Advice please - cruciate injury recovery + clipless

langdang

Hi,
Looking for advice from more people more experienced with knee injuries and recovery.

Herself has a dodgy cruciate, and has taken up road cycling for fitness (as jogging just makes it worse). She's been to a physio, got an mri, got orthotics and all that.

Now, at the moment she is just using the boggo crappy pedals that came with the bike - minus the clips and straps (because I reckon they are far more dangerous/annoying than SPDs or whatever)
She has complained about her foot slipping and sliding a bit on the boggo pedals, and I'm also concerned that she might exacerbate the knee if she continues to slip the foot around on the pedal and is only pushing and not pulling (if you know what I mean).

Two solutions spring to mind:
Use different shoes ( the shoes she is using are stiff soled but not grippy) and better flat pedals.

OR :I have a spare set of MTB Time ATAC pedals (similar to http://www.chainreactioncycles.com/Models.aspx?ModelID=4733 ) knocking around. These are meant to be very knee friendly (no complaints from me anyway).

So, after all that jibberjabber - those in the know, would you say she would be better or worse off with the Time ATAC pedals?

IM0

you've got flat pedals on at the mo, with no toe clips, so they are going to give her the range of motion which is best at the mo...limitless!, you say she is slipping off these ones, so wait untill she can cycle and support her feet on them propperly and then start in to the cleats if that is what you want after that and she gets more comfortable with the current set-up.

doozerie

I'll start by saying that given her injury she should really get advice from a qualified health professional (physio, etc.), and preferably one that has experience of cycling given that the question is specifically about bike position etc. Whatever about the differences in advice you may receive from different health professionals, at least it is based on medical knowledge which can't necessarily be said of advice from people on the Internet.

Having said all that, my un-educated opinion is that clipless pedals with float are a better bet than flat pedals. There is always a danger that your foot will slip off flat pedals, and with an existing injury the risk of making it worse in that scenario are considerable. By comparison, the risk of falling off with clipless pedals tends to diminish quickly after you've used them a few times. Some people just don't take to clipless pedals though, so she might not like them. The float just prevents the knees from being held in an artificial position, instead your foot will naturally adjust position while pedaling to find a knee position which is comfortable.

She'll have to be careful with the height of her saddle too, and her choice of gears. Too low a saddle may put excessive pressure on her knees, as might riding high gears.

langdang

doozerie wrote: »

She'll have to be careful with the height of her saddle too, and her choice of gears. Too low a saddle may put excessive pressure on her knees, as might riding high gears.

Both are an issue - saddle height out of fear, it's not really bad but will just have to work it up slowly so she's confident.
I looked over the other night and she was grinding away in top gear while I was spinning away about 3 gears above that (different bikes different gearing but she was def 2 gears too heavy). Mainly flat around here at least.

The Time ATACs are excellent for releasing the feet - I never once went down with the ship, the natural bail out motion releases the cleats immediately. So ya, there will be a confidence building period there too but of all the pedals she should be fine with them. Easier to walk around in the shoes with MTB cleats too (roadie cleats and tiled floors make for some great Saturday Night Fever dance moves tho).

IM0

doozerie wrote: »

Having said all that, my un-educated opinion is that clipless pedals with float are a better bet than flat pedals. There is always a danger that your foot will slip off flat pedals, and with an existing injury the risk of making it worse in that scenario are considerable. By comparison, the risk of falling off with clipless pedals tends to diminish quickly after you've used them a few times. Some people just don't take to clipless pedals though, so she might not like them. The float just prevents the knees from being held in an artificial position, instead your foot will naturally adjust position while pedaling to find a knee position which is comfortable.

She'll have to be careful with the height of her saddle too, and her choice of gears. Too low a saddle may put excessive pressure on her knees, as might riding high gears.

if her co-ordination isnt to the point of being able to keep the feet on the flat pedals without help [toe clips for ex], then believe me she is going to hurt herself more from falling over learning how to use the clipless! - im not sure what you mean by the "risk of making it worse in that scenario are considerable" its having her feet set up in clipless pedals with float that will make her worse if anything..

the first part of what you said I took as an obvious and would have said it myself if I didnt feel it was obvious enough..

langdang

Thanks so far guys, let me just confirm - I'm not looking for a free medical recommendation here, I'm not going to come after you if it doesn't stack up, just looking for a general "feeling" on the topic.
When I had a knee problem (not cruciate)I was advised to use clipless pedals to even out the enormous amounts of torque (LOL) and make it easier on my knees. I found it helped me spin the pedals in a better motion, as previously I had been doing a bit of "slipping/squirming" the foot around on the pedal to compensate for the injury - I'm wondering does the same logic apply here. I've a feeling it does, so unless someone comes on shouting "NO NO NO she'll be crippled", I'd say we'll have a bash off them once she's a bit more used to the bike and has worked up the saddle to correct height (yes, I know that this will most likely have to be adjusted for the new pedals)

IM0

thats good ^ I think its a good thing given what youve just said about your own experience! were not mind readers :pac: Im sure it will work out fine.

