Knee pain (probably tendonitis) - recovery time + tips?

loz_the_guru

After a fairly hefty ride I started getting some pains towards the top of my knee. Stupidly I ignored these and went mountain biking a few days later, which made the problem significantly worse. I went to the docs who said it sounded like tendonitis, which appears to be pretty common. Normally I would have just rested it, but i'd already booked a hotel for the following weekend, and yep, you guessed, decided to go anyway rather than just chuck away the train/hotel fees. Which, obviously, made it even worse.

So injury schedule goes something like this.

Sustain original injury
3 days later, mountain biking
a further 7 days later, 150mile weekend trip.

We're now three weeks from the weekend trip and it's still causing a problem. I was taking diclofenac, which helped, but have ran out. Under the recommendation of the doctor i've switched to ibuprofen (much cheaper), but I honestly thought it'd be gone by now.

I'm a fairly keen cyclist and used to do around 50-75 miles per week, cycling to work and back + the odd evening trip, so it's pretty frustrating.

I just wondered if anyone had any ideas RE time frame for me to get back to full cycling again?

Also, is it best to rest it completely, or should I do the odd short stint to work the muscle a little bit?

Any advice gratefully received!

t.m.h.n.e.t

Did your doctor tell you anything? Why are you buying ibuprofen instead of a prescription?

loz_the_guru

Hi,
The doctor said I should take an anti-inflammatory, and that the prescription stuff wasn't noticeably better than what he could give me on prescription. I had some diplofenac from a previous injury, so used that for a bit

dw300

Fix it before it becomes chronic. Work through it, as resting for a long period will mean you'll loose strength and fitness, but don't push much harder than you know you can. It can take weeks for tendons to heal as they have poor blood supply, so you need to try and retain fitness and strength without damaging further. Every time you do it'll be one step forward, two steps back.

Try not to exercise while you have inflammation, which is kinda what you've done. If you've been treating for 3 weeks, give it another few weeks of light training to get it under control, using ibuprofen before you train and stop training and ice it if it starts to get too bad.

I've always thought that tight muscles might contribute to my tendons being stressed more, not sure if that's true, but it's a good excuse to stretch the muscles when i'm not suffering pain from the condition.

loz_the_guru

Hi,

Thanks for the response, very helpful! The 'chronic' bit is what i'm worrying about.

dw300 wrote:

Try not to exercise while you have inflammation, which is kinda what you've done. If you've been treating for 3 weeks, give it another few weeks of light training to get it under control, using ibuprofen before you train and stop training and ice it if it starts to get too bad.

When you say 'while you have inflammation', do you mean visible inflammation or just the pain?

I have to say on the two (very) short rides i've done, getting up to speed/hills is painful, but I do wonder if the flats are actually beneficial as it must be such a gentle work out for my knee.

ut_och_cykla

My understanding is that pain = inflammation of some sort. My physio told me that pain = irritation of injury and a lengthening of the healing process/time. Exercise by all means but don't do anything (exerrcise or other everyday activity) that provokes the injury to pain.
See a good sports physio and get diagnosis and treat thereafter. DW300 is spot on - fix it properly now or it could become chronic. Icing teh area 3-6 times a day (strap a chill pack loosely in place) is an excellent compliment to drug stuff.

patchy

Get to a physio quick sharp. I did the same as you, left it for way too long, (6 weeks +) it became chronic and am still suffering 4 months later. Only in the last couple of weeks has it improved any. It's ruined my racing plans for the year.

dw300

loz_the_guru wrote:

Hi,

Thanks for the response, very helpful! The 'chronic' bit is what i'm worrying about.

dw300 wrote:

Try not to exercise while you have inflammation, which is kinda what you've done. If you've been treating for 3 weeks, give it another few weeks of light training to get it under control, using ibuprofen before you train and stop training and ice it if it starts to get too bad.

When you say 'while you have inflammation', do you mean visible inflammation or just the pain?

I have to say on the two (very) short rides i've done, getting up to speed/hills is painful, but I do wonder if the flats are actually beneficial as it must be such a gentle work out for my knee.

Yeh, I just meant if you have significant pain (you'll probably always have a small amount until you get rid of it). The inflammation probably won't be visible, it's the tendon and tendon sheath inflammation that cause the problems and the pain, the tendon can't move properly within its sheath and stick and pulls which leads to more inflammation and pain. This is why anti-inflammatories prior to exercise help, as you have more of a buffer before you start doing damage.

I have problems when the force through the muscle/tendon is high, rather than the volume of work, ie. mashing would be bad, but spinning would be ok. But that doesn't mean that it's helping the injury, it's helping maintain your fitness and avoid further problems, and that's what you're aiming for.

loz_the_guru

Thanks for the replies guys, looks like a trip to the docs is called for. Until then i'll definitely be resting it, no cycling for a while

Regarding the ice, it's quite tricky due to the nature of my job for me to work this in - is it significantly beneficial?

ut_och_cykla

Yes if there is inflammation ice will help especially in the initial stages. As often as possible is good but obviously impractical. But while you eat (sitting) you can ice, while you watch TV/read paper/use computer. And with a bit of fiddling you can ice even when standing walking by taping/strapping ice pack in place under trousers/shorts.

Be careful not to hurt your skin with too much ice though - wrap it in a thin towel or similar.
You can get chemical ice packs from chemists that can be activated if ice access is difficult.

But get to a physio sharpish whatever you decide to do as there may be an underlying injury that in the long term WONT appreciate ice. e.g ligaments need improved blood flow which ice obviously prevents.

Eag1E

If you have pain at the top of the knee its unlikely to be patella tendonitis.

As others have said seek out a sport specific physio, ask your local cycle\tri club\coach for a recommendation if in doubt. Most GPs are pretty poor at sports injury advice other than the general R.I.C.E.

Be careful of overusing NSAIDs like ibuprofen, studies have shown these can hamper the healing of soft tissues including tendons and ligaments and even weaken them.

HTH.

TheEnglishman

Eag1E wrote:

Be careful of overusing NSAIDs like ibuprofen, studies have shown these can hamper the healing of soft tissues including tendons and ligaments and even weaken them.

HTH.

I got told that after breaking my leg and having knee alignment problems. The best solution by far (also the most expensive) has been to seek out a proper bike fit shop, get my bike adjusted accordingly and then employing a suitably qualified physio/rehabilitation personal trainer to work on the bits that need working on.

Since doing this I've been pain and inflammation free (well, just muscle exercise pain, but that's to be expected).

The NHS didn't want to know me once they could see I could walk and function. Which is fair enough I guess.

Moontrane

5-6 years ago I thought that I'd strained my quad tendon and saw an ortho. MRI showed no strain, diagnosed with quad tendinitis.

Ortho said that he'd normally prescribe cycling for someone with QT, but I'd developed mine from cycling. Ironic. (I was overgeared for the local hills.)

I spent the next 2-3 weeks cycling only flats, and iced several times per day. A-OK. I occasionally (once or twice a yea) get a twinge, which I promptly quell with a few sessions of icing.

The key is to stop inflaming the area and bring about healing. Good suggestions in previous posts.