Patella tendonitis - sick of it

weeve · February 2009

Cant seem to shake this- in both knees. Been off the bike for a season and building legs but a easy test on the flat last week set me back to square one. Stength/treatment tips welcome (apart from the obvious do nothing on the bike...)
thanks

birdy247 · February 2009

Ive had this in my right knee for going on 5 months. The good news is it is getting better, but slowly. I have found lots of hamstring stretches, and strengthening the VMO's has helped, esp the last 20 degrees on seated leg extensions.

Also realised my right foot points out slightly more than my left so adjusted my cleats to suit. Seat height made a difference too. Slightly too low/high irritated it.

Good luck

pbracing · February 2009

What are the symptoms of this? I had two arthroscopies last year, (sat nearly all year out

), the most recent just before Xmas. Though the doc can't identify the problem exactly he worked on the patella cartalige last time. It seemed to have worked as I was able to walk pain free, until my knee broke down again on Monday, and it's been back to square one since.
The biggest issue I have is that I can't walk down hill, even a very gentle slope. Does that sound familiar? I'm clutching at straws for a diagnosis, it is desperate times.

Back to rhe op, all the excersises in the world haven't made a difference to me. I even bought a fitness bech on Saturday for leg extensions and curls, but don't know whether to use it now my knee has gone again. Aaaaaaaaaaahhh. Help, please.

warrior4life · February 2009

Im a gym instructor who's had patella tendonitis and worked with physio's and sports rehabers in giving programmes to help people overcome it.

Have you seen a sports rehab / physio?

The main thing i would say (if it is patella tendonitis) is stretch your hip flexor
http://images.teamsugar.com/files/users ... tretch.jpg

this is the main cause, tight hip flexor, which is caused by a normal ridning position.
stretch your legs everyday, all the muscles, should takie 10 to 15 mins.

As far as weights its not what you do its how you do it.

Find a good gym instructor and make sure your technique is ok.

if you stretch properly the problem should go pretty fast, try classes at the gyms as well, pilates, yoga etc.

After every ride the pros stretch properly and have a massge.

weeve · February 2009

maybe its a devon thing? haha sympathies with pbracing - Im from south devon (although live in Netherlands) and I too have had 2 artho's last May after doing my knees in last january cycling- one arthos for each knee and appears only limited cartilage issues...however still in fxcxing pain though.

The reason my physio and sports doc I think I have PT it is from a test you can do. Its all about pushing up the tendon to poke it (its not at surface) - sit with leg out flat relaxed and pushing knee cap towards toes. You then feel (or getting someone else to-better) feel along the rim between the base of the knee and the lower leg. If sore then good sign ONE of the problems COULD by PT. I can explain more by phone (email) if your desparate but get a physio to do the test really as I know jack shxt except from speaking to those in the know

solution ? according to the physio something like this I found on web

http://www.sportsinjurybulletin.com/arc ... endon.html

now thats the theory..in practise my knees are still doing my fxcxing head in. Sorry to swear but really..I have the Flanders, Vatternrunden, Dartmoor Sportive and Etape paid for..must be mad...

Hope that helps....anyone with better ideas please post

weeve · February 2009

http://images.teamsugar.com/files/users ... tretch.jpg

she looks like she knows whats she's doing....I'll ask her round for some tips

weeve · February 2009

sorry one last thing ....bench knee weights where you sit and hook you feet under and straighten leg ..curls is it? According to my doc DONT. apparently the quickest way to knacker you knees even if they are young (and mine arent at 38 )

bobbymeister · February 2009

Is your bike set up at the root of the problem?
I had a similar problem in both knees a couple of years ago, albeit to an apparently lesser degree by the sound of it.
I sought advice from a lot of people and in the end a chance call to Martin Earley, the former pro who now runs some kind of sports therapy business, got to the root of the problem.
I was using Sidi shoes at the time and because there was a lack of arch support (ie none!) my knees were pushing in and out during the pedal stroke, pulling the tendon from side to side.
As soon as I mentioned the brand of shoe, Mr Earley hit the nail on the head, correctly predicting the outside of shoe would have stretch marks where it had twisted, so it's obviously not the first time he's come across this.
One pair of Sidas footbeds (bought from local camping shop for £30) and a Lemond wedge under each foot to straighten things up a little more and it was problem solved.
I'm not saying you've got the exact same problem, but it's something worth checking out.

gkerr4 · February 2009

weeve wrote:

sorry one last thing ....bench knee weights where you sit and hook you feet under and straighten leg ..curls is it? According to my doc DONT. apparently the quickest way to knacker you knees even if they are young (and mine arent at 38 )

thats weird - they were recommended by my physio to build up the VM/VMO following two arthroscopies last year.

I had surgery on each knee too last year (and also sat out most of the year!) left one in june right one in october. The left one was an odd injury at the back centre of the knee so the procedure caused a lot of swelling with it - I was off work for 3 weeks and still limping after 5 - but becuase I had the right injury too I never did any exercise at all between June and Oct (well - november as I had to recover on the right one too!)

i lost a lot of muscle on the inner thigh - the vastus medialis - in Oct the left leg was 2.5 inches thinner than the right at a point about 3 inches above the kneecap. This caused a lot of patellofemoral syndrome (I think) which hurt on coming down stairs or hils - a sharp pain in the inner side of the knee - right on the joint line.

post right-knee op I followed my physio advice religously and did the exercises for VM/VMO strenght as follows:
Single leg mini-dips
squat against the wall - squeezing a cushion between the knees
leg raises to give strngth to hip flexors using a rubber resistance band
after three weeks:
leg extenstions on the weights bench
unweighted squats
back on the bike!!

it seems to have worked (touching wood as I type!) and the legs feel much stronger than they have for a long time.

