Hi all, I'm reaching a breaking point.
Last November I developed patellar tendonitis in my left knee, and then after rest and physical therapy, developed medial hamstring tendonitis on the same leg in March! It's now September and I've barely biked. Left leg still feels tender even on a slow 4-mile ride. I stretch daily and am doing physical therapy at home. I can't figure out why I'm still having issues. I used to be a daily commuter, including some hills i(Austin, TX). I'm now back in Chicago and can barely do a flat, leisurely ride to the store. Anyone have any ideas/suggestions?

ps- for patellar tendonitis, the advice is to move the saddle up, and for hamstring tendonitis, it's to move the saddle down. So basically I'm at a loss....

Get a professional bike fit?

^^^Best advice you're going to get^^^

use a compression sleeve that spans the entire length, raise the seat to minimum of the rise to satisfy the patellar. let me know of the outcome after a few days of bicycling.

Hey Carrie Ann,

How much experience have you had with biking regularly? From the sounds of things, it sounds like you are fairly fit, have biked for a good regular amount and this is a rather "sudden" onset of issues? This is the same bike as in TX?

What has the doctor and physical therapist said about this? Any previous injuries? Good arch/flat feet?

What is your inseam/height and what is the length of your crank arm?

Based on the initial problem and results of "the fix", I suspect the crankarm is much too long but it'd be good to hear more from you first.

yeah I think that has to be my next step

I've been bike commuting regurlarly since about 2012, and I've never had an injury before. I basically thought I was invincible before last november haha. The physical therapist just recommended more strengthening, and the doctor did an MRI and didn't see any tears or damage, which is why I'm confused it's lasted so long. I've never had issues with flat feet and used to stand hours at a time when I was working bar/restaurant jobs. Not sure about the measurements of my inseam or crank arm, so I need to look into that.

the constant warm weather might've hid the underlying issues. Being exposed to the colder environment, it may have allowed those issues to surface. Does icy/hot help if when applied?

Yeah I think I'm going to get a bike fit to see about the saddle position. As for stretching, I've been doing a deep stretch routine for dancers because it really targets hamstrings, which feel really tight.

I thought patellar tendonitis was brought on by overly strong quads that pull the kneecap off track? I haven't been doing quad strengthening exercises for that reason

You might be right about the hot weather masking the issue because it happened after one of the first "cold" days of the year. I've also been icing fairly regularly and I'm not sure if it's having much effect considering I still have soreness after all these months.

I apply icy/hot on my lower back when I'm experiencing major discomfort with that region aforementioned. The outcome of it lets me carry-on with my work/bicycling/whateverI'mdoing-day

I suspect that some cases could involve too strong of quads but much more likely...

My understanding about patellar tendonitis is that often it is a result of weak quads. The straight leg raises that PT usually recommend effectively shorten the quad, which pulls the patella up ever so slightly, easing pain there. Following this line of reasoning you might even benefit from doing some light squats one or two days a week in a group fitness class or just with freeweights if you are comfortable with that. When doing squats you should never lock your knees out at the top of its travel to protect from hyperextension.

Hopefully your deep dancer stretch routine is restorative enough for your needs right now. Too much ballistic stretching or trying to take your hamstrings too far could slow healing. From what I understand, tendonitis is almost always a type of overuse injury. The areas will heal but since connective tissue (tendons and ligaments) are much less vascular, the tears from overuse take much longer to heal - say 12 to 18 months.

The point about too long of crank arms is a good one. If you have, say - 175's on you bike - this might not be conducive to the light spinning style that you are going to need to develop while you heal. If you do a lot of hill climbing on your commute, you could consciously try to spin more and mash less. You might go a little slower but you will strengthen other accessory muscles that will further allow healing in those angry tendons.

Maybe crosstraining? 6-8 years ago, I had persistent tendinitis in my knee that just wouldn't go away. It lasted 3 years. I eventually backed off the cycling and switched to running and hiking for awhile. The tendinitis went away and now I'm back to riding more then ever and have no pain at all.

