Popliteus Muscle and Knee Pain

My left knee issue does not involve and behind-the-knee pain, but this note from reader John S was so interesting and well writen that I thought I’d share it with readers.

John S writes:

Interesting what you describe is very similar to an injury that I had.

About 30 years ago, I blew my ACL. Faithful care and wearing of a knee brace during athletics meant that I was able to preserve the integrity of my knee, meniscus etc… This was the only choice since ACL repair was not very good back in the day.

Two years ago, while eating at an outdoor restaurant on a sunny day, I went inside and stepped off of a step that I was not able to see since my eyes had not adapted well to the dim light. I landed with a stiff leg and instantly knew I had hurt something in my knee. From that time on, walking and other activities caused as snap and pop in my knee that was really uncomfortable. I thought I had torn the meniscus or done something else.

Two trips to sports medicine docs showed led to treatments that were not effective. An MRI reviewed by my ace ortho surgeon showed a knee and meniscus that were "pristine" to use her words (other than the vanished ACL). I was told to come back in several months if no change.

Finally I went back to my family practice doc (also a friend) and told him I wanted to see the very best knee PT that they had. He asked around and set me up with just such a person. She looked at my knee, examined it and told me to come back in a week after she had done some research.

Turns out the pain in my knee was the popliteus muscle- a little known muscle that helps the knee to twist and helps stabilize my knee . What I had apparently done was to stretch the iliotibital band (ligament) which was being compensated for by the popliteus muscle which subsequently was getting over used and was becoming quite painful. This injury is one that could only have come about in a patient without an ACL but other intact structures in the knee - unusual. It can be fixed by surgery, but it has a low success rate.

What she did note - and what you might find very useful, is that due to all my cycling, there was a misbalance in the muscles in the front of my leg compared to the muscles in the back of my leg (hamstrings). She set me on a regime of strengthening the hamstrings and other muscles in the rear to help stabilize and better balance the knee. After about 4 weeks of this, the pain suddenly decreased and after another two weeks all the clicking and clunking stopped. I'm wondering if with all your cycling, if you are not suffering from a similar problem (misbalance). Mine was brought on by the injury and then exacerbated by the cycling (pre and post injury, it seems). Now I'm wondering if had I balanced the groups better, I might have avoided the injury entirely.

Your clicking problem sounds like mine. Your MRI is similar to mine (no problem). So I'm wondering if you might not want to take the path I did with the PT and have them look at similar clues to mine. It's also worthy to note that the pain from my popliteus muscle was really quite debilitating and, interestingly, non specific. My whole knee felt quite sore and tender not just at the site of the muscle. I attribute this to the fact that it's so deeply buried. My doc found it by using his iPad anatomy app, asking me to point at where it hurt and then peeling back "layers" in his software until it's clear that that was the only thing there.

WIND: maybe I should resume my inline speed skating and Olympus squats.

The Left Knee Persists in Griping

My left knee continues to be unhappy; some ache that I cannot even localize and after hard rides (next day) increased crepitation and even a small click. Yet the February MRI showed only mild inflammation in otherwise healthy knee tissues.

As it is, there is no h0pe of training hard enough for any event; the knee can’t accept the training load. My plan at present is to continue training in the hope that the issue slowly improves. Which might be a good plan or a terrible one—I don’t know.

I made an adjustment to road bike cleats and I’d have to say that my knees are tracking vertically as well as ever, and probably better. It doesn’t seem to fix anything. I rode my mountain bike for two (fairly hard) days. That setup has not changed, but my left knee tells me that it is just as unhappy. So more and more I am not thinking this is a fit issue, with the caveat that healing in connective tissue is very slow and thus very hard to say without an extended period of trial.

Pedal offset

The left leg pedal offset is different now: most of 2012 I rode the Cannondale Hollowgram SL crankset, and it had and has a 6mm asymmetry which twisted me up after 10K miles of riding, see Make Sure Pedals are Symmetric!.

