It’s been awhile since I’ve been motivated to post any updates. The last year or so has been crazy for all of us. I thought I was holding up pretty well up until my world record ride last November, but all the stress finally took its toll on me physically, mentally, emotionally, and professionally over the last few months. I made the announcement earlier this year that I would be deferring RAAM until 2022 without going into too much detail for my reasons. I’ve been thinking for awhile that someday this will all make for a great comeback story, but I really didn’t have much desire to talk about it until it looked like there would actually be a comeback. There has finally been some progress that has encouraged me over the last week or so. I mentioned to a friend this weekend that the comeback is finally starting to shape up. She told me not to think of it as a comeback, but as a new adventure.
Hopefully this will be the first of a series of updates on my progress as well as an explanation of everything that’s been going on for the last 5-6 months. The easiest thing for me to talk about at this point is my knee pain, so I’ll start with that.
I first starting noticing some knee pain associated with my cycling 3-4 years ago. I believe it was just in my right knee at first and it came and went for a year or two. It seemed to improve in early 2019 when I changed my diet, and I don’t recall having any issues with my knees during Race Across the West that year. Both knees seemed to start flaring up again about a year ago. I specifically remember really struggling on the two long indoor rides I did during the early days of the COVID lockdown. Interestingly, both knees did okay when I did VRAW in June on the indoor trainer. I attributed that to the lower intensity riding I was doing over those 12 days. Both knees started getting irritated again at some point over the summer as I ramped up my training for the Borrego Springs WTTC, which turned into my 24 hour world record attempt once the race was cancelled. The long stretches of constant pedaling would usually start to cause some irritation, and sometimes it would be quite painful to go out for my Sunday long ride after putting in a long session on Saturday. They never prevented me from riding, mostly because I was too determined, which may have been my downfall.
By January, I was starting to really struggle just to get through day to day stuff – going up and down stairs, kneeling down to tie my shoes, demonstrating exercises for patients at work, even standing up from a chair sometimes. One of the most painful things for me was to sit with my knee bent for a long period of time. When it was really bad, even my 12 minute drive to work would be painful. I let my coach Rachel know what was going on. I had already deferred my RAAM registration, so we backed off on the training, and I reluctantly started working on getting my knees checked out after insisting on trying to take care of them myself for several months.
I had some X-rays done and the radiology report came back showing no abnormalities. Because I’d been pretty consistently trying to rehab the knees myself, my primary physician put in a request for an ortho referral without going through the usual first step of physical therapy. When I actually got a chance to look at the pictures of my knees during my ortho consult, it was obvious that both kneecaps were laterally displaced and laterally tilted so that the outer portions of my kneecaps were being compressed against the femurs. There were bone spurs on both femurs as a result. The surgeon was also concerned about a shadow on the undersurface of my left kneecap that he thought might be a defect in the articular cartilage, so he ordered an MRI of the left knee. I was able to read the MRI report before speaking with him and was pretty discouraged to see that I had “diffuse loss of articular cartilage” on the kneecap as well as a “partial tear” of the quadriceps tendon. I was pretty certain I was going to be having surgery on at least one of my knees. I spoke with the surgeon about a week later, and was a bit surprised that he didn’t have any recommendations for surgery or further treatment. He also mentioned that the partial tear really looked more like tendonosis of the quad tendon. He advised me to continue backing off on my training and consider taking time off the bike completely if the symptoms don’t improve. He also approved a course of physical therapy so I could get another set of eyes on my knees. It was a relief to not be headed for surgery, but it also felt like I’d reached a dead end. My knee pain wasn’t any better after weeks of decreased mileage and dedicated rehab to strengthening my quads and glutes. I couldn’t bear the thought of having to stop riding my bike for 8 weeks if they didn’t get better. I knew I could pursue some other non-surgical options, but I decided to try a few conservative options first.
At some point in the middle of all this, I listened to a podcast featuring Nate Koch, a physical therapist who owns several physical therapy clinics in Arizona that specialize in treating endurance athletes. Their facility in Scottsdale works in conjunction with a bike shop next door to provide medical bike fits. I’d spent plenty of time having my bikes fit for me in the past, but I was intrigued. I got in contact with Nate and Cyclologic, the bike shop, and set up an appointment. They recommended spending three days in Scottsdale, one day for the initial assessment and fitting plus two days to go riding and follow up as needed. It would cost me a full week off work, travel expenses, and the hefty cost of the bike fit itself, but I figured I wasn’t in any shape to be racing anytime soon so I might as well spend the money I’d be spending on races on this instead.
