious which page you started with.

You need to change the slope to 0.  It defaults at 0.03 or 3% grade.

I actually used this page

http://www.analyticcycling.com/ForcesSpeed_Page.html

Pretty much the same calculation, but easier to work with if you want to adjust the power numbers and see what the resulting speed is.

That's one of those things that falls into the category that was mentioned above.  By itself, where you place your water bottles isn't going to have a massive effect on your speed (unless you go from something completely awful to something ideal) but when you combine it with 2 or 3 other small details, the gains start to add up.  5.6w for a bottle between your arms (that's from the Cervelo article), 5 watts with good tires and tubes, a few watts from cleaning up the placement of cables etc, an aero helmet, tight fitting clothes.  

Depending on what you are starting from, you could be looking at 20+ watts and now you are talking about the kind of speed gains that would take months of hard training to achieve.  Now that's not to say it should be a replacement for training because it's the combination of the two that gives the final result.  Some people call it "free speed" but there was a discussion recently on ST where someone called it "smart speed".  I like that better because there is obviously some cost to buying new equipment.

Then it might be called "purchased speed". 

That sounds negative.  I'm sticking with "smart speed".    

ok.. but IMO "smart speed" gives off a negative impression too... Like, if one doesn't have the expensive equipment they are somehow.. not smart?