skeem

I must start by saying that I normally would not ask on BF for medical help, but it seems the medical community is failing me.

I was racing and training pretty hard towards the end of the summer and i started to feel a nice ache/pain around my left vmo when I would be doing very hard efforts, but on longer easier training rides it was hardly an issue. After cross season I got an MRI/XRAY etc. and my orthopedist/sports med. dr. (who happens to be the doc for the philadelphia flyers, I believe) said i have a minor meniscal cyst (which he said was a non issue, mostly) but he diagnosed me with quadriceps tendonosis. He explained it as weakening of the tendon caused by overuse. I followed his and my coach's orders and took 6 weeks off and got physical therapy, where i was given a regimen of quad/hamstring stretching and strengthening. After 6 weeks of that I hopped back on the bike and attempted a few very easy 4-5 miles rides for about a week. I felt pain in my knee during a very very (painfully) easy ride and I went back to the doc. He then said I have quadriceps tendonitis (not tendonosis now) and said I should go back to PT and get more exercises and iontophoresis and an icing regimen. He also said I could ride on very short, easy rides if I had no pain. After a few weeks of a new PT and iontophoresis 3 day$$$ a week I started feeling ok so I began riding easy and increasing the distance to around 2x5mile rides (to and from work) a few days a week. I steadily increased my miles but today (after about 10-12 weeks of this nonsense) on a 30 mile easy ride (2+hours flat course) my leg felt/feels worse than it ever did when I was actually training.

THIS IS THE MOST FRUSTRATING AND TRYING ORDEAL I HAVE EVER BEEN THROUGH!

I was really looking forward to get back into riding by now and maybe start training for battenkill (and my general peace of mind) in a few weeks. However, as it stands, I have never felt this much knee pain and Im and VERY discouraged. does anyone have serious advice/tips? My family/coach/teammates all tell me to keep my head up and be positive but its really starting to suck (and the treatment is not free either). My coach and friend (recent physical therapy school grad) tell me to continue to be active and continue my routine, but I am starting to doubt them, my doctor, my pt and myself. Any advice or names of AMESOME doctors in the Philly area would be greatly appreciated.

Carbonfiberboy 

Yeah, that's a bad one. One strong possibility is that it's misdiagnosed chondromalacia, which would be the reason it's not getting better. Straight legged high kicks seem to be the best fix for that. Another possibility is that it's a foot misalignment problem, in which case you need a very good bike fit therapist guy to look into wedges. In any case, my guess is that the docs are wrong, and that's why it's not getting better. Football docs are not cycling docs.

Thirstyman

it does seem to make sense that it might be chondromalacia in that cycling inactivity has made it worse. I am not a health care prof

skeem

carbonfiberboy, what are straight legged high kicks? also, does chondromalacia hurt in the quads above the knee?

skeem

also, any reason why it might hurt after 2.5 months of rest and PT. I have a lingering ache 2 days after a super easy (sub 180 watt) ride whereas before I could do a century at endurance pace and feel nothing- this issue would only arise longer during sprints, at the top of hard 6+ minute climbs or maybe 3 minute all out intervals. Anyone have a clue why this might be? its troubling that symptoms have gotten worse after doing everything I was told to do.

Carbonfiberboy 

Mine never did, but people have posted that this happens. So I don't know. But referred pain is a real phenomenon.

Carbonfiberboy 

Yeah, damage. To what is the question. You might try an orthopod, though many of them just say "never ride a bike again." I'd say the best entry point into a diagnosis-based solution would be to try a bike fit physiologist. They do exist. A local racing team might know of one. Asking here is a good start, because you throw a wide net. But a guy like that throws an even wider net, since people with problems come to them. One runs into this all the time with sports. Docs or trainers say, "oh it's this" because they've encountered similar symptoms in the past. But that's not a diagnosis, that's a guess. You have to use diagnostic tools to make a diagnosis.

