Patellar tendonitis? Soloutions?

Nebuchadnezzar

Hi,

I took up cycling at the beginning of the year and covered about 5000 miles up to September. I was feeling slight pain just below my knee for a couple months so i decided i should rest it, especially with the new football season and the hard pitches making it worse. Have barely been on the bike since Sept.

I believe i have patellar tendonitis, it is a pain just below the knee at the front - on the left leg only. I think i have slight supination on my left foot (weight is on the outside of the foot?), could this be the cause of the tendonitis? I also think i may have slight pronation on my right foot ( weight is on the inside of the foot.) after long hard rides i would feel pain in my big toe and the the inside of the ball of my right foot.

Knee pain only in left, foot pain only in right. I hope that someone can shed some light on this for me as i would like to get back on the bike soon. Hopefully it is just small adjustments that need to be made, and the problems are just exaggerated due to the number of miles.

Any help much appreciated.

DavidJB

I have this as well. Stop playing football / running its the only way to stop it. I still have tenderness to the touch over a year later but get no pain when riding. I play an hour of football once every 3 weeks. (1 on two off) but anything impact will aggravate it and it will start hurting when riding.

lpretro1

Get it properly diagnosed by a sports physio and then treat it appropriately - if you persist it will get worse and damage will occur and you will be off the bike a lot longer. You may have to rest it frst off. You do not wnat this to recur I can assure you.

Monty Dog

It is a chronic condition and will only improve with rest and alleviation of the cause, which is likely to be too much strain through the quads - the patellar tendon effectively 'anchors' the big muscles on the front of the leg and the strain could be due to pushing big gears / pressing too hard on the pedals. You may benefit from some complimentary exercises to help balance your muscles.
If you want to continue riding, keep to low gears and avoid heavy efforts. Taking anti-inflammatories and R.I.C.E. help alleviate symptoms - seek expert opinion if you haven't already done so.

Wirral_paul

Sounds very very similar to me too - an ache around 3" below the kneecap right at the front / top of shin. I've been mostly off the bike since mid August. Since waiting for a proper diagnosis myself after an X-ray and MRI scan havent shown anything up. Just waiting to go and see a specialist at the moment after seeing my doc on Wednesday.

Currently using a "jumpers knee" strap every day which is helping a lot (bought it Monday). http://www.wiggle.co.uk/mueller-jumpers-knee-strap/?utm_source=google&utm_medium=base&utm_campaign=uk&utm_content=Mueller-Mueller_Jumpers_Knee_Strap-Black

Nebuchadnezzar

Thanks for all the responses so far, it's good to know i am not the only one with this problem.

I know i have to rest it otherwise it will get worse for longer, only doing 90mins of football once a week on the now sodden grass. Usually it is only tender for the rest of the day after football, so it's not too bad. Will definitely be resting it over Christmas though. Using Deep Freeze before/during/after football seems to have helped, will have to look into a strap.

I think i probably was pushing too high a gear, but why is the problem only in my left leg? My right leg is my strong leg, so surely if this was the main cause then this problem would be on my right leg also? This is what i am most interested in finding out, what caused the tendonitis? so when i have rested it i can take precautions to prevent it from reoccurring.

BruceG

you may need to look at your cleat set up. Thic could be out thus the problem in one knee only

bobgfish

Get a bike fit by someone that does it for a living. It cured my kneepain !!! And this was after looking for a solution for many years.

Nebuchadnezzar

BruceG wrote:

you may need to look at your cleat set up. Thic could be out thus the problem in one knee only

bobgfish wrote:

Get a bike fit by someone that does it for a living. It cured my kneepain !!! And this was after looking for a solution for many years.

Yes, there has to be some problem with the setup. Read many positive comments like yours bob about pro bike fits. Can anyone recommend someone in the S Yorks area?

bobgfish

Sorry. I know a good one in Belguim. The cleats and seat postion(fore and aft) is what will probably help the most. Both were only moved a few mm's and the knee pain ended.

kingrollo

Do and spend whatever it takes to get it sorted.

I ignored a 'crunching' knee - it then locked up on me a couple of months back. an MRI has shown severe arthritus under the knee cap - theres a good chance thats the end of serious cycling for me.

Hope you get it sorted

Wrath Rob

Had this over 10 years ago through playing lots of sprinting based sport. Treatment was rest, ultra-sound to break down scar tissue and the TENS type electro-shock therapy. Plus strengthening exercises on the under-developed vastus medialis (smallest quad on the inside of your leg down by the knee) which had caused my problems. Never had it return since then. Get to a physio, get it sorted and get back on the bike. Easy.

Nebuchadnezzar

bobgfish wrote:

Sorry. I know a good one in Belguim. The cleats and seat postion(fore and aft) is what will probably help the most. Both were only moved a few mm's and the knee pain ended.

I will have to have a look and see if i can adjust the seat position and cleats and what effect it has. Any good guides to setting up a bike (seat pos, cleat pos etc)?

saunaboy

Be very careful with this mate. I can offer some advice here that I hope will be helpful.

