Injury prevention strategies

I have been cycling competitively for 3 years now, coming into the sport from Triathlon. Throughout my entire athletic career I have had to deal with nagging injuries that I feel have limited my ability to train and perform.

I have been using trainingpeaks for 3 years to manage my fatigue, stress and recovery and I feel this has made a big difference. With that said I still feel that I am susceptible to overuse tendon injuries more than other athletes I know and train with. I have been dealing with off and on quadriceps tendonitis (left leg only) as well as some Posterior tibialis tendonitis (also left leg). My current pattern is that I will train consistently for 2-3 weeks, then do a big race or ride of ~ 200 TSS with high intensity efforts and aggravate my tendons and have to take time off to recover.

I recently took off 10 days and came back feeling great, only to do a hard race and start the cycle all over again.

Its hard to make a diagnosis because there are so many possible causes for injuries of over use so I will try to sum up my situation:
•I am 30 year old male with education in exercise physiology
•I ride between 500-650 TSS during building weeks and 200-300 TSS during recovery weeks.
•I do functional strength training 2x per week with weights, body weight exercises, core strength and lots of one legged exercises. I also do foam rolling and exercises specific to my tendon issues.
•I recently had a bike fit on a guru fit machine and am very happy with my fit, in fact ive never felt more comfortable
*I have 2 rest days per week and prioritize my sleep (always over 8 hours) and recovery
*I train early morning before work and always in a fasted state (even high intensity work) I have been doing this for 10 years and have not noticed any performance detriments in workouts under 2 hours. (I eat oats pre-ride before races and workouts longer than 2 hours)
*I have been 98% vegan for last 10 years (occasional fish as my “nutritional insurance policy” :smile:

I am feeling frustrated because I feel as if I am doing everything correctly and am still being plagued by overuse tendon issues. I am writing this post to see if anyone else has struggled with injuries and been able to overcome them. Any suggestions are welcome, especially from the coaches here!

how “recent” is your bike fit?
Things can take time to settle down if they have been nagging for a while. Did you point out these issues to your fitter?

I was fit 6 months ago. I did mention these issues to the fitter but I don’t know if he did anything special. I use Shimano cleats with 6 degrees of float. My fit feels good so I think it’s safe to assume the bike fit is not the issue, however I would be open
to getting a new fit if I thought it would keep me healthy.

I would absolutely go have another conversation with fitter & physio. There are different levels in bike fitters. The base level is someone who took a weekend course and that’s it. The better ones either have bio-mechanic training or are fully qualified physio-therapists.
You likely want to be working with someone on the better-end of things as you have some bio-mech issues that need addressing. They either need addressing on the bike or off the bike, but the bike fit SHOULD NOT be making those issues worse.
If you don’t think the fitter you saw is qualified to address your needs ask around.

I’m sorry to hear about your injury prevalence. I’m about a month into rehabbing Achilles Tendinosis—something that was brought on 12 weeks into SSBII and something completely new to me. Never have had tendon related injuries. It’s extremely frustrating to put in so much work only to have it negated by injury. I’m learning the hard way that feeling good for 3-5 days is not a sign that I can return to my normal cycling. I’m naturally impatient and have surely drawn recovery out a week longer than I should have by not slowing down and sticking to a protocol.

In my researching, I’m learning that tendons can take up to 12 months to fully heal depending on how badly injured they are. And all rehab protocols are in the 8-12 week duration and always include maintenance work thereafter. Everyone is different, but if I can boil down the information I’ve read is that tendon rehabilitation is a long process and full recovery takes a lot of time. My guess is that you take time off, your body stops sending the pain response associated with whatever tendon pain you have, and tells you that you feel good. Then you take it as a sign to start back up and get re-injured by going too hard too soon. Your body felt ready, but it really wasn’t.

I think you need to slow it down. I’m in the process of accepting the fact that, in May, my road season is done (before it even started), and that my cyclocross season will be in jeopardy if I don’t force myself to focus and commit on recovery. With that comes the fact that I will detrain, all of the fitness I built from January on will go away, and I will be slow upon return. I’m realizing that this is what has to happen if I want to be healthy long term.

I’m also doing the same Achilles rehab/strength exercises on my healthy side so that I can prevent future injury.

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Thank you for the reply. I am with you completely that it is very frustrating. We are very disciplined in our training, and I am learning that we must be equally disciplined in our rest and rehab.

I recently bought a PADO purewave percussion massager which has really helped my tendon. It breaks up tissue adhesions, which is key for tendons to return to normal function. You might want to look into it as several PTs have recommended this to me.

Thank you for the advice. I will definitely look at my bike fit as something that is aggravating these injuries. I cannot rule anything out at this point, and just because I feel good on the bike doesnt mean that this is the proper fit for me.

@solonger just throwing this out there…

Saddle too high? And/or shoe/cleat change?

Landis, I actually did change shoes from specialized road expert to sworks shoes. My saddle felt a tad high after the switch so I lowered it. I now believe that this may have triggered this latest episode as I have never had this exact pain before switching.I
am going to lower saddle 1cm and see if it helps, while also taking a few days of rest.

@solonger I’m not a fitter nor a MD/medical expert but, I’ve made every mistake in the book cycling wise. Twice! So, the quadricep tendonitis seems consistent with a saddle slightly low. You said you switched shoes and it felt high so you moved the saddle down. Did you move the saddle down after or before the pain started because maybe you’re too low.

The posterior tibial tendon issue I’ve not had but, some of the symptoms are similar to plantar fasciitis which I have had. For me the plantar fasciitis was caused by a saddle too high. Moving it down and stretching the hell out of my calf resolved that issue relatively quickly. Not saying this is you just that trying to piece the clues together have you ruled out plantar fasciitis? from what I understand it’s more common to develop this with a saddle too high however, if a rider ankles deep enough with a saddle too low, I could see how the same symptoms could arise.

Lastly, cleats can be tricky tricky tricky. Even with SPD-SL yellows (float) if mine are not aligned reasonably close and/or they move forward for lack of me checking my knees will feel it first.

Now that I’v confused you I’m going riding! Hope you get it sorted soon…Cheers :stuck_out_tongue_winking_eye:

It seems like you are already doing so much to prevent the nagging injuries, so sorry to hear you have this pain. I too have joint/tendon pain in my legs (knees mostly) and have found two long term practices that have reduced and almost completely eliminated the nagging injuries.

  • First, would be to look at any potential supplements or healthy oils/fats that you may be missing out on in your current diet. As an endurance athlete and vegan for 10 years I am sure you are well on top of this, but would suggest this daily supplement if you are not getting sufficient omegas or inflammation reducing intakes. https://www.florahealth.com/ca-en/products/omega-sport/

  • Second is a regular if not daily stretching/yoga routine. I’ve compiled various stretches from my physiotherapist, trainerroad videos, and other respectable resources to construct 30 routine that I try to do 5 days a week at a minimum.

I have recently been between apartments and not having the Omega Sport on hand has caused a return of knee pain, while my lack of stretching results in lower backpain within days, so I’ve been reminded recently of how important they have been for my injury prevention. For the oil, I don’t take it multiple times per day as recommended, just a small swig from the bottle before breakfast usually. Some people dislike the taste, so combine with meals/salads if thats you.

I found this to be a beneficial read as it relates directly to my injury, but I think it’s a good read in general if you’re experiencing tendon pain.

https://www.jospt.org/doi/full/10.2519/jospt.2015.5885