That left/right leg asymmetry has been addressed by using the long spindle Shimano DuraAce pedal on the left side; together with appropriate cleat placement so that my left and right feet and knees now have the same offset. This can be seen and the knee tracking is very vertically confined, showing good positioning (really minimal “looping” of the knee).

Unfortunately, James A might be on to something.

James A writes:

Is it correct that the knee issues stem from the bike fit in the city late last year? I know it improved your power output but the joint memory of many years of cycling is what MAY be causing the pain.

It is doubtful from a medical standpoint that continued use will fix the problem. There can be subtle grooving etc. in any mechanical system that is now out of alignment however slightly. Is it an option to go back on one of your older bikes that was set up during your pain free period and train on it. If the pain improves the diagnosis is made and the added power of the new setup may need to be sacrificed for a long term painless ride. Just my thoughts.

Lloyd: At this point I am reluctant to blame the fit because my mountain bikes (setup unchanged) don’t seem to make my left knee any happier, and I also see excellent knee tracking on the road bike. Of course it could be just a different angle to the pedal as well as loading of the knee as well as offset: it’s tricky.

However, the point James A makes is a troublesome one if true: if I have to go back to the 2012 setup, I don’t really want to build in that 6mm asymmetry (seems like a bad long term idea if nothing else), and it is also a problem for any future crankset change, which I plan to make in June/July. As well, all my other bikes have a symmetric crankset. So I could “go back” but this not be strictly speaking the same with a symmetric crankset arrangement.

A Brief Update: Shoulder, Training, etc

Thanks to the well wishers who emailed me about my shoulder: it is doing great, the shoulder surgery was a success and it is working with 90-95% range and no pain.

On the cycling front, the left knee is still giving me problems, so I am going to abandon the blue Shimano road shoe cleats (very little float) and put the yellow cleats back on. And I still cannot feel that comfortable in the new fit, even though the power numbers are higher. This has been a frustrating season, psychologically more difficult than any race, pretty much a goner as far as anything competetive: I cannot make up 2 months of base training and I feel like a porker on the bike (6 pounds heavier than last year at this time).

But today I had a wonderful ride on my Moots MootoX RSL mountain bike up to Black Mountain, the first good ride on it since last fall. Wow! With the tubeless Furious Fred tires, the thing is incredibly responsive and fast.

Weight loss has not happened. With a caloric deficit for 10 days now, I’ve gained 2 pounds. Well, I’ve probably lost some fat, the the heavier training seems to have my body retaining water or food or both. Damned hard pyschologically, so I’ll just have to keep at it. But that damned left knee has to get happy to make it possible.

With all this, I am totally intimidated by the idea of doing the Alta Alpine 8-Pass Challenge this year, which is only 7 weeks away. Last year I romped through it (first one to finish for the day, but 2nd place) and was rather pleased with my effort. This year I doubt I could finish. It’s hard to underperform past levels.

Sony DSC-RX100: Perfect Cycling Camera?

Putting my recent post of Form Factor and Camera Appeal to a real-world trial, I stuffed the diminutive Sony RX100 into my jersey pocket and headed out for a multi-hour mountain bike ride on my Moots Mooto X YBB 29er. I also have the handy Richard Franiec stick-on grip on mine.

The Sony RX100 had impressed me last fall, but it did so all over again: small and light so that I scarcely notice it in a jersey pocket, the most natural fill flash I have found in any camera at any price (set to -1.7 slow sync), excellent exposure accuracy, very pleasing color, bitingly sharp centrally at close range at the 28mm setting.

The RX100 just gets the job done fast and without any of the size/weight hassles of larger cameras: no excuse for not taking it, no excuses for not getting highly satisfactory images. Its a real winner in my book for its combination of features for this type of use. Which is what any successful camera is about. Well, I do wish there were an EVF option, but its rear LCD is excellent even in bright sun.

This image is cropped down to ~12 megapixels. Note the perfect exposure in aperture priority mode, along with flash that is so natural one wouldn’t even know it had been used except for the catch-lights in the eyes.

Alpine Road (Dirt) is Blocked 2/3 Up

Update April 29, 2013: the barriers are still there, but nicely parted, no problem getting through.

