Patellar Tendonitis

by Mr Jono   May 28, 2013  

I've been riding seriously (100 miles+ a week) for a year now. I've been out of action for a month with an injury I picked up on a long, cold and wet descent in Mallorca. What started on the last ride of the week (100 miler) as a niggle turned out to be tendonitis. I built up my miles in the weeks before the trip (150, 200 then 250), and was rigorous with stretching before and after every ride. I wasn't planning on riding so much there but ended up doing 390 miles by the end of the week, classic overuse really.

I've seen a sports physio twice, which was beneficial but not so much that I feel it's worth paying any more as I'm quite poor at the moment. I think it just needs time. How much time is what I'm struggling with though.

I've been following the physio's advice; icing it, regular quad stretches every day and completely avoiding getting on a bike. The physio advised me to try very short, flat rides once the pain had subsided. I gave that a go at the weekend but after about 2 miles the pain started to come back. Today it's not painful per se, but I can definitely feel the sensations of slight pain again.

I'm trying not to get bummed about about it, but I can't stop thinking that this is going to ruin my summer in terms of riding.

Just wondered if anyone else has had the injury and how long the rehab took them?

Should I ignore the sensations and keep doing short rides? Or am I exacerbating the injury by riding when I can feel the niggle?

24 user comments

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My mate had it, he was off from excercise for about 6weeks -2 months I think. I'll double check.

I'm no physio, but If it hurts or anything I wouldn't ride. As tough as that may be! I'd say wait till the end of june?

posted by Cycle_Jim [282 posts]
28th May 2013 - 16:03

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Rest is key and recovery as well. I used a a week off then intense foam roller use, stretching and ice to get rid of mine. It was a bit sore when restarting but just took it easy and always rolled and iced after. I also reexamined my cleat alignment and put my seat back slightly. You could look at at speedplay pedals which have heaps of float too.

Good luck

posted by Nzlucas [111 posts]
28th May 2013 - 16:08

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Thanks for the info. Should have mentioned that I had a bike fit before I went to Mallorca, during which they put the cleats back about 10mm I think. I hired a bike out there but used my pedals. Have no idea if that contributed.

What do you mean by foam roller? Sorry if that's a dumb question!

How long did you use your week on/week off programme?

Nzlucas wrote:
Rest is key and recovery as well. I used a a week off then intense foam roller use, stretching and ice to get rid of mine. It was a bit sore when restarting but just took it easy and always rolled and iced after. I also reexamined my cleat alignment and put my seat back slightly. You could look at at speedplay pedals which have heaps of float too.

Good luck

I'm so lazy I'd rather order something off Wiggle than go to the shops for Haribo...

posted by Mr Jono [106 posts]
28th May 2013 - 16:21

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Takes ages I'm afraid, not much blood flow to that tendon so takes a while to recover/improve.
Hamstring stretches and a slightly higher saddle height helped me, had it for 30 years though!

posted by jengy [67 posts]
28th May 2013 - 18:53

4 Likes

Jono, He means myofascial (sp) rollers (I think) They are quite cheap on amazon and there are some instructional videos on youtube!

My mates recovery time was mid feb till mid april to give you a time scale.

posted by Cycle_Jim [282 posts]
28th May 2013 - 18:57

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Here's a depressing update: knee gave way walking down the stairs this evening. Stacked it completely. Pain is now the worst it's ever been. Crying

I'm so lazy I'd rather order something off Wiggle than go to the shops for Haribo...

posted by Mr Jono [106 posts]
28th May 2013 - 21:39

6 Likes

Bad day for your ey Jono! Wish you a speedy recovery, take it easy.

posted by Cycle_Jim [282 posts]
29th May 2013 - 8:13

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I'm sorry to hear this. I developed patella tendonitis about two years ago and am only now getting back to where I was before it developed. My advice would be to see if you can get your GP to refer you to a specialist knee service. Mine did, and after going through two separate courses of physio, a visit to the musculo-skeletal service, an MRI scan and an appointment with a consultant, we worked out that it stemmed from a misplaced kneecap and a poorly-aligned IT band, coupled with under-used glutes (the latter a consequence of cycling).

You say you have had a bike fit, which is good. I had an appointment with Adrian Timmis which was the first major step towards recovery. I also now make sure I keep my knees warm throughout the ride, so thermal tights throughout winter and 3/4s when it gets warmer. Save the Yates-style shorts until high summer!

If I have any advice other than that, it's to avoid the bike whenever you have pain. Don't even think of trying to ride through it. I tried it and it just made things worse.

To maintain my knee health I use the foam rollers on the IT band and a number of resistance exercises on my glutes, coupled with stretches on a daily basis, and a double session after cycling. I also have orthotics in my shoes to correct my pronation.

