Yipes! My Hip Hurts!

I dunno. I must be getting old. About a month ago, I started to feel it. Whenever I came back from a bike ride, I felt great. I stretched, showered, and changed, then sat down — maybe for a meal, maybe to watch a little TV, maybe to noodle on this blog.

And when I stood up again — Yow! My left hip hurt like a sonuvagun.

It didn’t take long to get rid of the pain. I just walked it off, stepping around the house or outside a bit. But it persisted. Whenever I sat down for any length of time, I could count on the ache — soreness –hurt — when I got up again.

I was at the doctor’s on a routine visit, when I brought it up. “Could be arthritis,” was the guess. “Take anti-inflammatories — Aleve, Ibuprofen.”

“What about glucosamine-chondroitin?” I asked.

“Well, that might work,” she said. “Try it if you want. Some people say it’s good.”

My wife is one of those who do. But I haven’t gone that route yet. In fact, I’ve noticed the pain isn’t as bad lately. Partly, that’s because the Aleve really works well.

“You took two Aleve?” asked my wife, incredulous. “The dose is only one.”

“Yeah, worked good,” I said. “Rode the bike for two hours, and I haven’t felt any soreness all day.”

Well, it’s not all gone yet. I still get a twinge when I stand. But all I need to do is walk down the hall, and it shakes out. I think I won’t panic for the time being.

Slow Recovery

It’s been a disappointing week. I thought I had been making a good comeback from my fall two weeks ago. Last Sunday, I did an easy 32-mile ride with no bad consequences. But Monday, I developed some pains in my side.

I had been having these feelings pretty much since the fall, but they were minor. I mostly concentrated on that huge bruise I blogged about last week, and then a hip pointer made itself known. Football players (American football) and hockey players get these, from banging the point of their pelvis bones against something hard. Most of the time, it’s not there, but when I bend my left leg a certain way, the pain is enough to make me jump.

Then on Tuesday, I decided to do my after work ride. It’s a 19-20 mile jaunt through my neighborhood. This time, as soon as I got on the bike, I could feel that pain in my side again. It feels as though something under my ribs is bruised, and if I bend at the waist a certain way, it’s quite painful.

On the bike Tuesday, that ache was with me throughout the ride. Instead of 19 miles, I cut it short and did only 12.

“You should see the doc,” said my wife, when I told her what had happened.

Luckily, my doctor keeps evening hours on Wednesday, and booked me an appointment that evening. He’s always been supportive of my biking, because of the changes it’s made in such indicators as blood pressure and cholesterol levels. Of course, this is a negative effect.

He had me do some stretches, which didn’t hurt. He poked and prodded my sides, and found the quarter-sized spot on my left ribcage that triggered the pain. It’s where the rib meets cartilage, and he told me the cartilage is the damaged part.

“In my professional opinion,” he said, adopting a pedantic tone, “you’re banged up.”

There is nothing to be done. “Even if you had a broken rib, we wouldn’t do anything,” he said. “We’ve stopped wrapping ribs. It turns out that can cause pneumonia.”

He did recommend heat. And anti-inflammatories, which I’d already been taking. But it looks like it will be several weeks before the aches and pains go away.

I dug out the heating pad, and it does work. Saturday, I got on the bike and repeated the ride I had started Tuesday. This time, I did the whole 19 miles. My torso felt fine.

I rode again today. The only time it feels sore is when I stand to pedal up a hill, so I rode a mostly flat course. But I can ride without pain.

I’m looking forward to riding again Tuesday after work. My time in the saddle is really down this year. I’ve got some catching up to do.

 

Biking Through a Bruise

My fingers next to the bruise give an idea of its size.

My fingers next to the bruise give an idea of its size.

I’m still feeling the effects of that fall I had a week ago. I’ve got the biggest bruise on my hip that I’ve ever had, and it was quite painful to start with. However, one nice aspect of our sport is that it seems to help in recovery from these kinds of injuries.