I use Alpine Road on a regular basis to get to and from Skyline drive and El Monte Open Space.

But the county has put up barriers about 1/5 of the way down and 2/3 of the way up. I hear that there is absolutely no issue with the “road” (which is after all a trail), which makes this closure rather irritating.

The detour is a slog up a steep and poorly maintained (rutted) Coal Mine Ridge trail.

Sometimes Good Surprises Happen

Mastering one’s own psychology is an ongoing challenge for any athletic goal.

As I wrote in Training Restarts as the Virus Retreats, I have to be realistic about what losing nearly three months of base miles means for competitiveness in the Everest Challenge (or even being able to complete a double century anytime soon). It’s especially hard (for me at least) to come down from the “high” (last fall’s extreme fitness).

Then there are those unexpected bonus days in which everything “works”.

Like today when after being almost sedentary for six weeks (shoulder surgery and a 2+ week virus assault following weeks having to back-off from a knee irritation). So today I rode my most enjoyable ride of the year; it just felt easy and fluid and everything that it ought to feel like when things are working optimally. Well, my legs did feel it by the end (endurance down), but dang it felt good, which was a much needed pyschological boost after several challenging months in multiple ways. This kind of positive result helps reestablish a sense of normalcy when too many disruptions have occured.

Surely the new bike fit helped in delivering the respectable 254 watts for 75 minutes (though it remains to untrain my body from its asymmetric twist from the former asymmetric-crank mistake). The pouring rain did not dissuade me in the least as I was feeling relaxed on the bike.

My heart rate was ~17 beats higher than a similar workout last fall (155 = 88% of my max of 175), and that is too high for this power output, but such HR behavior is always true early in the season and/or when detraining occurs and/or if not fully hydrated (I wasn’t). That should drop with miles on the bike, so I have no concern there, and one ride does not establish a baseline. Besides, my small airways remain somewhat impaired and reactive from the virus, and that definitely raises heart rate by reducing oxygen uptake.

Training Restarts as the Virus Retreats

Aside from one aborted “raw lungs with coughing fits and wiped out afterward” ride back on March 22, today is the first day back on the bike since a virus made its way into my lungs. A two week lapse.

But let me digress first: about 10 years ago I had a case of viral pneumonia (“a lung full of pus” according to my doctor. Pulse oximeter down to the low 90's, minor exertions being major efforts. Took three months to recover and the left lung had some presumed scarring.

So now when a bad virus gets into my lungs, where does it head? Straight into the left lung with its damaged tissue. I can feel it set up shop with each and every pulmonary infection. These are infrequent, and my body usually kills it off quickly. But virii just love hanging out there and sticking it to me, and this latest nasty bugger started whole body first, then finally set up shop in the lungs. It is a definite physiological weak area in which my body clearly has a hard time killing off the intruder. A real risk with the wrong virus—I suspect that I have an increased risk of mortality from pneumonia later in life due to this weak area. But we all have our issues, don’t we? :)

So I’ve been mending slowly over the past week, and I felt well enough to ride today. Small airways perhaps at 60-70% of my usual function (my own estimate based on pulmonary tests over the years), with noticeable impairment so that any effort over ~240 watts couldn’t last very long without inducing asthma-coughing (yes I am treating with an inhaler every day). I expect that it will take 2-3 weeks for the lungs to perform without griping, as the inflammation recedes.

The good news is that I completed a 80 minute ride at decent wattage (210 watts), the legs felt OK and I wasn’t worn out by the effort. With the weather lovely and balmy, what a treat.

The disappointing angle is that as far as the 2013 Everest Challenge, it is pretty much impossible to make up missing the three solid months of base miles and double centuries that I had done by this time last year. But if all goes well I should be able to complete it, even if not realistically aiming for top-5.

James T writes:

I had my first case of viral pneumonia back in 1970 after riding a motorcycle across the U.S. - almost nonstop. Spent a week in the hospital. Now I get it pretty easily. My first year of teaching elementary I "caught it" thrice. Boy, talk about sick.

