knee/hamstring - is it my new bike?

[robing]

I have been having a lot of problems recently in my knee which I had an ACL reconstruction in 2006.
But also a lot of hamstring pain/tightness in this leg.

So had a MRI done and it showed a meniscal tear and also some inflammation of the hamstring(s).
I wonder whether my new bike bought in March might be the culprit? It's a hybrid so more upright and more weight through the saddle.
I also get sciatica in this leg so difficult to differentiate this from hamstring pain.

I am booked in for an arthroscopy - but wondering if I should cancel this and try some physio and a different bike?
I am also a keen runner and this week I cycled less and ran a lot more - 4 x half marathons - and the knee does seem better.
If it was down to the meniscus then surely I wouldn't be able to do that amount of running?

[Jdsk]

Have you discussed these with the orthopaedic surgeon or physiotherapist as part of the current investigations?

Jonathan

[robing]

I saw my consultant last month and we discussed the options for my knee. Either a steroid injection (I had one of these 3 years ago) or arthroscopy. He didn't say the tear was bad enough that surgery was 100% necessary.

He's very approachable so I'll probably email him. (He fixed my other knee with a 3rd arthroscopy after 2 previous failed attempts with a different surgeon so I have utmost confidence in him)

Haven't seen a physio yet, but I have an excellent local physio who sorted out my back a few years ago.

[Jdsk]

Thanks

Emailing in advance sounds like a good idea. You've got some specific questions about running and cycling and it would be good to get those into his thinking as early as possible.

Jonathan

[Paulatic]

Why change the bike?
I’d try saddle lower or forward or a bit of each to ease the work of the hamstrings. Combined with some regular exercise to ease that sciatica.

[robing]

I meant use one of my other bikes, not change it!
It's a hybrid so a lot more upright riding position.
I think the saddle height and position is spot on, I did change the saddle it came with as that was very uncomfortable.
So maybe I need another saddle altogether.
I love the bike so definitely don't want to stop using it.

I just think hamstring issues could have a knock on effect on the knee as they are flexors of the knee joint.
I'm also 2 hamstring tendons down in this leg as used for the ACL graft.

[Paulatic]

I think the saddle height and position is spot on,

and yet your hamstrings are grumbling…

[robing]

It's only the hamstring on one side - the side I had the op. I know my exact saddle height I need on all my bikes as I have had knee problems before. Hence why I don't think it's the cause this time.

More likely the saddle itself and riding position .

[Paulatic]

I’ve no interest in the cause like you it’s only something I could guess at. I was only suggesting what I would try to ease things.
I get occasional sciatica on my left leg, I’m also stiffer on my left side therefore I set my saddle to keep my left side happy. The big difference between us is I’d never say my saddle is spot on, I don’t have that confidence, and I know from experience it can change with bodily changes. Also experimenting is a great learning curve.

[Cyclo2022]

I would try raising the seat first to see if that helps. Too low a seat will give you knee problems so it's worth a try.

[531colin]

Wow, this is complicated, and its past 10pm......so I'll make a few note-type comments....

ACL reconstruction in 2006 .....by now you are "habituated" to your "new" hamstring/ACL situation......at least, you are habituated until you change your riding position.

When I had a medial meniscus tear, I couldn't walk to the end of the street, never mind run half marathons.

Hamstrings are a complex muscle group...some of the constituent muscles cross the knee joint, and some the hip joint (and maybe some cross both, its too late at night for me to think about that....)
So, one function of the hamstrings group is to flex the knee, no doubt about that......(but on a bike, the Hamstrings function to extend the hip, ie to pull the knee down. ....and pull the pedal back, if you use cleats

You have altered your riding position, and not become habituated to the new, more upright position. Sitting up straighter, (ie less pelvic tilt) you are necessarily using a different part of the range of contraction of your hamstrings (and glutes, and probably quads as well)

If you change nothing else then moving the saddle forward will load your quads and spare your hamstrings....and vice versa. I can't explain that, but it is so....moving cleats also changes the relative workload

I'm a bit worried by "more weight through the saddle"

Too high saddle is much more likely to cause injury than too low.

[robing]

Thanks Colin - very helpful post.

I also get sciatica in this leg from a previous slipped disc which may be to blame and is hard to differentiate from the hamstring. But I am getting some tingling in the foot.

The most logical thing to do is use one of my other bikes for now which I've done many miles on without any problems.

[531colin]

I have to agree, I would hang up the new bike for a month.....if it all sorts itself out, you know what caused it!

A couple of other things occurred to me in the small hours....
Could the different back angle be irritating the sciatica?....tingly foot sounds like it!
What exactly is happening with the knee?

[robing]

I have to agree, I would hang up the new bike for a month.....if it all sorts itself out, you know what caused it!

A couple of other things occurred to me in the small hours....
Could the different back angle be irritating the sciatica?....tingly foot sounds like it!
What exactly is happening with the knee?

Re sciatica - I think increased/different point of contact with the saddle on this more upright hybrid could be irritating the sciatic nerve. I've had it on/off for several years. I really feel it on long drives in the car.

Re knee - when it's bad I get medial pain, the classic 'cinema sign' where it doesn't like being in flexion, better leg straight out. But also I get the caudal back of thigh pain, which I am unsure if is hamstring or sciatic. Though the MRI did identify some medial hamstring tendonopathy as well as the tear in the posterior horn of the medial meniscus.

I have also had 3 menisectomies on the other knee! All good now, but I know that a torn meniscus feels like.

Looking back at my Strava is interesting - because I record which bike I am using - and there is a possible correlation with the new bike.
I have moved my saddle forward on the new bike, but I have retired it for now and am using my road bike.

Currently, knee/leg is feeling pretty good - still a bit of a twinge with the hamstring/sciatic. I did 2 half marathons over the weekend, and over 40 miles on the road bike this morning.

Physio appointment booked for later this week. I have an excellent physio.

Thanks for your interest!

[robing]

...........
Re sciatica - I think increased/different point of contact with the saddle on this more upright hybrid could be irritating the sciatic nerve. I've had it on/off for several years. I really feel it on long drives in the car.
..............

Riding with drop bars and your back in flexion (that is, curved forwards) may move the sciatic nerve out of conflict with the prolapsed disc, compared to sitting more upright in the car or with flat bars.
....also possible that you can more effectively "distribute your weight" between the 3 contact points when you have a longer reach....
the aim is to have the bike move underneath you like a rocking horse....upright and actually sitting with your weight on the saddle a bump can fire you up in the air

Hi Colin, I think it was all wishful thinking as the knee is quite bad again, mostly medial typical for meniscal tear. Oddly though cycling seems to aggravate more than running. I've had 3 meniscal surgeries on the other knee so now how it feels now. You said that you struggled with a meniscal tear yourself. Did you have surgery for this I presume? I have arthroscopic surgery scheduled for later this month so will definitely go ahead.