Jim’s Tech Talk
By Jim Langley
I’m opening this week with a funny story because I’m in a much better mood recently (tell you why in a minute). It’s a tale about something that happened while my wife Deb and I were biking across country in the winter of 1979.
We left New Hampshire in October, just days after the season’s first snowstorm. So my custom Richard Sachs and her Takara were as loaded as bikes can be with our winter camping gear. Every time the road rose – like when scaling the seemingly never-ending walls through Massachusetts’ Berkshires, we slowed so much it seemed we might fall over.
Our route took us to Florida to visit relatives and then hugged the coast to Texas. Covering about 65 miles a day, we had lovely weather across Florida, Alabama, Mississippi and Louisiana. It turned cold again in Texas and we were glad to still have our woolies in our bags.
Texas is huge and it took over a month to cross it. We met so many friendly and super hospitable people there – to the extent that families in Galveston, San Antonio and El Paso let us stay in their homes and even took us out on the town.
A Soothsayer Speaks
The day after Christmas, while heading out of El Paso, the funny incident took place. We probably looked pretty road-worn by then with roughly 2,800 miles under our wheels and everything but the kitchen sink still hanging from our bikes – even a goofy “California or bust!” cardboard sign I stuck on. We were surely crawling along, too, since we weren’t in any hurry.
As we cruised through a quaint neighborhood like this, an old timer sitting in a rocker on his porch apparently took notice. Because he hollered out something loud and clear that cracked me up at the time and has since come back to me many times over the years.
What that guy shouted was, “You better enjoy it – because you won’t be able to walk when you’re my age!”
I was 26 at the time, fit and injury-free. The previous year I’d pedaled 5,000 miles and ran enough to qualify for the Boston Marathon. I didn’t foresee any problems walking in my future.
The Worst Kind of Gravel Grinding
Fast forward to the winter of 2018 – as in seven months ago, and I (now 65-years-old) was almost convinced that Texan was spot-on about me not walking again. Well, I could walk, but cycling had become so painful that I was only able to get my daily rides in at a conversational pace.
This was frustrating because I had big goals for 2018, but there was no way I could train, let alone put out the watts to compete. Due to the drop in intensity, over a period of weeks I started putting on weight, lost motivation and began having trouble sleeping.
The feeling in both knees was like there was gravel under the kneecaps. I could spin the pedals fine but every time I applied pressure the pain was so severe I had to back off. I started riding easier and easier. I stuck to flat routes. I stopped doing the team’s weekly training rides. I rode the trainer more and more.
But the pain didn’t get any better. None of my regular stretching and foam roller work that helped before did anything. 1,000 mg of ibuprofen dulled the pain but it didn’t last.
Doctor Spiegel to the Rescue
In May I’d had enough and decided to get professional help. I had X-rays taken, which showed that both kneecaps were bone-on-bone. There’s supposed to be clearance between the bones and zero contact. Even to my untrained eyes, it was obvious why it hurt so much to turn the pedals.
Then Chris Baker, one of my teammates who heard I was suffering with knee pain told me that he too had a bone-on-bone knee condition. And, that he had seen Santa Cruz, California orthopedic surgeon Dr. James Spiegel. Chris said that he and the doc had determined his best option was knee-replacement surgery.
The prospect that I might need knee replacements terrified me, however, hearing the name Dr. Spiegel gave me hope. He’s the doc who put three screws in my right hip to fix it when I fell on black ice in 1993. I was riding like new only 10 weeks later. I made an appointment straight away.
And, just like how he got me back on my bike after my broken hip, Dr. Spiegel.. in just a few minutes essentially took me from the depths of despair to giddy with excitement over the possibility of actually getting past the knee pain and successfully training and racing again.
I should pause here and state clearly that if you have serious knee pain and a bone-on-bone condition, you should get checked out by a doctor, too. However, I want to share how Dr. Spiegel helped me just in case his advice might help you, too.
Helpful Words and an Easy-to-Perform Exercise
After reviewing my X-rays and sharing his observations with me, Dr. Spiegel did a physical exam of both my knees. Then he asked what I was hoping to hear from him. I told him I wanted badly to be able to race again and did not want to have knee replacements.
