Just checking in to learn more about patellar tendonitis. I’ve been riding and racing for 30 years now…never had and knee problems in my 20’s, sometimes in the spring ramp up in my 30’s, had a touch of it most springs in my 40’s, and now that I am 50 it has been on and off for a few months.
-Most of my racing is 20-40K TT’s but I’ve raced in a lot of different events including a couple of 25-30 hour gravel races and a full randonneur series in the past.
-It never hurts on the bike! Never!
-But I feel it the night after a hard ride or two nights after a hard ride
-Lifted weights over the winter, really love my dead squat bar, worked up to 2 sets of 185# X 10 reps after 3 warmup sets…no knee pain from this
-A single dose of 200-400mg ibuprofen resolves the pain and I can train a day later. Usually causing it to flare up again. (I know, I’m an idiot about this)
-Pain will move around…just below the patella, just above the patella, but always the ligament or tendon. It switches legs seemingly randomly.
Work schedule changed (less!) so I’m booking my annual visit with a GP and I’ll go over this but would like to know something more beforehand.
So far I’ve found…quad and hammie stretches, wall-sits, partial squats with ramped foot, cross fiber massage.
I have access to a class 4 therapy laser and…doesn’t seem to do anything.
I suffered with the same issue for a while, including having the pain after riding but not during! - I know a common recommendation when experiencing knee pain (if you haven’t already had one) is to get a bike fit.
For me, finally forking out was definitely worth it. I obviously can’t recommend the specific changes to my position that were made as these will be very specific to myself, however one thing I feel has had a significant positive impact was being recommended to use insoles (particularly as my bike fit didn’t make many changes to my position!). I have quite a high arch in my foot so I feel this additional support of the insoles reduced lateral movement in my knee during the pedal stroke. Not suffered from patella tendonitis (or any other knee pain) since.
I have used hire bikes which were not exactly set up the same as my bike at home and have not had issues, which again makes me wonder if its down to the insoles.
As always with issues such as these, the solution can be very individual - but don’t see any harm in giving insoles a try!
Bike fit, yeah I hear you. I like to think that I’ve been at this long enough to know where my body wants to be but a once-over might be a good idea.
My reluctance is picking a fitter. As in “it takes one to know one” Unless you’re already an expert you can’t really know for sure if you’re seeing an expert or somebody who just acts like one. Reviews on fitters…like doctors (I’m a veterinarian) are based more on personality than an evaluation of skill and knowledge. You might see me with your dog and have a nice visit because I’m Dr. Friendly to you and your pet but you can’t possibly know if I’m a good dr or a complete hack. If you could know if I was a good doc or bad you wouldn’t need me because you’d know what the problem is yourself. It takes one (a good fitter) to know one (evaluate if they are, in fact, a good fitter).
Ok now, having said that (whew!) I’m in Rockford IL and pretty close to Chicago, Madison, and Milwaukee. Does anybody have a recommendation?
What you are describing sounds like osteo-arthritis. The dull ache that moves around and comes and goes but has gotten a little worse with each passing decade is pretty much the calling card. Arthritis of the knee can be relieved on the bike (synovial fluid is released, waste products are flushed).
@rp123 Usually either a ‘fit related’ issue or structural issue (tight quads/IT band/Hip Flexor). Seems like you have a lot of experience under your belt so may be better able to sort out what camp this falls into. I tend to get issues w/my left patella tendon. For me its been a bit of both this year. First ‘fit’ related as new shoes (bont) I needed to dial in cleats and wedges to get better tracking. Also, structurally I have some things to continue to sort out (mainly pelvic stability) and core strength. These are the things I can let go and favor time on the bike, a mistake I know, for me its just locating the time in a very busy schedule. I have also had good luck w/class iv lasers for other soft tissue injuries in past. I will add that along w/all the mobility, flexibility and strengthening / activation work I have one go to that I am using every day to keep pain issues at a minimum. I purchased a few mobility tips (favorite is pappa bit) through mobilitybit.com These attach to end of a jigsaw ( I use a cordless ryobi jigsaw) and work incredibly well as a percussion tool. You can certainly go out and purchase some polished looking models such as a theragun, but this works just as effective. I will add I am also a soft tissue therapist and I can do more in 30 secs w/this tool than it takes minutes to do w/my hands. The pappa bit is a rubber / spikey tip and I use this all around my patella, the rubber aspect allows you to go over bone w/out bruising or issues. Can’t recommend more.
Self determined. I have an appointment but the pain is right on the ligament at the bottom of the patella just like in the picture. I’ll bust out some X-rays later today, need’em for the appointment anyway.
If you’ve changed cycling shoes, or cleats recently that might be your culprit.
The only time I ever had it was when swapped shoes and didn’t have good arch support. It literally went away within 2 days of getting that straightened out.
Good luck. I only struggled with it for a short, short time … but found it maddening.
Yeah this sounds like the patellar tendonitis I experienced. For me it’s usually caused by overactive quads. So getting your fit dialed should address it, moving my saddle back and down helped me a number of years ago by forcing my other muscles to take more of the load.
Recently I had it flair up a bit, turned out I hadn’t transferred my cleats position correctly and the one on the leg that was bothering me was angled slightly off. Fixing that cleared it up in a couple of weeks.
Other things you can do is foam roll the heck out of your quads every day and ice your knees a couple times a day (instead of taking the NSAIDs). These can help address the symptoms but you’ll need to address the root cause to really kick it.
That’s the last thing I want to do because…time trials!!! But I can see how this might make a difference. Let me get some images with measurements up over the weekend and see what is going on.
Also…for you guys who have had success with insoles…what is the theory on why that helped? I can see how moving the saddle back might make a difference but insoles? Like…wha?
Good stuff - soft tissue is something you can work on and figure out. Structural bone stuff is only something you can manage and mitigate. Here’s hoping you are on the path to knees like pistons.
They do not repair like muscles and respond well to (the right) load. They also have a delayed onset of pain so you could train one day and be totally fine and pain will appear 24-48 hours later which makes it tricky to manage. NSAIDS don’t particularly help as you want the tendon to ‘inflame’ and then repair after loading it.
I struggled with this for a couple of years. I can’t pinpoint exactly what helped but here’s a list of things I did:
Shockwave therapy (following correct protocol of once a week for 3 weeks - no exercise during or for 2 weeks after. Different physios may give different advice)
Eccentric loading. Lots of info on the internet about this
Not training unless pain returns to where it was after 24-48 hours.
Reduced out of the saddle/high watts/low cadence riding
Ensuring I didn’t walk/run in high heel/toe drop shoes which put stress on patellar
When it started to improve I did a lot of single leg exercises i.e. Bulgarian SS, SL squat (not weighted).
Things that I didn’t feel made a difference for me were stretching/rolling/massage, bike fit, cleat position, ice, NSAIDs, steroid injections, rest (too much).
This is just a snapshot of 1 person. It’s SO SO frustrating but give it time to figure out what works for you. There is no quick fix but it does get better.
Okay, got some pictures yesterday…haven’t looked up what these numbers are supposed to be but this is where we are.
Over the winter I fiddled with my position nearly every ride…a nudge here, a tilt there, until I ended up in a position I could live with for an hour. Not talking big changes here…I’ll try to get a picture from years past up for comparison.
Fixing that cleared it up in a couple of weeks.
