oomps83

Hi Machka,
Thanks for the reply. Could you possibly go into more detail about how you ramped up your rides afterwards? I am pretty new to cycling, and after being sedentary for a decade put 500 miles on my bike in two months. So it is obviously overuse in my case. The issue only occurs after 20 miles or so, and I immediately get off the bike. I am thinking about taking 6-8 weeks off, then starting my training at 12 miles twice per week. I will increase by 10% per week and after 14 weeks should be at 50 mile rides. Do you have any experience or comment about this plan?

Thanks again!

Machka 

My symptoms came on after doing a fairly hilly 300K randonnee on a bicycle which had been hastily put together for me after the bicycle I intended to use for the event was stolen.

I was in decent shape and the bicycle was pretty good, but in an ideal world, I should have probably ridden it more than about 5 minutes the day before the event.


So my first suggestion would be to have the fit of your bicycle checked.

Secondly, when you ride, focus on spinning rather than mashing. In my case, I was mashing up some of those hills ... and that is a recipe for disaster when it comes to the knees. Aim to spin at least 80 rpm ... 85 or 90 rpm if you can manage it.


In my case, I was comfortable with the 300 km in one day distance, so after I took about a month off and then got back into it again, I started doing a 10-15 km evening ride 3-4 days a week, and at least one ride about double that on the weekend. A flat route at a slowish pace and spinning about 85-90 rpm. It wasn't too long before I had doubled that. (I'll have to check my logs to confirm)

I'd encourage you to ride more than twice per week when you get going again. Maybe alternate between about 5 and 10 mile rides 3-4 times a week. Keep it flat for the first month or so, don't push the speed, and focus on the cadence.

You might also see if you can incorporate other activity. I could still walk to and from work (3.2 km each day) without pain ... flat ground, relatively easy pace.


And if the pain continues after you've been resting a couple weeks ... try to get in and see a sports Dr.

Carbonfiberboy 

Yeah, as I said in one of my posts above, folks seldom come back and tell us what worked and didn't. However, since they didn't come back, maybe something did? So go back through this thread and start trying stuff. Most promising are probably a bike fit from an expert in these injuries, followed by the high kicks and roller workouts, focusing on the hams and glutes. For that latter, IOW stop using your quads to pedal so much and shift that load to your hams and glutes as much as possible.

IIRC, a poster in a different thread but with similar symptoms got relief using a program of working up to heavy squats.

oomps83

Machka and CFB,
Thanks for the information. Yes while searching the forum I have rarely seen a good follow up so I appreciate the responses.

I have had the pro bike fit and preferred high cadence since the beginning. I also spent some $$ on shorter cranks. So now it is likely a medical issue. I will hopefully see a sports Dr. this week. I've seen some information on base miles, where racers should build up 500-1500 miles of easy riding before doing more serious training. This doubly applies to beginners. I assume I just need to spend 6-12 months easing into it.

I will definitely do shorter rides, but winter hours might make it hard to do more than twice per week but spring time this should be okay.

Thanks for the responses.

Machka 

Get a trainer and do some indoor riding ... and/or join a spinning class. These things all work toward those base miles.

But first rest till the knee feels better.


EDIT: If you join a spinning class ... if they suggest to the class that you all shift into a hard gear, slow your cadence, and really push ... ignore them. Do not slow your cadence below 80 rpm ... do not push too hard while seated.

I like my spinning classes, but there are a couple things they do that aren't good for the knees and that's one of them.

oomps83

So it has nearly six months since I have posted. 10/25/14 was my last bike ride until about 3 weeks ago. I went to the doc and was told nothing is wrong. I was determined to get over this issue.

First of all I am not sure the issue is solved yet. I have not had pain in nearly 5 months (except once, mentioned below) and have rested most of that time. I took 120 days off of cycling (yes, I counted the days) because supposedly it takes 100 days for tendons to heal. In February, I began walking on a treadmill after 100 days away from any leg exercise. So 120 days off cycling, and 100 days of rest from any exercise at all.

One piece of advice at the beginning of my time off was to get a sports massage. I had two sessions, one in Nov and one in Dec. Both sessions focused solely on my right knee. Basically, my knee was so “knotted up” that it took two sessions to work the knots out. These are the same knots like you would get in your back, except they were ALL OVER my quad muscles. My entire quad was filled with knots and the tendon area above the knee was “crunchy” (which was scare tissue). So after my Dec appointment, I hibernated for the winter.

I had a sort of light bulb moment after my first week of walking on the treadmill in February. I was walking 20 min per day and after a week I HAD THE TENDONITIS PAIN AGAIN! I was livid. I was frustrated. I almost cried. How can I ever cycle again if I can’t even walk?

I went back to the massage therapist and my knee was knotted again. After much research and conversation with the therapist, I began self-myofascial release by rolling my quad. And man did I roll. For the past six weeks, I have “rolled” every part of my quad muscles and IT band twice a day and used smaller and smaller rollers. It was brutal. I also dropped the coin and have been getting my knee worked on by the massage therapist twice a month.

