Monthly Archives: May 2013

Grand Bois Hetre Extra Leger. Shaved. Tubeless.

Thanks to Peter Weigle! According to his note on the inside of the tire, the front went from 370 to 313 grams. The rear tires, on which Peter left a trace of tread, lost about 40 grams.

Extra Leger Shaved

First 1000 miles on these will be on the new English 650B. Next thousand will be on the Herse (probably with tubes though).

Knees are recovering and I should be back in business shortly. If my knee wasn’t injured, I’d be in the middle of George Swain’s Catskills Climbfest right now instead of sitting in front of my computer, working.

And PS: Can anyone make my grass grow? Believe it or not, it was exactly 50 degrees colder today than it was on Tuesday. 92 degrees to 42 degrees in 4 days, plus 30-40 mph winds.

John

medicalwriter.net

Glucosamine and Chondroitin for Knee Pain: What’s the Evidence?

If you’ve been reading along, you know that I’m taking a week or two off from longer rides because of knee pain. I don’t think there’s anything wrong with my fit, it’s clearly from pushing too big a gear up extended 20% grades, plus a saddle collapse that put me almost a centimeter below my usual position. The knee pain really started after a long, long cat 1 climb in the northern Catskills. I’m feeling much better now, but I’m still only going for daily 10-15 mile rides, rather than the 80- to 120-mile rides I prefer. I’ve also, much to my disgust, replaced my Brooks Swallow saddle. I wish something else worked for me, because I don’t like spending $300 on a new saddle every 6000-7000 miles, which amounts to only a year of riding for me—probably less now that I live somewhere that is much more conducive to riding.

So now I have a new found interest in treating and preventing knee pain. My girlfriend, who is a runner, swears by glucosamine/chondroitin supplements, together with krill oil. Being a biomedical scientist, I asked, what’s the evidence?

Before you read this, I want you to keep in mind that I have my own inherent bias, in that I want the supplements to work; also remember that I wrote this post in 15 minutes at 10:00 at night, so it is far from a complete assessment of the current literature!

The GAIT trial was a prospective (meaning planned in advance) 24-month, placebo-controlled study conducted in 572 patients who, at baseline, satisfied criteria for osteoarthritis of the knee. These patients were randomly assigned to several treatments: glucosamine, glucosamine plus chondroitin sulfate, the COX-2 inhibitor celecoxib (a non-steroidal anti-inflammatory drug, like naproxen, with somewhat different properties), or placebo. The primary outcome measure was a 20% decrease in knee pain from baseline to week 24.

Unfortunately, GAIT showed that there were no significant differences among the groups in terms of response: the placebo response rate was 60.1%, whereas the response to glucosamine was only 3.9 percentage points higher, and the response to the combination was 5.3 percentage points higher.

On the other hand, the STOPP trial, which was published in 2009 in the generally high-quality journal Arthritis and Rheumatism, found that there was a significant reduction in joint-space width loss and a significantly more rapid improvement in pain among patients who received chondroitin sulfate, with no safety issues. While I would ordinarily discount a single study, this represents the largest single prospective study of chondroitin in the literature that I am aware of (I’m not writing this for work, so I’m being a little casual about my research). But it’s not much bigger than the previously noted negative trial. Again, this study was conducted in patients with pre-existing, relatively severe osteoarthritis.

The results of these small trials are interesting, but given their small size and the fact that they enrolled patients with osteoarthritis that was fairly significant (and thus, a group that is unlikely to be participating in exercises that stress the knee), they don’t have a lot of relevance for your average active athlete. Another study, conducted in Navy Seals, found that knee osteoarthritis symptoms were relieved in patients who took the active treatment, which in this case included glucosamine, chondroitin, and manganese ascorbate. This study may be the most relevant to the average athlete, as Navy Seals, one would suspect, are reasonably active.

Now, what about meta-analyses? Meta-analyses combine data from multiple trials, and are often considered to be the best evidence for or against a treatment. Unfortunately, we get contradictory results here as well. A recent meta-analysis, published in 2010 in BMJ, assessed the efficacy of glucosamine, chondroitin, and placebo, again in patients with preexisting osteoarthritis, and found no evidence for efficacy in terms of joint-space narrowing or functional/pain outcomes. Again, all of the studies were conducted in patients with pre-existing, relatively severe osteoarthritis. However, several earlier meta-analyses identified clear benefits associated with these supplements

Setting aside the meta-analyses, which could contradict each other for any number of methodologic reasons, why are the results of the STOPP and GAIT studies discordant? I think GAIT was poorly designed and run. First, the GAIT study had an extraordinarily high drop-out rate. Second, the study used an older radiologic technique to assess joint space narrowing. Third, GAIT used a low threshold to identify responders—a threshold so low that it could easily be reached by many patients in the placebo arm, eliminating any chance to identify a significant difference between active treatment and control.

It seems like the evidence is equivocal, as so much is in medicine. So what am I going to do? Neither glucosamine nor chondroitin appear to have significant side effects, so I am going to keep taking them.

John

medicalwriter.net

New Route: The Great Northern Catskills

About 90% of the time, whether I’m riding alone or with a group, we’re following a route that I designed on Ride With GPS. Since the first time I used it, about three years ago, I’ve become well-versed in designing low-traffic, scenic routes that make everyone happy (at least until the 10,000th foot of climbing). So it was refreshing to follow a route designed by someone else, in this case, Doug. I didn’t know what to expect, but it turned out to be a great route. Here’s the route, with full GPS, of course.