In the Seattle area, Eric Moen is The Man. https://bikept.com/ I know several people with difficult problems whom he has fixed up. It might be worth coming to see him. Give him a call, anyway. He might know someone in your area.

Carbonfiberboy 

High kicks: With your leg locked as straight as possible, kick forward as high as you can. Some people try to touch their opposite hand. Try 15 kicks on each leg as one set. You might have to work up to it. They're not easy. The idea is to improve how your knee cap tracks by improving muscle balance in the thigh, which is something that frequently goes wrong with cyclists, possibly due to incorrect position, fit, or pedaling action.

merlin55

I am an engineer in a family in which everybody works in healthcare....so I have an inside line on getting seen by the "right" doctors. IMHO you need to find a Ortho who is focused on sports medicine. Research your injury, and explain to the doctor that you have a serious problem that is impacting your normal daily life...i.e sitting on couch watching the TV is not an option. The right doctor will be happy to have a highly motivated patient that will work with the Doc and/or PT to get back to their sport ASAP. Good luck and get better.

skeem

Merlin, I have been seeing a sports medicine guy who cares and I think he is doing everything he can ( I think... I hope). I was wondering if anyone knows if acupuncture or other remedies like that may work?

bikerbert

The key to getting rid of what you have is hammering the glutes (I'm a strength coach who works with a ton of endurance athletes who have had this exact problem). More times than not, the repetitive stress nature of riding tightens the hip flexors, quads, erectors in the back and shuts down the glutes which can easily lead to what you're experiencing.

Unless you've got structural damage in the knee, I'd bet confidently it is an issue in the hips manifesting in the knee.

skeem

bikebert, my (new) doctor who is a cat 1 road guy and a dr. for some pro teams says something similar to that. my core (obliques mostly) etc. are too weak and my abductors (ones which pull the leg towards the center of the body?) are too strong so my vmo essentially has to take all of this lateral force along with the super hard riding i was doing with a saddle which was drastically too low (i must have gotten a bad fit buy a guy i thought was really pro)

does that sound plausible? this injury is starting to kill me mentally- i need to ride!

do you think i should stay off the bike or will easy riding be ok as long as i do my PT stretching and strengthening?

lastly, when do you know that this issue is fully gone? at this point i feel it will never ever go away. Thanks

skeem

Title sorta hints at my point. Im dealing with quadriceps tendonitis, and I havent seriously ridden a bike for 3.5 months. Im about to lose my mind! Have you ever had tendonitis, and if so did physical therapy help? Were you active with your condition? Lastly, the issue im dealing with the hardest is how do you know when it is fully healed, and how long did that take?

Also, any advise would be greatly appreciated, im going nuts not being able to train and race. Thanks.

Carbonfiberboy 

Yes, I think that's very likely the problem. So buy a set of rollers, with resistance so you can use them for training later. Raise your saddle until the heel of your cycling shoe is about 4mm off the pedal with your knee completely locked out. Do your high kicks and whatever other PT you're doing, and try riding the rollers 1/2 hr./day in a low gear at maybe 80-85 rpm, just enough speed to stay up comfortably. Pedal with the heel cups in your shoes, not your toes. You shouldn't feel it in your legs. So you'll also need a cyclometer with cadence. And don't balk at the cost. It's nothing.

If it hurts, stop. Wait a few days and try again. But it is important to get your cycling muscles firing properly, which is what the roller work does. The whole idea is to keep the hhhuuummm a completely even sound. Later, when you get out on the road, you'll try to pedal just the same way.

And yeah, if it's a problem I've probably had it, including rupturing my Achilles. The latest thing I'm working with is pes anserine bursitis. Getting it fixed, though.

skeem

Thanks for the advice, you really know your stuff. I do have a set of rollers with the killer headwind unit which i have been using for years. I guess a poor fit (though i thought the guy was very highly regarded) and weakness around my core caused my left vmo to give up and my tendon to get stressed. ill try the high kicks as its just about the only thing i have not done yet. a new pt today told me she was very confident i could be a lot better in a few weeks on her plan of core workouts. ill wait and see.