I feel your pain though - last year I was thinking "will I ever ride a bike again"
see a good physio - get recommendations for your area (perhaps on here?) pay the cash and go see what they say.

best of luck!

weeve · February 2009

sidi shoes... I do have them now- and high arch feet is definately me and the shoes have no arch support - would appreciate some links to stuff you mention but will google- I use arch supports in my ice climbing boots to prevent heel lift so could indeed help longer run but I actually did my knees in wearing shimanos with a little support and which Id worn for years so not sure its the cause - still - cant hurt to try. will get on to it

re: the last post - leg weights etc...yeah seem to get differing advise depending on who you speak to..bottom line I think is to build your legs up to tree trunks however you do it...thats on my to do list.....

bobbymeister · February 2009

The Sidas and Lewedges can be had from Cyclefit via mailorder.
I actually have a spare pair of footbeds, used once - long story, don't ask - but they're cut down for a 44 Sidi.
If they're any good to you, send me a PM.
Glad if I've been of assistance.

bobbymeister · February 2009

The Sidas and Lewedges can be had from Cyclefit via mailorder.
I actually have a spare pair of footbeds, used once - long story, don't ask - but they're cut down for a 44 Sidi.
If they're any good to you, send me a PM.
I actually used Sidi shoes for about 10 years before I started to get any problems, so it's obviously a gradual process...
Glad if I've been of assistance.

felgen · February 2009

weeve wrote:

sorry one last thing ....bench knee weights where you sit and hook you feet under and straighten leg ..curls is it? According to my doc DONT. apparently the quickest way to knacker you knees even if they are young (and mine arent at 38 )

Yes you are correct - very bad exercise for the patellofemoral joint, so dont do it. Squats are better. Big ring sprints are even better (assuming you can get on the bike of course!)

Lots of things can affect the patellar tendon - it might be that the kneecap sits in the wrong position (Alta/Baja) or that there is patellar matracking which means it wont sit properly inthe groove. If you do get knee pain, try looking at the VMO muscle - best seen at the end of the thigh on the inside (medial) compare legs... is one smaller/weaker. Do you get pain on the inside or outside of the kneecap, is it pain just past (distal) to the kneecap. If you get pain distally around the patellar tendon is it more near the surface or deeper inside? Patellar tendinopathy can be treated by physio, stretching, antiinflammatories, (sometimes paratenon injections but steriod around tendons and especially into tendons is bad) or by decompression surgery. It might be Hoffas Fat pad impingement (a lump of fat that sits under the patellar tendon) - felt as a catching as you bring the knee almost straight - it gets irritated and then swells and catches more and more.

An MRI is pretty sensitive to picking up the problem, be it fat pad or patellar tandon, or indeed cartilage. If you really can't wait you can self refer (or your physio can refer to one of these pay as you go scans - such as Vista in Waterloo or the like) but of course, once you have the diagnosis you need to see someone who knows what to do with the information.

Good luck getting it sorted.

8)

weeve · February 2009

thanks for the offer -im a 42 so will get directly...might try and get an appointment with cyclefit in london actually next time im in town- spend enough money on "not cycling" so might as well spend some on a someone who might help
cheers

weeve · February 2009

felgen - thanks. had the mri's and two exploratory ops (one in each knee) - not a lot of clarity but does seem more cycling than anything else specific. Ive not been running for a year but did climb a few mountains in the alps in the summer which was less comforatble than previously but not impossible. Its the sodding bike (or shopuld I say er ahem 4 bikes - commute/mtn/winter and road parked doing nothing much that kills me) The knees just need to be pointed in the direction of the shed and they start hurting

Manage 6km to work (vv easy here in NL) and thats it

dennisn · February 2009

Steroids can be very useful in getting rid of tendonitis(if this is an option).

Dennis Noward

patchy · February 2009

seconded on the tendonitis - did my first long ride in about a month yesterday, my left knee is killing me today...

So, simple way to address is:

more stretching
check bike set up – esp shoes, saddle

and if still causing problems, then seek a physio.... cool.

brit66 · February 2009

Had the same problem with my left knee about six months ago. It was very frustrating not being able to cycle when I wanted.

I never got it diagnosed and instead just took a complete rest from the bike, whilst at the same time supplimenting my diet with fish oil tablets. The knee is now pain free (hopefully will reamin so but who knows?).

This is the best time of year to take a complete rest, even if that means coming back in 2-3 months completely unfit.

pbracing · February 2009

Interesting info fellas. Googled tendonitis, got some good info. After a quick read it looks like I have it. Pain at inside of knee, aching/ discomfort all around knee, difficulty walking esp down hill, and aches when just sitting (like now :roll: ).

Riding is actually my best/ most pain free time, though. Is that odd? Also, unrelated arthroscopy made it better for a month - could that be the complete rest after?

Does anyone get real heat in their knee in the evening? Even if just watching tv? By the time I go to bed it's v v hot. Have to use ice a lot, esp in summer. And that can be on a lazy day.

I know none of us are doctors, I'm just trying to compare symptoms.
Cheers

weeve · February 2009

pbracing
your knee will feel better (for a month) after op..as mine did...the fluids in knee have been replaced by saline and that removes the irritation...soon comes back as the natural fluids normalise and irritation builds up again...false dawn..I know Ive had two of them

the latter hot symptons are prob associated with just use and more irritation ...what I told you about getting to the tendon ...do the same and apply ice ...helps a lot ...i would do it but too busy/too lazy so dont unless done a little exercise

in worst cases that is can be arthritis but but your doc would have seen that if youve had ops. I know that too as my mate is an orthoped surgeon and shxt me right up pre op .....ps can I ask how old your knees are?

Patella tendonitis - sick of it

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