This happened to me... bike fit was the answer. They moved the saddle forward to better align the KOP. Patellar tendonitis still flares up once in a while, but not in a way that affected my riding at all. Instead, I get twinges every now and then, usually when I tense my upper body as this causes my legs to adopt a less natural position. I just use the twinge as a reminder to relax, and it is usually gone instantly.

Our chiropractor does magic. He has a qualification A. C. T. I discovered him after listening to another guy with this qualification who works with pro teams.
Typically we go to him with a fitness injury and it hurts like heck (the treatment), but we leave his office with it fixed.

He was the Canadian Ironman champ at one point.

What type of bike do you normally ride? Have you tried riding a different style bike to see if the pain goes away? For example, if you normally ride a road type bike with a more stretched out aero position have you tried a city cruiser with a more upright position to see if it alleviates the pain?

I am leaning heavily towards the too-long crank arm length.

I suspect where your issues are arising from is at the top of the stroke say 10 o'clock to 3 o'clock. With a too-long crankarm, the hip and knees are at really acute angles. Your knee can kick out of alignment and/or powering through the stroke can put a lot more stress on the knees.

Raising the seatpost can help alleviate the issue since it opens up the hip and thus the knee angle. Raising it too far however, can create too much extension for your leg, stretching and working your hamstring more and why your hamstring is now hurting.

Moving to a more upright position or shorter crank arms allows the hip angle, and thus knee angle, to open up more.

A bike fitting is probably a good idea but I would suggest finding a knowledgeable fitter who is comfortable with short cranks. I've found shorter cranks aren't even on many "fitters" radar since crankarm length is limited by the OEMs (Origin8 has a good selection of ahort arm triple and double cranksets) and they rely too much on "general" fitting procedures and/or software.

You could try a cheap used city cruiser off CL or borrow something similar to see if that helps as well.

Wow, I feel your pain... I think...

I had terrible knee pain that suddenly showed up after a long hike at Ricketts Glen SP. It didn't hurt when I stopped walking but every step down (especially stairs) was agony. Eventually it went away and I thought maybe my hiking boots were the culprit. So I took it easy on following hikes and avoided wearing the boots thinking I had solved the problem. Fast forward to Glacier Natl' Park Highline Trail. During the "descent" that familiar pain came ROARING back, I was ready to just lie down and be fed to the bears it hurt so bad... Took me a couple of weeks of babying my knee before I got back to normal.

In between these times I was frequently cycling and had never experienced this knee pain in relation to any those rides. So here I am thinking that maybe I should focus on the low impact exercise that cycling provides and avoid strenuous hiking or even attempting jogging.

When I got married, the wife (much smarter than me but that's no great feat btw) encouraged me to start jogging.
"But my knee!" I protested.
"Have you ever used a Foam Roller?" she replied.

Well, no I hadn't! Nor had I ever even HEARD of such a thing! However, I had at THAT point identified the pain as an ITB issue that I thought I could "stretch" my way out of (I couldn't). So, per her instruction, I started "rolling" and holy bologna did it hurt like the dickens!!! But you know what? The knee pain VANISHED!

So there I was, still cycling and commuting and NOW jogging with judicious "roll-outs" before and after. Then we had the BRILLIANT idea that we should load as much crap as possible into a trailer, hook it up to my bike, and go on a 110 mile RT tour to a local campground, Inks Lake SP... We packed everything and I mean EVERYTHING… except the foam roller... I feel like I've telegraphed this punch pretty well to you, but just in case I haven't COMPLETLY bored you with my tale of woe in wall of text form, I shall continue:

Getting there was fine with no issue except that the load was too heavy and the going was too slow, but it was mercifully pain free. During the return trip, however, the horrible knee pain reared its head and sidelined me completely. Until that point I had not had the ITB issue on the bike and had assumed it was only a problem when jogging or hiking.

So, I know you're not saying you have an ITB issue, HOWEVER, if you haven't tried rolling your leg out with a foam roller to help with knee pain, I recommend it. It may hurt to roll at first (like rubbing a VERY tender muscle) but the benefits were nothing short of miraculous for me!

Hope things improve for you!