Great Northern Catskills

GNC elevation

We started from Doug’s place in Woodstock. You could also start this route from Stone Ridge, Kingston, or any of the surrounding towns. We headed east out of town, and then north on Glasco Turnpike and West Saugerties Road, crossing the dreaded Platte Clove Road on our way to Palenville. As you can see, everything has gone blindingly green.

L1020500_pe

At Palenville, we headed back west on Route 23A and into Catskill Park.

L1020502_pe

L1020507_pe

23A will take you past Kaaterskill Falls (which actually isn’t visible from the road, at least from what I could see). This picture is of Kaaterskill Clove. I should have taken a picture a little earlier, but Doug assured me that there was a good view from this bridge. Well, this is what I got.

L1020508_pe

About here, my GPS died. Permanently. I think the rain on last week’s ride might have been a little too much for it to handle. This will be the third Garmin I’ve been through in five years. Is it too much to ask that a device intended for outdoor use be waterproof? Garmins are just awful…not only the construction, but also the user interface is something straight out of 2002. If there were any choice in the matter I’d use a different device. I have a Garmin 810 coming in the mail.

The ride up to Palenville is nice—it’s full of rolling hills and you can keep up a high speed. But when you turn onto 23A, things get interesting. There is a massive, extended climb up from about 500 feet to 2570 feet, full of twists, turns, scenic views, and waterfalls. You’re basically doing the same climb as Platte Clove, just a few miles north and much more extended. As a side note, this is a genuine Cat 1 climb–one of the few on the east coast. There are lots of climbs that are much, much harder, but this one combines steepness and length in a way that makes it a Cat 1 climb.

L1020509_pe

L1020511_pe

L1020512_pe

L1020513_pe

The morning of the ride, I agonized over what to wear. I didn’t want to dress for rain and cold temperatures, and I almost left the house in nothing more than a jersey, one light underlayer, arm warmers, and shorts. At the last minute, I turned around and put on tights, a winter jersey, and my Castelli Radiation jacket, albeit without the snap-in space blanket liner. When we left Doug’s place in the morning, I was sure that I was going to fry. As it turned out, it was a very good choice, because by the time we got to the top of 23A, it started raining with wind gusts of 20-30 mph and the temperature dropped to the low 40s. On one descent, I actually had to slow down because my hands were going numb.

We continued north in the freezing rain and wind in the high Catskills, passing through a number of tiny towns—Jewett, Ashland, and Red Falls, before rejoining 23A to head south.

L1020514_pe

L1020516_pe

But first, we took a detour up to a diner in Prattsville—a town on a river that was more-or-less completely destroyed during Hurricane Irene. I didn’t take pictures, but the town is still a mess, particularly west of the road next to the river. We arrived too early for the annual farm machinery show, I regret to say.

L1020521

From there, we headed back south on 23A, crossing the river at Lexington to continue on Route 42. Route 42 passes through some beautiful country. Unfortunately, this section of the ride—which was supposed to be easy—was plagued by 20-30 mph headwinds. We barely touched 15 mph, even on downhill segments. Between the climbs and the death march into the wind, I messed up my knee. The wind acted as a blow drier, though, so eventually I dried out.

L1020522_pe

L1020526_pe

After the ride, I looked at my saddle, and I realized that my Brooks Swallow was undergoing its annual irrevocable collapse, which lowered my position by almost a centimeter. Hence the knee pain. Garmin and Brooks should get together to make a leather-covered GPS unit that breaks down after a year of use. If I had any choice in the matter I’d use anything but a Brooks Swallow, but that’s the only saddle that works for me.

A few more pictures of this segment.

L1020527_pe

L1020531_pe

Once we hit 28, Doug and I parted ways. He headed back to Woodstock, and I rode home to Olivebridge. At this point, my knee was really hurting, so I was going slow.

L1020533_pe

I took a break only about 8 miles from home, at my favorite spot on the Ashokan Reservoir. Two teenage girls complimented me on my bike, but in retrospect I think they were being sarcastic, because it (and me) was covered with a thick coating of muck and mud.

L1020534_pe

The last leg was tough, and I actually walked my bike up a little hill near my place because I didn’t want to further stress my knee. When a car passed, I bent over like I was fixing something. So embarrassing.

Although it isn’t really feasible from Poughkeepsie, this route is definitely worth the trip if you can make it out to Woodstock for an overnight. You get a couple great climbs, absolutely gorgeous scenery, and long downhill segments (hopefully you won’t have to battle a headwind). Nice work, Doug!

I’m taking a few days off the bike so my knee can fully recover, and then this week I’m going to do daily 15 or 20 mile rides.I am particularly annoyed because I had planned on doing a 400k in New Jersey this weekend (in fact, I would be finishing it up right about now).

Although the knee pain is probably attributable to the saddle collapse, it also—in part—might be a case of spring knee. I’ve really overdone it the past few weeks, riding well in excess of 200 miles a week. Not a big deal in the flatlands, but when 250 miles means 20,000 feet of climbing or more, it isn’t easy on your body! I’m also strongly considering lowering my gearing considerably—although climbing these hills in 34-27 isn’t a problem aerobically, it is clearly causing undue wear and tear on my joints. Maybe I’ll ask Rob English to put a mountain bike derailleur on the 650B he’s building for me…34-36 would likely cause a lot less stress.

Oh, and some news. I bought a Leica R6.2, so I’m taking photos with gen-u-ine film now. Now I can annoy my riding companions even more with extended stops so I can manually adjust my shutter speed and aperture before snapping a photo!

Leica 6.2Film photos coming to a blog near you soon.

John

medicalwriter.net