ashleey

I snapped my pcl a while ago but use spd sl pedals now. She must concentrate on thigh strength to protect the knee from outside of range movement. The big problem is that rotating the heel to unclick is a bad movement for her. If you use clipless start on the loosest setting. Overall cycling will be a good exercise though

langdang

thanks Ashleey, cool - getting good input here, the power of boards.ie ha?
Will tell her to be careful with the clipping out. Again, the Time ATACs seem to be fine for this (for my elephant legs at least) but I know some SPDs can require a definite kick-out. There is no setting for the ATACs, IIRC you put the cleats on one way for very easy release, and swap cleats/feet for less easy release.
I think it's her anterior cruciate, will check if it makes any specific difference?

statto25

I am in the same boat. I damaged my cruciate last year and I took up cycling to keep fit. Im using spd's on the lowest setting and I have had no issues yet (touch wood)
I was using flat pedals for a while when I started and found my foot slipping forwards and more than once I jerked my knee pretty badly.
I would recommend the clipless pedals as long as unclipping is as easy as possible on her knee.

doozerie

me@ucd wrote: »

im not sure what you mean by the "risk of making it worse in that scenario are considerable"

Having your foot slip off a pedal can lead to a variety of injuries, ranging from the minor to the serious. I injured my cruciate many years ago by hyper-extending my knee - my foot slipped off something as I was putting a lot of force on it and it hit the ground with my leg locked and basically hinged in the wrong direction. This didn't happen to me on the bike, but pedaling hard on flat pedals and having your foot slip is just one scenario where it can happen. I've jarred my knees in the past when using toe-clips off-road where the pedal cage became very slippery when coated with water and mud and my foot slipped out while I was pedaling hard - when your knee is in good nick it can perhaps absorb the kind of jarring it gets in that scenario, but if is is already weakened by an existing injury then the risk of doing serious damage is much greater.

Gipo3

Did she have the ACL reconstructed? I tore mine and had it reconstructed 3 years ago. I use spd sl pedals and have no problems with my knee. As well as that Im back playing football as well no probs.

English Bob

Cycling will be an excellent way to strengthen the quadricep muscles to help support the knee but beware that you take time to make sure the saddle height is correct.
As the knee joint is primarily a hinge joint the action of cycling will be of major benefit in re-establishing a return to normal range of motion and strength. The cruciate ligaments prevent anterior and posterior gliding of the femur on the tibia so commonly sufferers would have problems climbing up or going downstairs.
If the foot slips on the pedal when pushing down there is the possibility the knee will hyper-extend and aggravate the ligamentous damage.
There are proprioceptors within ligaments that give contionuous feedback as to where the joint is 'in space' to the central nervous system, so as time progresses you should find balance and co-ordination will improve. There are some rehabilitation exercises that should be done to help this progress.
If in any doubt maybe beginning with a stationary bike would suit better until said co-ordination has been improved which may reduce the risk of slipping on the pedals. To help strengthen the muscles a higher resistance and lower cadence would be best.
Make sure to follow all rehab advice to reduce the chances of this becoming a re-occuring injury.
Hope this helps.

BostonB

For commuting on my MTB I was slipping off my pedal in the rain. So I got a set of flat studded MTB pedals. With a soft sole the grip is great.

IM0

English Bob wrote: »

Cycling will be an excellent way to strengthen the quadricep muscles to help support the knee but beware that you take time to make sure the saddle height is correct.
As the knee joint is primarily a hinge joint the action of cycling will be of major benefit in re-establishing a return to normal range of motion and strength. The cruciate ligaments prevent anterior and posterior gliding of the femur on the tibia so commonly sufferers would have problems climbing up or going downstairs.
If the foot slips on the pedal when pushing down there is the possibility the knee will hyper-extend and aggravate the ligamentous damage.
There are proprioceptors within ligaments that give contionuous feedback as to where the joint is 'in space' to the central nervous system, so as time progresses you should find balance and co-ordination will improve. There are some rehabilitation exercises that should be done to help this progress.
If in any doubt maybe beginning with a stationary bike would suit better until said co-ordination has been improved which may reduce the risk of slipping on the pedals. To help strengthen the muscles a higher resistance and lower cadence would be best.
Make sure to follow all rehab advice to reduce the chances of this becoming a re-occuring injury.
Hope this helps.

lots of good advice in there and an explanation of whats going on and re-assurance op ,
excellent stuff english bob.

Lumen

Anyone got this? I had a poke around the Google Books version for some stuff about cruciate ligaments and it looks interesting.

langdang

Thanks guys, was in a wifi free zone for the weekend.
@Gipo, no not reconstructed. Did you have any problems clipping out? Or just set to the lowest tension ans away you go?
@EnglishBob - yes - stairs and walking hills really showed it up. It was an underlying niggle for a while but really hit in a few months ago. Women are at much greater risk of damaging the cruciate due to a combination of factors apparently.

doozerie

Good point above about clipping out possibly aggravating the injury. I noticed this too on my commute bike (using Shimano SPD pedals - metal cleats on metal pedal catches) but had no problems on my road bike (using Look pedals - plastic cleats on plastic pedal catches). I found that keeping my leg straight when clipping out was easier on my knee as I was able to twist my entire leg rather than just my lower leg, the worst point to clip out was with my knee bent as the knee joint bore the brunt of the effort.