Knee Injury

[gazza1286]

Hi

I'm currently suffering from Quadriceps (Patella) Tendonitis mainly in my right knee. This was brought on and aggravated by cycling. It began in mid-September after roughly 1800 miles riding throughout the year. No other issues had arisen up until that point. It initially manifested as a general pain when climbing/descending the stairs. Very minor inflammation. Cycling since then has curtailed quickly.
I originally believed that there may have been an IT band problem but eliminated this quite quickly. During October I went on a couple of short rides which aggravated the problem and haven't been on the bike since early November. I've had X-rays which show that there isn't any issues with Arthritis.

I've only just been referred to an NHS physio who has given me a number of exercises designed to strengthen my VMO. I asked if he was planing some ultrasound therapy but he said not as there was no obvious inflammation??

There is tenderness along the top edge of the fibres across the top of my patella.

Having rested the injury for a number of weeks I am now getting somewhat frustrated that the problem isn't really improving. Can someone suggests a solution? Specifically I'm am looking at:

Friction Massage:
Can anyone suggest a web site/link/video. Will this help? Or might it cause further problems? I'm assuming that such massage will break-down scar tissues and increase blood supply to the tendons?

Ultra-Sound Therapy:
Is my physio correct in what he is saying? I thought that US would have been beneficial?

Rehabilitation:
Will cycling on rollers help at all? Should I be considering getting back on the bike at all?

Thanks all

 

[Kennf1]

Here's my two cents. I've stuggled with patello-femoral pain for the last year, and have reduced the pain to where it is isolated to the region you've described--the very top of the patella, and it almost feels like it's the bone itself that is sore. Earlier in the year, the whole inside of the kneecap would hurt because the kneecap was not tracking correctly. This is a very complicated problem to fix, and the physical therapists all have different ideas on the best approach. My first PT had me doing mostly VMO exercises (straight leg lifts, etc.), which I did for nearly three months with ZERO improvement. The exercises that worked (with a subsequent therapist) were those that strengthened the gluteus medius, and the various muscles that help your femur externally rotate. Stengthening the stabilizer muscles of my lower leg also helped keep my ankle, and knee, from collapsing inward.

The lingering pain, as I said, is at the very top of the kneecap, and I've yet to find a solution.

 

[brianf7]

Check seat too low and forward or maybe cleats not back far enough .

Also get someone to check your knee is not tracking sideways if so check hips or tight hip flexor on other side. get phisio to check Hip flexors.

Sent an email to Steve Hogg on the CN fitness forum.

The knee is a hinge in middle of Feet and hip so both need looking at DONT get cought up with weight exercises .
Start with Bike and shoes try moving seat back 10mm.
make sure the ball of foot is over in front of the pedal axel
Put ice on it imediatly after you ride .
Glucosamine helps with some people.
Just ride easy in low gear for a few days and see how you go.

Good luck

 

[Kennf1]

I agree with everything Brianf7 said. Tight hip flexor (TFL or psoas), which often goes hand in hand with weak glutes, can throw your pelvis off, which makes your knee track incorrectly.

 

[gazza1286]

Thanks for the advice guys.

Can you post up a link to some videos regarding Hip Flexors?

It's not something I've come across. I suspect that it is a 'tracking' issue as the pain described by Kennf1 is exactly the same as mine.

I'm really unsure about having 'over-stressed' my Quad tendons. I think correcting an imbalance will hopefully resolve the problem!

 

[2thetop]

I have had this same problem for over a year. To get this injury I was riding too many miles (250m/wk) with too much elevation gain (20k/wk) in too high of gears without proper warm up and stretching after riding and also not having the proper training base.

Now after about 14 months I am still struggling with the problem but it is slowly getting better to where at least I can ride again. I hope more people chime in about this as I need what ever help I can get also.

Here is what I have done (including notes) starting from the beginning of the injury.
1. Tried cutting back mileage, icing 3x/day, riding flats, high cadence (no help).
1.5 Stopped riding with groups or people because I could not hold back ego speed.
2. Got shot with cortisone (no help).
3. Therapy and strength training (made it hurt worse, probably to much).
4. Took five months completely off the bike (helped but sucked).
4.5 Took Advil until I got nervous I was taking too many.
5. Started riding 10 miles twice a week on flat roads and increased mileage slowly (I thought) each week. Still icing 3x day (better but holding back is a *****).
6. Felt good so I increased my mileage too quick and got up to 100 miles a week and felt the pain again (sucked).
7. Backed off and cut my mileage to 50 miles a week (at least I was riding).
8. Searched all the internet and books on knee injury I could find (Andy Pruitt's book, Patella Femoral Pain book on-line, etc.).
9. Started really slowly with low weight or band, high reps with all the leg, **** and core strengthening exercises I could find on-line and in books. Currently at 1 hour twice a week.
10. Stretch and use the foam roller for 20 minutes after riding and during the day as well.
11. Started taking glucosamine (studies show it takes 3 months before it has any value. I just cant tell if it's doing anything but I am going to keep taking it.).
11.5 Icy Hot on the knees and knee warmers if cold out.
12. After two paid bike fits decided to learn how to fit myself (tons on great info on-line and knowing how to do it yourself is invaluable for fine tuning).
13. Purchased cleat shims from http://www.bikefit.com as one of my legs was 1/4 inch shorter than the other. One of the pro bike fitters noted my leg discrepancy but did not do anything about it (This was one of the things I have done that I think was the most beneficial).
14. Pedal with a very high cadence averaging over 85 almost always but I am avoiding major hills. (much smarter than before my injury).
15. Changed out my 172.5 cranks for 170's (I'm 5'9" and was concerned I would loose leverage and power but what good is leverage and power if you cant ride. Glad I did this).

