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Tendon issue

Old 09-09-15, 11:46 AM
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hillcrawler
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Tendon issue

Hi everyone. I am feeling some kind of tension around the quadriceps tendons area after the rides. I suspect it is quadriceps tendinopathy. Anyone else has the same problem?
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Old 09-09-15, 01:41 PM
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More details would be good. Are you referring to the area just above the kneecap? When the front of the knee gets sore, the people who know about these things say to raise the saddle. If the back of the knee is sore, lower the saddle.
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Old 09-09-15, 06:48 PM
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Another thing you can do is stretch your quads and hamstrings and see if that helps. I find that can make that sense of tension, or even incipient pain, in my tendons go away. I hold each stretch 25 - 30 seconds and do each one 3 times (therefore, 3 minutes per leg total).
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Old 09-10-15, 04:40 AM
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Actually I have this knee issue for 3,5 years but I didn't want to go into too much detail because I wanted to have a quick reply. Long story is like this:

In 2012, I was out with two youngsters who had road bikes and I was riding a hybrid bike back then. We did some sprints and climbed a steep hill. I hadn't pushed myself that much before and that night I felt something strange with my knees when I got back to the home. They were not moving smoothly. It was like I had lost all the fluid in my joints suddenly. I didn't know I was going to have lots of pain following days. I wasn't able to sleep because of pain and wasn't able to move around for few days. I went to the hospital and doctor wrote down something into a piece of paper. It was reading Patellofemoral Syndrome. He said you have this. He gave me another paper which has a set of quadriceps exercises. He said perform these exercises or you'll be visiting hospitals through the rest of your life. I did them for a couple of weeks. When I got rid of pain I went out with my bike again. I did know nothing about bike fitting nor cadence back then. I keep pushing myself with my unfitting hybrid bike. I was having pain every time after the rides. Weird thing is I had no pain during the rides but the pain was crawling through my legs after few hours. It was not a sharp pain, not in a specific area. It was a diffusing kind of pain covering all around the upper knee. Sometimes it was on the lateral corner of the kneecap but most of the times it was like inflammation. Then I kept riding, bought myself a road bike, learned about basics of bike fitting. I adjusted the bike as good as I can. Got clipless pedals. Once I did a 220 km ride, I was having pain following days. It wasn't about bike fitting I thought. I kept visiting doctors. They were telling me same things over and over again. You have pfps, you have chondromalacia. Do these exercises, take glucosamine support etc. Finally I had to stop doing long rides by the end of 2013. I gave myself 1 month, 2 months breaks but my situation wasn't getting any better. Now I was having pain even after short commuter rides. Now I have pain even after 2-3 km almost zero effort rides.

I did a lot of research on the internet and the best remedy for this anterior knee pain, patellar maltracking kind of problems is getting strength on your hips. Now I am doing some hip exercises daily and waiting to see results.

My MRI's or x-rays don't reveal a big problem on the cartilage. They say there is a thinning but it shouldn't cause that much problem I guess. There is a problem with the movement of kneecap and it should be because of weak glute muscles. It causes femoral internal rotation. I am just hoping in 6 months I can have a stronger butt and I can do at least some commuter rides.
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Old 09-11-15, 09:29 AM
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One thing I found is that doctors aren't necessarily very helpful in recovering from these types of injuries, and may actually be almost useless beyond their ability to order x-rays and prescribe physical therapy. Have you worked with a good physical therapist? They tend to do a much more thorough assessment of strength, flexibility, posture, and joint movement than doctors will do, and can be of great assistance in targeting the correct strength training and mobility exercises.
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Old 09-12-15, 03:35 AM
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Originally Posted by Spld cyclist View Post
One thing I found is that doctors aren't necessarily very helpful in recovering from these types of injuries, and may actually be almost useless beyond their ability to order x-rays and prescribe physical therapy. Have you worked with a good physical therapist? They tend to do a much more thorough assessment of strength, flexibility, posture, and joint movement than doctors will do, and can be of great assistance in targeting the correct strength training and mobility exercises.
+1 ... Physicians seem to know less about exercise than they do about nutrition (Now THAT's a scary thought!)

But, I would add: Finding the right PT is critical... There seem to be 2 main types:
1) They make an initial assessment and usually put you into some predefined, canned category with a preplanned, canned program which involves you coming back several times a week to do exercises in their facility either on your own or with an assistant (with occasional glances from the actual PT). That goes on until your insurance runs out.

2) The PT listens to you and does a complete assessment. He then describes to you what he thinks the problem is and its solution. He then works with you to develop an initial exercise routine (which is mostly done at home or in the gym) with periodic return visits so he can re-evaluate your condition and progress and update the exercise routine...

The first way helps the therapist pay for his Disney vacation and, as a side benefit, may even help you.
The second gets you better.

It is true that some problems are pretty standard with pretty standard treatment. The OP's problem is probably not one of those... But even if it isn't, why would he go to a PT of the first type anyway? Unfortunately, most PTs are of the first sort...
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Old 09-12-15, 03:50 AM
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Originally Posted by hillcrawler View Post
Actually I have this knee issue for 3,5 years but I didn't want to go into too much detail because I wanted to have a quick reply. Long story is like this:

