Who has overcome patellar tendonitis?

I thought that was the Tri-trix. I think it may have been my first speaker kit. They are in the basement now and the TV room is up to 7.2.4.

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Apologies for taking this thread in a different direction. I have consistent pain underneath my Patella presumably due to loss of cartilage. Does anyone else have this? If so, how have you been managing it?

I guess I’m running a 2.3 in the pain cave LOL IMG_4788

Pt appt in 2 weeks, have been doing eccentric step downs, and cut my training by about 50%, no pain for a week so feeling encouraged.

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Great to hear, seems like you’ve gotten it to a good place. Just make sure you address the overworked muscles so this is stay on track when you ramp back up the volume/intensity.

When I first started I had this really bad. After 2 years I went to a physiotherapist- mri- whole
Shebang. The end result from them was “hip strength, flexibility, balance, and DO LESS”.

I hit the gym, bought a foam roller, and stretched but did not do less. About a year of working and with proper upkeep I’m good.

I learned that tendons and joints cannot get stronger but the muscles that support them can and that’s what I needed.

Find a local gym, get a trainer for a bit, do some squats and get a foam roller. You will be fine.

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This is my experience. 5 year of racing and riding around 250-300 hr/year pain free, then all of a sudden this spring I started to feel some soreness at the base of the patella tendon where it connects to my tibia.

It never hurt or hurts when riding, and I’m able to do squats, lunges, step ups, step downs w/o any sort of pain. I spent most of the winter and spring doing posterior chain focused strength training to work on a knee injury (PFPS) in my other knee (which I have solved) and assume that all of that strength work would have helped stave off another injury, but it seems that it hasn’t.

I’m starting to question things…

  • What’s causing this then? I’ve had my lowest volume year in the last 4 years so I don’t feel like it’s overuse.

  • Over-active quads and under-active glutes. Again, I have been strength training since December and have gotten noticeably stronger in my posterior chain, so I have my doubts here. Unless, when I’m pedaling I’m not recruiting my ham and glute and am over working the quad…this is definitely possible.

  • I haven’t ever gotten a bike fit, because I’ve always been injury/pain free, but I’m starting to think that this has been a slow build up that’s culminated over the last half decade.

For those who have worked through this type of injury did a bike fit help you? What ultimately led to you recovering? Did you reduce on-bike time?

The over use could have happened in the previous seasons.

This is the key

I have a friend going through this. It seems that he has more pain on bike than you, but the recommendation has been no bike at all.

My brother recovered from this with a lot of strength training. Mostly PT type of work with planks, bands, balls. He did get an injection every 6 months for a while. Some sort of “ Hyaluronic acid”, he claimed he felt a big difference. He worked with a ppl specialized in high level athletes.

I was off the bike for over a month, did some solid PT work, got a bike fit, AND the final cure was dry needling.

Thanks for reviving this thread. Personally not much has changed for me, I overdo it, I get pain, I back off for a week, then repeat in a month or two.

My new plan is to try to ramp up the weekly TSS slower and more consistently. It’s gonna be hard because I just love overdoing it…but that’s my plan ATM.

Unsuccessful things I’ve tried include high doses of glucosamine, BPT 157 injections, and the exercises in the knee ability zero book. Although I’m still doing the knee ability zero exercises because they seem like they should help.

Joe

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40 year old guy here who’s struggled with this issue for a couple years and now finally 95% pain free. I only get a slight niggle if I’ve overdone it with the low cadence high torque work. But that disapears quickly.

The 2 thing that fixed the issue for me were:

  • squat using knee sleeves. The extra compression they give instantly resulted in less pain post exercise.
  • a shorter crank length. Went from 172,5 to 165. This decreases the angle of the knee joint. Side benefit was it also made holding the TT position more comfortable.
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I had the same issue until during bike fit, I discover one leg is longer than the other. I have been using a cleat spacer in the short leg sine the discovery.

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Skimmed the responses from the 2019 discussion. Then looked at the recent ones and didn’t see anything resembling my recovery from this issue. So I’ll share.

I had this issue in 2009. It was resolved by doing non-intuitive therapy. It turned out that the patellar tendon was being aggravated by poor tracking of the patella, which was caused by overtight IT bands that were pulling the patella to the side. (It’s another problem nicknamed “runners knee”.) So the problem was actually fixed in the end by two things: 1) massaging the entire IT band (focusing on the connections at the hip and at the knee); and 2) exercises that strengthened the the hip flexors and the groin muscles. (Stretch band stuff.)

