Persistent knee pain with stiffness and swelling may be a sign of osteoarthritis. Osteoarthritis is a condition that causes wearing away of the cartilage in a joint. Cartilage is a flexible tissue which allows bones to glide smoothly when moving a joint. When it wears away, there is no cushioning between the bones and they come into contact with one another. A number of problems cause osteoarthritis, but it is seen commonly in people with prior joint injuries and those who have relatives with the condition.
For cyclists, osteoarthritis may or may not be a problem. Depending on how far the disease has progressed, cycling may be affected to some degree. According to orthopedic surgeons, cycling is good for arthritic knees. Keeping leg muscles strong helps to support the knee. And riding helps to keep weight down which puts less stress on joints. However, if knees have deteriorated severely, riding a bicycle may become difficult. In some cases, it may be necessary to ride a recumbent bicycle or trainer to ease the stress on joints. This is particularly true if arthritis is also present in the hips. At some point, the knees may become so painful that a knee replacement is the only choice. Although it’s still possible to ride a bike after a knee replacement, riding as aggressively as with a natural joint won’t be possible. So, prolonging the life of bad knees is a good goal for avid cyclists.
Steps can be taken to continue riding pain free. Taking care of the knee(s) in question is crucial. Pain can be kept at bay with ice, heat, topical treatments (such as those containing Capsaisin, the active component of chili peppers) and over the counter or prescription pain medications.
Regular icing can keep swelling down and minimize pain. Stiffness upon waking and after prolonged sitting is common. Heat alleviates the stiffness, and frequent standing with walking breaks keeps knees loose.
With respect to cycling, I’ve found that a regular regimen of care keeps arthritic knees in good enough condition to ride on a daily basis. Having lived with this condition for over a decade, I’ve discovered some surprising things. For instance, stretching before a ride makes my knee more sore during the ride. Foregoing a leg stretching routine (other than Achilles tendon stretches well before the ride) in favor of taking a brief walk makes my arthritic knee glide better, with less pain, when I get on my bike. Stretching can be done after a ride when knees and muscles have warmed up.
If there isn’t time to walk, applying heat to the joint and surrounding leg muscles helps. Warm water or a moist heat pack will suffice. In winter, wearing cycling tights is a must when temperatures dip below sixty degrees. Arthritic knees perform better when kept warm. Putting on tights right after applying heat can retain the benefit of the warmth and help loosen up knees early in a ride.
And last, but not least, is the subject of the Granny gear (smallest chainwheel on a triple crank set). Those who have been riding for years tend to eschew the use of good old Granny. Much debate can be found regarding the subject of Granny gears and whether they are worthwhile. Detractors of the idea maintain that gear ranges are more important than specific low gears. Proponents of Granny gears point to the benefit of having a low enough gear to always spin at a high rate of revolutions per minute to avoid straining (or worse yet, having to walk the bike up a hill).
After years of riding a double, I finally broke down and purchased a triple crank set. My arthritic knee pushed me into this decision. By spinning easily throughout my rides, I have been able to ride decent distances (up to thirty miles per ride). Navigating the steep hills in my neighborhood, without pain, is now possible. Although I’m climbing hills more slowly, I can stay in the saddle (patients with arthritic knees are instructed to avoid standing on the pedals) and I can reach the top without discomfort. Moreover, I’m well within my doctor’s guidelines (he cautioned against “charging up steep hills” on a bike). To counter any perceptions of wimping out, I remind myself that I can still ride a double in warm weather and climb with the best of them. I attribute this to differences in the way arthritic knees function in heat and cold and the outstanding care I give to my arthritic knee.
While it’s universally known that a Granny gear can help when climbing steep hills, riders with bad knees can use this gear in a variety of circumstances. To avoid knee strain when starting from a dead stop at the bottom of a steep hill, the Granny gear can be used to make it easier to push the pedals forward until gaining enough momentum to shift to a higher gear. In winter, the Granny gear gives legs a chance to warm up before exerting knees with a bigger gear. Riding on a moderate hill at a snail’s pace may look a bit foolish, but this tactic allows riders to push their knees harder and last longer on a cold ride. It’s simply a matter of starting slowly to give the knees a chance to loosen up.
With the moments of embarrassment from using a Granny gear comes the knowledge that using this gear will help to preserve knees and will keep a cyclist in the saddle longer.