How to Fix Patellar Tendonitis
 

Suggestions?

Im 22 years old.
Realized the pain after moving cleats around and doing an intense ride down jupiter island (real windy).
Never had knee pain before
Train 7-25 hours/week
Been riding for 6 months after about 21 years of sedentary life style
149 pounds

Rest. That's about it. I've have serious bouts of patella tendonitis and elbow tendonitis. It can take months or years before you fully recover. Cortisone injections will provide a quick fix for a few months, but without the rest, the tendonitis has always come back.

First off, talk to a Dr. and PT about this.

Other than that, thesmoothdome's experience matches my own. I broke a kneecap and the tendonitis after that lasted for years. Get in the habit of not doing anything that irritates it. I learned to pedal with my glutes a bit more and got the power back up. It's been 9 years now, and I really think this is the first year I've felt like I don't have any tendonitis.

To put it in perspective though, the last two years have been some amazing race results for me, even with the injury, including many race wins and upgrading to Cat 2 (I've since requested a downgrade because I lost a bunch of weekly training hours). The point is that it doesn't need to kill your cycling. Focus on what hurts and don't do that. Your muscles will figure out how to fire at the right times and how not to at the wrong times.

Just don't ever do anything that hurts it. I would go months and realize I hadn't "tested" my knee in a while (hadn't felt it hurt). After testing, I'd realized that it still hurt, but I could do more with it, so healing had occurred. Just be patient with it and deal with it.

Oh, and go see a Dr. :thumb:

Someone correct me if I'm wrong here: Tendonitis is the initial flare up. Tendonosis is the long-term damage. I was diagnosed with tendonosis a few years back. On the suggestion of my PT and Doctor, I tried eccentric leg exercises on a foam ramp (toes pointing down). My PT also taught me cross friction massage for the tendon, which is pretty painful. Finally, if I though it was flaring up (the tendonitis) I used ice immediately after a ride. Most important for me was treating my treatment like I did my training. Never cutting it short or skipping out. (Actually, if I trained the way I treated I'd probably be faster this year ;)) I would bring ice in a cooler with me if I was travelling with the bike to a training ride or race. I also took, and continue to take, fish oil supplements.

I think the biggest challenge was ramping up the miles slowly. After the injury I could only ride five miles or so. I would feel good and want to go further, but held to the 10% rule that is stated all the time. I also tried to make sure my knee was warm, wearing knee warmers when no one else was, and when I really didn't want to. Unless I'm warming up on a trainer ahead of time, knee warmers are on below 65 degrees for me. No exceptions. In about 6 months I was back to pretty regular training. Now I'm on to my first full season of racing and I've been ok so far.

Sorry for the long post.

Jimmy

THanks guys, been a lot of help.

I just want to halt this before it turns into something long term.

Been told that im just overtraining.

Your muscles can become strong faster than your tendons can handle. Just up the mileage slowly and be careful.

Tendonitis means it is an injury to the tendon with inflammation cells present, and Tendonosis is an injury to the tendon without inflammation cells being present...You do not need to have inflammation first, and injury can start as Tendonosis...

In chronic tendonitis, tendon becomes scared, thickened, less elastic, harder to slide in sheath, sometimes with limited ROM...

There is also Tenosynovitis which is inflammation of the synovial sheath or covering of a tendon...

There is also the danger of Calcific Tendonitis where a calcium growth will occur within the tendon, or in other words a small bone fragment could form within the tendon.

Like previously mentioned...You can treat tendonitis/osis/synovitis with increasing ROM through stretching, increasing tissue extensibility via Myofascial Release. Cross Friction massage is nice because it is used to "restart" the healing process by kind of damaging you in a minor way... Ultrasound treatment is used in a clinical setting in combination with massage and stretching to increase tissue extensibility, increase ROM, and to decrease fascial adhesions.

I would also recommend the use of an NSAID such as Ibuprofen if not contraindicated medically. I would recommend the use of it for a 2 week stint, taking it 2-3 times a day. You need the constant exposure in your bloodstream for a prolonged length of time for it to do it's job.

