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Chronic lateral knee pain, Biceps tendinosis NOT ITB

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Chronic lateral knee pain, Biceps tendinosis NOT ITB

Old 02-04-19, 02:56 PM
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rosefarts
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Chronic lateral knee pain, Biceps tendinosis NOT ITB

Usually when someone comes to these forums with an injury, the first thing everyone says is "Go to a doctor". I have.


So, last summer I went way up on miles. I developed progressively worse soreness on the lateral side of my knee. I couldn't seem to shake it. I figured it was my IT band, since it was awfully close to there. In August or September, I saw an ortho doc who corrected me that it was the attachment of the Biceps Tendonosis, a hamstring muscle. Only by palpating my specific sore spots did he determine this, since the sore spot is almost exactly where a sore ITB would be. He gave me a steroid injection then that gave me nearly 100% relief. It was temporary but I figured that since I don't ride much in the fall and winter, it'd heal up. The doc said to take it easy, I actually did, I haven't ridden beyond 50 miles since and less frequently. I did a ton of centuries and big gravel rides and the Triple this summer, so this is waay less.


Fast forward to now. I'm not putting many miles on, just a few hours a week on a good week. Also doing quite a bit of AT skiing that keeps me working. The soreness has come back pretty strong. Rest doesn't seem to help. Sometimes, rest makes it worse. It's getting to about the time where I start riding more and it hurts. Nothing I can't manage now but I worry as the spring opens up to longer days it's going to get bad again.


My current plan, in this order is

1) business as usual plus nsaids and voltaren gel as needed

2) if it gets worse, revisit the doc and get another injection to get me through a big ride I'll be doing in a couple months

3) if it still doesn't improve, MRI etc.


In the meantime, I'd sure be curious to to hear if others have experienced the same thing and how they got over it. Specific stretches, strengthening, massage, rehab,.....surgery?
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Old 02-04-19, 10:51 PM
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I've had a thing like this many years ago, but I can't remember if it was on the inside or outside, though I think the outside. I used stretches and it went away pretty quickly so my guess is that it wasn't what you have..

I think you misremember the doc's terminology. Probably the doc said "biceps femoris tendinosis," biceps femoris being the name of the muscle, tendinosis being what the disease of a badly deteriorated tendon is called, a big step worse than tendinitis.

So a few things.
1) Rest never fixed anything. Today that's like medieval. Sure it got worse. Ice and heat don't work either.
2) Stretching almost always helps. I use these stretches for knee health: IT Band pain (during ride)
3) Tendinosis pretty much only responds to strength training of a very particular type: heavy slow eccentric resistance training. (google that phrase).
4) NSAIDs are particularly not recommended. Inflammation is how you heal.

So you'll want to do exercises in the gym with relatively heavy weights which work this particular tendon hard. So probably leg sled, stiff legged deadlifts, barbell squats in a rack, knee curls, concentrating on lowering the weight slowly, say 3 seconds down, quicker up, and using all the weight you can tolerate for say 3 sets of 10 reps to start with, decreasing to 5 reps with appropriately increasing weight over time as it gets better. You want enough weight so that the last rep is very difficult. It's going to take a while. I'd say you can do whatever you want on the bike as long as it does not hurt at all, so probably not too much. You might be able to find a PT who knows about this stuff at a gym.

I can't imagine surgery would do anything but bad. For sure do NOT mask it with more injections or pain killer of any sort. You want to know exactly what's going on with it. You don't want it to get worse - this is a disease of deterioration which, in the long run, may not be totally fixable, back like new as it were. Maybe, maybe not.

Docs who don't know what they're doing can really screw you up. They want a fix they can deliver and charge for. That's now how your problem gets fixed.
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Old 02-05-19, 09:36 AM
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So I confused myself, semimembranosus, semitendinosus, and biceps femoris. I threw in a tendinosis where Dr. T didn't mention one. I do think he's genuinely interested in helping, I've known him awhile. He's one of those grumpy old dudes who would do anything for you.

There is a full weight room where I work, I use it to park my bike. Itd be pretty efficient to add a half hour routine a couple days a week.

Wolf Creek got 16" in the last day, so I'm going to go do that. I'll hit the weights on Thursday.
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Old 02-05-19, 07:24 PM
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Originally Posted by rosefarts View Post
So I confused myself, semimembranosus, semitendinosus, and biceps femoris. I threw in a tendinosis where Dr. T didn't mention one. I do think he's genuinely interested in helping, I've known him awhile. He's one of those grumpy old dudes who would do anything for you.

There is a full weight room where I work, I use it to park my bike. Itd be pretty efficient to add a half hour routine a couple days a week.

