Hello!
Are there any riders out there training with osteoarthritis, or do any of the TR coaches have experience training riders with arthritis or inflammation issues?
I’ll start by telling you a bit about my situation, then go into some of the tricks I’ve found to managing the injury and still be able to train on my bike.
I’m 40 and I have advanced osteoarthritis in my left hip, the result of a lifetime of doing impact sports with a hereditary misshaping of the femur head. The arthritis (and misshapen femur) were only diagnosed a few years ago because the arthritis would manifest itself as soft tissue and muscular injuries in my back and groin, as well as in my left knee and ankle joints. It turns out that I had been slowly twisting for 25 years, becoming more and more right-side dominant to protect my left side, and developed a huge muscle imbalance as a result of that twisting. It was only because of getting back into road cycling in a big way a few years ago - adapting my asymmetrical body to a symmetrical bike - that my hip started to hurt. Trying to line up straight on a bike, and have both sides of my body and all the muscles in my leg contributing equally to a pedal stroke, isolated the real problem. I was then sent for an MRI scan, which confirmed the diagnosis.
The upside to finally knowing what the issue is means I can concentrate all my efforts on mitigating the symptoms of this one injury, and all the back and knee and ankle pains have gone. The downside is I’m in a constant battle to keep inflammation (and, as a result, pain) down - something that is an inevitable bi-product of trying to stay fit on a bike. Unfortunately, being a single-parent and running my own small business with long days and physically demanding work creates a lot of stress, too. The upside to my job is I can be flexible with my hours and, providing I meet my deadlines and be at the school gates by a certain time, I can build training and treatment into my schedule. The other big upside is I am now obsessed with a form of bike riding that is low impact and amazing for my mental health. When I get the balance right, cycling gives me the calm and patience I need to tackle the arthritis and general life stuff.
I’m constantly trying to learn about and try new tricks, but here’s some of what I’ve learned in the last year or so:
Training
First off - I don’t race nor intend to in the foreseeable future. I just like to do whatever I do as well as I can (and efficiently), so that’s why I use structured training. I’ve currently managed to find a rough balance between work and training stress where, in a typical week, I can train relatively hard for around 5 hours. I currently do a one hour TR threshold or sweetspot session on Tuesdays and another on a Thursday, with a longer outdoor ride on a Sunday. I focus more on sustainable power at around threshold because I found that puts my joint under a lot less stress than anaerobic intervals, and means I am still have enough mental and physical energy for a full day of work afterwards. I tend to save the more explosive efforts for outdoor riding when I can use my body and bike to generate power. I am also on the lighter side compared to a lot of the larger friends I ride with, and I suspect I’m naturally a bit more punchy, so threshold work helps me keep up on the flat. In short, it’s my weakest attribute. I was also told to keep my cadence low by a bike fitter as a result of poor hip stability… but instead I’ve worked at increasing my cadence to reduce the torque required and my power has gone up and pain has gone down. I do enjoy some slow cadence work to help correct any bad posture, however.
Bike fit
In order to reduce the pain in my hip, multiple bike fitters have encouraged me to have my seat really far back (and decrease my reach at the front) to better engage my hamstrings and glutes more. The theory being that sharing the workload over more muscles would help manage the pain and take the strain of off my hip flexors. I found that the fact I have long legs and short body means my seat post is really high (on a bike size that fits my torso) and fairly far behind my bottom bracket as a result of that height. So to push my seat back more only closed my hips off even more. This was painful over longer distances. Instead, I switched to an in-line seat post and slammed my seat forwards (and raised my seat a tiny bit). This brings my seat 15mm closer to the BB and opens up the front of my hips, preventing painful impingement. I can also keep lower and eat a bit less wind. I’ve been running this for a few months and done several 4 hour rides and not experienced any shoulder or neck pain as a result… yet. I also run 165mm cranks to stop my left knee having to come quote so high at the top of the stroke and have my cleats right back. I also run compact gearing and that allows me to spin a high cadence with less torque on climbs.
Off-the-bike exercise
As a result of my self-fit (and previous love of BMXing and skateboarding), I am very quad dominant, so I’ve recently started some basic off-the-bike work on hamstrings and glutes twice a week, as well as core and any muscles to help hip stability. I also do daily flexibility stretches and poses each morning concentrated around my hip flexers. Releasing my psoas has been really beneficial in preventing a lot of pain. To keep treatment costs down, I check in with a high performance sports physio every few months, as well as a local osteopath, but get most of my information for exercises from Dr Eric Goodman’s Foundation Training YouTube channel. I can share links if anyone is interested. I definitely feel this is an area I can explore more for reducing pain and increasing flexibility.
Diet and supplements
I avoid red meat and try to limit my meat intake (in the form of chicken or turkey) to days I ride for protein. I try to get most of my carbs from low gluten sources, and mainly have a vegetarian diet of real and whole food. As I rarely do consecutive days on the bike (with the exception of trips or over certain holiday periods), I tend to use time restricted eating the day after training to help deal with the sheer quantity of starchy or sugary food I’ve eaten to fuel the previous ride. This has helped with inflammation. I also take turmeric, D3 and fish oil supplements. And occasionally aloe vera to help with digestion.
Other
I’m one of those Andrew Huberman podcast nerds who’s tried to implement a more consistent sleep schedule, and have a few tricks for getting to and staying asleep. Cutting out caffeine after lunch, lowering lights, no phone when possible. I’ve have a wearable device that tracks my sleep and I have been able to get a rough idea, as I don’t totally trust the precision of the sleep data, for what helps me get more restful sleep - baths, being cooler at night, learning to breath through my nose better. I also keep an eye on the HRV to see when I am under too much stress tor getting ill. If I drink alcohol or stay out late (for work, believe it or not), I don’t train the next day and do no more than Z2 in the days afterwards. I also commute (with and without my son) by bike, so converted a mid-90s GT MTB into a dad-mobile (with chunky slicks and shot-gun saddle), and found that the big range of gearing on that era bike allows me to spin away at high cadences without fatiguing my legs, even with the extra 20kg human weight on the front. I don’t track the commutes all the time, but have worn my HRM on several of my regular rides to get a rough understanding of my efforts for the benefit of my overall training stress.
So… basically, I would love to hear from anyone going through something similar, or hear about any tips people might have.
MUCH LOVE
Rhys from London