The crash was odd in that I wasn’t moving all that fast. In fact, I was just slowing to make a turn when the rear wheel slid out from under me. But the full force of the impact fell on my left hip. I must have hit the pavement a lot harder than it first seemed, because two days after the crash, I had trouble rising from a chair. It felt like the whole left torso was bruised as well, although I could find no marks.

How did I treat the big bruise? It turns out that I did everything wrong. The recommended treatment for a bruise is to stretch and ice the affected area after the workout. In my case, I felt so good after riding this week that I did nothing except shower. For pain, acetaminophen is the recommended treatment — not ibuprofen. I gobbled ibuprofen two or three times a day.

Sitting for awhile, while watching TV, exacerbated the pain. Moving eased it. Except for Sunday, the day after the crash, I have been on the bike every day — sometimes pushing myself to climb a small hill a little bit faster, or do some intervals. Without fail, I felt better once I got home.

In one regard, I was lucky. I wasn’t bruised anywhere that came into contact with the bike. So when I ride, I feel like a normal person. It’s only after I’ve been stationary for an hour or more that pain becomes a problem.

Bruises heal themselves in seven to 10 days. My bruise is still impressive, in terms of the area it covers, but I can tell the coloring is already starting to fade. I expect to be back to normal in another couple of days. But in the meantime, I think I’ve healed a little faster by exercising those muscles under the bruise than I would have if I’d done nothing.

Biker’s Elbow

For the last few weeks, I’ve been dealing with some minor pain. It started on the LBJ 100 ride, I think. The day after the hilly metric century, I experienced some soreness in my left elbow when I went out for an easy recovery ride. It’s not a big deal, but it is a noticeable twinge.

I thought it might have something to do with the way I held my arms during the long ride. Maybe I was pushing the elbows too far out for help on the hills. I noticed that if I kept my elbows in, the soreness went away.

I hadn’t realized it before, but I have Biker’s Elbow. No, although I capitalized it, that’s not its real name. It’s called “lateral epicondylitis.” You might know it better as “tennis elbow.” The American Association for Hand Surgery (Yes, it’s a real organization) says despite the name, most people who have tennis elbow have never played tennis. And if you want to get into the medical minutia, lateral epicondylitis is considered a form of tendonitis — but it isn’t really, because it doesn’t involve inflammation. It’s considered more a mechanical problem related to degeneration of the tendon that passes over a bony protrusion on the elbow.

What causes it? Repetitive motion. Any activities that repeatedly stress the same forearm muscles can cause symptoms, according to the orthopedic-oriented website, Orthogate. So besides swinging a tennis racquet, such things as running a chain saw, or using a paint roller can have similar results.

Now, cyclists don’t repeat motions much. Their hands are mostly on the brake hoods or in the drops. But it turns out that gripping can cause the same kinds of pain. Again, according to Orthogate, “When you bend your wrist back or grip with your hand, the wrist extensor muscles contract. The contracting muscles pull on the extensor tendon. The forces that pull on these tendons can build when you grip things.”

Treatment is simple in simple cases like mine: rest. (Duh.) Aspirin or ibuprofen should help. If it’s more serious, you’d better be talking to a doctor, because then treatment will involve everything from stretching exercises to physical therapy to, in extreme cases, surgery. Most disturbing was this advice from the Hand Surgery website: “It is recommended that activities that aggravate the symptoms are limited.” What, no biking? No way!

Since the LBJ ride, I’ve felt that twinge in my elbow on every ride. But on every ride there’s less of it. On today’s after-work quick 15 miles, I felt it once, moved my arm a little bit, and didn’t feel it any more. Knock wood, but I think the situation is under control. But you can be sure that I’ll be very aware of how tightly I grip the handlebars from here on out.

You’re Going to Fall – Here’s How

Note: The series of guest posts on The Most Important Thing I’ve Learned About Cycling will reappear later this week. I must resume contributing to my own blog!

You might have noticed in the Twitter box on the right of this blog last week that I had a minor crash on my bike. I missed a shift on a hill, dropped my chain, was unable to clip out, and I went over.

Just a bruise on my hip and a sore hand, but that was enough to trigger this reprimand:

“Hands on the bars at all times,” commented Mike Weiland, who should know, because he’s had his share of hard falls.

