Pedals turning

For sanity’s sake as much as anything, I kept the pedals turning on every day since the injury. Riding the Dahon I didn’t make it above 5 or 6km for the first six days. Under the circumstances, I was very pleased to be able to join the family New Year’s Day ride, even if I did only jump on board for the final 6km.

By the seventh day (4 January), I was confident that I could put quite a bit of force through the ankle in the cycling motion, even though walking was still a little dicey. So I joined the family again for an excursion along the Eastlink Trail and Dandenong Creek Trail.

This sudden jump to 20km with no ill-effects (I think this was the last day I applied ice to the ankle) indicated that recovery was progressing well—just in time to ride to work the next day. So much for the much-needed fortnight of hill work during the Christmas holidays!

Normal service resumes

The week of commuting was largely uneventful and led to no serious ill-effects on the ankle. I felt so good to be riding again that I included a Yarra Boulevard detour to my commute on Friday.

I started removing the ankle bandage on about the tenth day (7 Jan), and went without completely on Friday and yesterday (nearly two weeks from injury).

Into the hills

I returned to the hills yesterday with a ride in the Dandenongs. The hills were gorgeous but it was hard work—not what an excursion to the Dandenongs should be within a fortnight of the Alpine Classic! I took that as a reality check: I won’t be doing the 200km ride at Bright (unless I have a complete rush of blood to the head the day before!)

I can’t really blame the lack of form on the ankle sprain—I should have done much more climbing in the later part of last year—but I reckon I’d be in better shape if I’d had that post-Xmas week to push myself. As it is, I feel that I’ve lost a little form because I didn’t feel nearly as strong as I did on my last visit to the Dandenongs at the end of November.

All I can do now is take myself up some big hills next weekend and see how I go.

Current score

I’m still walking a bit gingerly as the ankle continues to feel a little unstable and tends to get tired. It’s amazing how often during an average day you nudge, push, kick and turn things with your foot—all of which are quite painful when I forget that I’ve got a dodgy ankle. As for running, forget it. But that said, I shifted some bulky furniture yesterday (very carefully!) with no complaints.

However, when cycling things feel great—presumably because the ankle moves through a predictable and safe range of movement. The odd road bump may cause uncomfortable jarring and I still prefer to help my foot out of the pedal by hand, but other than that I can only conclude that cycling is aiding my recovery.

The boffins say that detraining is:

the partial or complete loss of training-induced anatomical, physiological and performance adaptations, as a consequence of training reduction or cessation.

Training cessation implies a temporary discontinuation or complete abandonment of a systematic programme of physical conditioning.

We’re talking discontinuation here, not reduced exercise or tapering. I hardly think of my daily ride as “training” and certainly not “a systematic programme”, but I guess that’s what it amounts to.

It’s interesting to note that they don’t talk about levels of “fitness”. As they say over at Peak Performance,

‘fitness’ is a difficult term to define because we often find ourselves asking ‘fit for what?’

This rings true for me: I’ve been unwell but I don’t feel “unfit”. But I have noted before that even a few days off the bike takes a bit of an edge off my usual capacity. So what can I expect now that it’s been several weeks without a ride?

There a whole stack of things that happen when you detrain, a few of which I actually understand.

Cardiovascular

In the heart and lung department total blood volume drops within the first few days, which leads to reduced cardiac stroke volume (the amount of the red stuff squeezed out of the heart at each pump) and increased exercise heart rate.

Now cardiac output is calculated using the simple formula:

cardiac output = heart rate × stroke volume

so you’d think the increased heart rate would balance the decreased stroke volume. Not so, apparently:

The increased exercise heart rate values resulting from cardiovascular detraining do not seem to be sufficient to counterbalance the reduction in stroke volume.

Added to that—even without the chest infection—my breathing is going downhill:

Maximal oxygen uptake (VO_2max) has been shown to decline by anything from 4-20% with inactivity of two weeks or more

Joy.

I’ll just skip the metabolism stuff because I don’t pretend to understand it (although a rapid reduction in glucose uptake doesn’t sound like a good thing to me), and move straight on to muscles.