Since rolling and frequent massage therapy, I have had no issues. I have done a few rides, but no pain. They were very basic rides and no more than 5 miles. I have also done quite a bit of walking and have felt no pain, as long as I rolled before and after each activity using my legs.

So the plan is to now ride once or twice a week with plenty of rest in between, and do a full leg routine in the gym. Squats, glutes, hams, calves, abductors, adductors, etc. Also, and likely most importantly, I have begun to incoporate DECLINE DROP SQUATS into my routine. I will let you all investigate this further on google, but it is AMAZING how it targets the petellar tendon both below and above (quad tendon) the knee. Be warned, only do two or three quick drop squats to begin with, they are brutal. I also built my own board at 20 degree decline, and it still was near painful.

As for cycling, I plan to go at a snail’s pace. Resistance training and rolling will be the focus for me for the rest of this year. At the end of the year, I plan to be at 20 mile rides maybe once a week (which is half of what I used to do), but the plan is to never be injured again. At 32 years old, I need to practice patience and be on the lifetime cycling plan, not the 2015 cycling plan.

So that’s the story and I will keep BF posted on the progress. I know there are lots of people out there with this issue, so the least I can do is share my progress, plan, and results. Again, I would like to reiterate that I am not sure if the problem is solved, but I intend to do so much resistance training and ease ever so slowly back into cycling that I hope to never find out.

Carbonfiberboy 

So cool. I found this website with rationale and study links:
FITS TORONTO ? STOP Decline Squats for Patellar Tendinopathies

Doesn't seem rational at first glance, but it does after you think about it. Funny thing - I had trouble with my knees years ago and fixed them simply by stopping taking ibuprofen for the pain. My reasoning was about as shown by these studies. Still don't know what was really wrong with them.

oomps83

Hi CFB,
Yes I had read that article you linked during my research. (I always try to search for why NOT to do something). I agree with some of it, but I don't take the drop squats as far as some people. I use it more as a supplemental exercise to leg day before I go to bed, so I will only be doing them 1-3 times per week. I also agree that pain should not ever be involved, so the pain issue will be the same as any other exercise. But there does need to be stimulation of the tendon areas and strength can be returned, so I also want to be sure to stress that area just enough to encourage muscle and tendon strengthening (just like any other exercise).
As to the ibuprofen, I completely agree. People just tell me to take it when I have pain and I completely reject that. I need to rehab my knee without pain. Also, I have read that ibuprofen inhibits the growth/repair response when inflammation is down. Basically I have read that it is for immediate acute pain only, not as a major part of a rehab program.

Carbonfiberboy 

However that STOP article doesn't have the support of athletes and the research community that eccentric decline squats has.

Yes, that bold is the most important part. My understanding is that causing inflammation is the whole idea of this exercise. Lack of inflammation caused the problem and only inflammation can heal those tendons. Also, my reading of the literature is that pain is part of the process. IIRC they want the pain level to stay at 4-5. IOW as one gets better, they want the subject to keep increasing the stress, thus keeping the pain at about that level, thus progressing from a 2-legged decline squat to putting the weight more over one leg, to 1-legged declines, to 1-legged declines with a backpack. The other thing they are recommending is doing the declines twice a day, 7 days a week. My guess is that's to keep the inflammation going by not allowing recovery.

The other thing I'm seeing is that it would be a good idea after rehabbing the tendons with declines, i.e. when it doesn't hurt any more, to go back to regular leg work at the gym: heavy squats, 150°-180° leg extensions, one legged leg presses and the like in order to prevent future problems with those tendons by increasing strength of the other leg muscles.

I know this is controversial, but when I'm cycling I seldom consciously push down on the pedals during the downstroke. I try to just let the weight of my leg carry the pedal down while concentrating on the pull-back at the bottom and push forward at the top to provide power. Of course I'm aware that I'm pushing down more than it feels like I am. The idea is to not stress the front of the leg unduly. When I'm upping my bike conditioning, I will frequently cramp my hams before I cramp my quads.

pdxtex

you are not a rockette, i would not suggest high kicks in your current state. bad advice. 1, id start with a comeplete review of bike settings, correct seat height, ditching shimano pedals all together or anything with with high tension release. consider speedplays if you aren't riding with them already. for quad strengthening, try seated leg lifts instead. slow!! seated leg lifts. next get ye olde foam roller or the "stick" and learn how to use it well. tight hip flexors can be a *****. sleep on your side in a fetal position? dont! it shortens hip flexors. id also consider adding some type of BCAA supplement and if you are over 40, take alternate days off. also, no high kicks!

GeorgeBMac

Not all PTs and not all physicians are created equal.
... And one that is good at one thing may not be so good at something else.

In my own experience:
I injured something in my right hip last May. After seeing 4 physicians I finally found one who diagnosed it correctly (the rest, I fortunately knew were blowing smoke). The 4th physician correctly prescribed PT -- but then it took till the third PT for me to find one who ordered the right blend of stretching and strengthening exercises.
... My leg is still a bit weak and painful -- but, for the first time in a year I know it is headed in the right direction and I have hope that it will fully heal.