But that’s the problem. When you find yourself going down, what’s the most natural reaction? To put out a hand to brace yourself when you hit the ground.

“You brace, you break a hand or a collarbone,” said Mike. Or an arm, or dislocate your shoulder…

Even experienced riders brace for falls. It’s a natural reaction.

Okay, so I’m going to resist the temptation to brace next time (yeah, right). What can I do instead?

It depends on the type of fall. If you find yourself going over the handlebars, you can plan to roll on your shoulder. I did this in the first bad fall I had on my road bike, and although I was sore, I wasn’t hurt badly.

The guy in this crash looks like he might be able to drop his right shoulder, and roll on it.

Ted Rogers, who runs the blog, Biking in L.A., urges cyclists to do two things: stay clipped in, and hold the handlebars tightly. He tucks his elbows into his body. “At the same time,” he says, “I tuck my head down between my shoulders, and round my shoulders to shape my upper body into a ball. My momentum will continue to move my body forward, rolling me over the handlebars, still attached to my bike, which helps me maintain my curved position.” With luck, you’ll be able to roll on your shoulder rather than fall on your face. If he finds himself going down sideways, instead of over the bars, he does pretty much the same thing. When I went down last week, I stayed clipped in (not intentionally). That may have prevented me from being hurt worse than I was.

The roll might work for low-speed crashes, says Mike Weiland, but at higher speeds, all you can do is just skid. “Of course the one a few months ago at 24 mph I ended up hurting my hand/wrist not from bracing, but more or less punching the ground as my hand was still in the drops when the bars made contact with the pavement,” he told me.

It appears the best place to land in a crash is on your side. Hitting your chest or back on the ground could mean worse injuries. “As you hit the ground,” said one commenter on a biking forum, “try to stay as loose as possible. If you’re tense or stiff, it’s easier to get hurt.”

In practice, none of this might be possible. One cyclist posted to a forum that he’d been in two bad road crashes. “In neither case, do I remember having any time to react,” he said. “I was aware that I was in trouble, and then on the ground bleeding.”

What’s the old saying? “There are two kinds of cyclists: Those who have crashed, and those who are going to.”

Keep the rubber side down.

During the coming week, Bike Noob will feature two more posts in the series, What’s the Most Important Thing You’ve Learned About Cycling? If you’d like to submit your thing, check here.

Falling Into Fall

Guest poster Don Blount recalls a year-old incident.

The first day of fall brings back memories of the day I first fell. At least the day I fell badly enough to suffer a significant injury. It was Sept. 22, 2009 and I was halfway through a 46-mile ride. The turnaround point was at an area nature preserve and I had gone to the visitors center to look for a trashcan to throw away a banana peel.

A long driveway and sidewalk leads to and from the visitors’ center, and as I was on my way out, a car was on its way in. The driveway is just wide enough for two oncoming cars to pass each other if they go slowly. As the car approached, I moved to get over and onto the sidewalk to be completely out the driver’s way.

I vaguely remember the feeling of falling. I clearly remember the pain of being slammed to the ground. And then the next thing I remembered was someone, the driver of the car, asking me if I was alright.

It took me a bit to collect myself, check my bike and then ride the remaining 23 miles home – with a fractured left wrist.

The gap shown in the photos is what caught my front tire. The sidewalk is about an inch higher than the road surface and that gap is just wide enough to trap a tire.

I watch out for these little road inconsistencies more closely now and work hard at keeping the rubber side down.

The Bad Ride

I really enjoy riding. Even a quick half-hour jaunt through the neighborhood leaves me feeling good.  So I was looking forward to my Saturday morning 25-miler.

About four miles into the ride, I had to stop for a red light.  I moved the bike out of the right turn lane, unclipped my right shoe, and made the fatal mistake: I turned the handlebars to the right.

That caused the bike to lean left, and I was still clipped in on that side.  I frantically tried to wrench my foot loose, but I went down on the left side.  If this has ever happened to you (come on, now — I know it has!), you know your only concern is to get upright again, so all those people at the intersection don’t laugh and point fingers.  In this case, there was only one cyclist who had just crossed in front of me.  When she heard me go down, she immediately stopped and asked if I needed help.