Carbonfiberboy 

Good luck and tell us how it goes. Too few people come back to report.

Phugoid 

Thought I'd add my experience, which has been similar to what the op described. Last year I started to get pain in two places in my right leg- the adductor/groin and the hamstring near the back of the knee. This would come and go, but got steadily worse when I ramped up my training rides to prepare for a big event this year (Death Ride!). Eventually, it ached all the time. It was never a very intense pain, but pretty constant and definitely worse after a lot of riding. Resting it up to two weeks didn't do much to make it better so I saw a sports medicine doc. He was reluctant to give me a particular diagnosis other than "soft tissue damage", but he cleared me of any knee problems and sent me off to PT.

My PT was confused by my symptoms at first. Guess it's not something they see often. She didn't find any obvious muscle weaknesses, but found that my glutes were "under-utilized" and my calves, hamstrings and hip flexors were very stiff. And that my injured muscles and tendons were lumpy with scar tissue. The best sounding theory is that I was doing too much too fast with possibly poor muscle balance and possibly a bad position on the bike. That didn't give the tissue enough time to heal properly and I built up scar tissue (tendinosis, probably?).

So I spent about 2mo strengthening, stretching and getting the scar tissue broken up with a deep tissue massage that uses smooth metal tools (Graston Technique). Fun. It actually didn't hurt that much and it really felt like it helped. Left some nice bruises though. Pain was better, but would still flare up if I did too much too fast.

Eventually, the pain decreased enough that my PT suggested I get a really good fit to be sure I was set up well on the bike. So I paid the $300(!) for a Retul fit from a local coach/fitter. Really cool to see your pedaling motion diagnosed instantly! He noticed my saddle was too low and that my pedaling stroke was funky- I was basically keeping my foot parallel to the ground through the whole stroke. So I took the time to learn a proper stroke, using my hip flexors and glutes more and keeping my ankle more stable.

Since then, I've been building up on the trainer for another 6wks. Started off with zero resistance (like rollers) and a very short duration. Then *very* gradually increased time, then resistance. Lots of stretching before and after sessions. Ice afterwards. I'm still very cautious with road rides, since it's easy to overdo the intensity.

So after almost 4mo, I'm back to where I have little pain (though it still aches sometimes) and I'm able to ride an hour at moderate intensity with no flare up of the injury. I'm hoping to stay on this trajectory and get back up to 4 hour rides with lots of climbing on the weekends. Maybe another couple months...

Anyway, that's my story. Good luck to others with similar issues. It really is a frustrating injury, but it seems to eventually get better with time and slow progress...

Dave

humboldt'sroads

Wow, it's almost unbeliveable that I found this thread! I woke up at 4:00 am today with unbelieveable pain in the soft tissue just above the knee and have not had a chance to get to the doc yet (have an apt today). I have not been on the bike at all in a few months, as I am also an avid runner and snowboarder and simply don't have the time during the winter. I was on the slopes Saturday, Sunday and Monday and my knees took a pounding but with no more than my "usual" background-level pain that I've become accustomed to. I went on a 4.5 mile run on Tuesday - no pain; I felt great. No pain yesterday or even when I went to bed last night, but it came on so severe this morning that I shot straight out of bed with a yell.

OP, can you please let me know if you have syptoms as follows:

I can stand on the injured knee just fine, so long as it's locked. I cannot do so much as walk without a bad hobble (must take very short steps and up/down stairs one at a time). What really hurts is trying to extend the lower leg straight out in front of me, or pick it up behind me. Basically, anything other than standing perfectly straight hurts badly. When extending the leg, I hit a "dead zone" where there's just no strength and lots of pain. It's possible to extend my leg almost completely but with a great deal of pain.

When the pain woke me up this morning, I also experienced shooting pain and numbness down to my ankle. After moving around this morning, the ankle pains went away, but the knee deal is not making improvements.

