Road Cycling - Patellar tendinitis

I've done a small amount of searching and reading and have come across a condition that may explain the small amount of knee discomfort/pain I am having, patellar tendinitis. Anybody know if cyclists suffer from this much? The discomfort is primarily around the edge of the left knee cap and just below it. If I spin in lower gears it helps a lot when on the bike but I can feel it when climbing stairs or getting up from a seated position. (I wanted to add something funny about getting off the toilet but couldn't come up with anything clever enough.)

I get this condition from playing Volleyball too much. Cycling tends to be a good rehabilitation for it. If you get this from cycling I would say there is something wrong with your bike setup/fit.

I get this condition from playing Volleyball too much. Cycling tends to be a good rehabilitation for it. If you get this from cycling I would say there is something wrong with your bike setup/fit.

If it is bike set-up, why just in one knee? If I make adjustments to make my left knee happy what if my right one rebels? I suppose there has to be a happy medium.

You may have one leg that is longer than another or you may favor one leg over another because it is stronger. You may be making compromises for a poor fit that only effect half your stroke. Can't know without a proper fitting. If you have a leg that is shorter you can use a product like the Lemond Lewedge toshim the one leg so they are the same length. A good fitter will have a solution IF this is a fit problem.

Hehe, just make sure you fix it, in my running days, I ignored that, which led to a stress fracture, which I ignored, which led to a rather larger one, and a LONG vacation from running

I agree with GrassChopper.

I took up cycling last year because of severe and reoccurring 'Runner's knee'. It is not unusual for only one knee to start hurting in this condition.

My knee started to hurt a little this winter from cycling in the same way. in my case it was because the seat was just a little too high and my cleat was not aligned properly. Once fixed, the pain immediately went away. My left knee (affected) is more knocked knee than the right thus requires a different cleat position to have proper tracking of the knee.

Another possible reason is too much too soon on hill work or pushing big gears, back off and allow your gluts and quads to get stronger before you up the intensity. This would be a simple overuse cause, not related but perhaps excerbated by the a minor fit issue.

Another note.

I feel unless you get a very good professional fit by an expert with experience in these biomechanical issues, the best thing to do is experiment on the trainer on your own until you nail it.

I was "fitted" (they they used protractors and everything) for my bike last summer and rode it all summer fine. But this winter, the trainer really brought out fit issues that were easy to ignore on the road because you move around on the bike more. I have changed the stem, bar angle, saddle height, saddle fore/aft position and cleat position on both pedals. It is like I have a whole new bike.

Most importantly, I can now do intervals in a high gear with out knee pain the next day.

Something else to shed light on the subject....A few months ago I ran back to my home from a neighbors. That's about the time the discomfort started. I hate running and I rarely do it but it was raining so I ran on the road, up a small hill but a very short distance. I have taken time off the bike a couple of times (7-10 days) and it seems a bit better afterward but then progresses back to where I am now. Up until that "sprint" I had no problems. I hate the thought of taking more than a few days off the bike but maybe that is what it's going to come to?

Another note.

I feel unless you get a very good professional fit by an expert with experience in these biomechanical issues, the best thing to do is experiment on the trainer on your own until you nail it.

I was "fitted" (they they used protractors and everything) for my bike last summer and rode it all summer fine. But this winter, the trainer really brought out fit issues that were easy to ignore on the road because you move around on the bike more. I have changed the stem, bar angle, saddle height, saddle fore/aft position and cleat position on both pedals. It is like I have a whole new bike.

Most importantly, I can now do intervals in a high gear with out knee pain the next day.

Good one.

If you can't afford a professional fit, then a trainer is a must. Dialing a bicycle takes time and doing it on the road is impossible.

You were probably well on your way to the injury before you ran up the hill.

You must check your (1) fit on the bike (2) training program and (3) muscle imbalances.

If you read the running message boards, you will find a plethora of information because it is a very common type of injury.

I was once incorrectly diagnosed as having patella tendonitis, but it was Chrondomalacia, which dispappeared in three days after doing some straight leg kicking exercises with light weights.

The last time I went for a jog (~2km) it came back.

I had it, mine was over use.

I get it in my right knee if I push too big a gear early in the season. Raising the seat, or extending the leg farther may help. But the best advice my orthopedic surgeon gave me was to stretch my hamstrings. I thought "BS, how is touching my toes going to help my knee" but he explained all the force from the back of your leg gets transferred through the knee, and to trust him on it. I went home, and in a few days was flexible enough to put my head on myknee cap while doing seated stretches, and sure enough it was gone.

You can also take Bextra, which is an anti arthritis drug, workes like a charm. It blocks the enzyme which causes the inflamtion. While this provides literally amazing relief, very quickly, (I went from not being able to climb stairs without wincing,swearing, and almost crying, to jumping up and down within 2 days) It simply masks it and does not address the cause.

Now, when I feel it coming back, after a couple of hard hard days. I stretch my hamstrings at night, and in the morning, its all but gone.
try it

Grasschopper is right. If one femur is shorter than the other, that knee will be farther behind the pedal spindle at the 3:00 position, and it may be more vulnerable to injury. In that case, the solution may be to push the saddle forward to favor the more vulnerable leg. You can have a similar problem with a twisted pelvis too: if one hip socket is behind the other, that can cause a problem for the knee that is farthest back. I wouldn't be willing to venture a guess on how common these problems are, but I'd be inclined to think they are scarce, and that the cause of your problem lies elsewhere.