I grinned and said, “No, I just didn’t clip out in time.”

“Oh, that’s happened to me,” she said.

I got moving again, glad that the bike seemed all right.  But in a little while, I felt an odd sensation at the back of my leg.  Blood was pooling in my sock from a puncture wound left by the chainring when I fell.

The blood and the chainring tattoo made an interesting pattern.

It didn’t seem as bad as it was, so I kept going.

Several miles later, I turned onto a four-lane divided street that runs through my neighborhood.  It has a bike lane, but as usual, the lane was littered with debris.  It wasn’t long before I sensed that my rear tire was going flat.

I pulled off onto a side street, in the shade, took off the wheel, and found the problem. A tiny nail, a brad no more than a half-inch long, had made a neat puncture in the tire.  I yanked the nail out with my teeth, and changed the tube.

One move I have always had trouble with is remounting the rear tire after a flat.  I can’t seem to get the cassette and chain to mesh properly, even though I have it shifted into the smallest cog.  I must have done something stupid, because suddenly, my shifter cable popped out of the brake hood on the handlebar.

I fiddled with it and fiddled with it, but couldn’t get it to reattach.  I was a little more than a mile from home, and rode in the big ring and smallest cog all the way.

In the bathroom, I cleaned the wound and put a Band-Aid on it — but in a few minutes, I was back in the bathroom again, when the Band-Aid became saturated with blood.  After putting on several gauze pads and applying pressure, the bleeding stopped.  Sort of.

Then I tried to sop up all the blood spots from the bathroom carpet.  The results are less than stellar.

I like to think that every time I’m on the bike, it’s a good ride.  Not today.

The Return

You might recall that regular guest poster Don Blount has been out of action for awhile, after a bad fall.  Well, Don’s back. How he handled his recovery could be instructive if any of us find ourselves in a similar predicament.

It has been three weeks since I was cleared by my doctor to begin riding without restrictions.

It’s good to be back.

I was cleared for activity on July 22. On July 23 I was back on the bike. The first full week back I rode a total of 101 miles, the second week it was 103 miles. I expect to be back in that range again this week. I even started doing intervals and plan on heading up to the hills soon.

I think the reason I transitioned back to the outdoor bike world so well was because of what I did during my recovery.

In quick review: On May 15 I took a nasty tumble from my bike, fracturing my left wrist and breaking my left arm. About a week later I had surgery and then spent another nine weeks on restricted duty.

Restriction meant to not do anything that put any pressure on my arm. Of course riding my bike was out. I was allowed to ride a stationary bike but only provided that I didn’t violate that restriction.

I became good friends with a bike at my gym. I think I had about six hours on it during the first week.

Later, a member of my bike club loaned me his Cateye CS-1000 cycle simulator. This trainer had adjustable settings that allowed the resistance to be increased to get a harder bike workout.

I found this time incredibly boring, even if I was watching videos or the Tour de France or listening to music. Particularly when the weather is good, bike riding is most enjoyed when done outdoors. I gained additional appreciation for living in California where I can pretty much ride outdoors year round.

But the time on the trainer helped. I focused on making sure I got saddle time and trying to keep my cardio level up so I wouldn’t suffer from saddle soreness or too much fatigue when I returned to riding outdoors.

And it worked for the most part. My wrist was a little tender initially but the discomfort was tolerable. I have stretches and exercises to help strengthen my wrist and arm. More importantly I gained a greater appreciation for an act as simple as riding a bike and its value to my quality of life.

Is Cycling Dangerous?

Our friend Don Blount got some bad news last week: In addition to a broken wrist from a fall during his first century ride, it turned out that his arm was broken, too.

Don had surgery on the arm Friday, and says it went well, but he’ll be off the bike for six to eight weeks while he heals.

That gives him time to do some thinking. He’s been thinking about his second major crash in the last nine months, and breaking the same wrist in those crashes. On top of that, many of us rode in the Ride of Silence last week, which commemorates riders who died in bicycle crashes.