The last piece of advice is probably the most common...Ice...Ice Ice Ice...The physiological affects of ice are very beneficial. For patellar tendonitis you could try and use Ice Cup Massage over the tendon :).....If using a commercial gel pack from a freezer, cover it with a wet damp cloth...Not a bath towel, but a dish towel style cloth. If you are using ice cubes or crushed ice, then apply the ice directly to the skin for 20-30 minutes with compression if not contraindicated by cold allergies or peripheral vascular disease...

Brought to you by a soon to be Certified Athletic Trainer :)

Jimmy is absolutely right - you need to approach the treatment just as vigorously as a training plan. Tendonitis in general can be treated and healed by constant stretching, icing, and slow progression up the intensity scale. I have tendonitis and will stretch 3 times a day and try to ice once every 2-3 hours for 10-15mins. This reduces the inflammation and speeds healing. Don't do activities that aggravate your condition; that said, you can't really just rest and expect to get better. You need to be doing some sort of stretching to beat tendonitis, and usually a warm-up is required before stretching. So take it easy, do small things, and you need to gradually increase your training over time. If you keep at it, it will get better.

I'm pretty sure I got to where I am because of extreme overtraining and overuse (literally jumped from minimal training to high use everyday). Just slow it down immediately and think of "resetting" the training log and starting from scratch. Surprisingly, your muscles will spring back pretty quickly.

If you're like me and you don't like taking drugs that you really don't need to...look into pineapples. Alot of research is coming out supporting the ability of pineapple's anti-inflammatory properties. And it tastes much better.

Edit - Granted you will have to eat more pineapples than taking pills but I'm just not a pill taking guy if I can help it.

Yeah stay away from extended use of anti-inflammatories. I still feel so stupid for how many I took. Now my stomach is really a lot weaker than it used to be, and I can't take one NSAID without feeling stomach pain. A few days will be beneficial, but any more than even a week is just stupid and damaging.

Pineapples - that's interesting, never knew that, thanks.

Also, consider that you may have a fit problem that started the pain in the first place. I know my knee problems started from poor fit, and they didn't become a potentially crippling issue until I tried to jump up a classification in my club's rides. My knees were simply not able to tolerate the increased strain. After some months, work and adjustments on fit, and regular stretching and exercises, I am getting stronger and am able to rider faster and harder, although I am and will always be very limited in my speeds up hills since I cannot do anything other than spin a low gear at high cadence (I'm talking 30-32 gearing here) or my knees start hurting to the point where I can't do anything, let alone bike.

wear this and suck it up http://www.runtolive.co.uk/images/RT...skneestrap.jpg worry about it later ;-)

It might have something to do with that you went from " 21 years of sedentary life style" to "Training 7-25 hours/week" and only "been riding for 6 months".

Don't fool around with tendinitis. I had it. Take a rest.

bismillah,
I'm a rehab professional and totally agree with Lykolate, but you also may need to check your position in the saddle.
Make sure that your knee is slightly behind your toes when the crank is horizontal. If your knee is too far forward, you'll be putting a
tremendous amount of stress over the patellar ligament. The same irritation can be felt if you do squats wrong- knee should be behind toes there too.
Let me also ask you this: does it hurt just slightly below your knee cap? I'm guessing yes.

Yes! Thats exactly where it hurts.

How do I fix?

hey bismillah, what's your favorite place on the internet?

25hrs a week? take a break man! There are some pros that don't ride that much.

Oh, Good catch jacobsdad...How did I miss that aspect? Bismillah, to fix this you need a good bike fitting with proper adjustments and measurements like plum line and etc. I got my pro fitting done at a local bike shop where they used goniometers, cameras, and other little tools for measuring angles and etc. Definitely worth it.

As for the NSAID issue, I am the type of guy that does not like pills either, but as for the dangers of taking ibuprofen...If you do not have any pre-existing conditions with stomach ulcers, bleeds, or other GI issues/allergies then taking the recommended dosage of Ibuprofen with food for only a 2 week stint like I mentioned earlier is completely fine. Prolonged and chronic dependance upon NSAID's is where the problems are.

As for the patellar tendon strap, yes those can help, but it is something I would recommend to somebody to use only if the problem had just started and they had a race or a charity ride planned or something and needed it to get through the event. I would not recommend it as a permanent solution. Definitely going to be better for you in the long run if you put in the effort and time to kick this issue in the butt.

