Life's Latest Lesson: Don't Panic

Based on the way my knees felt, I returned home after our three days of cycling in France thinking I may need to start preparing for the next round of knee surgery sooner rather than later. 

Backstory -- or, how Grumpy Knees Came To Be

I had an arthroscopy on my left knee in October 2010. There was so much damage to the cartilage (which started degenerating when I was a child), the surgeon said: 

• I have removed as much as I dare and still leave you a little bit of cartilage for at least some 'cushioning', but what's left is still quite damaged; 
• Further procedures like this will not be an option (for this knee; for the other, rinse and repeat); 
• Frankly, if you need another invasive procedure, that will be the end of your cycling*. 

I had a fantastic physiotherapist following the procedure and then transitioned into Pilates, which furthered my rehabilitation and taught me a great deal about how the knees work. 

That doesn't mean they don't give me trouble from time to time! 

Following the 2010 procedure on the "bad" knee ('bad' being relative, as the other wasn't exactly 'good'), I hoped it would be realistic to think I had bought myself more time to continue with the lifestyle I had without too much modification. I knew knee replacement was inevitable but my hope was that it would not become necessary for the left knee until age 50 or so, with perhaps an arthroscopy on the right knee around the same time. 

A Family History of "Bad Knees"

My mother has suffered with knee pain most of her life. I was born when she was 35 and I do not ever remember a time when she could move around without commenting on knee pain. She consulted an orthopaedic surgeon at some point in her 40s and was told she had degenerative osteoarthritis but was far too young to be a candidate for knee replacement surgery, as she would outlive the materials and only need to have it repeated. She was advised to have another evaluation in 10 years' time. 

Ten years later she duly returned and was told the same thing. 

Another 10 years went by. By this time, she could hobble for only short distances, with a walking stick, then a "Zimmer frame" (walker). The doctor was appalled: "Why haven't you come back to see me sooner?!"  She burst into tears and wailed "Because you told me not to!"  And he said "Oh but science has moved on tremendously. We can give you knees that will last ages!" 

So she had one knee replaced. I don't recall her age at the time but she wasn't much more than 70, if that. Recovery was prolonged and difficult. My mother has never been athletic or active and, I'll be brutally honest, she didn't do anything her physiotherapist told her to do. Her new knee was painful and stiff and she said repeatedly that she wondered if she should have bothered with the replacement at all. But a few years went by and gradually she felt better. And then she announced in late 2011 (age 76) that she was ready to go ahead and have the other knee replaced. Around the time arrangements for the knee surgery were being finalised, she was diagnosed with Alzheimers. We were advised that general anaesthetic carried a risk of affecting her mental capacities in ways impossible to predict or quantify. So she had the procedure with a spinal block, conscious throughout. And one of the unexpected "benefits" of her at-times child-like view of things was that she followed the physiotherapist's advice and regime to the letter.  That knee replacement was a complete success. When I visited a few months later, her mobility was amazingly improved. We went sight-seeing. She often forgot her walking stick in the car and could get along perfectly well without it. There's some irony in the fact that now she can physically do all sorts of things that are now impossible due to her mental state. But she can walk, and walk without pain, and that's amazing.

My eldest sister had both of her knees replaced while in her early 50s. She hadn't had any procedures carried out in the interim as I had; basically, she went to an orthopaedic surgeon who viewed her x-rays and said "those are the knees of a woman in her 80s" and she went straight to knee replacements. My sister loves to hike in the Cascade Mountains. Following her post-op instructions to the letter, she was back up in the mountains just a few months later. 

My knees seemed to be degenerating at a faster rate and/or from an earlier age than in my sister's case. Nonetheless, following my arthroscopy, my expectation and hope was to not be facing that first knee replacement this side of 50. 

What Now? 

Returning from France, Adam and I tried not to sink into "What if..." speculations. What if I can't do long rides any more? Will I be able to do the September tour? What if? Should I go see another orthopaedic surgeon, find out the current situation, explore my treatment options? What if?  

I decided the first step was to see my sports therapist for his assessment. In the meantime, don't look for trouble!!

I don't know where to even begin, to describe what David McGill does and how he does it. It's a holistic approach with a strong emphasis on corrective exercise and self-help. David is also a personal trainer though I've never seen him for that. I've often thought I might benefit more from a few personal training sessions with him each month than I do with weekly Pilates. But that would be an expensive proposition and at the end of the day, I know his philosophy is that I need to be doing the right things at home, not in a gym or studio. 

David's assessment was thorough and his conclusion incredibly reassuring:  my knee joints are no worse than they've ever been but the pressure in each of them when put under load was being intensified by the degree of accumulated tension in my quads. Treatment? Deep massage focussing on soft tissue release, targeting 4 key trigger points (3 in the meaty bulk of the quad, 1 much higher up nearly overlaying the hip flexors). And then what I can only describe as excruciating massage and release of muscles down the lateral aspects of both lower legs where I didn't even know there were muscles. I've forgotten what these muscles are called but they apparently function as shock absorbers and conductors. 

We also talked a lot about referred pain, because it was from my descriptions of where I felt pain and discomfort that David deduced where the source of that pain actually was. He shared these two illustrations from one of his practitioners' texts, showing the relationship between sites of pain and actual sources of pain. 

Where's the pain?

Where's it coming from?

Going Forward

I feel incredibly lucky: my knees can still be managed through corrective exercise, certain specific stretches (done in particular ways that may differ from what is taught in group classes) and judicious use of a foam roller for soft tissue release. 

I appreciate every one's situation is different and I could never advise anyone else on how to manage their own knee pain. I do from time to time dip into threads about knee pain in cycling forums, but I limit myself to asking questions, not giving answers, such as "has your position on your bike and/or cleat position been checked?" My aim is to suggest avenues that the person with the problem may not have considered exploring. However, each person will need to seek out and find the most appropriate treatment for their individual case. But sometimes the obvious is overlooked and that's where questions and observations by others with some relevant experience can help. 

For me, I am very pleased that the spectre of surgery has receded into the future. I know what I need to do, and where to go if something new develops. Meanwhile, I need to remind myself not to assume the worst, not to worry without reason. 

* He did scare me, but then I read numerous accounts online of cyclists who were back to riding 200+ miles remarkably soon after total knee replacement, took comfort from those and was able to put the surgeon's "expertise" into proper context: He may know his way around with a knife but knows far less than his patients do about their post-op lives.  

Just a few of many links that I found helpful: 

Info: http://www.kneesociety.org/web/patienteducation_totalknee.html

Others' experiences: 

https://www.crazyguyonabike.com/doc/page/?o=tS&page_id=23641&v=3b

http://www.roadbikerider.com/medical/total-knee-replacement-tkr

http://www.bikeforums.net/fifty-plus-50/838626-biking-after-total-knee-replacement.html

http://bonesmart.org/forum/view/knee-replacement-recovery-area.9/