My knee issues began at an early age thanks to American football. A stupid activity, but it was fun. Really bad for knees. Tennis and racketball both killed my knees years later after I'd had a couple of surgeries to repair stuff.
Hockey, whether ice or roller was also not great. Free skating was tears inducing pain. But, I'd do it then go play hockey until I was exhausted.
Through and between and after all that came cycling. I learned early to spin lower gearing to save the knees. That strengthened that little muscle at the inside of the knee that on cyclists ends up being a big bulging knob. That stabilizes the patella from the larger muscles along the outside of the upper leg pulling it off center.
My PT people had me sitting on the floor with a coffee can under my knee and doing flex-extensions. As I got stronger I'd do very similar range of motion squats on a machine where I laid on my back and pushed the weight with legs.
When we had a cycling team medical coach,
Andy Pruitt, we learned a whole lot about strength training and cycling along with position.
Andy was the only English speaker at the world conference at the 1984 World Championships. He was local and became a great friend to our team. His diagnosis leg to my last surgery that leg to a long road to recovery from an injury that ended my bicycle racing days. That was 30 years ago and now my muscles are stronger as far as the stability in my knees is concerned.
There is still scar tissue of course, at my age there has to be and I avoid a lot of stuff. Pickleball being the latest.
Cycling is the lowest impact activity one can pursue if done correctly.
Mashing big gears while concentrating on speed or power is not good for old or injured knees.
I know from experience how long the road is back from even a slight strain. That road gets longer the older and more injured the knee is.
I've not found any good cycling PT out here, but also have not really looked.
So, with all that blather, what works for me is spinning. I started with a professional bike fit and have had this done several times since the first fitting back in the early 80's for my team bike. All the while I biased that fit to what I knew worked best for my body.
I know what works to a close enough degree that when I bought the Roubaix and they were fitting it to me, a few days after I'd picked it up, they were surprised my saddle was within a few mm's of where the indicators said it should be.
Spinning lower gears is one thing, but outside of cycling, I don't play any ball sports or racket sports and run very little. I can walk and hike on uneven ground without bothering my knees now because the muscles that support the joints are string enough to stabilize those joints as I negotiate uneven pavement, rocks and sand.
Back when I tore up my knee for the last time, it was basketball that did it. I unshipped my femur from my knee joint, tearing the ACL. I popped the knee back into place and continued. I used a fancy brace left over from high school football to stabilize the joint when laying under heat or ice at night to deal with the pain.
I eventually found that heat and the brace did the trick. NSAIDs did not touch the pain. Alcohol only worked for minutes. Mostly I relied on exhaustion. Doctors can't see the soft tissue damage with x-ray, and only see the scar tissue and buildup in the joint in the "moonrise" shot.
I found I could not lay on my back with my leg straight. I had to have a rolled towel under my knee with the heel off the end of the bed.
Oh, and no skiing. My first love as a kid. I quit skiing in the 90's after figuring out every run ended in a moaning teary eyed session to recover enough to ride the lift back up. I figured out real quick that no footrest on the lift meant pain.
After surgery I had a very long five month recovery period where I had multiple incidents of blood filling my knee to the point it would not fit in pants. Sweat pant ride to the doc for very painful draining session. The first time was immediately after my very first PT with a bunch of geriatrics in a pool with as low of impact exercise as possible. just moving the leg in the water was enough to blow it up. After the second time we changed to electro muscle stimulation for a month then back to the pool walk and finally I got to doing those floor extensions. And five months later I could ride my bike and not nearly pass out from pain.
I'd tried to ride about a month after the surgery and nearly fell on the ground after riding across a crack in the pavement.
My awakening to caring for an injured knee that will never again be the same as it was before really hit me when I could not walk at 40. I had one good leg to stand on and needed crutches at least to move off that leg. Live for a month at work with a walker. I got serious and focused on caring for that knee. I took notes from my PT guy and asked questions. Very specific.
And I talked to Andy again to make sure I wasn't going to mess up what was according to my surgeon was my last chance before full knee replacement.
And now almost 40 years after that last surgery my knees are not a real problem. I've been amazed at how much stronger I am than I thought I was.
No, I'm not fast as I was before. 40 years has a way of using up stuff, but I'm stronger than many in my age group and strong enough to still enjoy walking and especially riding.
I also know I am absolutely not ever going to have a knee I can race on at the level I could back in the day. I'm fine with that. I'm also fine with not playing ball sports or skiing or playing hockey or racket sports. Surfing doesn't bother my knee because cycling has stabilized my joint to where kicking with my legs while swimming doesn't hyper-extend the joint anymore. Of course my left leg can't straighten to 100% after the surgery thanks to my tearing that ACL three times, making it not long enough to do that. But, it gets to a bit better than 90% and that is good enough.
Good luck.