Fortunately the bicycling seems to have strengthen the lungs although I've got plenty of scar tissue (which my doc keeps an eye on . . . just in case). My doctor is an avid bicycle rider – to from work daily – and does as many centuries as he can find time for.

Since you've already experienced the joys of pulmonary issues I won't say more. Let's just say I was delighted to hear you're back on the bike and working on getting back "up to speed."

DIGLLOYD: I agree on both counts:

• A prior pneumonia damages lung tissue with internal trauma resulting in overly sensitive and not entirely happy lung tissue, and possible scarring.
• Vigorous physical exercise strengthens lungs in general; over the past two years of vigorous cycling my lung function as tested at a pulmonary specialist shows small and large airway function to be at a 20-year peak.

So I suppose that one could argue that cycling or any form of regular vigorous excercise is a preventive measure against lung problems in general. Not a guarantee, but at least moving the odds in a favorable direction.

Back on the Bike — And Back Off

Well, I was a little optimistic five days ago about being back on the bike. It seems that this year is throwing me a lot of curve balls.

After a few hearty days of riding, I picked up some kind of achy virus thing four days ago. It wasn’t so bad in general, but Saturday night my entire lower back hurt so intensely that I was practically hyperventilating with the pain (I could feel a throb of sharp pain with every heartbeat). Not particular to any position or motion at all (in short not a disc thing or something structural). It was worse than my post-surgical pain, and I have a high pain tolerance. I was literally just about ready to head to the ER, thinking maybe caution was in order (e.g. infection of spinal area), but finally around 2 AM it settled down and I was able to sleep and besides I had no signs of any issues with lower body neuromuscular control. Still feeling weak today, but the back pain has gone away entirely. It’s a puzzling rapid onset thing, but I feel a rawness in my lungs too and some overall lingering achiness, so it almost certainly has to be an infection. Puzzling thing is I had a 3-4 day bout of something like this two weeks ago, which disappeared prior to resuming riding. Maybe resuming riding weakened me just enough for it to resurge.

Anyway, my 2013 season is shaping up to be a total loss in racing terms. I guess that’s the way it goes when summer weather arrives in March.

Elliptical Trainer for Cross Trainer?

I don’t currently cross train much, but an elliptical trainer is surely a good complement to cycling, so I mention it here. And no doubt a good elliptical trainer ought to cost as much as a nice road bike.

According to a cardiac surgeon friend of mine who has “been through them all”, the brand and model of choice is the Landice E950 ElliptiMill Elliptical Trainer with the executive panel.

Search for Landice E950 Executive Trainer ElliptiMill

Make Sure Pedals are Symmetric!

The new bike fit has given my body some grief (knee) simply because my body was twisted oddly from the old fit; it’s taking some time to retrain my body to be symmetric on the bike.

It turns out that the Cannondale Hollowgram SRM crankset was 6mm skewed to one side for 10,000 miles due to the way it mounts in a PressFit 30 BB (or whatever), which caused my body to develop a hip/knee twist thing that I am now trying to 'unwind' in the new symmetric pedal offset position. The body is good at long adaptation to insults. And not so good at unlearning them, especially if one drives power and endurance gain through legs asking “what the heck is going on here”. Hence my knee irritation.

My unconfirmed information is that the latest Cannondale Hollowgram model does not have this asymmetry knee-ache problem, but I don’t know that for a fact.

I don’t quite understand if the 6mm asymmetry was due to the crankset itself, the SRM modification or the PressFit 30 adapter or all of the above. But now that both Chris King and Shimano are releasing PressFit 30 adapters for a DuraAce crankset, I’d rather sell the Hollowgram SRM crankset (FOR SALE) and get a 2013 DuraAce crankset. To this day, nothing shifts or lasts like DuraAce. I wore out the FSA chainrings and am currently running new Praxis rings. DuraAce does not wear out like that and it shifts better too.

