Riding in the Snow - Knee Pain Update

It has been 122 days since my knee surgery, but it's been slow going getting my knee back in to riding. Not being able to get my heart rate up the past couple months have taken a toll on my spirit and my body. I rode a hand full of times in January, but had to stop because my knee wasn't ready to be loaded yet. I rode once in February and managed about 6 rides in March. It's been slow going indeed, but I'm trying to listen to my knee and not over do it. I pushed it too hard last week and have been suffering all weekend. I'm going to have to take a few days off to let it calm down.

My basic rides are about 5-15 miles of mostly soft pedaling, keeping disciplined, and not letting my ego get the best of me when someone gets on my wheel. I just let them go with a smile and keep on trucking. March is the snowiest month in Colorado and my days off have coincided with every snow laden low pressure system. Maybe it's been good because there are less people to keep my ego in check with.

The Ritchie Break-Away Cross bike is perfectly at home in the snow, allowing me to choose the route I please. The Superfly might as well be a snowmobile, its huge 29 inch tires just glide through snowdrifts as deep as 8 inches. The other day it was so deep I got off the bike and it was still standing! Here are few pics of the last storm:

Pics from my Normal Route

The Snow was so Deep I Didn't Need a Kick Stand!

At the rate I'm getting back to speed I have serious doubts about racing this year, but that's okay because I've got something else in the works. Stay tuned...

First Ride 2010

It's been 6 weeks since my knee surgery. Doctor Paul and John my Physical Therapist both encouraged me to get back on the bike, but just to mobilize it, not load it up. 20 minutes at conversational intensity,nothing more. I hate riding on the trainer and have a only ridden the Ritche Break-Away Cross bike once, so I planned a perfect mission for my first ride of the year. An epic 2 mile jaunt home from Costco where I dropped my truck off to get the tires rotated!

I spent an hour the night before fitting the Break-Away to my bike fit dimensions down to the millimeter. Then I added a much needed accessory for this time of year - fenders. I used to heckle people that rode with fenders, but at the end of the day their ass was dry and mine was wet. Before I left my house I taped a hot pack to my knee to keep it warm and help it stay mobile.

Fitting the Break-Away Cross



Fenders





Knee Heater



To keep a conversational pace I had to avoid the "bump" a steep hill on the normal route back to my house. Instead, I took the bike path, which was covered in tacky wet snow. I had to load my knee slightly in the snow, but I downshifted into my granny gear to keep it light. I actually got passed by a runner! Once I was off the snow I kept my discipline and spun the remaining mile home lightly.

Snow



Knobby Tires



A Dry Seat



Almost Home





It was a short taste of 2 wheeled fun and good to ease back into saddle. My knee hurt later in the day so I decided to give it a few days before I head out again. The Break-Away ran like a champ, I can't wait to ride it more.

Knee Pain Update

It still hurts... Like this...

Knee Surgery and a New Bike

No Love for Cycling...

When I rolled across the line at 11:51pm on October 9th at the 24 Hours of Moab it would be the last time I touched a bike until November 30th. That's 52 days off the saddle, one of the longest stints in my modern cycling career. My cycling this season has been a train wreck. I started off the year with a solid base, but was plagued with stubborn patella tendinitis. I reached my peak fitness for the year just before I got a PRP injection in late April. The PRP injection required a few months of taking it easy. The result was doing San Juan Hut Trip, The Laramie Enduro, and the 24 Hours of Moab "off the couch". All things considered, I think I pulled off some amazing results, but none that were competitive.

Fast forward to October 10th and I needed a break. I would look at my bike and feel conflicting emotions from guilt that I should be out maintaining my fitness to disgust that I had let cycling define such a large part of my identity. I planned to fill my fall with hang gliding and a few other projects I'd been putting off. Ironically, El Nino ensured perfect riding weather this fall with mild temperatures and almost no wind, keeping me on the ground more often than not.

The Break-Away Cross

I started off the year with four bikes, one for every possible training scenario. This was 3 bikes more than I could afford so by October I was down to only one, the Superfly. Through all the bike shuffling I did manage to snag a Ritchie Break-Away Cross frame and patiently trolled Craig's List for killer deals here and there until I had horded enough parts to build it up. By the last week of November I couldn't take it anymore and set out to build up the new Break-Away.