You need to be VERY careful in sorting whether this is tendonitis or tendinosis. Tendonitis is inflammatory, and will likely have heat, redness etc. Tendinosis is rapidly becoming accepted as the probable diagnosis for many apparent 'tendonitis' cases, and is the non-inflammatory degradation of the tendon. Often called 'chronic tendonitis'. Think Owen Hargreaves as an extreme case. There's evidence that certain people are predisposed to this. If you've had 1) symptoms for >2 weeks and 2) you're not seeing swelling etc, then it's likely you have -osis rather than -itis.

In my experience (hamstring attachment at knee) a physio will tell you that you have 'tendonitis-like symptoms' which means you have a sore knee. No disrespect at all there to the physion - the diagnosis of tendinosis can only be confirmed by MRI or I think ultrasound.

The reason I'm saying this, is that the treatment of the two are very different. I was diagnosed by a physio with tendonitis, and did all the rest, ice, stretches etc with no effect. Stretches actualy aggravated it. Physio treatment also did nowt. An ortho surgeon diagnosed 'tendinopathy' which I have read is a bit of a catch-all term for ongoing tendon damage. I went for a screen of muscle strength assessment was told that that two serious deficiencies were found (glutes & core). These were making the hammies work too hard & causing an imbalance in my hips. I worked HARD on those areas, and more importantly, began eccentric exercises on the hammies. This is exercise that goes easy on the contraction, then puts heavy force through the muscles on the release. This stimulates the collagen in the tendons to repair the damage.

For a patellar tendon, you would be doing stuff that's like controlled walking down stairs. When you step down, the quads take the force, but are actually lengthening. Search this on youtube & there'll be a few things to do. The exercises hurt a bit unfortunately.

I was hurt in March, and it was only in Sept when I started the -osis treatment plan. Since then, far stronger very quickly & just about to get on the bike in next few weeks to try & get fit for next year. If you need any more info give me a shout.

saunaboy

http://www.youtube.com/watch?v=1_wbW0ce ... re=related

there you go. That might be worth a shot if you get nowhere with your current treatment. Word of warning - tendons can take a long time to heal (2-3 months +) so don't find you're getting somewhere with a treatment & then go & knack yourself on the bike just because you've had a couple of days pain-free.

good luck.

Nebuchadnezzar

Thanks for that post saunaboy. Will have to keep on resting it and try and see a physio asap find out what is really wrong so it can get treated correctly.

Don't mind missing winter rides too badly if it means i can enjoy the summer!

Thelittlesthobo

Agree with a lot of what has been said above.

Supports & Bands - Neither use nor ornament imo
Exercises - Including the link above and those suggested by physios. Can be very helpfull in limiting any further pain and any muscle imbalances which may cause the condition
REST - Absolutely essential.

2008 & 2009 played football and rode my mtb with tendonitus of both knees (Family history of knee problems). I could manage the pain with a routine i had involving the above. 2010 it got worse. I went to see a sports physio and was informed that this tendon is about 1" thick and you would have to be in a car crash to do it any major damage. As i could handle the pain and i was doing everything that they could recommend then it was either quit or live with it.

Have you heard of it described as jumpers knee? If you google basketball & american football injuries they have a high proportion of this type of injury. I must admit to being a lump of a defender who can outjump lads much much bigger than me. Whilst playing in January 2011 mine snapped with so much force a knee brace was ripped off (Its calculated at about 17times your body weight) and i ended up with a knee cap about 3" higher up and ambulanced off for repair.

Nearly 12 mths later i walk with a permanent limp, i will never play football again and i run like bambi on ice. Luckily cycling is the one big plus.

The reason i said rest is essential is that the consultant pointed out that a tendon with tendonitus isnt exactly a healthy tendon. There isnt really anything you can do with it sugically or drugs wise. Physio will build up the muscles which help to limit any further damage or pain. But at the end of the day the only thing that will get it healthy again is rest. Funnily enough, i snapped my right patella tendon (Below the kneecap), and the enforced rest has meant my left knee has never felt so good.

Google image ruptured patella tendon if you fanct a laugh :-)

ronit

I am talking as I have effectively healed Jumpers Knee after battling for 4 years. I loved playing football . However I was more susceptible to injury as I had patella Alta. However I followed Martin Kobans book on patellar tendonitis and that finally healed. Physiotherapists and their exercises didn't really help. Now I have taken up cycling as it is kinda on my knees and I ride a relatively high cadence. This in theory puts more pressure on your muscles and less on your knees. However I would suggest you to please go through Martins course for 2 months atlleast. 3-4 would heal it completely. Especially the decline squats on a slanted board. That is the best exercise known that heals it. Please understand resting doesn't heal it. It will of course not make it worse but also not make it better. You need to do the exercises to make it better. I rested for 1 year. Nothing happened. After a certain stage rest does nothing. It works only in primary stages.