To unf*ck the crankset asymmetry, I am actually riding with a Shimano DuraAce long-spindle left pedal and regular (short) spindle right pedal to compensate for the 6mm crankset, along with a small cleat offset on the left. This yields pedal symmetry left/right to within 0.5mm now. My knees are tracking visibly better.

My advice: never, ever install an asymmetric crankset, or at least adjust the cleats or pedals to compensate. Forcing hips and knees to deal with an asymmetric pedal position is a serious long-term concern for generating problems. I think I vaguely recall my LBS noting the asymmetry, but the significance was not explained to me. Knowing what I know now, I say avoid it like the plague.

You can check asymmetry by measuring to the same point on each pedal from a center point on the seat tube.

Everest Challenge 2013 is a Month Earlier — Late August

The Everest Challenge for 2013 has been moved a month earlier to August 2013:

Everest Challenge Stage Race and Fun Ride (8/23-25, 2013) Yes, circumstances have pushed us to either earlier or later than the weekend we would really prefer. But this is our new home on the calendar.

This is the one everybody talks about, and looks forward to every year. The toughest back to back days of climbing at altitude. Anywhere. Same course as 2012, including the *extra* bit up Waucoba Canyon. This will be the permanent EC course.

Even better support, more goodies in the goody bags, more Free Friday Feast, and more of everything you love about the best road race – and fun ride – on the planet!

Ouch. Late August can be HOT. As in 100° or more tandoori oven style in certain canyons. Bring the intravenous saline drip for those who forget to take the right amount of electrolytes.

With the knee and shoulder thing, I’ve already lost nearly 2 months of key early season distance training, and now with the Everest Challenge a month+ earlier, I’m just going to do my best.

Back on the Bike

My shoulder surgery is all but healed for reasonable uses, and I am able to ride my mountain bike and road bikes again, for a week or so now. Full strength isn’t there, and the shoulder capsule needs work (still tight but the obstructions are gone), but boy is it nice to be riding again, especially with the balmy near-summerlike weather.

But fitness doesn’t stick around at my late middle age, and I can tell that the month or so of downtime has not made me faster. Hard work ahead.

Shoulder Healing, Left Knee Happy or So I Hope

My shoulder surgery was two weeks ago; the shoulder shows promise, but the physical therapy / recovery end of it is no picnic. And darned if surgical anaesthetic constipates badly for an entire week. MiraLax to the rescue and all is finally back to normal.

As for my left knee, it is a happy camper having been off the bike for two weeks. Going back in for a bike fit adjustment to compromise with it so I can (hopefully) get back to some rigorous training. Nothing is for certain there on what might please the Left Knee, but at least an MRI shows nice healthy tissue.

As long as things all work out on both 'joint' fronts then I can’t complain.

But I’ve lost ~6 weeks of key early season endurance training, and the Everest Challenge for 2013 has been moved a month earlier to August 2013:

Everest Challenge Stage Race and Fun Ride (8/23-25, 2013) Yes, circumstances have pushed us to either earlier or later than the weekend we would really prefer. But this is our new home on the calendar.

This is the one everybody talks about, and looks forward to every year. The toughest back to back days of climbing at altitude. Anywhere. Same course as 2012, including the *extra* bit up Waucoba Canyon. This will be the permanent EC course.

Even better support, more goodies in the goody bags, more Free Friday Feast, and more of everything you love about the best road race – and fun ride – on the planet!

Well, this sucks: late August can be HOT. As in 100° or more with a tandoori oven effect in certain canyons. Bring the IVs for those who forget to take the right amount of electrolytes.

So now I have one less month to train at the end of the season on top of being at least 6 weeks in deficit so far, which makes 2013 even more of a challenge. But so long as I can ride and ride hard within a month, I’m game.

I Am a Cyclist (video)

Uh oh, this hits home all too closely!

This video from Xtranormal, sent by Denny D. Press the Play button below.

Snow Has To Wait for the FrosTi and Me

Due to recent shoulder surgery and a knee issue (feeling fine there now due to time off the bike), riding the Moots FrosTi has been on hold and my planned 'snow' trip has been postponed. I’ll get to it when physically fit for it, but at present I am in recovery mode for the shoulder, which cannot take pounding or torque riding such a bike.

