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Old 07-31-09, 10:41 AM   #1
Yen
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Riding with patellar tendonitis

I'm having yet another flare-up of tendonitis pain in both knees. Extensive reading leads me to believe I have the variety known as "Patellar Tendonitis", with pain just below the kneecap. This week, after two 1-hour easy rides on Monday and Tuesday (low gears, mostly flat, no hills, moderate pace) I'm having a new symptom -- mild shooting pains on the front of my leg from the knee down, and mild pains even while sitting (even as I sit here this morning, after no riding for 2 days).

Now, before I go any further, I want to add I WILL SEE A DOCTOR, AND SOON. I'm asking about this in this forum because... well... older riders, older knees.

My riding has been somewhat inconsistent since the weather heated up, yet it seems I've been riding long enough and often enough that my knees should be stronger by now. I am not overweight, so weight is not an issue. I apply ice after rides. Stretching..... I could do more stretching and I'm working on that but I do a little after each ride. I took an Advil after each ride this week, but I don't take it all day long because I'll develop heartburn very soon. I eat a healthy diet, and as long as I'm not losing weight I believe I'm eating enough, and I believe I'm consuming enough good protein.

Today, I'll take a look at the saddle position and see if I can make any adjustments there. Since I bought the Surly, I've changed the saddle twice (I added the Brooks B17, then replaced it with a Terry Butterfly). I did not experience pain this consistently on the Roubaix, which I now ride less often.

If a saddle adjustment doesn't seem to work, I plan to pay a visit to the fitter-owner of our favorite LBS.

QUESTION: Has anyone experienced this form (or any form) of knee tendonitis and found relief while continuing to ride? Every resource I've read about this problem says to rest and avoid the activities that caused it, which could mean weeks or even months off the bike (and weeks or months of fitness down the drain).
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Old 07-31-09, 11:55 AM   #2
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I have suffered from knee pain quite a bit. It took me years to discover what worked for me and how to manage it and have a reasonable guess at what the root cause is. My situation may be different. Before I start the tale let me say that when I saw my doc he gave me a script for anit inflamatory drugs, they did not help and just made me sick to my stomach.

My issue tends to be inflamation of the tendons around the knee casued by lack of strength in the quads particularly in early season before I have adequately built up my muscles to protect the knee. I find a knee brace such as those sold in the drug stores (typically a neoprene tube with a hole cut for the patella) will improve blood flow to the tendons and support the knee and allow me to build the strength. This happens to me every season, once I have my muscles built up sufficiently I no longer need it. Right now I am riding fast and climbing steep hills pain free and without the brace but I know I will need it again next spring. I have also learned that if inflamation sets in that I have to wear the brace and take it easy for about 4 weeks.

Your situation may be totally different, for me it was a $20< fix.
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Old 07-31-09, 02:10 PM   #3
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Hi Yen--

I've had patellar tendinitis for many years. It was first diagnosed by an ortho back when I ran track and XC in college. It usually hurts when I start out running and then as I warm up, it starts to go away. It will also hurt at night and after sitting for a long time. I think that's characterisitc of tendinits in general, so that might help with your diagnosis.

PT only seems to bother me when I'm running, and when I've started up after a long lay-off from running. As I get more fit, it seems to get better. It has never bothered me while cycling, unless it has already started bothering me from running. So fitness seems to be a factor. When I had it in college, the trainer would have me lift weights to increase the strength of my inner quads. I think that has since become controversial, with some saying now that there is no correlation between quad strength and PT. (I've ignored that kind of strength training since college anyway, so I can't really say if it ever helped.) I do know that it bothers me less as my fitness improves, and that it seems to be an overuse, or "too much, too soon" injury. Have you had a lay-off from cycling and have started back again recently? If so, maybe you pushed it a little hard before the quads were ready to support the tendons? Maybe your back-to back rides were a factor. I find that I simply cannot run two days in a row anymore. I have to have a rest day in between--the whole reason I got into cycling, in fact, was to have something to do on my "rest" day.

Also, I'll echo cyclinfool and say that one thing that does seem to help if it has really been bothering me is to wear a "thermal" wrap on the affected knee when I run. I think that is the name for them--they are those neoprene knee braces. I get one that is a loose as I can find it, as it seems to be less about supporting the knee than keeping it hot and toasty during exercise. Too tight, in fact, really messes my knee up...