So Don poses the question: Is cycling dangerous?

Don says some of his non-biking friends are telling him to give up cycling, because it’s “too dangerous.”

A couple of studies done in the 1990s found about 500,000 visits to the emergency room each year in the U.S. as the result of bicycle crashes. Just a small fraction required a hospital stay.  Over half the accidents involved motor vehicles, and road surface and mechanical problems with the bicycle are also common causes of accidents.

That reminded me of a club ride I was on a couple of months ago. We were nearing the end, but had to ride for a short distance on a two-lane highway with no shoulders. The road is hilly and curvy, and we mostly avoid it. When we turned off it to cut across a parking lot to another road, one of the riders remarked how glad she was to have survived another ride.

“Well,” I said, “it seems to me that every time we get on our bikes we’re taking a risk. It could be the car that doesn’t see you, or the car that does, and wants to ‘teach you a lesson.’ Or you could hit some bad road surface and lose your balance, or any number of things. But usually we don’t. We’re smart enough to know the risks and we watch out for problems.”

I guess that’s how I’d answer Don’s question, too. Cycling can be risky, but it’s not inherently dangerous.

Don concurs. “I never thought of riding a bike as dangerous,” he emailed me, “probably because it’s something I learned to do as a child. And if I felt it was dangerous, I doubt I would have taught my children to ride.”

He says his injury occurred because he became overly concerned with one risk factor - cars – and lost sight of another – a railroad track at an intersection bad for riding.

But he also notes that other adults get hurt in sports like skiing, soccer, or basketball, and don’t think twice about getting back to them.

And after his convalescence, he says, “I intend to get back on my bike as soon as I can. After all, I received my new helmet just a few days ago.”

Kneesavers

It’s fascinating what you can learn from the cycling community.

Last week, I was battling a painful bout of gout in my left knee. I couldn’t bend the knee without it hurting, and I walked with a pronounced limp.

That’s all in the past now. A steroid injection into the knee and some time on the bike has done wonders. I’m walking normally again. The more time I ride, the better the knee feels.

But while I was laid up, I got lots of interesting advice. One item didn’t apply to my gout, but it’s interesting enough that I’m going to look into it anyway. It’s called the Kneesaver.

The idea behind the Kneesaver is simple. It’s an extension to the pedal axle, just 20, 25 or 30 mm long. The company says that added width to the pedal (what it calls the “Q factor”) can reduce or eliminate pain in the hip, knee, ankle or foot.

The Kneesavers web site (www.kneesaver.net) has testimonials from satisfied users, but I put more stock in the unsolicited testimonials from riders in my club whose experience I respect.

One said he bought them to help alleviate pain in his hip that came on after a crash.  Not only did the pain go away, he said, but his knees felt younger, too (he’s in his upper 50s). When he started riding his “rain bike” during colder winter weather, the hip pain came back. He moved the Kneesavers over to his rain bike, and the pain went away. “A wider stance on the pedals will more closely approximate your ‘at rest’ standing position and that’s where you will have the most comfortable knee rotation,” he said.  “It’s an old guy thing.” He was so happy with his experience that he’s buying another set for his wife.

Lending even more credibility to the worth of Kneesavers is a comment from another club member, who happens to be a physician. He also complained of hip pain after long bike rides. “What put me onto it was I noticed that long rides on our tandem didn’t give me this problem,” he said, “so when I checked I discovered that the Q on the tandem was an estimated 30% wider–because they use a MTB crankset (MTB cranksets have a significantly wider Q). When I measured my ‘standing Q’ it was 10cm wider than my road bike, so I increased it the minimum.”

One thing to watch for if using pedal extenders is the increased possibility of “pedal strike” in corners. You can’t lean the bike as far without the pedal hitting the ground. But since we’re supposed to corner with the inside pedal up, that shouldn’t be a problem.

This post is not to be considered an endorsement for Kneesavers. I haven’t tried them yet.  But I’m not getting any younger, and anything that keeps me going in comfort is worth a look.