A Personal Story Of An (Almost) Trip Ending Knee Injury
Back in 2005, less than one month before I was planning to start my thru-hike attempt of the Appalachian Trail, a 2,000 mile long trek from Maine to Georgia, I found myself completely incapacitated, in excruciating pain and unable to walk. Sparring with a second degree black belt during a karate class, I took a hard kick to the side of my left leg. Not catching it in time I was unable to deflect it properly and absorbed the full force of the kick with my knee. The joint promptly popped out (and luckily immediately popped back in) of its socket.
(Scroll to the bottom if you want to see the resources I’ve found useful for diagnosing and treating cycling related knee pain)
I went through a couple weeks of doctors visits, MRIs, X-Rays, and physical therapy appointments during which time I was almost entirely off my feet. I was in my senior year of high school at the time and I ended up spending the final weeks of school, including graduation and prom, either on crutches or with a cane.
My plan was originally to leave for Maine the day after graduation with two friends who would hike the first two weeks with me. With my knee still unable to fully support my weight comfortably nearly a month after the accident, that plan was clearly unrealistic.
More devastating still though was that because the Appalachian Trail requires such a time commitment, hiking through several seasons, there is not unlimited flexibility for when you can start. Start too early and sections of the trail remain blocked with snow. Start too late and you run in to the same problem when you’re finishing.
With the couple months of rehab I would need to go through to recover, it looked like my thru-hike might have to be cancelled.
Stubborn in my persistence, not wanting to admit defeat, I religiously followed every instruction given to me by my physical therapist. I went through every repetition, each set of the mundane exercises assigned to me, I did every stretch I was supposed to, made every appointment, and so, nearly 50 days after my accident when the window to start seemed to have just closed, I finally got the go-ahead that I could hike.
I left soon after with the plan that I would go and see how far I could get until weather or park rangers stopped me. 5-months later, on December 11th, I found myself at the southern terminus in Georgia having successfully completed a thru-hike of the Appalachian Trail.
Facing the Emotional and Physical Challenge of Injury
The reason for telling this story is because unfortunately I have once again found myself in the position of an injury derailing my plans. For the past few months, as I’ve written about in recent posts, I’ve been planning and training for a 24-hour, 300km (200 mile) cycle challenge from the Forbidden City in Beijing to the end of The Great Wall. Unfortunately, as a result of training with a bike whose frame turned out to be a couple sizes too small for me, I found myself with tendonitis in two places of my right knee (the opposite knee that put a wrench in my hiking plans), with pain getting so severe after as little as 30km that I would end up relying on my left knee for 90% of my pedalling.
Making The Right Decision
Deciding to call off the ride was very difficult for me, particularly because my injury was not completely debilitating. I could walk, run, and wasn’t experiencing severe pain on a regular basis. It was just when I was cycling. There was a very persistent voice in my head making the argument that it was just a 24 hour event. Worst case scenario I could just take a ton of Ibuprofen (nicknamed “Vitamin I” on the Appalachian Trail) until I got to the end of the wall.
Luckily, my experience leading up to the AT was formative for me. This is not just because I ended up being able to hike the whole thing but also because I believe that my knee will be stronger and better off in the long run because of how much work I put in to make sure I rehabbed as quickly (and efficiently) as possible.
Listen To Your Body
If you’re enthusiastic about any sort of hobby that requires physical exertion, whether hiking, cycling, tennis, or even motorcycling, your body is your most important resource. If you, like me, hope to continue with your hobbies long into old age, you need to do the little things now that give your body the longevity to stay active even into your 60s or 70s (I actually met 60 somethings thru-hiking the Appalachian Trail, so if you think you’re too old to try something, never say never!).
I could have chosen to start the AT early, self-medicate, and see how far I got. I was 17 at the time. My body was relatively resilient and could take some punishment. But by listening to my body (and my doctor) and holding off until my knee was ready, not only did I still finish but I likely saved my knees years of pain decades in the future giving me the opportunity for hopefully many more future thru-hikes.
Back to the cycling now… on our recent training rides on the outskirts of Beijing I had begun to notice some discomfort. I assumed though that it was just soreness due to insufficient stretching or not being used to riding longer distances.
More stretching though didn’t seem to make the problem go away. First the pain would start after about 150km/100 miles, but then it would happen earlier and earlier until I started having persistent pain in my knee for a couple days after only just an hour in the saddle.
Had I taken action sooner, taken time off the bike, gotten a bigger one, seen a specialist, and done the proper strengthening exercises and stretches, there’s a chance I would have been able to do the ride on June 5th as planned. Unfortunately that’s not how it went. I am hoping though that I still didn’t push myself too hard to the point that it has to be put off indefinitely.
Recovery, Rehab, and Resources
With cycling, I’ve found through research and personal experience now that a major cause of overuse injuries is bicycle fit and technique. There are a lot of great resources online for testing and adjusting these yourself (see the list of one’s I’ve found below).
If you’re starting to feel any problems (most common areas for cyclists are knees, back, and neck) it’s important to admit to yourself that this is not normal. Even a small discomfort can turn into something more serious when you’re doing a constant, repetitive motion over increasingly extreme distances, so rectifying whatever the cause is early can save a lot of time and frustration in the future.
Here are some of the resources I’ve found useful:
- Competitive Cyclist’s Fit Calculator for finding the the right measurements for your bike
- Identifying Your Knee Injuries– This is specific to cyclists. Useful for when it’s too early to go to a specialist but you want to see what could be causing problems before they get worse
- Bike Dynamics– As I said earlier, bike fit is an important contributor to knee pain. Use this guide to try and find what about your fit could be causing your specific pain
- Stretches for Cyclists– Good stretching technique can be important to preventing injury. This just doesn’t apply to the kinds of stretches but also the timing and duration too!
- Knee Pain Causes and Solutions– From I Love Cycling, talks about a lot of the things I mentioned here with additional links to more detailed diagnoses and solutions
- Overuse Injuries– From the McKinley Health Clinic at the University of Illinois, includes resource to identify which common knee injury you might have and stretches and exercises to help fix them.
There is of course a lot more available on the internet. I’m also not an expert and there can sometimes be conflicting information online, so if you have any pain that persists after attempting a self-diagnosis, there are professional bike fitters that can help and definitely try and see a specialist to help identify what’s going on. The body (and especially the knee) is a complicated piece of machinery and sometimes it can be very difficult to get the entire picture on your own.
The most important thing is to take good care of your body. There’s no event or race that’s worth sacrificing your entire future in the sport or activity you’re passionate about. A couple of weeks of recovery is a small price to pay for decades of longevity!
As a sidebar- I still fully intend to attempt the 24-hour cycle challenge once I’ve recovered. If you’re interested in learning more about that ride, you can check out the event website for the Beijing to Dragon’s Head 24 Hour Challenge, sign up for our newsletter via the form in our sidebar, or follow us on twitter @rubberonroad08 or @buckperley.