I'm up to 100 miles a week (3 days riding, 2 days strength training) again with about 3k-4k elevation gain. Warm up with easy spinning on flat roads for 15 minutes. Keep a super high cadence, increase my mileage 5 percent a week if no pain. If pain back off and take 3 rest days and do not increase mileage. lots of stretching and foam roller (especially after riding). Still icing a lot. I'm always on the verge of getting the tender pain again and I could go crank a good 40 miler with some hills and get it. Some talk about this "glass ceiling"?

It would be valuable to hear from some more people with even more time and experience at this than myself.

Latest update and what I think is good information to assist knee pain victims.

With the help of an extremely experienced bicycling coach I have been working diligently on my pedaling technique and I believe this is really helping a lot. By utilizing (better) different muscles in the leg to power through the pedal stroke I have eliminated much of the hammer down force that caused my knee pain in the first place. This is more technical than I will share here but knowing to work on pedal technique is very important.

In addition my coach put me on a serious leg strengthening routine. I believe had I not already been "therapy level" strengthening for quite some time this might have been a bit much. However since I had been doing a lot of gradual strengthing exercises over many months prior to the much heavier leg lifting exercises I am doing now, my legs can handle it.

A year and a half into this quest to ride hard again things are looking up. I'm up to over 120 miles a week with some hill work and hard efforts (but nothing like before).

 

[brianf7]

Thanks for the advice guys.

Can you post up a link to some videos regarding Hip Flexors?

It's not something I've come across. I suspect that it is a 'tracking' issue as the pain described by Kennf1 is exactly the same as mine.

I'm really unsure about having 'over-stressed' my Quad tendons. I think correcting an imbalance will hopefully resolve the problem!

In the groin is where you will feel tight if you lunge forward try both sides then Google hip flexor exercise or look it up on Cycling news fittness forum.

Take it easy at first if its tight and it will be. bit more each day more walking less driving helps. I should talk.

 

[brianf7]

Try this
http://www.abc-of-fitness.com/leg-stretch/hip-flexor-stretch.asp

 

[gazza1286]

Thanks brianf7.

One thing people may be able to comment upon is "Friction Massage". I've come across this which specifically mentions massage in relation to tendonitis:

http://saveyourself.ca/articles/frictions.php

However it doesn't make any reference to "quadriceps tendonitis" as such. Has anyone tried this and can they comment upon any successes they may have had?

 

[Kennf1]

I've done friction massage, but for a different knee and a totally different problem. That one was a traumatic injury to my patellar tendon (below the kneecap) from a fall. That one also took forever to get better, but it was a much simpler injury. Did lots of fiction massage on the tendon crosswise against the fibers to get rid of/prevent scar tissue adhesions within the tendon as it healed.

Whether it will work for you depends on whether your problem is truly tendonitis.

 

[Kennf1]

Sounds like 2thetop has done almost everything I have!

I still haven't found the magic cure, but I'm a heck of lot better than I was a year ago, when I struggled to go up stairs. Now I'm pain free on stairs, but I still get some tightness and mild pain in the knee after exercise.

Just a few of my general observations:

1. The so-called VMO isolation exercises (the inside quad muscle next to the knee) did nothing, nada, zilch for me, and I did them religiously for three months.

2. Functional hip strengthening exercises helped a lot. Exercises that target the gluteus medius and all the various external rotator muscles.

3. Ice never seemed to help. Advil did.

4. Yoga helped, as it incorporated a lot of hip flexor and glute stretches (not to mention hamstrings).

5. Bought a stand-up desk for work so I wouldn't sit on my *** all day (after 17 years, this REALLY shortens your hip flexors).

6. Th orthopedic surgeon and physical therapist he referred me to were worthless. I've had the best results working with an athletic kinesiologist.

7. A leg length difference isn't always a leg length difference. If your pelvis is rotated (for whatever reason, i.e. stuck SI joint), one leg will appear shorter when lying down.

7. Once you get out of the chronic pain phase, shallow single legged squats with a fitness ball between you and the wall are great for strengthening the quads in conjunction with the glutes and all the stabilizers. The key is to never go in the pain zone with any strength exercise (joint pain, not muscle). As soon as you feel a twinge of knee pain, back off. You'll only flare up the problem and set back the recovery.

8. I still do glute/stability exercises three times a week. In January, I couldn't run 20 feet without terrible knee pain. Now I can run a 5k at a 7:00 pace.