This was my first build from scratch without any outside help. It took way longer than past builds, but I've never build a cross bike before. I got it all together by Thanksgiving Day, but it was too late to ride when I finished. Here's the finished build:

Steel Break-Away Cross Frame
Ritchie WCS Bits
Ultegra SL 10 Speed Components
Mavic Ksyrium Elite Wheels
Hutchinson Tubeless Bulldog Tires
Avid Shorty Cantilever Brakes









The Break-Away Cross will be the perfect all around bike. It's a steel frame that breaks in half so I can take it on the road. I can ride the tubeless knobby tires on dirt, snow, and mud. On December 1st I took it out on a 20 mile loop of road, bike path, dirt fire roads, snow, mud, and a piece of technical single track. I was super impressed with the bike. Having tubeless tires filled with Stans, I didn't have to worry about flats and could run a much lower pressure than normal tires. The bike did great on all but the technical single track, which took all the skill I could muster to negotiate. Cantilever brakes are horrible compared to road brakes, they do not scrub speed quickly and require some planning to stop completely. Over the bike was great and it finally felt good to get out for a ride.

Knee Surgery

After the ride my knee was killing me and I was reminded of why I hung up my helmet for almost 2 months. It didn't matter because I was headed to the hospital for knee surgery. The PRP Injection I got in April might have helped my patella tendinitis, but it was not a decisive fix. Faced with an expensive change in health insurance on January 1st I was forced to make a decision. I could get another PRP injection and hope for the best or clean it up the old fashion way with a scalpel. After much thought and consultation I choose the latter. Dr. Paul said he would "part my patella tendon like a violin bow" and clean out a ball of scar tissue underneath that extended under the tip of my knee cap. It was too deep to get to with body work or physical therapy.

The surgery was pretty straight forward, I was in and out in 4 hours. Now my job is to stay off my feet and let it heal properly. I have a propensity to develop scar tissue, so I'll have to take extra care to mobilize my patella tendon once I'm back on my feet. If it works I should be back on my bike by the spring and possibly racing again by summer, but I'm not going to rush things. If I never race again so be it, I just want to be able to ride my bike without being in pain.

The Burn 2009 - Just Riding Along

"Just riding my bike on the race course, while the race is going on." That was my plan for The Burn in 2009 and that's exactly what happened. The Burn was one of my favorite races last year. It's held as a time trial because of two endangered species that inhabit the course, the Preble's Jumping Mouse and the Pawnee Montane Skipper Butterfly. The time trail format is great because it opens up the course allowing riders to go faster. It also suited my injured state.

It had been 3 weeks since my PRP Injection (here), of which recovery has been a roller coaster ride. Sometimes I feel fine and other times it hurts for no reason. Including our epic ride in Taos I had only ridden 3 times since the injection. I had built up a good base before the injection, but 3 weeks off before a race is not a recipe for success. A hectic work schedule and poor sleep the 5 days before the race put me over the top. When I woke up at 6:30am on Saturday morning I was already in survival mode. It didn't matter. My plan is to rehab my knee and focus on the Laramie Enduro and 24 Hours of Moab. Keeping this in mind and tried to just go out and enjoy the course and the race scene.

Jo and I met up with Jonny V. and carpooled to Lake Wellington, where the start / finish is. We brought Sugar and Molly along with my kayak to round out the day. Doug was going to meet us there with Joni and a teammate. I registered in the Expert Class back in the winter before my knee pain set in. With all of my knee issues and chronic fatigue I didn't expect to be competitive in Sport, much less Expert. Expert also meant that my start time was earlier. As soon as we parked the truck I was hustling to get ready. After hurried hello's with Doug and Joni, I rolled into the start tent at 9:40am. That gave me 9 minutes to warm up, good thing I was just riding my bike on the race course.

Lake Wellington



Hurrying to Make My Start Time



I cued up and sprinted out of the gate at 9:49. The riders were spaced out at one minute intervals. The course started on a dirt road that winded through the camp ground, along the creek to a steep rutted descent. It finishes with a climb up the same road, which I reminded myself of throughout the race. At the bottom of the descent the course turned left onto a gradual singletrack climb. The guy behind me caught me here. I couldn't believe it. Already! It was going to be a long race. I'm not used to getting passed, much less by someone I can't catch. I could have buried myself and rode his wheel up the climb, but the huge climb lurking at the end of the course shut down that idea. "Ride your own race"; I told myself. My own race today needed to be slow and not wreck my knee. Discipline, not suffering would be hardest part of the race.