There is some sort of knee thingy that some runners wear across the patellar tendon. I tried it once and couldn't tell any difference, but it might work for you. If you're interested, I could try to find a link to what I'm talking about.

I think you're smart to consider the fit issue. If it didn't bother you on the Roubaix, maybe it's because of the fit. I still have a lot of knee trouble in general, and I have found that as little as 1/8 inch difference in seat height can make a difference between pain and pain-free.

Finally, you wanted to know if you could train through it. I did all through college, and continue to do it even now if it starts bothering me. I don't think it causes any long-term damage because it actually bothers me less as the years go by. When it flares up, I ease back on the training a little, warm up slowly during the run, ice it down after, and generally otherwise ignore it.
Good luck. I hope you get it all figured out.

Oh, and PS: My trainer used to always say, "Ice is nice, but liquor is quicker." I'd stick with the ice, though.

Last edited by PrairieDog; 07-31-09 at 02:33 PM.
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Old 07-31-09, 02:37 PM   #4
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Based on your symptons I doubt this is an issue but just wanted to offer in case you needed to consider it. Some folks have issues with the pedaling motion of their knees (slightly twisting or bowing out) due to their pedaling motion-or the width of the pedals related to their hips, etc. To check this, a fitter can put a rod on your shoe and you can see how much your foot is twistig or moving "out of line". If needed, shims can be installed to assist with correcting the motion. This affected a buddy of mine for quite some time and he was finally able to get some relief after going through a fitting like that. My guess is that would cause more a ligament issue than tendons but th knee is a pretty complex joint!!


Good luck finding a fix. Of course my wife tells me that acupuncture fixes all ills!!
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Old 07-31-09, 02:48 PM   #5
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I recently had a very short bout of pain in that area. It suddenly started during a 20 mile ride, got home, and measured the seat height, Post had slipped down about an inch and a quarter ,I Put it back, no more pain,,,Dont know if this applies to you , but as others have said , look at fit...
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Old 07-31-09, 09:28 PM   #6
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Thanks all -- I appreciate your suggestions. It's encouraging to see that others have resolved it while still participating in their sport.

I read that if not resolved early, it could worsen into something ugly and chronic -- thus, I'm trying to be sensible and not act like I'm 20 and never going to grow old (my mind-set when I was 20 and people warned me to stay out of the sun or I'll regret it when I'm older..... now I'm older, and they were right!).

It's hard to know where to start, so I'll start with the saddle. Today was busy with family so I'll try the saddle tomorrow. I hope the solution will be a simple one!
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Old 08-01-09, 12:06 AM   #7
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It's hard to know where to start, so I'll start with the saddle. Today was busy with family so I'll try the saddle tomorrow. I hope the solution will be a simple one!
don't just be random with the position thing. nows not the time to be screwin with position on a bike where the position might be responsible for your affliction.
Don;t waste time and money on 'fitting' when you can;t even tell if you're moving in the right direction.
do the 'fit' session after you've recovered.
if the other bike feels better (less knee pain) then go ride that for a while.
ride - twiddle
if the knee pain flares after every ride, then rest is best. If that can;t happen (and I understand that), then short excursions done in silly small gears, not spun, just make circles. stay off hills.
put on platform pedals and ride with sneaks. go real easy
make plenty of really short stops. longer stops allow things to tighten up.
give it a couple weeks to recover.
be serious about allowing recovery now, rather than having months of lingering issues.

after things improve for some duration, come back and lets talk 'position' and pedals.
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Old 08-01-09, 07:18 AM   #8
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This might help: http://www.ehow.com/how_2303560_prev...s-cycling.html
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Old 08-01-09, 08:00 AM   #9
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don't just be random with the position thing. nows not the time to be screwin with position on a bike where the position might be responsible for your affliction.
Don;t waste time and money on 'fitting' when you can;t even tell if you're moving in the right direction.
do the 'fit' session after you've recovered.
if the other bike feels better (less knee pain) then go ride that for a while.
ride - twiddle
if the knee pain flares after every ride, then rest is best. If that can;t happen (and I understand that), then short excursions done in silly small gears, not spun, just make circles. stay off hills.
put on platform pedals and ride with sneaks. go real easy
make plenty of really short stops. longer stops allow things to tighten up.
give it a couple weeks to recover.
be serious about allowing recovery now, rather than having months of lingering issues.