A quick check for leg length inequality would be to stand symmetrically with your feet together, and look to see if one knee is lower than the other, or if one hip is lower than the other, or if the waistband or belt on your pants slants to one side or the other. You can also try lying on your back with a 90 degree bend behind your knees, legs together, and see what the relative positions of your knees are, which will allow you to detect a leg length inequality and to figure out which segment it is in. These tests are moderately sensitive, and not as good as getting CT'ed for LLI.

A leg length inequality tends to produce a line of saddlesores where the leg meets the crotch, on the side of the short leg, if the seat height is high enough so the short leg runs out of travel and causes hip rocking. For some people, this will be diagnostic down to a difference of just 3mm or so, but some others are resistant, and will not have this problem.

If you find something, let us know. I don't know diddly about patellar tendonitis, or about pain in the location you describe, so I won't comment.

how is hip rotation rectified?

Just by stretching everything?

I had the same problem. I went ot see a local cycling coach and he found that my saddle height was too low so my knees were bottoming out and shooting outwards causing the pain. I am now pain free and riding much stronger.

Remember that if you are riding an average of 200 miles a week at an average of 90rpm and 18mph, you are doing about 3120000 revolutions per year. Think about the effect it has on your knees when you are not set up correctly.

Spend the money on a decent bike fit.

how can i find someone who does a professional fit in my area?

I just had a professional bike fit today and mentioned patellar tendonitis. Check your cleat setup on your shoe to see if it's in the right place. If it's too far forward, then this may help out at least a little.

If it is bike set-up, why just in one knee? If I make adjustments to make my left knee happy what if my right one rebels? I suppose there has to be a happy medium.

I had the same thing in only my right knee. For christmas, I received a two hour professional bike fitting - not one of the standard, ineffective, BS, LBS, alleged fittings. Part of said fitting was dealing with a discovered leg length discrepancy by putting shims under my right cleat. I haven't had knee pains since and I ride 5-7 days a week at pretty reasonable speeds.

This condition (If I understand you correctly) is called Osgood Shlaghters (Sp?). It is a condition usually associated with growth spurts in active adolescents. It is when either the quadriceps are overdeveloped or the lower body muscles are too tight. If the quadriceps are too short (or overdeveloped) they will pull on the insertion point right below the patella. I grew about 2 inches in 2 months and in one year about 6 inches. This incredible growth spurt along with me playing club soccer really hurt my knees. I would only be able to war-up for about 10 minutes before I was crippled and incappacitated. I could literally not walk to the car. I then started rehab where i was put on a rigerous stretching routine along with piriformis and hip-flexor strength exercises. I can now play a full game with no pain at all. Road biking is terrible for your hip-flexors because of the severe angle when you are bent over. Also the fact that biking works the quadriceps could also be a big factor.

This condition (If I understand you correctly) is called Osgood Shlaghters (Sp?). It is a condition usually associated with growth spurts in active adolescents. It is when either the quadriceps are overdeveloped or the lower body muscles are too tight. If the quadriceps are too short (or overdeveloped) they will pull on the insertion point right below the patella. I grew about 2 inches in 2 months and in one year about 6 inches. This incredible growth spurt along with me playing club soccer really hurt my knees. I would only be able to war-up for about 10 minutes before I was crippled and incappacitated. I could literally not walk to the car. I then started rehab where i was put on a rigerous stretching routine along with piriformis and hip-flexor strength exercises. I can now play a full game with no pain at all. Road biking is terrible for your hip-flexors because of the severe angle when you are bent over. Also the fact that biking works the quadriceps could also be a big factor.

I don't think you can assume that he has OSD unless there are the usual symtoms. Normally, this is a disease of youth - I had it when I was 12, and typically the only residual affects would be a protruding lump under the knee.

I don't think you can rule out Osgood-Schlatter's or any other disease that is not typically related to cycling or biomechanics. Not all diseases present with the classic symptoms.

If you could then people in the forums would probalby have told Lance to get a new seat or tilt it down.

My differential (without seeing the guy or asking any questions) would include:
1. Neoplasm
2. Infection
3. Trauma
4. Hereditary
5. Orthopedic differences
6. Improper form/biomechanics
7. Improper bike setup/equipment

I would ask a bunch of questions and probably take an xray but before you go to the doctor get a GOOD fitting at a LBS letting them know of your pains. Try to isolate when it hurts and how bad. i.e. does it feel better when you don't wear your cleats, etc? Does it hurt first thing in the morning when you get out of bed. Does it hurt walking around? Does it hurt when you get off the toilet? Does it hurt when you walk around after that? When did the problem first begin? Anyone else in your family have similar problems (or not similar)? etc.. What makes it feel better? etc..

These are some of the questions your doc will ask you. If he's a good sports-minded guy then he might ask you to bring your bike, shoes, trainer in and have a look.

You can PM me your $10 copay :p

Though we all have our opinions on what your problem may be, you should get a pro bike fit done and/or see a kinesiologist. They'll fix you right up.