In a desperate attempt to understand and hopefully manage my increasingly debilitating knee pain during and after bicycling, this weekend I sought the assistance of Dr. Greg Combs at Velosmart. During the three-hour evaluation, he took some measurements, ran a motion analysis of my pedal stroke aboard my current mountain bike situated on a stationary trainer, and devised a rehabilitation plan for me. Reviewing the video motion capture was quite an interesting experience, as was seeing the results of his measurements.
It appears that while my so-called "leg length discrepancy" is minimal, there is a significant difference with regard to the left/right and fore/aft sections of my pelvic alignment. In other words, I am apparently twisting the core part of my body substantially, particularly when on the bike, which is putting extensive unnecessary stress on not only my knees, but also my hips, ankles, feet, back and abdominal core - yikes.
My initial video analysis showed a fairly significant discrepancy between the right and left legs and feet during the pedal stroke, along with a definitive shift in hip motion. And while riding with only one hand on the handlebar, I was also unable to balance myself without leaning disproportionately to one side or the other when pedaling - even on my own bike on the stationary trainer!
To help resolve these problems, Dr. Combs demonstrated a couple of pre-biking stretches to help realign my pelvis and legs to a more even and normal position. During Steve's observation of these stretches - they are partner assisted so he watched closely to learn his role and had a better view of the shifts in body alignment changes before and after - he noted that the improvement after just four repetitions was "astonishing". The stretches consisted of adducting (moving toward the centerline of the body) bent knees against pressure and then abducting (moving away from the centerline of the body) bent knees against pressure. I have to admit I was quite surprised at the magnitude of change generated in my hip/knee/ankle/pelvic alignment with just four repetitions of such simple stretches.
Additionally, the worn-out orthotics in my bike shoes were replaced with some that provided increased support and alignment assistance. My saddle position was tweaked and surprisingly to me, it was suggested to move my cleats a bit BEHIND the traditional ball of the foot position. Then it was back on my bike for a second video analysis. This time my left/right leg pedal strokes were vastly improved and much closer to ideal, and I was able to balance much better riding one-handed. Additionally, with the new - and in my opinion, improved - cleat position, I also noticed no more toe numbness/tingling, and my feet felt more solidly supported on the pedals.
A couple more tiny adjustments, and it was on the bike again for the third video analysis. This time, the alignment was improved even more, and I felt completely balanced riding one-handed. So Dr. Combs elected to leave the adjustments at this level and had me dismount the bike. Then he brought out two scary looking pieces of rubber tubing. Placing one around both legs above the knees and one around both legs at the ankles, he instructed me in several resistance exercises which he said would clearly delineate areas of weakness where the muscles were firing insufficiently or not at all. In my case, that apparently was predominately the gluteus medius (the muscle just at the top of the hip joint), as there was intense burning in that location after one - yes just ONE - set of 10 reps of the three exercises on each leg. And that was using the "beginner" lightweight straps! He prescribed doing those exercises several times a day until I was strong enough to move to the "intermediate" heavier straps and then eventually to the "advanced" heaviest straps (can you say "OUCH"?). He also prescribed doing four sets of the adduction/abduction stretching exercises before each bike ride. Finally, he suggested that I work on getting comfortable mounting and dismounting the bike from either side instead of just the left like I always have, in order to facilitate even muscular strength and development (not to mention it's just a good idea to be able to get on and off the bike from either side since you never know what trail terrain is going to be!...).
Naturally, it started raining while I was at the human performance lab and the rain has continued to the current time with even more forecast for the next few days, so I haven't yet been able to do a test ride to see what, if any, difference these changes make. But as soon as the weather breaks and the trails are sufficiently dry to ride, I'm looking forward to seeing how I feel on the bike. On the upside, all this rain is at least giving me time to get started solidly on the new exercise routine so maybe by the time I head out to the trails, my pelvis will be on its way toward realignment and my glutes will have strengthened up enough to provide some much needed support for my knees and the rest of my bicycling "engine".