In 2012, I was out with two youngsters who had road bikes and I was riding a hybrid bike back then. We did some sprints and climbed a steep hill. I hadn't pushed myself that much before and that night I felt something strange with my knees when I got back to the home. They were not moving smoothly. It was like I had lost all the fluid in my joints suddenly. I didn't know I was going to have lots of pain following days. I wasn't able to sleep because of pain and wasn't able to move around for few days. I went to the hospital and doctor wrote down something into a piece of paper. It was reading Patellofemoral Syndrome. He said you have this. He gave me another paper which has a set of quadriceps exercises. He said perform these exercises or you'll be visiting hospitals through the rest of your life. I did them for a couple of weeks. When I got rid of pain I went out with my bike again. I did know nothing about bike fitting nor cadence back then. I keep pushing myself with my unfitting hybrid bike. I was having pain every time after the rides. Weird thing is I had no pain during the rides but the pain was crawling through my legs after few hours. It was not a sharp pain, not in a specific area. It was a diffusing kind of pain covering all around the upper knee. Sometimes it was on the lateral corner of the kneecap but most of the times it was like inflammation. Then I kept riding, bought myself a road bike, learned about basics of bike fitting. I adjusted the bike as good as I can. Got clipless pedals. Once I did a 220 km ride, I was having pain following days. It wasn't about bike fitting I thought. I kept visiting doctors. They were telling me same things over and over again. You have pfps, you have chondromalacia. Do these exercises, take glucosamine support etc. Finally I had to stop doing long rides by the end of 2013. I gave myself 1 month, 2 months breaks but my situation wasn't getting any better. Now I was having pain even after short commuter rides. Now I have pain even after 2-3 km almost zero effort rides.

I did a lot of research on the internet and the best remedy for this anterior knee pain, patellar maltracking kind of problems is getting strength on your hips. Now I am doing some hip exercises daily and waiting to see results.

My MRI's or x-rays don't reveal a big problem on the cartilage. They say there is a thinning but it shouldn't cause that much problem I guess. There is a problem with the movement of kneecap and it should be because of weak glute muscles. It causes femoral internal rotation. I am just hoping in 6 months I can have a stronger butt and I can do at least some commuter rides.
Yes, cross training is good... I had a similar problem after going from years and years of a sedentary lifestyle to cycling 150 miles a week. A rebalance of the hip and upper leg muscles (mostly with ankle weights) helped a great deal. Now though I have incorporated those exercises into my daily life along with the cycling and also added some gym routines that I just can't get at home. I also added some running into my routine -- which created a whole new set of muscle imbalance issues! But, despite ongoing problems, my legs & hips keep getting stronger -- in all of their muscles...

As a result, I am becoming increasingly skeptical of using just a single form of exercise. It's like doing just a single barbell exercise. It only builds a few strong muscles and the rest remain weak -- which creates new problems you didn't have before starting the barbell exercises....

But equally (or more) important: is flexibility. As your muscles strengthen, they also tend to tighten. Keep them stretched out. I am finding that typical 15-30 second stretches before or after a workout do not do much. Instead I find that a combination of dynamic stretches along with extended 60 full second passive stretches done daily to be the most effective.
... Perhaps in your youth this is not as important. But being well into my 60's, I find stretching to be as important as strengthening those muscles.

p.s. I found that orthopedists overly focus on bones, joints and cartilage and ignore muscle, tendon and peripheral nerves. That's understandable: they make their money working on bones, joints and cartilage. Unless there is an outright tear, there's no money in muscle, tendon and peripheral nerves...
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Old 09-12-15, 04:00 AM
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I remember I read somwhere that muscle stretches are good only for 5-10 secs. Beyond that, muscles loses its oxygen support and stretching becomes useless.
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Old 09-13-15, 05:03 AM
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Originally Posted by hillcrawler View Post
I remember I read somwhere that muscle stretches are good only for 5-10 secs. Beyond that, muscles loses its oxygen support and stretching becomes useless.
I've never heard that. However, I don't believe 5 - 10 second stretches are effective for me at all.
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Old 09-14-15, 10:43 PM
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Yes, you've posted about your knee problems for a long time. Look: Your doctors are correct. The PT worked. The problem is that you haven't changed your behavior. You need to stick with the PT program permanently, just like the doctor said. You also need to learn to pedal and increase your cadence. Did the doctor say this was a problem with your hips or did you read this on the internets?

I'm going with the doctor: it's Patellofemoral Syndrome or chondromalacia patella, which is simply mal-tracking of the patella. That's caused by muscular imbalance in your legs, but once the area is inflamed, one has to both fix the muscular imbalance and the inflammation.

I'd advise a multi-pronged approach to the patella issue:
1) Do the PT work or follow the suggestions here: https://www.bikeforums.net/training-n...l#post16081392
2) Stretch every day and twice is better than once. These stretches: https://www.bikeforums.net/road-cycli...l#post15372967
3) Learn to pedal circles: https://www.youtube.com/watch?v=z04uoO7U_SA and a good thread about it here: https://www.bikeforums.net/fifty-plus...ing-about.html
4) Buy a set of rollers and learn to use them. Practice pedaling circles on them, at a low intensity, and no more than 30 minutes at a time until your pain is all gone. Don't ride outside, and don't ride at a cadence under 85. When you do get back outside, never ride a cadence under 80 unless you know your knees are bullet-proof. Low gears are the thing.

For the quad tendon problem:
1) Doing the above will probably fix it.
2) But if it doesn't, hit the gym which you have to go to anyway to do the PT work for the patella. There, start doing barbell squats. Also do single leg presses on the leg press machine. Always warm up with just the bar. Then gradually add weight, doing say 3 sets of 12, very gradually increasing the weight over a period of weeks. When that gets heavy, cut the reps, so you do a set of 12, a set of 8, then a set of 4 with the max you can handle on that last set. It takes heavy weights at low reps to fix tendon issues, and it takes a while because tendons are about the slowest thing to strengthen.

I also think I get benefit from hiking in the mountains, especially on rough, rocky trails. Even riding the Stepmill (also known as the Stairway to Hell) at the gym a couple times a week for a half hour or so helps.

This is probably a multi-year thing, but if you keep at it you'll see steady improvement.

Oh . . . and you want to always hold each stretch for 20 seconds.
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