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Same here. I noticed recently when bumping into in a chair in the dark. Felt an unusual sharp pain. I wouldn’t have noticed otherwise.
I circled the area on my leg. Exactly at the end of the tendon.


I have to press significantly to feel something, so I guess it is very early stage. I’ve had the same fit for months, and like @anthonylane have been working on my posterior chain ( I feel the burn in my butt when riding around ftp, especially if I’ve been doing some single leg deadlift in the previous days.). During intervals, cadence is in the 90’s
I will raise my saddle a little and move it back, and see if it helps. That should open the knee angle when the pedal is at 12:00

Could you provide some links to the exercices ?

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So I’ve had huge issues with my right knee, and I’ve had lingering pain coming and going around where your circle is.

I managed to slowly solve it with my bikefitter, and ended up doing the following things:

  • Shimano to Speedplay
  • 6mm leg length shim under right foot
  • Set proper saddle height (this is almost always culprit if I feel it coming back, 3mm too low and I feel it)
  • Move saddle forward (too far back and my hip causes knee to flick inwards at top of stroke = triggers pain)
  • Work A LOT on keeping core engaged, push from glutes, straight back on the bike, no Quasimodo-hunching.
  • Proper insoles (G8s)

Sounds like a shitload of stuff, but all in all, if we ignore the leg length discrepancy, its mostly about having the right saddle height, good foot support, and good posture on the bike.

My knee doesn’t get better from resting, it gets better from consistency of riding and immediately raising the saddle if I feel that its too low (sometimes I even bring torque wrench on a ride and adjust it until it feels right).

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This is a hallmark of tendon and ligament injuries. Both have very little bloodflow and thus rest doesn’t really do much, unless it’s an acute injury. Then yes, you should probably give it a few days or so to calm down. But in my experience, rest has zero positive effect.

I’m really curious about bike fit, and need to finally invest the money into getting a proper fit. I’ve felt that I’ve always been a very adaptable rider, being able to ride comfortably with a range of saddle heights and setbacks.

I’m attacking this new problem with as much heavy slow resistance strength training as I can handle. Basically this equates to barbell back squats @ a load that is an RPE of 8 at 12 reps with a 3-1-3 tempo. 3 second descend, 1 second pause, 3 second ascend.

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Did you chose to have concentric+eccentric on purpose? (vs having eccentric only at maybe a higher load)

I’m following the protocol discussed here:

https://thekneeresource.com/conditions/patellar-tendinopathy/

If you do a search on “HSR knee rehab” you’ll find research papers on it.

I just like keeping the tendon under a lot of tension so I do an eccentric with concentric.

It was helping, then I had to back off after a hard fall on MTB which set me backwards 3 weeks. Just getting back into the heavy slow resistance work with bi lateral and unilateral squats.

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Heavy slow resistance has the same outcomes as eccentric only and is only three days a week versus 2x15 twice a day. So less workload in terms of volume with similar results.

Some of the other more recent evidence for tendon injuries is also that it’s ok to ride if your pain is about a 4/10 and below. Karen Silbernagel has some papers about ppl who kept training with some pain (4/10 and below) and did heavy slow resistance training. They had the same outcomes without all of the aerobic endurance loss that the weight training only group had.

Most of the eccentric only stuff was based off Alfrredsons (spelling) original Achilles research and has been extrapolated to other tendons. But there is nothing special about leaving out concentric contractions. Your tendon might have slightly less loading during concentric because the non contractile tissue is working less in terms of stress to the tissue but doing both phases of the contraction is beneficial and also functional.

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Also, posterior chain work is good for motor control if someone has poor patellar tracking or is a quad dominant squatter. But should be an ADJUNCTIVE part of a rehab routine for tendon injuries. Strengthening the quad in isolation is important and paramount to offload the tendon.

So squats, leg press, knee extensions performed slowly and heavy is what ppl should be doing.

Yes you want strong glutes and good motor control to avoid crappy movement patterns that could also lead to different types of knee pain but the quad need to be able to produce more force to offload the tendon (and someone might be super strong and still get this. The idea is that it’s overuse. So they might be working beyond their current physiologic limit even if they’re super strong in terms of workload).

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