Speed vs Power

I used one of these wattage calculators to compute the speed (miles per hour) vs power (watts) to maintain that speed.

The relationship is highly non-linear (cubic). This leads to a few generalized conclusions:

• Once over 20 mph, over-efforting to go just a little faster result in diminishing returns: much higher wattage to go marginally faster; most power is going into wind resistance.
• While ascending a steep slope, speeds are low and thus over-efforting translates almost directly into increased speed proportional to increased effort (low wind resistance).

In short, pushing 10% harder on a steep climb will result in nearly a 10% speed increase uphill. But pushing ~10% harder at 25 mph results in only a 4% increase in speed to 26 mph.

This simple idea translates directly into race strategy especially: go extra hard uphill, rest downhill, go moderate on the flats (and draft whenever possible). But there’s a twist: drop your competitors on a climb and then miss a drafting group by soloing out in front not a net gain (you’ll be caught)!

See also:

• Faster Ascents By Reducing TOTAL Riding Weight
• Predicting Ascent Times From Total Riding Weight
• How To Drop Pounds For Climbing
• Climbing Speed Case Study for Everest Challenge Stage Race
• and other related articles.

My reams of training data over the years validates the idea that climbing weight matters more than aerodynamics in climbing intensive races. Drafting (a key race strategy) nullifies any aero advantage on the flats (aero bars are prohibited also). As for descents, the gains are marginal compared to climbing (easily observed vs other riders even those on aero bikes), and the super steep descents in the Sierra are perilous under some wind conditions, so I reduce speed intentionally anyway. And the rest of the race, it’s steep climbing.

Omega 3 in a Tablet

I’m no expert on Omega 3 supplements (fish oil), but I want the real deal from consistent fish, and I want mercury-free.

Lately I’ve been taking Vectomega tablets instead of the oil gels. Though the latest research (sent to me by a cardiovascular surgeon) suggests that Omega 3 supplementation is useless for cardiovascular health, there might be some anti-inflammatory prospects. Still, is it worth spending money on this? I can’t say.

I’ll miss those fish burps.

Vectomega is a natural whole food omega 3 complex containing DHA, EPA, phospholipids and hydrolyzed peptides (amino acids) from salmon (Salmo salar) extracted by a patented, chemical free process, using only natural enzymes and a cold water flush.

Vectomega is a high grade biologically active Omega 3 (DHA/EPA) vectorized under a phospholipidmethod.It is the only omega 3 with DHA and EPA in a biological form as it naturally occurs in salmon (not chemically altered or spiked), ensuring absorption.

Vectomegas unique bio-molecular profile, based on the vectorization of its omega 3 fatty acids, phospholipids and in association with hydrolyzed peptides present a remarkable natural food supplement, which is absorbed up to 50 times greater than fish oils, free of cholesterol, heavy metal contamination, and of any toxicity; its ability to be digested and assimilated are at the maximum level, based on clinical studies.

Phospholipids and hydrolyzed peptides are the transport system enabling DHA and EPA to penetrate the cell membrane and blood brain barrier. This unique phospholipid transport system is only found in Vectomega and increases considerably the nutritional potential.

It's not how much you take that is important, it is how much that is absorbed at the cellular level. Vectomega is the ONLY 1 a day, Omega 3 complex with DHA/EPA, phospholipids and hydrolyzed peptides from Salmon.

Off the Bike For a Week — Shoulder Surgery

With my recent shoulder surgery, I haven’t been on the bike for a week now, which is the longest period in 2 years for me. Feels a bit weird, but the whole shoulder thing is distracting enough to make me not notice so much. Perhaps by the end of this week I can do a shorter ride with some care. Still, I seem to need to sleep 12 hours a day post-op, so hastiness is probably not wise, not just yet.

The good news is that my knee seems to have completely lost any achiness, indicating recovery from its inflammation. The question is, can I get onto the bike and avoid re-irritating it? Hence a conservative re-entry to mileage.