/never had a professional “bike fitting”
//my bikes are extremely adjustable
///If it hurts, stop, think, grok, then adjust your bike… MAGIC!

1) Try a pro bike fit with someone with years or decades of experience who really understands your issues and

is not fresh out of bike fit school or new to bike fitting: someone with decades of coaching racers and/or a PT degree may help, too.


2) What kind(s) of clipless (or other) pedals do you use? Does more or less pedal float help or hurt your knee?


3) Do you have any leg length or strength disparities side-to-side? Hip discomfort? Ankle or foot pain when riding?


4) Do you have experienced **sports medicine certified** PTs, trainers, chiropractors, and/or orthopedists on your care team

**who also ride bikes a lot**? If not, find some...


5) Have you tried not riding at all for a few months and swimming or walking instead? (This is very, very hard for us addicts,

but may be necessary to fully rehab and rest...)


6) How are the muscle-joint balances and your flexibility? Do you stretch regularly, do yoga, Pilates, or other flexibility-enhancing regimens?

How even is your 360-degree and side-to-side power output balance? Have you been tested for this?


7) I suffered with chronic right knee pain for decades after a 1970 rock climbing fall that encased my right lower leg ion a cast for 6 months

and reconfigured my right foot. This included multiple bike fits but the "cookbook" settings never worked. Finally, a couple of years ago,

I was fitted by former 6-day racer and semi-retired coach Ted Ernst, who was 80 at the time. He was able to achieve what others --

mostly younger and more formula-based -- fitters had not.


Keep trying different options -- and caregivers, including pro bike fitters, PTs, and other medical providers -- until you find the right one(s).

And put most of your efforts into rest and rebalancing your flexibility and muscle imbalances to develop more support for our stressed-out knee.


Best wishes to you,


Jon (been there, done that, bought that tee shirt)

As others have suggested GET A BIKE FIT. This isn't saddle height - it is the saddle placement and the reach. You might even have the incorrect size bike so that the top tube is too short for proper placement.

One of the worst things to do for tendonitis is to become sedentary and stop moving. Too much rest isn't good...You need to find the right balance between getting enough rest and enough exercise...Movement is very important because it gets the blood flowing and circulating around the injured tendon...I never had tendonitis from cycling but I did have it from weightlifting, in both of my elbows and one knee. I did the opposite of what most experts recommend and continued to exercise but at a much lower intensity and using much lighter weight and rotating my exercises more often, I also continued cycling because I find cycling great for recovery and healing... With knee tendonitis I started putting more emphasis on my posterior chain and hamstrings and less on the quads. IOW I trained my posterior chain and hams a lot more then my quads and after about one year my knee tendonitis was gone...I found out that sitting or laying down for too long and standing in one place for too long was the worst, as soon as I started moving everything felt better...I've been cycling for 11 years and never had any bike fitting done and never had any problems from riding my bikes, bike fitting isn't a guarantee. You need to be sure what caused your tendonitis before trying to diagnose it.

Stop stretching.

Hi all,

Thanks for the recommendations. I think the next thing I'm going to try is a professional bike fit because I've never had one done. I'm also going to continue home PT and try not to 'baby it' because I have been doing that for months. (Although I do live in a city where a lot of walking is necessary, and I do light yoga).

Fingers crossed!

^^^^^^^^^^^^^^^^^^^ This. Look for maybe better PT, preferably from a sports medicine expert.

IMO less important that they ride a bike, more important that they know how to treat people who ride a bike. Not just that they're sports certified, but that they have a reputation. Start asking around. Not just the local bike shop, but visit local races, see who the respected sports doctors are in your area.

Good luck!

"With knee tendonitis I started putting more emphasis on my posterior chain and hamstrings and less on the quads. IOW I trained my posterior chain and hams a lot more then my quads and after about one year my knee tendonitis was gone...I found out that sitting or laying down for too long "

Been fighting it all year, and found the solution as described in the above quote. Although not 100% gone, it is considerably more manageable. Hiking really aggravates it, especially steep inclines. If I use the posterior chain more, it typically will abate. Raising the seat 5mm was effective as well. Hope you find the solution that works for you!