Sprinting out of the Campground





After the first climb was a smooth, fast, single track that carved through the rolling, burnt hills of Buffalo Creek. Buff Creek was on the western end of the Hayman Fire in 2002. It's been 7 years, but there is still a stark contrast between the burnt open areas and thick forest that was spared. The sweet singletrack of the course treats you to both. I couldn't think of a more beautiful place to ride my bike on a race course while the race was going on.

The Burn

(from last year)

On the next climb I started to feel my lack of fitness and got passed again. The elevation profile of the climb is a series of steps separated by flatter spots. Each step look a little more out of me and by the top I had been passed by 3 other riders. Ouch! "Maintain, maintain, let em go..."; I repeated in my head - not that I could catch them anyway!

Jo Going Out

On the second descent I felt tight and awkward on my bike. Part of it was my lack of warm up and loosening my upper body and part of it was the longer stem I mounted after my bike fit. I couldn't seem to flow with the trail and maintain my speed. I suspect my lack of sleep was affecting my concentration too. I put my focus on staying loose and not getting frustrated.

Doug Going Out

Soon I was at the start of the last climb. I had marked it on earlier on the GPS. According to my calculations it started at 20.75 miles. I dropped into my granny gear and spun as the road pointed skyward. It hurt, but it wasn't as bad as I had anticipated. I got passed by a few more riders, but soon was at the top. If anything I erred too conservatively and could have hit it a little harder, but my knee appreciated the pace.

At the top I put in a solid sprint to the finish, but my time was going to be dismal. I finished the 22 mile course in 1 hour and 53 minutes, 10 minutes slower than last year and 23rd out of 26 people. I wasn't last, but I'm not used to finishing so close to the bottom. I really was just riding my bike on the race course while the race was going on. Like any race there were lessons to be learned. The most obvious one was that things are going to be different in Cat 1 / Expert. The talent level is high and once my knee is right I'm going to need to work on all areas of my riding to be competitive. Even though my time was bad, I succeeded in my goals of sticking to my plan and not wrecking my knee. Now my job is to follow plan through, follow Coach Brian's advice, and incrementally build my fitness so I am competitive for The Laramie Enduro and 24 Hours of Moab.

Jo Coming In

Jo on the other hand had a great race. It was her first race on the Superfly Single Speed and even though she has only been training for 6 weeks she rode her way into first place! I missed her start because I was out on the course, but watched her finish and she looked strong. I can't wait to see how fast she is going to be at the Laramie Enduro.

Crossing the Finish Line in 1st Place

Old Man Wounded Knee

It's been 3 days since my PRP injection and I've been going non-stop the entire time. My doc told me to let my pain guide me, but to stay mobile. Today was the Battle of the Bear mountain bike race. Jo and I went to support all the Phoenix Multisport athletes who were racing. My knee has been psychitsophrenic since the injection, ranging from achy, tender, perfect, sore, stiff, 100 percent, swollen, and unhappy. I was told this would happen, but after lots of walking today it was just unhappy. By mid-day I had to go find a large walking stick to help me bear the load. At times it was all I could do to hobble from place to place rather dramatically garnering much unwanted attention. (Yes, I actually didn't want attention for once). I should have some pics of the race up soon, once I get through editing them.

Old Man Wounded Knee
(That's the Break-Away in my hand being delivered to its new home.)

PRP Injections and Bike Fits (Knee pain update)

It's been about 6 weeks since my knee really started hurting bad this year. The pain originally started as IT Band Syndrome while doing the 24 Hours in the Sage - solo on my birthday in August of 2005. That set off a chain of pain and imbalance that morphed into posterior pain and Popliteus Tendinitis that completely derailed me in 2006 and much of 2007. After a relatively pain free season in 2008 it's back in the form of continual IT Band tightness and acute Patella Tendinitis just below my left knee cap. My experience over the past 3 years has taught me that my knee pain will probably never go away completely, but with proper treatment it can be managed enough to race competitively. Holding out hope that this is true I put together a plan to be able to race this year.