Here's a decent-enough video on using rollers:
http://www.youtube.com/watch?v=RoHBDim_fzk&feature=youtube_gdata_player
You can also use them on your hamstrings and calves. The harder the roller, the better they work in my experience (although do be prepared for a bit of muscle pain and the odd area of bruising). Ninja exercisers do this sort of thing with hockey balls. I've not dared to yet.

Give me a yell if you want any more info -- happy to help.

posted by stereojet [119 posts]
29th May 2013 - 8:34

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Thanks for the info mate, sorry to hear you've struggled to get back to fitness.

Definitely going to buy one of these rollers. I've requested an NHS physio appointment, hopefully should get one in the next couple weeks. I'd love to keep using the sports physio at BW Cycling in Bristol but I just don't have the funds.

I've always kept my knees warm, base layer on the legs in deep winters and thermal bib tights up until april. At the bike fit I was actually warned about 'winter's knee' which is a strain from wearing too much on the legs in winter, causing the knee to work more to bend. Perhaps a winter of 2 layers on the legs contributed. I feel the cold quite badly though, might just have to harden the f*ck up next winter!

Knee is painful today but hopefully just a minor set back, not a return to the first stages of the injury.

I'm so lazy I'd rather order something off Wiggle than go to the shops for Haribo...

posted by Mr Jono [106 posts]
29th May 2013 - 9:16

9 Likes

Have you tried Gore's windstopper tights? They're almost too warm for me, and quite thin.
Best of luck with the physio.

posted by stereojet [119 posts]
29th May 2013 - 11:01

6 Likes

Another stretch is to do slow squats with no weight, but just stretching out the knee. I do both legs, then one leg ata time.

[custom] '12 Cannondale CAAD10 - Rival

badkneestom's picture

posted by badkneestom [129 posts]
29th May 2013 - 11:36

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Thanks, physio recommended those too, and I've been doing them but not today, too painful.

Just booked an appointment with NHS physio for 2 weeks time which is a bonus, was expecting 4-6 weeks.

I'm so lazy I'd rather order something off Wiggle than go to the shops for Haribo...

posted by Mr Jono [106 posts]
29th May 2013 - 12:54

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stereojet wrote:
Have you tried Gore's windstopper tights? They're almost too warm for me, and quite thin.
Best of luck with the physio.

Cheers for the tip. Currently using sportful no rain bib tights, happy enough with them but might grab a pair of the gore ones in the sales and see what they're like.

I'm so lazy I'd rather order something off Wiggle than go to the shops for Haribo...

posted by Mr Jono [106 posts]
29th May 2013 - 12:55

7 Likes

Kiniseology tape can really help (as popularised by Gareth Bale and others). This basically helps to support the tendon during exercise and takes the pressure off the affected tendon muscle.

It's super good that you are doing stretching. Make sure you are doing the physio exercises everyday (or however much they recommend). I just add that as I have friends that see the physio and expect those sessions to cure them, not realising it is about the homework.

I would recommend MWOD.com. The site was free, but now he's got a membership deal up there, but there are a heap of stretches, and exercises which are free. You can find them all on Youtube anyway (sanfranciscocrossfit is his handle).

As someone else said, tendon are slow healers because the blood supply to them is pretty weak. They're the missing link between muscle and bone from an evolutionary perspective. It sounds like there maybe some imbalance in your riding, or muscle strength. It maybe time to do some cross training to balance your body up. Cyclists have that tendency to avoid other exercise (don't want to carry excess weight), but the fallacy of this is that you get over use strains and muscle imbalances. Most cyclists these days incorporate some sort of gym work out to ward against these sorts of issues.

It maybe that changing your bike in Majorca was the cause given that the bike may have had different geometry (and your pedal set-up was different) which caused you to sit either further forward and increase your knee bend.

Don't rush this one back. I would advise against icing the area too. Instead, reduce inflammation by exercising the muscles around the area - the lymphatic systems that sits around the muscles removes the gunk from healing (not the blood system) and so you just need to active the muscles to pump the gunk out - this doesn't mean further aggravating the muscle/tendon, but using the surrounding tissue to start the job e.g. if you bust you bicep, use activate your forearm muscles and deltoid muscles......compression is also good.

posted by Colin Peyresourde [1203 posts]
29th May 2013 - 13:15

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Thanks for the info Colin. Have just ordered some tape and a foam roller too. Will also have a look at the youtube user you mentioned.

I'm just starting yoga and pilates in the hope that will give me some flexibility and balance in terms of power distribution around my body. The though of joining a gym horrifies me though, so will try my best at home.

Interesting to hear your reservations about icing the knee. I had some too. Surely I should be trying to encourage blood supply to it, not away from it?