Muscular

Here the news is mixed, but generally not good:

In previously active individuals, four weeks without training results in muscle capillarisation returning to pre-training baseline but it still remains above that found in sedentary individuals.

These guys report a number for the difference:

Interestingly, capillarisation in [athletes] appears to remain about 50% higher than in sedentary controls.

I don’t think of myself as an “athlete”, but I guess I do normally exercise fairly regularly, so I don’t really qualify as “sedentary”. Eh, I’ll claim the higher capillary count.

While the distribution of fast-twitch and slow-twitch muscle fibres doesn’t change much in a couple of weeks, the cross-sectional area—the bulk of the muscles—decreases. I reckon this was observable in my quadriceps in less than a week since I stopped riding.

Muscle strength and power also appears to drop off a bit within a few weeks, as does joint flexibility (although I don’t think I had much of that to start with).

Other stuff

Another earth-shattering study found that:

The initiation of vigorous exercise and its cessation decrease and increase, respectively, body weight and intra-abdominal fat, and these changes are proportional to the change in exercise dose.

In other words, if you exercise you lose body fat and that if you stop exercising you put fat back on. Who’d have thunk it?

That said, I don’t think I’ve put on any weight in the last few weeks of relative inactivity (don’t really track it very closely), but then again I have been sick. Or it could just be the exchange of muscle bulk for blubber.

At the same time, my food intake has dropped quite a bit—I’ve had no need for second breakfasts or second lunches!

As for the psychological aspects, as I learned last year during the dark days of knee injury, withdrawal symptoms from lack of exercise are real:

Depressed mood and fatigue are commonly observed in individuals deprived of usual exercise activities, and the increase in fatigue may be partially mediated by reduced fitness levels. These findings may explain mood changes in response to short-term exercise withdrawal such as injuries and recovery from medical procedures that do not require full bedrest.

I suspect I’m not quite as grumpy as I was last year, possibly because there’s an endpoint in sight and returning to cycling is highly unlikely to hinder my recovery. But I’m still not happy to be missing good Autumnal riding!

Implications

The cliché “use it or lose it” is broadly true, but if you do use it on a regular basis you don’t lose all of it immediately when you’re forced to stop using it for a little while. (And if you can follow that, you’ve done very well.)

As for returning to the bike, I’m clearly a fair way from my usual condition, so it would be unwise to leap straight back on and go hammer-and-tongs. Despite feeling better this week, I consciously resisted the temptation to rush back to the riding—painful though it is to go without a daily ride—because I’m still on the mend.

I hope to take myself out for a gentle trundle over the weekend and, if all goes well, hit the commute route again next week. The plans for doing a few brevets in May have long ago been abandoned, though hope springs eternal. Provided I’m riding well, some extra distance could be just the thing for regaining that lost condition. But maybe I’ll give it a week or two before I push my luck.

But for now, I’ll just be happy to ride again.

[Heart and lung image from Gray's Anatomy, via Wikipedia.]

Tentative steps

About three weeks ago I took a couple of gentle weekend rides, with only a few slight clicks and creaks coming from the recovering knee. SuperGran said that I’d probably be very aware of anything odd going on down there for a while and that it was probably nothing to worry about. She’s a wise lady is SuperGran.

I might have tackled the commute that week, but I wanted to test it one or two more times. A few busy weekends passed without the chance to get out for another spin. Then for some reason I was extra grumpy yesterday morning, so MLSP threw me out of the house telling me to get on the bike and not come back until I could be cheerful.

So off I went, along my usual commute route. Barely the fainest pang or crick was felt in the left knee. Everything was going OK, so I continued along to tackle my nemesis: the little roller coaster dip under MacRobertsons Bridge. This is where it all fell apart last time.

The deadly dipper: city side of MacRobertsons Bridge

I cruised through with considerably more glee than would be normal and healthy in someone reaching the top of such a pathetically small incline. But when you’re in recovery mode, you take ‘em where you can get ‘em. I was pleased to find that I did it much easier than the kid and his dad who were following along behind me—it looked like it nearly killed them.