At that he smiled and told me a few things that made my day and completely turned things around for me. In a nutshell, what Dr. Spiegel told me was (I’m not a doctor – I’m paraphrasing what I heard here):
- Your knees are already ruined. You can’t hurt them any worse riding. If you can stand the pain and discomfort, your knees will keep on going.
- To ease bone-on-bone pain all that’s required is the tiniest amount of clearance between bones.
- There are lots of things to try to ease the pain including physical therapy exercises and even home treatments such as cannabis oil and other salves.
- Cortisone shots can be effective and last for up to six months. Usually not recommended for young athletes, cortisone is less worrisome as you get along in life as I have.
- Having knee replacement surgery is the last option and only considered when every other option has been tried. Also, there’s no guarantee that a knee replacement will eliminate pain and discomfort. It might, but it’s possible to have issues with artificial knees, too.
My Recovery Track
It’s been three months since my visit with the doc and I’m delighted to report that I’m back training and racing. While my knees hurt a little now and then, it’s nothing like before and I don’t see them stopping me meeting my goals again.
I’m not 100% sure which was the magic cure, but first, I took Dr. Spiegel’s advice and had him give me a shot of cortisone in both knees. I didn’t notice that that made a difference cycling right away but it might have.
The reason I don’t know if the shots did the trick is because the same day I had the shots, I also started doing an exercise Dr. Spiegel recommended called the Muncie Method or Exercise. It’s a simple one done at least three days a week while sitting on the floor (no apparatus required). It strengthens the quadriceps muscles inside of the legs just above the kneecaps. As these get stronger, they pull on the kneecaps in such a way to create clearance to help my anterior bone-on-bone condition.
The first week I did the Muncie Method my legs were super sore, so I am pretty sure it’s this exercise that did the most for my recovery (there’s no soreness after doing the exercise any more). I don’t know if the Muncie Method will help everyone with bone-on-bone knee pain, however, it is helping me and I wanted to share it.
The exercise is not difficult but it needs to be done correctly. So, please follow this link for clear instructions and an illustration. You can also search on the “Muncie Method” or “Muncie Exercise” and find lots more. I hope that if you have bad knees it can help you as much as it has me.
For more information, see http://www.sportsmed.net.nz/knee then click on Muncie Exercise.
Here’s a YouTube video that also demonstrates it, but it makes more sense if you read the instructions and then try to follow the video.
Ride total: 8,961
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Glad you can still ride. I see cyclists all the time and to get them pain free back on the bike, I have installed MANY shorter cranks. If any are interested, please contact me and, along with Jims exercises, we can get you back on the bike riding with a lot less discomfort.
In fact, I’m currently working with a 24 year old domestic pro (previously on) KHS Maxxis that is having knee pain. Way too long of crank arms. With the current cranks arms, his knee pain went away!
Jim Langley says
Thanks for making that point, Coach! I did actually go to shorter cranks a few years ago and it did make my knees feel better. I went from 175 to 170 on my road bikes and down to 160 on my time trial bike. To describe the feeling, what I felt was a smoother pedal stroke. With the longer cranks it had started to feel like I had a hitch or hiccup in my pedal stroke – like a machine with rods that are loose or bumping into each other. With the shorter cranks that feeling went away and I felt like I could spin smoothly at any rpm.
Great to hear Jim! I know you’ve been struggling to find a solution for a while now. It’s kind of surprising to me that your cartilage is gone, I think it’s generally assumed cycling is low stress, and good for our joints. Did your Dr. speculate on why your cartilage is so worn?
And, as an aside, I see Chris is back riding with his new knees. Glad to see him back on the bike.
Jim Langley says
Thanks, Mark! I asked the doctor if my running or many consecutive days of cycling caused my knee issues because I wondered why, too. But he said that there isn’t any way to know for sure and that it could be anything, including genetics. I thought that was pretty interesting because right along I was thinking it was due to overuse or abuse.
Makes sense. I am 66. Five years ago, I had what my coach/PT and my orthopedist assumed was a torn meniscus. An MRI told a different story: bone on bone arthritis. Ortho said keep riding, but not climbing (I was training for the Death Ride), and don’t run. My PT laughed, and assured me that leg strengthening exercises to keep those bones separated would keep me riding and running. I didn’t do Muncie, but the various exercises I did seem to have worked. I rode up Haleakala on Maui last week, and it wasn’t my joints that hurt…
Jim Langley says
Thanks for sharing your experience, Winnie! I’m really happy to hear your PT was right and you were able to keep training and racing. And congrats on your Haleakala conquest – one of my favorite climbs.. Sounds like you did the Cycle to the Sun ride since that took place last week http://cycletothesun.com/ My friend Chris was there and said it was incredible.