Wolf Creek got 16" in the last day, so I'm going to go do that. I'll hit the weights on Thursday.
Ah well, if you actually don't know what the diagnosis is, I take back my recommendation, which would be for a particular diagnosis. Usually one gets a written diagnosis in the mail after a visit like yours.
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Old 02-06-19, 01:21 AM
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Get the MRI.
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Old 02-07-19, 07:06 PM
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Originally Posted by Machka View Post
Get the MRI.
Tell him, Machka! Whatever he's got it needs to be imaged.
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Old 02-08-19, 04:45 AM
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Originally Posted by Road Fan View Post
Tell him, Machka! Whatever he's got it needs to be imaged.

I went for my MRI on Wednesday ...

Fortunately, the PT's assumption wasn't quite right.
Unfortunately, the PT's assumption wasn't quite right.

In other words, it turned out to be something different than expected, better in some ways, possibly worse in others. But definitely with a different treatment plan.



In my case, around the end of Nov, I started feeling a bit of an ache in my right leg when running. Figured it was muscle. Rested a bit, did some stretching, and it felt a little bit better.

Ran a half-marathon, and could barely hobble by the end. Still figured it was muscle, tried more rest and stretching, but lots of difficulty walking, and definitely no running. It even hurt to cycle.

Went to a PT who ran me through a whole bunch of tests and was pretty sure I'd fractured my hip ... stress fracture. No walking, no cycling, no running, no stretching ... nothing for a week until my MRI. If it were a stress fracture, I would have had to rest for the next 4-6 weeks.

But it's not a stress fracture! Instead, I've torn the cartilage in my hip and have really messed up the ligaments.

Yes, I'll still have to rest, so treating it as a stress fracture would have been all right in that regard, but I can still do some exercise (slow walking and cycling, not running) and it will be treated with specific stretching and strengthening by my PT. If we had assumed it was a stress fracture and I just rested, I would have lost a lot of fitness, and I would not have done the stretching and strengthening aspect so my ligaments may not have recovered as well as they might. (Of course, we still have to wait and see)


These days we have the technology ... it's no longer a guessing game.
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Old 02-08-19, 06:35 AM
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Originally Posted by Machka View Post
These days we have the technology ... it's no longer a guessing game.
That never stops the “experts” on this forum from lobbing in their guesses.
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Old 02-08-19, 11:16 AM
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Originally Posted by Machka View Post
I went for my MRI on Wednesday ...

Fortunately, the PT's assumption wasn't quite right.
Unfortunately, the PT's assumption wasn't quite right.

In other words, it turned out to be something different than expected, better in some ways, possibly worse in others. But definitely with a different treatment plan.



In my case, around the end of Nov, I started feeling a bit of an ache in my right leg when running. Figured it was muscle. Rested a bit, did some stretching, and it felt a little bit better.

Ran a half-marathon, and could barely hobble by the end. Still figured it was muscle, tried more rest and stretching, but lots of difficulty walking, and definitely no running. It even hurt to cycle.

Went to a PT who ran me through a whole bunch of tests and was pretty sure I'd fractured my hip ... stress fracture. No walking, no cycling, no running, no stretching ... nothing for a week until my MRI. If it were a stress fracture, I would have had to rest for the next 4-6 weeks.

But it's not a stress fracture! Instead, I've torn the cartilage in my hip and have really messed up the ligaments.

Yes, I'll still have to rest, so treating it as a stress fracture would have been all right in that regard, but I can still do some exercise (slow walking and cycling, not running) and it will be treated with specific stretching and strengthening by my PT. If we had assumed it was a stress fracture and I just rested, I would have lost a lot of fitness, and I would not have done the stretching and strengthening aspect so my ligaments may not have recovered as well as they might. (Of course, we still have to wait and see)


These days we have the technology ... it's no longer a guessing game.
Thanks for sharing all that! Maybe I should have my hips checked! Many days we go out and walk 10000 steps, either on streets or at the shopping mall. Usually in the first 300m or so I'm comfortable. Through the next km my hips hurt and it feels like at the ball/socket joints. If I stop for a 2 minute rest it abates. After about 1500 m it feels mostly good, and I can even walk fast on impulse in that stage and make it home in decent comfort to complete the 10 k steps. Pace is not too high, and if I felt fully smooth flow I'd be going maybe 4 mph (6 kph?).

It could have to do with surface. I was in Munich for two weeks last November and did a similar length walk nearly every day in the city, up and down the hills near the Isar river. Most of the sidewalks were square stone patterns or otherwise smaller pieces of paving materials. In US cities sidewalks are large slabs o concrete on firm beds of gravel, and shopping mall interiors are similarly hard and smooth.

I haven't done much cycling, even indoor. I'm planning to do 30 minutes today on trainer.