after things improve for some duration, come back and lets talk 'position' and pedals.
If the solution could be moving the saddle forward or back just a tiny bit, then why not try that first? In the recent past, I did rest for weeks, my knees felt better, then I took another few rides and it was back. I don't ride very hard or hammer up hills in high gears. The solution could be something as simple as moving the seat forward/backward 1/8", so why not try that first (after my knees feel better)?
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Old 08-01-09, 08:16 AM   #10
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Thank you, PrairieDog. I've read lots of things that explain how to fix it, but very few that suggest I can continue riding while I work it out. That's my main question -- should I continue riding while I work on the solution if the pain persists after rides, or will I do further, irreversible damage? I think the question has been answered (easy rides). I may need to skip the longer group rides this summer until I work this out on my own with my shorter rides. As long as I can continue riding, I'll not let myself get discouraged about that --- at the end of the summer (or fall, whatever it takes), I may come out of this with a strong base strength, ready to go on the longer rides in the cool season.
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Old 08-01-09, 08:30 AM   #11
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Thank you, PrairieDog. I've read lots of things that explain how to fix it, but very few that suggest I can continue riding while I work it out. That's my main question -- should I continue riding while I work on the solution if the pain persists after rides, or will I do further, irreversible damage? I think the question has been answered (easy rides). I may need to skip the longer group rides this summer until I work this out on my own with my shorter rides. As long as I can continue riding, I'll not let myself get discouraged about that --- at the end of the summer (or fall, whatever it takes), I may come out of this with a strong base strength, ready to go on the longer rides in the cool season.
Well, back in the day on the track team, we'd train through a lot of injuries, and sit out others. The PT was one I trained through, and as I said, I don't think it had any real long-term affect. I'd be more concerned about training through something like shin splints, would could mask a stress fracture.

The other concern is that it isn't PT, but something else. So if you go to a doctor and get it diagnosed, then you can make an informed decision. With the PT, I'd think you could train through it if you just ease back a little. Pain is a terrific limiter--as long as the pain is merely annoying and disappears when I'm warmed up, I don't worry about it too much.

Another good source of info about PT is Runner's World, here: http://www.runnersworld.com/. They have a good section on injuries--you could do a search and find out all kinds of info.
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Old 08-01-09, 10:21 AM   #12
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Arnie Baker MD says in Bicycling Medicine, increase saddle height, knee position a bit behind the spindle, cadence greater than 85 rpm, avoid long climbs for a while, cranks not too long, limit pedal float.

I have a little of this pain, and need to try these fixes. I just got a Selle AnAtomica, so in the coming orgy of saddle tweaking, I'll implement as much of this as possible.
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Old 08-01-09, 10:22 AM   #13
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QUESTION: Has anyone experienced this form (or any form) of knee tendonitis and found relief while continuing to ride? Every resource I've read about this problem says to rest and avoid the activities that caused it, which could mean weeks or even months off the bike (and weeks or months of fitness down the drain).
For me, this kind of pain results from applying excessive pedal pressure in a too high gear. If I get off the bike for a day or two and resume riding with self-lectures on the art of spinning, all is well.

For me, the main section of the lecture has a few key points:
  • only very slow and gentle stretches
  • the first five miles are slow warm up
  • if you notice you have knees, shift down
  • shift down now
  • smoothly spin
  • speed does not matter
  • no pushing just spinning
  • give different muscle groups a chance
The slow theme notwithstanding, lecture rides usually end up being a bit faster than my usual.

Best wishes for getting the problem resolved.
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Old 08-01-09, 01:14 PM   #14
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I agree with PD, you should be able to ride through it but get a doc to look at it first - just in case.
I went out on a long ride this spring, had forgotten to bring my brace but went on the ride anyway. 2/3 into the ride the pain hit and I had to finish the ride in pain. However after that i rode with the brace even on my short rides and rode a little easier - but did not stop riding. After 4 weeks I could go back to my regular routine. Rode a group ride metric today with no brace - we kept up a good pace.

The one thing I would caution you on though - if the pain is bad and easily returns then changes you make now may not give you any usefull information because any stress will hurt. When I first developed this problem I went up and down and back and forth on the saddle, my knee would hurt and there was no correlation between saddle position and pain, because the knee was already injured. It was only by pure luck and trying something completely different that I found out how to solve my problem. I hope your resolution is faster and easier but I also hope you are as lucky as I was and find the real problem/solution.

