Physio suggests 4-6 weeks off - advice?

I’ve just finished my CX season, despite a knee niggle for the second half. Figured I’d now go and see the Physio to try and fix it.

After a quick assessment she believed it’s tight quads and lack of core strength leading to it. That stacks up for me given they’re known weaknesses of mine.

She’s advised 4-6 week programme of massage and exercise to build a better foundation to train upon. Whilst I’m happy with that, she wants me not to ride too. I’ve not taken that amount of time off the bike in over a decade and it bothers me as I’m aware riding helps manage my mental health too.

My next ‘A’ event is mid-May and I’m in build for it at the moment.

Does anyone have any advice on how to approach this? I’m torn between listening to the physio to hopefully fix it long term, with my default “I’m sure 2-3 hours of endurance a week won’t hurt”.

1 Like

She obviously sees an issue with you riding. You can go look for someone to agree with you as there will always be someone with the viewpoint you want.

3 Likes

Would 4-6 weeks of riding and PT set you back severely? Sounds like you could try it with riding in the mix and fall back on your doctor’s recommendation if that doesn’t work.

Is she a general PT or a specialist in cycling injuries?

Personally, I’d want a specialist in cycling injuries. Maybe a couple weeks off, some low intensity riding to maintain, an exercise program and a fitting (by someone really good).

5 Likes

Do the 4-6 week programme you’ve paid for. Then ride.

3 Likes

Did she mention any imbalance? Such as weak gluteal and hamstring muscles.

1 Like

I’m wrapping up PT now for my back/hip, and I also had a weak core. My therapists didn’t tell me to stay off the bike. In fact, I’ve been ramping up my volume from being off the bike to 6 hrs/week. However, I have been riding mostly threshold and below, especially on the trainer.

Riding easy at a good cadence doesn’t put much stress on your core. When you ride at high power you are generating a lot of force that your core needs to resist. Your form will also tend to suffer, perhaps with your feet or knees not staying straight, which might be part of your problem.

You can do a pretty good job maintaining your aerobic and metabolic fitness (FTP and endurance) by doing sub-threshold workouts. That’s the fitness that takes months to build. You will lose some anaerobic fitness but that only takes 4-6 weeks to train up again. And anaerobic power still has a large dependent on aerobic capacity.

1 Like

One of the problems, can be that if something is inflamed or inflames because of some instability or issue, it can make sense to take a break for a prolonged time and only get back after the inflamation is gone completely and you have taken steps to adress the cause. But I’m not a Physio nor a doctor so it’s hard for me to tell if that is the case and if there would be an issue with riding while doing the physio.

1 Like

I would approach this from the following perspective: Do you trust your physiotherapist? Or are you just unhappy that her recommendation is you should stay off the bike for a while?

Even if I had a background in physiotherapy or orthopedics (which I absolutely do not!), I could not judge your case.

If I had to make that decision, I’d likely err on the side of caution and put the energy I’d normally invest into training into recovery and physio instead.

1 Like

Yeah, don’t listen to the qualified medical professional who’s examined you instead get your medical advice from some random people on an internet forum.

9 Likes

Let’s face it, very few medical professionals are trained in sport specific injuries and even those that did a general sports medicine fellowship are most likely not trained in cycling biomechanics.

Personally, I would probably not take 6 weeks off for a knee niggle. I’d get a second opinion from someone more expert and address any fit issues causing the niggle. I’d do the exercises to see if they help.

I had an issue like this once and my doc recommended taking advil for five days straight even if the issue felt better after a couple of days. A PT though technically cannot prescribe anything. A PT cannot even officially “diagnose” a problem at least in the US.

4 Likes

If the guidance is from someone with experience in sports related injuries, then I’d follow. If not, I’d get a second opinion from a doctor with a sports medicine background.

I broke my foot and was off a saddle for about a week (until swelling reduced), and back outside on a bike in only a few weeks. N =/= 1, but that doctor was used to dealing with athletes and not the average obese American looking for pain meds.

1 Like

4-6 weeks off for a knee niggle seems a bit much. Who doesn’t develop some kind of nagging soreness during a season on cx? It stresses your weak spots in a way that’s hard to replicate in training. I’d bet as long as you’re not pushing long intense workouts for a few weeks it’ll go away. Besides, post-cx probably should be some easy recovery weeks then base. Do the recommended strengthening exercises and back off (intensity / duration) on rides if you feel the knee acting up at all. If that doesn’t work, I’ll refund my consulting fee…

1 Like

Yeah, best to listen to the “medical professional”. After all, she’s a professional. A medical one.

Got knee pain? From cycling?

Quit cycling. Problem solved.

3 Likes

Physio here, first question I always ask is are we causing pain or damage? From what you’ve stated I’d guess you’re only risking pain. I’d dial back the intensity and do endurance rides and the physio. Higher stress of pushing higher power is likely the irritant. If the pain is not responding then maybe consider time off the bike but I’d bet you can accomplish both. I’ve trained through all kinds of injuries that people suggest time off for but I think that’s just erring on the side of caution.

6 Likes

Do not underestimate the impact on your mental health.

The Physio is only worried about your injury, and maybe the likelihood you will sue if they give the wrong advice. So, unless you are lucky enough to find a prgamatic one, they will only advise you on the best route to make your injury better.

You may get sorted physicially quicker, and better, if you don’t train. It may mean a 6 week misery rather than 60 months of intermittent nagging injury until it eventually goes bang. However if the consequence of this leaves you in a big mental hole of irrational desicions or depression, is it worth it?

If you are exercise dependant for mental health then 6 weeks is a frightening prospect that can do much harm mentally.

Its a tightrope and only you can choose how to walk it. Very few people will tell you to ignore the advice of a medical professional.

I would

  1. Ask the physio if there’s any other kinds of Cardio you can do.
  2. If you follow her advice and don’t ride, set yourself a 6 week non-physical challenge to run alongside her exercises. Perhaps decorate the spare room or learn a muscial instrument or whatever
  3. If you dont follow her advice, be very aware that the injury can drag on and on. Do the minimal low level cycling you can get away with to stay in charge of your mental well being. You mat find that low level recovery spins of 30 mins 3 x week is enough.

I’ve always exercised through my injuries in one way or another. It’s either that or I’m a non functioning member of society.

4 Likes