Anyway, perhaps I should have a doctor look at them.
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Old 02-08-19, 08:15 PM
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Originally Posted by Road Fan View Post
Thanks for sharing all that! Maybe I should have my hips checked! Many days we go out and walk 10000 steps, either on streets or at the shopping mall. Usually in the first 300m or so I'm comfortable. Through the next km my hips hurt and it feels like at the ball/socket joints. If I stop for a 2 minute rest it abates. After about 1500 m it feels mostly good, and I can even walk fast on impulse in that stage and make it home in decent comfort to complete the 10 k steps. Pace is not too high, and if I felt fully smooth flow I'd be going maybe 4 mph (6 kph?).

It could have to do with surface. I was in Munich for two weeks last November and did a similar length walk nearly every day in the city, up and down the hills near the Isar river. Most of the sidewalks were square stone patterns or otherwise smaller pieces of paving materials. In US cities sidewalks are large slabs o concrete on firm beds of gravel, and shopping mall interiors are similarly hard and smooth.

I haven't done much cycling, even indoor. I'm planning to do 30 minutes today on trainer.

Anyway, perhaps I should have a doctor look at them.

It is good to get it checked.


Mine was more than just the hip. My hip hurt a bit but it has for some time. I suspect that's the torn cartilage part. But what finally got me to the PT was the excruciating groin pain and pain all down the inside of my thigh. So bad I couldn't even walk fast and the leg would give out on me if I tried to push it a bit.

I was convinced it was the sartorius muscle and it's possible that factored into it a little bit. But a much greater issue are the ligaments.


One thing I'm discovering is that doctors are all right, but the PTs around here are amazingly well trained. I've gone to PTs in Canada and had mixed results, but here they seem to know anatomy and how to treat problems with the muscles, ligaments, tendons, etc. very well. And they specialise in different areas. I'm seeing 3 different ones for different things. I've also been impressed with the work they've done with Rowan in his recovery process.
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Old 02-09-19, 02:41 AM
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I've found the PTs in Michigan to be very good, too. Rotator cuff, neck, broken wrist (occupational therapy, not physical therapy), and other things in the family. Ultimately it's down to us to exercise and practice "the moves" until it seems like you didn't need ever to be there, but in reality I could not have known how to go from near-debilitated to almost normal.
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Old 02-09-19, 03:47 AM
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That exact same thing no, knee pain absolutely. When knees hurt I suspect there is an imbalance. It can be subtle, like mine. But it will still effect you over time. Of course the doctors will always tell you to stop or take it easy since that's their generic liability answer.

My solution was a regiment of progressive resistance, and it appears to be working well thus far. I started ridiculously light with the weights (leg extensions. and light squats), and have built up slowly over the past few months so now its hard for anyone to tell I have knee issues.

No more useless scans or X-rays and certainly not surgery. I did my own rehab, and its working well for me. I haven't had to use the Voltaren in months. Now if I could just cure my chronic back, neck, and shoulder pain, I'd be 100%. And yes, the rehab improved that too, though not nearly as well.
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Old 02-10-19, 02:33 PM
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Originally Posted by KraneXL View Post
That exact same thing no, knee pain absolutely. When knees hurt I suspect there is an imbalance. It can be subtle, like mine. But it will still effect you over time. Of course the doctors will always tell you to stop or take it easy since that's their generic liability answer.

My solution was a regiment of progressive resistance, and it appears to be working well thus far. I started ridiculously light with the weights (leg extensions. and light squats), and have built up slowly over the past few months so now its hard for anyone to tell I have knee issues.

No more useless scans or X-rays and certainly not surgery. I did my own rehab, and its working well for me. I haven't had to use the Voltaren in months. Now if I could just cure my chronic back, neck, and shoulder pain, I'd be 100%. And yes, the rehab improved that too, though not nearly as well.
I appreciate your response. The folks who think a doc is always the only way to go probably don't know and work with a lot of docs. I live and work on the other side of the veil, and am way more interested in others experience. I'm not a religious person and I don't put undue faith in physicians either.

Funny and impractical discovery. Hard skiing on deep powder days really make my "condition" feel great. Like the kind of day that leaves your quads sore for a week. If I could do that twice a week, I'm certain I'd be a new man by spring. The goal is to attempt to replicate that in the weight room.
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Old 02-10-19, 03:24 PM
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Originally Posted by rosefarts View Post

Funny and impractical discovery. Hard skiing on deep powder days really make my "condition" feel great. Like the kind of day that leaves your quads sore for a week. If I could do that twice a week, I'm certain I'd be a new man by spring. The goal is to attempt to replicate that in the weight room.
Are you comfortable doing squats with full range of motion ?? If you are, then maybe try doing squats with light weight for 2 sets of 20-30 reps, make sure to warm up well before doing the squats. Tendons have a very limited supply of blood flow and that's one of the reasons why tendonitis take so long to heal. High reps with light weight are good for getting blood flowing around the tendons.
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