You have two options:

1) Speak with your doctor and possibly get a referral to an orthopedist.

2) Rely on the infinite wisdom of bikeforums.

bismillah,
Your treatment will be to do a combination of all the things stated by myself and Lykolate. Position is crucial- if you don't correct that, it'll never go away and it'll get worse!
Lykolate already stated treatment-wise what should be done. I agree quad stretching to increase flexibility in the patellar tendon/ligament and ice, ice and more ice.
And finally, don't go balls- out when riding. It appears from you initial post that maybe you over did things. You mentioned twenty one years of sedentary
lifestyle and six months of riding with intense training. You won't get it all back in a month, so get to your goal reasonably. Some days you'll need to back off and others you can hammer.
Having said all that; listen to your body, because if you don't, you'll be off the bike entirely. If after all that it continues, then you should see an orthopod who would most likely send you to a guy like me- a P.T.! Good luck!

I am dealing with this right now and through all of this have become pretty proficient on the subject. I have been off the bike for 3 months and dealing with it for 4+ months. It is one of the most depressing things I have gone through considering I live on my bike; training 13-20hours a week. Cycling/racing is my favorite outlet. I am missing the whole race season because of this.

I have two doctors helping me (one of them has been a team doctor for many pro teams and will be working with Ag2r during the Tour of Cali) the other is my Ortho who has worked with pro sports teams as well as the Boston Ballet. They have been good and are now starting me on Plasma Rich Platlet Therapy in the next few weeks as my last resort. From what I am told and have read, it is the best fix there is. Unfortunately it is not covered by most insurance and it usually runs somewhere around 2,000-10,000 to get you back to normal.

Avoid cortisone shots. They can actually cause more damage and harm than good. Corticosteroids, such as cortisone and Prednisone, have an adverse effect on bone and soft tissue healing. Corticosteroids inactivate vitamin D, limiting calcium absorption by the gastrointestinal tract, and increasing the urinary excretion of calcium. Bone also shows a decrease in calcium uptake with cortisone use, ultimately leading to weakness at the fibro-osseous junction. Corticosteroids also inhibit the release of Growth Hormone, which further decreases soft tissue and bone repair. Ultimately, corticosteroids lead to a decrease in bone, ligament, and tendon strength.

Corticosteroids inhibit the synthesis of proteins, collagen, and proteoglycans. The result is weakened synovial joints, supporting structures, articular cartilage, ligaments, and tendons. This weakness increases the pain and the increased pain leads to more steroid injections. Cortisone injections should play almost no role in sports injury care.


So far this is what I have done:
PT for 3 months.

Rest.

I stretch for 10-20 min in the morning, including quads, calfs, hams, IT. Stretching is probably one of the best things you can do as stated above. People mostly talk about the quads when Tendinitis or Tendonois is mentioned, but your hamstrings are probably a bigger contributor to issues with the patellar tendon. Stretch them all just to be safe.

Ice. Ice up to 5 times a day if possible. I use ice packs in the morning for about 10-15 min. At about 11am I do an ice massage on the tendon for a few minutes then again at 3 or 4pm. Then I use ice packs again in the evening for 15 min or so.

Massage. I use the stick since all my massage is done by me. I roll the calfs, It, quads, and hams while watching tV. I do it in the morning and at night.

Eccentric squats.

Last of all. Get a good fit. Being too forward on the pedals or too low can cause stress to the tendon leading to more issues in the long run. Depending on where you are, I could reccommend a fitter in your area.

I thought I was getting better and decided to go out and do a few miles two weeks ago. I was not ready and I am now regretting it. With the introduction of PRP, I should be back within 6 months.

I will have to admit. Going through all this will make me a better cyclist. I have learned more about body and how to keep it going strong than ever. My stretching and massage routines will help me in the future as a racer and competitive cyclist.

Good luck.

Good post Spinwax. You defintely have a "personal" experience with this issue. I hope you get to feeling better soon. Being of the bike sucks, I'm sure.
Hey, you have the Pedal Force RS2, right? If so, I have the same bike and love it!