The first thing to do was visit Andy Pruitt of Boulder Center for Sports Medicine (BCFSM) to see how bad the Patella Tendinitis was. An ultrasound scan revealed a small growth on the my Patella tendon just below the left knee cap, probably due to misalignment and years of over use. A few measurements also confirmed what Bobby and Patrick have been telling me for months, that my left hip and pelvis are externally rotated the result and cause of more misalignment plus sculliosis in my spine. Andy suggested a PRP injection in my left knee to heal the tendinitis. PRP stands for Plasma-Rich Platelet injection. It is a relatively new tendinitis treatment that uses the patient's own blood as the main tool of healing. A small amount of the patient's blood is drawn and put in a centrifuge to separate red blood cells from protein rich platelets that are essential keys to the body's natural healing. A small amount of the platelet rich plasma is injected back into the injured area of the body to accelerate the healing process. The platelets stimulate stem cells into the area which rebuild the injured tissue. The recovery time is about two weeks and has been successful in 40-60 percent of stubborn tendinitis cases. More on PRP here, here, and here.

This expensive and experimental solution would be moot if I didn't also try to solve the cause of the tendinitis. To do that I scheduled a 3 dimensional medical bike fit with Andy at BCFSM and sought out world champion distance runner and expert physical therapist Mark Plaatjes. Ramin has had great success working with Mark and highly recommended him. I also backed off my training to shorter and lower intensity efforts and continued to get weekly body work.

Mark found that my left leg is 6mm longer than the right in the tibia. He suggested this was the cause of my hip rotation as my body tried to make up for the leg length difference by rotating my pelvis. The solution was a 3mm heel lift in my regular shoes and a shim in my cycling shoes to even my legs out. Mark also uses cross tissue frictional massage also known as Myofascial Massage on my patella and areas of my back that make me cry - literally! This breaks up the scar tissue and is similar to PRP in that it stimulates the body's natural healing methods. Incidentally, Mark let Molly come in the office on my first visit and while he was working on me she wiped her ass on the carpet right next to him. I was face down on the table and only heard him say is in his distinct South African accent; "I bring you in my house and you wipe your ass on my carpet!?" I was mortified, but he thought it was hilarious and we both had a good laugh.

The bike fit was next. I had a 3D bike fit at BCFSM in 2006, but it was after 3 months off the bike and done mainly on my road bike. Other than a few minor changes it didn't reveal much. This time things would be different, I had put in a solid 8 weeks of training and the main bike would be the Superfly. Before going to the fit studio Andy had another look at my alignment and ordered an x-ray to confirm the leg length issue. It showed an 8mm difference in the top of my hip bones causing my spine to depart the top of my pelvis at a 10 degree angle. In the studio Andy and his assistant Sean velcroed reflective foam balls to my back, hips, knees, ankles, and toes. I pedaled the Superfly on a trainer with moderate resistance inside an array of infrared cameras that took a 3D image of my movements, analyzed it, and plotted the results in 3 plains of motion. My leg length difference and pelvic rotation showed in the results. The side view showed that my right hip was extended forward and rotated with my leg. The front and top views showed that my right knee was not aligned over the top of my foot.

Before and After Views

The first fix was a wider saddle to stabilize my hips. The Fizik Gobi saddle I had been using was only 130mm wide. Sean measured my sit bones on a special foam pad and determined that I needed something at least 140mm wide. He recommended a Specialized Phenom saddle, size 143mm. He also moved my saddle forward and shimmed my right cleat which helped align my knee vertically. I pedaled for the camera again and the results showed much better vertical alignment and less rotation in my hips.

Top View

The two blue dots towards the bottom of the image are the balls on the back of my pelvis. You can see that on the before image they are not clean dots which shows hip rotation and instability. On the after image they are dots which shows good hip stabilization.

Side View

Note how the blue and green balls at the top left of the upper triangle are not in line on the before image which shows that my right hip was rotated forward. On the after image they are superimposed over each other. You can also see that this brought my knee plains in line, the red and black arcs.

Front View

Here you can see that my right knee (red line) is inside of my right foot (green line) on the before image. It is closer aligned on the after image.

Hip Rock and Vertical Alignment

Here are graphs of my hip rock and vertical alignment before and after the changes.