Were you able to walk somewhat normally when your tendonitis was at it's worst? What about taking stairs, or even putting on pants or shoes - could you bend your leg without much pain? Was your pain only/mostly associated with your riding, or did it permeate every aspect of your daily life off the bike too? I'm really hoping it's not a partial tendon tear.

Again, I'm going to the doc this afternoon, but I've had so many inconclusive doctor's visits for knee pain before that I really don't expect the best solution to come from my visit. If anyone who's experienced quadriceps tendonitis, or a tendon tear, I would appreciate your shedding light on the above syptoms and their severity.

Many thanks and best wishes to all!

Machka 

From my experience, there are two types of pain which occur above the knee:


1) From the kneecap (or even tucked under the kneecap a little bit) to about 1" above the kneecap, straight up from the kneecap, not very wide ... and that, I believe, is quadriceps tendonitis. It's a sharp, quite intense pain, and even leaves the knee feeling a little weak when climbing stairs, walking, etc.

This pain will come on after doing a ride with considerably more intensity than you're used to, something where the knees get much more of a workout than they should ... and where you're mashing a lot and putting a lot of pressure on the knees.

This is a pain that does not go away after a few days of rest ... it keep going and going for weeks.

For this, I ended up taking almost an entire month off the bicycle, and when I got on the bicycle again, it was shorter rides and light spinning. I was able to continue walking.



2) Starting a little, tiny bit above the kneecap (not right at the kneecap), and wider, taking up the whole of the bottom of the thigh and perhaps wrapping itself around the sides of the knee as well ... and that, I believe, is simply muscle pain -- DOMS pain. If you've ever decided to start a bodybuilding regimen and went at it a little hard on the first day, and then could hardly dress yourself the next day, that's DOMS pain.

The DOMS pain will often come on after doing a longer ride than what you're used to, or possibly a ride with a bit more climbing.

This is a pain that will go away after a few days of rest or walking or light riding.

skeem

machka got it mostly right. my pain was never as bad as yours sounds, but at the same time its been a nagging injury for 6 months.

MinnMan

OK, here's my story.

Beginning in December I had some minor pain in the back of my thigh, at the top of the hamstrings. It wasn't acute and I ignored it and kept riding. I had a vacation planned for mid-January and figured I would rest up then. Also, I was eager to clear 7000 miles for the year. I moved from the US to Australia Oct. 1, so I had this great opportunity to really pack in the miles.

Big mistake.

After my holiday I got back on the bike for an easy 20 mile ride, and my leg hurt bad. I took another week off, put platform pedals on, and tried a 10 mile ride (gentle! 12 MPH when I normally shoot for 18). It still hurt. I took another week off and tried another 10 mile ride. Same deal. At this point I decided that very gentle riding with a little pain was maybe better than no riding at all, so I started doing really gentle about 30-40 miles/week. THings got worse and I stopped after a couple of weeks.

OK, I'll spare you the details, but now 4 months into this, doing a ton of rest and little else in the last 6 weeks, I'm worse than I was at the outset. I can't walk 10 minutes without aggravating the leg.

I haven't yet had an MRI, but my PT and I both think it's tendinosis - chronic and degenerative weakening of the tendons. He wants me to do strengthening exercises, but it's hard to do when even a 10 minute walk leaves me hurting for the rest of the day.

I am in total despair. I've read a ton about different therapies, but my overall impression is that if there were a sure-fire therapy, there wouldn't be such a proliferation of techniques. I guess I have to try them all until I find one that works.

oomps83

Digging up this old thread. Does any of the posters with quad pain have an update? Did anything work? I have the same issue, just curious as to next best steps.

achoo

What, exactly, is the pain? Where exactly is it? What does it feel like? What sets it off? What makes it feel better?

"Quad pain" is too generic to address.

oomps83

Basically the pain described by the OP. Its my quad tendon for sure. Long rides set it off and its a dull ache which borders on "discomfort" and "pain".

Machka 

What works is rest ... as I mentioned in my post above.