That was enough, so I turned around and headed for home—cheerful would be an understatement.

Caution to the wind

No more excuses then—this meant I was fit enough to have another go at getting in to work.

Having missed most of winter, I did feel like a bit of a slacker as I blundered around the house this morning trying to find stray gloves and the other bits and pieces I needed to tackle the chilly conditions. When I’m in my commuting routine, I find that Monday mornings tend to involve retrieving bike gear from wherever the hell it’s become dispersed over the weekend. Today the dispersal was multiplied by three months…

Not unexpectedly, I completely failed to make an early start.

But eventually I was away. Every little hill was a test, as I anxiously waited for something to go “twang” and pain to return.

Yes, it really felt this good...

It didn’t.

I made it.

And my goodness, it’s a beautiful day, isn’t it? (If you were on the Gardiners Creek or Yarra Trails this morning and some grinning idiot burbled “Hello” at you, that was probably me.)

It was a slow ride and I was spectacularly late to the salt mine, but I didn’t care: the theme from “Rocky” was playing in my head as I walked in the door.

Now, I just need to decide whether I should ride home tonight, or should I follow MLSP‘s advice to take it easy and catch the train…

Super-Gran measured the ride at 19km—far enough to get me thinking about returning to the commute! So I gave it a few days, to be sure there were no nasty after effects, and decided to have a go at the commute this morning. I’ll admit to being as excited as a kid on Christmas Eve last night.

I laugh in the face of your so-called “gale warning”!

Others might have considered a weather forecast that includes gale warnings as pretty unfavourable, but in my world it was a perfect day for a ride. I trundled along, sending silent praises to just about everyone from Karl von Drais to Tullio Campagnolo, John Boyd Dunlop to…umm, whoever it was who invented bike mud guards. Anyone and everyone who has ever had a hand in developing and making these beautiful, elegant machines. What the heck, I even felt good toward the jokers who invented STI gears! Yes, it was indeed a beautiful morning.

But it’s funny how your mood can change in a flash, isn’t it? For as I rolled under MacRobertsons Bridge and tackled one of the few inclines on my route, it was all over. In the space of a few minutes I went from not a twinge to “Oooh —! That really —ing hurts!” From the warm glow of happiness to cold, hard despair. My knee may well have been OK for a leisurely trundle along the (almost completely flat) Rosstown Rail Trail on an unloaded bike, but it turns out that it wasn’t ready for a commute on a loaded bike.

And I wasn’t even pushing things—I was taking it really, really easy. Seriously annoyed, I can tell you.

Here’s my Big Lesson for the Week: when recovering, don’t rush your return. Bleeding obvious really, but I don’t think I’m the first or the last to fall for this mistake.

New insight

We used to gently tease the ol’ Retired Marathoner whenever (frequent) injuries kept him from his jogging routine. I’m not sure who first said that it was like he was having withdrawal symptoms, but I’m gaining a whole new insight into it. It really happens—and it turns out that I’m not alone:

Depressed mood and fatigue are commonly observed in individuals deprived of usual exercise activities, and the increase in fatigue may be partially mediated by reduced fitness levels. These findings may explain mood changes in response to short-term exercise withdrawal such as injuries and recovery from medical procedures that do not require full bedrest.

So steer clear people. For your own safety, steer well clear.

(However if you come with sympathy and support, you will be grudgingly tolerated…)

There were two main things I wanted:

Sound advice about cycling and knee injury

Something a bit more substantial than ‘just jump on a bike—it’s low impact so it’s good for your knees’, because my own experience shows that’s not necessarily the case

Sound advice on how I can help my knee recover

I’m thinking that maybe a sensible regime of exercise might be the go here

I found two titles: Knee Pain: The Self-Help Guide, published in 2000 by John Garrett, MD and Bob Reznik, MBA (MBA?!? Do the business schools cover anatomy and physiology these days?) and The Knee Crisis Handbook, published in 2003 by Brian Halpern, MD with Laura Tucker.