Moving my saddle forward revealed a more disturbing truth, that the Superfly is too small for me. In fact all of my bikes are the wrong size except for the Litespeed, which ironically hurts the most to ride. To get the Superfly close Sean recommended a longer stem, but the trade off is less agile steering. Riding on the trainer also showed a disturbing amount of forward / aft flex in the Bontrager Carbon Seatpost. Not wanting carbon splinters in my backside this would be replaced with the stem. I've never been a fan of Bontrager parts anyway so I opted for a Thomson aluminum stem and seatpost (both were lighter than the former). Here are the new bits and saddle.

New Bits and Saddle on the Superfly

As far as the rest of my bikes, the Ritchey Break-Away is too large and the HiFi is too small. The Superfly is close enough, but I haven't ridden it enough to know if I can live with the muted steering. The changes Sean and Andy made are pretty drastic and the two rides I've done so far felt like I was walking around with my shoes on backwards. After a 2:30 Switzerland Trail loop my seat height felt a little too high. This was confirmed by posterior knee, popliteus, and upper calve pain. That derailed me for entirety of last week. After a follow up visit, Sean moved the saddle slightly forward, but I was too scared to ride this week after how painful the Switzerland Trail ride was.

Today, I finished the last element of the plan and got my PRP injection. All I can say is there were a lot of needles involved and I didn't handle them well as it was early in the morning. Dr. Nichols and his pathologist were very informative and answered all of my questions in depth. The pathologist let me stay and watch blood and plasma separate in the centrifuge. Dr. Nichols encouraged me to watch the injection needle on the ultrasound screen, but the thick heavy gauge needle protruding through my patella tendon was too much. The whole procedure took less than an hour. I'm told it will be a 2 week immediate recovery time followed by up to 3 months of healing. I will be able to start riding easy as soon as this weekend and resume normal training by the end of the month.

Not training at the level I would like to has been frustrating, but I've tried to stay focused and keep out of the pit of despair. I have a great deal of fear that my knee will never heal enough to race at my potential. I try to balance that fear with gratitude that I couldn't have better resources and talent at my disposal. At times it feels like I have been swimming upstream, but such is life. Instead of grinding away the miles in rain, heat, and snow my tenacity is better placed in keeping on track and doing what I'm told. I'm a survivor and am confident that with discipline and some luck I'll be competitive for the Laramie Enduro on August 1st. Hopefully completing the last step of my plan today will be the light at the end of the tunnel.

This is my Fate Tomorrow

Wish me luck...

The Pit of Despair

If you haven't noticed, I've been avoiding following up my 2008 Race Results post with my 2009 Season Plan because my knee has been acting up lately. I'm hoping it's just something acute like an early season flare up or being slightly out of fit on HiFi, but I would be lying if I said I wasn't deep in a pit of despair.



Actually, it has been horrible day. I worked today and yesterday which consisted of 6 hours of sitting in cramped quarters without being able to move, much less stretch. My entire left leg was in pain, but the patella was the worst. It was the achy pain of old injury, scar tissue, and nerve damage. The kind that leaves the leg perfectly functional, but never lets you forget things aren't right.



The pain fuels voices of doubt echoing in my head which say "Ha, Sucka your never going to move up!", "Your never gonna race again!!", or "You suck, why to you even own a bike!?"



It takes every bit of resilience I can muster to disbelieve them and stay focused on the positive. Speaking of which, on Tuesday I have an appointment with arguably the best cycling specialist in the world. This is a rare opportunity I should be grateful for. (I am!) We have a history and although he hasn't been able to offer a clear answer yet, perhaps this time things will be different. Maybe this new pain will offer a clue.



Racing is much more a mental act than a physical act. If I do make it out on a race course this year I can promise that every single second of doubt, despair or anguish I have ever felt about my knee will be used to fuel intense determination that will be taken out on the race course and anyone who happens to be competing against me.



It's there already, waiting to be unleashed, but the time is not right. For now I will file it away, letting it slowly grow so I have it when I need it. Maybe the pit of despair serves a purpose. Maybe it's days like today that keep me going when it's too cold, when sun goes down, when the climb never ends, and when all I want to do is quit. Or maybe that's how I got in this situation in the first place! Hmm... Either way I'm here now and my immediate job is not to over do things, to stretch, and to keep pursuing a solution for my pain - mental and physical.



In truth, satire is my ladder out of the pit of despair and I wrote this post more for my own benefit than for yours. So keeping in line with that theme, the following couldn't be a more truthful satire of my blog. Even the picture is fitting!



Plug: Check out http://www.dispair.com/ for more hilarious demotivational posters.