Do not be afraid to spend the time and effort to shop for the right doctor and the right PT -- just as you would for the right bike if you were shopping for one. You are buying their service. If they aren't getting the job done, it is time to move on.

I am not trying to denigrate any medical people here. Everyone of them believed that they were telling me the right thing. But, they were wrong. They are, unfortunately, human first and physicians/PTs second.

p.s. It may not be one, single problem. I have found that the body compensates well for any weak part -- thus putting undue strain on the parts that are working... Resolving muscle & tendon problems can be very complex and involve a process like pealing an onion: resolving one thing reveals some other problem (perhaps a chronic one), which reveals another, and another....

Best of luck to you. Keep working the problem. You'll get there!

cellery

I have had for about a year what most with experience would consider the symptoms of quadricep/patellar tendonitis, possibly patellofemoral pain syndrome - generally as OP has described. My symptoms include quad pain of the right knee under, above and to the inside of the kneecap. My knee pops under flexion (but not while riding) and there is some pain going up stairs or upon standing from a seated position.

I have tried many remedies but the ones that have stuck that are practical and that actually worked (for me) are as follows:

Bike fit - I was pretty stretched out before, and had no idea becasue that's how my shop fitted me. I moved my seat almost as far forward as it would go (on a setback post), moved cleats as far back towards the center of the shoe they would go and raised my seat for maximum leg extension without rocking. The result is slightly behind center of the crank.

More importantly - stretches and self massage of the VMO and sometimes IT band area. Foam roller. Before EVERY ride, from a standing position you want to carefully pull your leg behind you and up to your butt - hold for 20-30 seconds. You should feel a good stretch in the VMO, upper-inner kneecap area. Repeat a few times.

In a chair seated position, rotate the affected leg(s) outward and raise them slowly and release, repeatedly. This works the outer quads which are underutilized and neglects your beefy inner VMO which is often overused in cycling. I do these at my desk while working.

Others have already pointed out the decline squats - not a bad idea but I haven't done enough of it so see if it works for me.

I continue to do these bascially every time out and it helps immensely for rides over about 35-40 miles. On days I neglect to do my stretches, I will feel patellar pain within an hour of riding and sooner on hard rides with a group.

Hope this helps - I am of course not a medical professional, this is only anecdotal, etc.

GeorgeBMac

I find stretching AFTER the workout -- when the muscles & tendons are warm and loose -- to be more helpful than any other time. It seems that most people stretch in order to loosen up for the workout. But, if you are stretching in order to rehab tight muscles & tendons, doing it while the muscles are warm and loose may be more productive.

cellery

I do both. Definitely the most widely accepted approach to stretching is to only do so after a workout - but having tried both I feel much better having stretched beforehand to loosen/warm up VMO tightness. It's more of a winter thing; less pre-ride stretching in warm weather.

Taylob90

I've greatly appreciated this forum. Learning from others is such a reward. I too am currently dealing with bilateral quadriceps tendonsosis, and it's been the worst experience of my life. I raced for 17 years, mostly mountain bike, and have been racing marathons for the past five years. I even raced through it last year, but that's all over now. In 2013 I got a lateral release that helped the left knee get better from the tendonois, but it came back last fall, 2015. Early spring of 2015, the right knee developed the quadriceps tendonsosis, and I hobbled through and got a lateral release on it this January. I tried ASTYM, Graston, hours of PT, acupuncture, light, light riding for three months, steroid patches, cortisone shots, but nothing has made a difference and it's now so crippling I can hardly stand.

My latest attempt to solve this has been plasma rich injections, and the doctor is fairly hopeful it will work because he found the 'holes' or thickened tendon area, and got in some good plasma into those areas. I got the injections yesterday and will share if it works or not. At this point, I don't know that there is anything else I can do. Even the ortho doesn't think surgery is a good option because it isn't clearly evident on the MRI.

I would like to hear from anyone who has come out the other side of this and to warn those who have felt tendon issues. It's crippling in that even standing or walking is painful...let alone riding or weights.

Cheers, B

Phugoid 

Othersider here. I can't say I had the same problem that you're seeing, but in my case trigger point therapy worked after I had no lasting improvement from rest, months of PT, Graston, getting a retul bike fit, etc. Got pretty bummed out that the pain would come back each time I tried to increase my training load. Then I got the trigger point therapy workbook and started self massage as recommended. Saw some benefit right away and had slow improvement over a year or so. And in fact I just did my first century last weekend (a hilly one)...and while my butt was sore, the leg didn't/doesn't hurt.

Oh, and something that seemed to help was regularly taking CoQ10 since I'm on a statin. I'm guessing the statin made it more likely for me to get muscle cramping (trigger points) which were alleviated by the massage. CoQ10 is supposed to help reduce this cramping if you're on a statin, but I'm not sure rigorous studies have been done to prove it out- YMMV and all of that. Good luck.