Self-help guide

Never really a fanatic for self-help guides, I warily poked inside Garrett and Reznik’s book for what they had to say about cycling. In the chapter on “How to prevent knee pain”:

Another way to stay in shape is to bike, either outside or inside on a stationary bike. Because you are seated, you are removing the bone on bone impact caused by running.

The downside of biking, however, is the movement required typically involves a fuller range of motion than other sports.

And that’s about the extent of it. Not altogether forthcoming about making sure the bike fits. But the point about the extra range of motion is well made: unless you’re running up stairs, you’ll generally put your knees through a greater angle of bend on a bike than on foot. And that’s something I reckon cyclists don’t often think about.

What about their recommended exercises? In the same chapter is a section on “Exercises that make the knee injury-resistant”. Most of these seem to involve squats and otherwise loading the bent knee—and that’s something that’s no longer an option for this little black duck.

True, my knees are probably more pathological than normal at the moment, so how about the entire chapter on “Exercises to relieve knee pain”? That sounds more like my speed. Mostly these look good: plenty of unloaded knee extensions and flexions, leg lifts, ankle rotations, and muscle stretches. (And unlike with the more aggressive exercises in the other chapter, there is only a light-handed attempt to flog their SpοrtCοrd®—something that you could easily substitute with an old bike inner tube and a bit of ingenuity.)

Overall it seems like a pretty comprehensive book on its topic, but for me its coverage of cycling aspects is slender at best (which is odd, considering it includes no less than five photos of cyclists, making it the most illustrated sport in the book). I am also distinctly nervous about the “injury-resistant” exercises they recommend—my experience is that repeatedly loading the bent knee can actually cause injury.

Crisis? What crisis?

So to Halpern’s book, where in the chapter “Play it safer: a activity-by-activity general knee health guide” I read:

Most cycling injuries are the result of overuse. Think about it—if you’re cycling between 60 and 100 revolutions per minute, then your knee is performing the same task between 3,600 and 6,000 times an hour! That’s a great deal of repetitve stress on the knee.

I seem to have heard that somewhere before, and I find it reassuring.

In terms of “protecting yourself”, Dr Halpern makes a series of reasonably detailed recommendations under the following headings.

On proper equipment:

• Make sure you bike is the right fit [yes! yes! yes!]

• Use proper footwear

• Correct leg-length differences

On training:

• Don’t do too much too soon

• Don’t build too fast

• Don’t ride in too low a gear

• Maintain proper technique

• Quit when you’re tired

• Strengthen your inner leg

When compared to the previous book, this is much better coverage of doing right thing by your knees while riding.

Halpern’s recommended exercises are similar to those of Garrett and Reznik—I suppose there aren’t too many different ways the knee can be bended and stretched—but Halpern definitely has fewer that involve loading the bent knee. He also gives a specific caution on squats:

It’s true about all exercises, but especially of squats: proper mechanics lead to results, poor mechanics lead to injury. I’m here to tell you that a properly executed squat is one of the safest exercises out there, and if you can remember to [follow my technique], you’ll be in good shape.

And I’m here to tell you that an improperly executed squat can lead to excruciating pain and debility. So, if you don’t mind Doc, I’ll just give them a miss altogether.

Other than the squats and a small selection of exercises with gymnasium equipment, his selection exercises is easy to perform and requires no equipment more exotic than a towel.

Conclusion

Although I favour Halpern’s book, it’s really unfair for me to “review” either because I only really dipped into them. The sections on knee anatomy and common maladies that affect the knee appear (on a quick skim) to be pretty comprehensive in both books. I must say that in Garrett and Reznik’s book the anatomical illustrations are more generously-sized and lusciously detailed (including a wonderfully squirm-inducing diagram of an arthroscopy). This book also makes better use of photos and diagnostic imaging. And their self-diagnosis flow chart is more extensive than Halpern’s too.

But for his sensible advice on cycling, his caution on squats, and his good selection of gentle exercises, it’s mostly Halpern’s advice that I’ll be following.

Now if you don’t mind, this old granny has to go and take some glucosamine (about which both books are cautiously positive).