Good luck!
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Old 08-01-09, 08:40 PM   #15
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If the solution could be moving the saddle forward or back just a tiny bit, then why not try that first? In the recent past, I did rest for weeks, my knees felt better, then I took another few rides and it was back. I don't ride very hard or hammer up hills in high gears. The solution could be something as simple as moving the seat forward/backward 1/8", so why not try that first (after my knees feel better)?
not tryin to be au contrare.
this kind of 'injury', regardless of the origin, tends to flare due to any similar activity; so minor adjustments, which under normal conditions might actually have some real effect, will likely only cause further flareup.
I'm not a bettin guy, but I;d put big money on your tiny saddle move not doing anything except more of the same pain. But then this is the interweb and your idea of 'serious' and my idea of same are bound to be different.

None of us are who we were "Back in the Day". Things we could ride thru and tough over at 30 cause longterm serious consequences for us now. Not to say we can't be strong and move forward positively; we just need to have a much further forward 'view'. I'm no longer "bulletproof and invincible". Twinges in the knee (and currently for me, the left hip) get my attention right quick and make me keenly aware of further progress either towards relief or increased stress and strain. Its the difference between pyschological and physcial. Anytime the 'brain; tells me "I can't", I'm just wimpin. If the body tells me "I can't", I gotta believe.

Since BOTH bikes seem to cause your issue, there is something with both which seems to contribute to the problem, one more than the other. Cycling may not be the only root cause, but it obviously is a main contributor.

I do have to ask, if one bike really greatly increases the issues, why do you persist in riding it on the current 'form'/setup/whatever of the bike which causes the most problem? Don;t make sense to me.

If it's really constant, I'd seek professional health care from someone who understands these injuries.
You note you've had this before, so its never been really defined nor addressed.

Recover, define the problem, start with the 'better' setup machine and refine that until it truly works for you, then match the other machine to those same resolutions.

that's what I'd do... (have done)
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Old 08-02-09, 07:23 AM   #16
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not tryin to be au contrare.

None of us are who we were "Back in the Day". Things we could ride thru and tough over at 30 cause longterm serious consequences for us now. Not to say we can't be strong and move forward positively; we just need to have a much further forward 'view'. I'm no longer "bulletproof and invincible". Twinges in the knee (and currently for me, the left hip) get my attention right quick and make me keenly aware of further progress either towards relief or increased stress and strain. Its the difference between pyschological and physcial. Anytime the 'brain; tells me "I can't", I'm just wimpin. If the body tells me "I can't", I gotta believe.
True.
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Old 08-02-09, 07:32 AM   #17
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[QUOTE=Yen;9399050]If the solution could be moving the saddle forward or back just a tiny bit, then why not try that first? In the recent past, I did rest for weeks, my knees felt better, then I took another few rides and it was back. I don't ride very hard or hammer up hills in high gears. The solution could be something as simple as moving the seat forward/backward 1/8", so why not try that first (after my knees feel better)?[/QUOTE

If you do decide to adjust the saddle, the old saying goes if the pain in the knee is in the front, move the saddle back. I'd also look at raising it just a little as well.

I've had similar pains in only one knee-so I adjusted the cleat on only that foot using the logic above (my feet are different lengths). If the knee pain was in the front, I slid the cleat on the leg with the knee pain more towards the arch to lengthen the distance to the pedal. Seemed to help.

Knee pain can take on different lives and fixes!!

Mine usually comes from doing the steeper, hillier rides from pushing too hard a gear for too long.
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Old 08-02-09, 11:34 AM   #18
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Thanks all. FINALLY, I have a free day today at home -- I'll examine the position of the saddle on the Surly, and go out for a ride. A member of our bike group is a chiropractor who has successfully treated many cases of PT, but wants to evaluate my knees to confirm that diagnosis. I'll start with small adjustments on my bike, and seeing the doc.

I appreciate the many thoughtful contributions to this thread.
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Old 08-02-09, 03:48 PM   #19
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If you are using clipless pedals the angle may be the demon that haunts you. If it is not 'correct'....
You need to have some degree of rotation IMHO. I used to use SpeedPlay Frogs I still have them but have retired them and ride with Teva sandals and old Suntour XC Comp pedals. Works for me but we are all different.
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