Steve Bayard says
Don’t fear getting replacement knees…. Mine are 20 years old and going strong like 1,000+++ road miles a month for the past ten years…. Will be doing RAGBRAI again thos year for the ninth time… Age???? A young 80…
KartaPurkh Khalsa says
Stupid Question Department: is tha 20 reps three times a day or three sessions with a total of 20 reps daily? Sorry to be so dense but i’m A former teacher and assignments should always be specific.
Jim Langley says
Maybe you’ll see this, sorry to only reply just now. What I do is 3 x 20 reps. So 20 reps left leg, 20, right and repeat so that each legs does 3 x 20 in one session. As you get stronger you add more.
Thanks for asking,
Mike T. says
What a great story Jim. Congrats. You must feel like a million dollars.
Decades ago my winter training bike had 165 cranks (170 on my summer road bike) and I loved those things, I could pedal such smooth tiny circles and wind them up so quickly. I’ve never had any knee problems so I didn’t bother sourcing a set for the summer road bike. I did go from the “traditional” 175 MTB cranks to a pair of 170s and I still love them.
Hi I know this is an old post but I think this exercise will help me too but I was just wondering if you continued cycling while doing the exercise or did you build up some strenght with the exercise first before returning to cycling ?
Jim Langley says
Yes, I kept cycling while doing the exercise. I was riding the trainer during the worst of the injury. So, I would essentially pedal on the trainer for a little over an hour trying to avoid making my knees hurt. The idea was to keep the leg muscles working and the heart/cardio without making the knees any worse. While riding the trainer, I added the Muncie exercises and gradually I was able to start adding outdoor rides.
I hope it helps you, too!
Martin Sigrist says
I am sure the exercise can benefit some. However knee pain is a symptom that can have many causes.
As well as strengthening (as in the exercise) mobility is critical. You need to be able to move all your joints through a normal range of motion freely and without pain.
This is not just about the knee joint. Pain that appears in the knee may be a result of issues elsewhere. The body is a connected system and if your hips or ankles are restricted then the knee may attempt to compensate. The result over time will manifest itself as knee pain but the cure will be elsewhere.
Any health or general wellness program should include mobility. My preferred source for this is The Supple Leopard and every thing else from Dr Kelly Starrett.
For me this is not just theory. I suffered 35 years of knee pain after knackering both knees playing football in my mid 20s.
My knees are now pain free and I have a wider range of motion than at any time since my injuries.
Just one simple thing has made a huge change. Every morning I drop into the bottom of a squat and spend time there breathing in and out and allowing my joint, including knees, relax. When I started I could barely get my butt lower than my hips and a few seconds was hard. Now I can sink all the way down and spend minutes there.
IMO this is one thing that every human on the planet should do every day. It is the way our bodies were designed to relax, not a drill (watch any child fascinated by an insect on the ground).
But use it or lose it, if you spend years never squatting and think it is something that is only ever done in gym it will not be just your knees but your whole body that will suffer in the long term.
Left knee was replaced a year ago. Right knee is probably due in another year. Absolutely worth the the hassle if you want to walk and ride your bike although I miss running which I did for 45 years.. Question I always get is from other bike riding sufferers is how did I know it was time to give up on the cortisone shots and Synvisc injections? You’ll know.
I had similar issues nearly 30 years ago, and did not get encouraging answers from an orthopedist. But, then I called Dr. Gabe Mirkin on his radio show (on WTOP, in Washington, DC), and he gave me very nearly this same exercise. Fixed me right up, and 30 years later, still going strong!
Hi Jim thanks for getting back on this , i have been suffering from medial knee pain and vmo issues which has kept me off the bike for quite some time , most of my problem is coming from vmo muscle the inner thigh muscle diagnoised by a physio but have struggled with finding exercises to strenghten it without aggravating the problem , I can do some light cycling at the moment but the problem is still there , this exercise is worth a shot , but it is great to hear that problems like this can be resolved .