I'm so lazy I'd rather order something off Wiggle than go to the shops for Haribo...

posted by Mr Jono [106 posts]
29th May 2013 - 14:30

6 Likes

Would quad exercises be any good, to help with the stability of the knee?

posted by paulfg42 [379 posts]
30th May 2013 - 21:59

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Some things I've learned this week:

1: Walking any further than half a mile aggravates the injury

2: Riding a couple miles on the flat doesn't actually cause any pain

3: Foam rollers are agonising when rolling your thighs over them! Got to be working.

4: Nightshade vegetables (potatoes, tomatoes, peppers, chillies) can cause joint inflammation in certain people. I'm going to try a month without them to see if it improves. Not looking forward to that, I love my spice!

I'm so lazy I'd rather order something off Wiggle than go to the shops for Haribo...

posted by Mr Jono [106 posts]
31st May 2013 - 9:23

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Also, a week before Wiggins got taken out by that van I got taken out by a car in the exact same way. Now Wiggo has a knee problem.

It is remotely possible I am a living, breathing Wiggo voodoo doll.

I'm so lazy I'd rather order something off Wiggle than go to the shops for Haribo...

posted by Mr Jono [106 posts]
31st May 2013 - 10:28

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Just thought I'd take a moment to update this. I've been back out on the bike for 10-15 mile rides for the past 2 weeks, so it's taken about 12 weeks to get to this point. Still a tiny bit painful and swollen by the end of rides but with some frozen peas on there it soon goes away and is gone the next morning.

I've built up from squats to one leg squats and eventually 3-5 mile flat rides. I've been doing yoga 2-3 times a week which has had a major improvement in my flexibility. I've gone from not being able to touch my toes to being able to lay my palms flat on the floor.

I've been using the foam roller twice a day where possible. It's hard to say how much that has helped but initially all of my thigh muscles were agonisingly painful after about 30 seconds of rolling whereas now I can comfortable roll every bit of both legs for minutes at a time.

I've also investing in a specific patella tendonitis strap for my knee, which again is hard to quantify but it can't hurt to use it.

I think it will still be another 2 months before I'm approaching the same sort of mileage per week that I was doing before the injury.

Hopefully this will give a bit of an idea about recover times to anyone else who is unfortunate enough to pick up the injury too!

I'm so lazy I'd rather order something off Wiggle than go to the shops for Haribo...

posted by Mr Jono [106 posts]
29th July 2013 - 10:23

3 Likes

Not sure if it's the same thing but I get occasional pain in my knee, the patella gets out of alignment. I use weights to exercise the knee but the best benefit I get is from a patella strap. Amazingingly effective, after about 15 minutes the pain subsides, I use it for about 3 days and with luck I am pain free for a couple of months.

Mixte Rider

posted by adriank999 [72 posts]
30th July 2013 - 10:26

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adriank999 wrote:
Not sure if it's the same thing but I get occasional pain in my knee, the patella gets out of alignment. I use weights to exercise the knee but the best benefit I get is from a patella strap. Amazingingly effective, after about 15 minutes the pain subsides, I use it for about 3 days and with luck I am pain free for a couple of months.

That sounds amazing. Which make do you use?

posted by paulfg42 [379 posts]
4th August 2013 - 20:41

2 Likes

I struggled for a period with this, I think it was after a particularly excessive ride, and I found the following helped....

Rollers - brilliant, hurt like buggery to start with but totally do a great job!
K-Tape, almost certainly helps
Frozen veg - mixed veg cheaper than peas Wink

Walking - after every ride I went for a 10 minute walk around the block, just a gentle bimble. It seemed to have a great effect on the knees, helping to loosen things out after rides.

I did very little stretching of the knees themselves - some would say stretching isnt good for you so i didnt risk it.

Whenever I get a tightness in the back of the knees now, I unclip that foot and just swing that leg back and forth for a while - keeping it all nice and smooth. it seems to just loosen things off nicely and I can carry on again.

It sounds like the OP caused this in the first place by hammering out lots of miles on a bike he wasnt used to and didnt have the same fit as his body was ready for - schoolboy error but easily done.

Racer 074 for the 2014 Transcontinental Race; 2,000 miles from London to Istanbul.

http://themartincox.co.uk/2014/03/racer-074-transcontinental-race-2014/

posted by themartincox [381 posts]
5th August 2013 - 17:08

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Just a thought but have you looked at your shoes as well.

Consider getting proper orthotics made.

A friend had terrible problems with knee pain and once he got orthotics and a foam roller he has been pain free.

Dont rush your recovery.

posted by pacef8 [8 posts]
5th August 2013 - 19:52

5 Likes

Rather than looking at the symptoms try to work out (or get someone else to) what caused and is maintaining the problem. It is probably patellar alignment & the answer probably lies in your backside (strength &/or flexibility), possibly ankle, particularly if you have sprained it, assuming the bike setup is correct.
Old tennis balls are a good roller bty.

posted by nick1c [7 posts]
18th August 2013 - 10:08

6 Likes