I was super frustrated and didn’t have much reason to look forward to the trip to Scottsdale. I had just had the conversation with ortho letting me know he couldn’t do anything for me. I’d spent weeks trying to rehab on my own. I hadn’t done a ride longer than 50-60 miles in two months. I would get frustrated watching other people ride without pain, watching other people do things that made me think about how much my knees would hurt if I tried to do the same thing, watching patients at work doing exercises that I wouldn’t even bother attempting to do. I was convinced these guys in Scottsdale would see how out of shape I was, not want to take me very seriously, maybe make a few tweaks to my bikes, and I’d come back and not notice any difference. Obviously, I was not in a very good mental state at this point.
The first morning in Scottsdale, I had an appointment with Ian, a physical therapist at Endurance Rehab. He spent 30 minutes or so doing an assessment to collect some information to pass along to my bike fitter. The most compelling thing to come out of this interaction was when he had me do a series of mini single leg squats to see how painful they were. He spent a few minutes using a Gua sha tool to scrape some of the ever present knots in my quads. I tried doing the single leg squat again and it was almost completely pain-free!
I spent most of the rest of the day in the fit studio at Cyclologic, the bike shop next door, with Paraic, the owner of the shop. He spent a great deal of time just collecting information from me on my cycling and injury history, making sure I mentioned any issues I might have been having, however minor – saddle sores, hotfoot, obviously the knee pain. He was impressed with what I’d been able to accomplish in my short stint in ultracycling and clearly wanted to help. After several hours of measuring my feet, taking and analyzing video, and mapping saddle pressure, we decided to shorten my crank length, try a new saddle, and get some new shoes with arch supports to match my arch index. After a late lunch, I headed back to Endurance Rehab to go over the exercise program Ian had prescribed for me, then went out for a short ride to see how the changes felt. I wasn’t expecting a miracle, but I could clearly notice the difference. My cadence had increased about 10 rpm without even thinking about it and it felt like so much less effort to get my knee over the top of the pedal stroke. The knees were still aching by the end of the ride, and they weren’t too happy when I had to stand up to accelerate from a stop, but I knew there was some chronic inflammation that wasn’t going to go away overnight. Paraic instructed me to head out for another 2-3 hour ride on Tuesday morning before coming back in for my follow-up in the afternoon.
I felt great riding on Tuesday morning and again on Wednesday. By the time I left Scottsdale, I had one road bike completely dialed in with the new fit and planned to incorporate the same changes on my other road bike. I realized on Wednesday morning that I had ridden seven days in a row for the first time in two months and my knees were feeling better than usual. Ian had set me up with a new exercise program that was a little different from what I’d been trying on my own, along with the idea to try scraping my quads a few days a week. Paraic seemed excited to continue helping me get my bike fit dialed in as I get my fitness back over the next several months. I headed home with a completely different outlook than I’d had earlier in the week.
In the month since my bike fitting, I’ve been riding 6 days a week, gradually increasing my mileage, and doing my rehab program religiously. The changes have been gradual, but I am absolutely noticing some improvement. I noticed within a couple of weeks that I could actually feel my sit bones getting a little sore from putting pressure on them after years of unconsciously doing everything I could to not sit on my saddle. I was starting to feel my glutes getting a little sore during and after rides, instead of the typical burning in my quads that I had gotten so used to feeling. There are still some knots in my quads when I do my foam rolling, but they’re not nearly as bad as they were a month ago. Some days are better than others, but I’m fairly consistently able to kneel on the floor and stand back up without grimacing. Sometimes I’m so surprised at how easy it is for me to demonstrate a squat or a lunge or a step down to a patient that I find myself doing a few extra just to make sure it’s not a fluke.
It had been so frustrating watching my fitness dropping precipitously on my Training Peaks profile between January and March. Now its kind of fun to see the gradual climb back up, almost back to where I was 90 days ago.
There’s still a lot of fitness to build back and recovery that needs to happen before I’m ready to race competitively again, but I’m happy to see that things are finally moving in the right direction. And hopefully when I am fully recovered I will be even stronger than before, mentally and physically. Having the chance to step back for a few months has had its upsides. For the last two years I’ve been putting in long solo training rides almost every weekend. I’ve been able to reconnect and ride with friends again and enjoy the social side of cycling. I was able to help a friend train for her first triathlon. I’m going to be crewing for my friend Rick Zwetsch in RAW in June.
If all goes well, I’m hoping to be back on my TT bike over the summer to start training for the 24 Hour WTTC in Borrego Springs in October. I will keep the updates coming. I appreciate everyone who has reached out over the last few months to check on me and give me some encouragement.