Quad and patella tendonitis

Hi,

Having recently bought a new mountain bike, I appear to have overdone it and given myself quad and patella tendonitis in both knees.

I’ve done loads of research, seen a physio and have a fair idea of what I need to do to HOPEFULLY resolve this. I cant even walk up a hill, never mind cycle up one just now.

I know the RICE model. I realise hamstring, quad, calf and IT stretches are useful.

The advice I have been given is then work on strengthening the quad by doing leg rises and angled single leg squats as well as other similar exercises.

I am also trying out some funky taping.

Is is this a common injury in this group? Any helpful tips, stories re length of recovery?

patella tendinopathy takes time to heal and you need to let it heal properly. I suffer from it.

Both knees?….nasty.
The main advice I would give is that you have to be serious about doing the exercises regularly, doing them properly in the correct position, stick to the regime, increasing reps, maybe use weights (ie wearing heavy mountaineering boots). Once it’s fixed, you might have to consider continuing to keep doing them, at least just occasionally to keep the patella aligned
I did my right patella when doing a 2hr bike ride with the dropper stuck down, I got the post as high as poss but basically the seat was still an inch or 2 too low. August 2016
I just stopped riding for 8 months thinking it would get better with time, which it didn’t.
Then went to physio who gave me a few exercises, which I did halfheartedly and only saw a small improvement. physio described it as a patella tracking issue. May – July 2017
When physio finished I went back to just putting up with it, I still wasn’t riding the bike other than on the canal, but could walk up a steep mountain (mostly using my left leg for leading etc).
Then I did some winter mountaineering in snow and ice and it was a bit of a nightmare because any trip or slip or stumble resulted in a shooting pain thru my knee and it happens a fair bit when walking on/thru snow and ice. That kind of gave me a kick up the arse to do something about it. Jan/Feb 2018
So decided to get serious about doing the exercises again, this time with a proper sense of purpose, found some you tube videos for exercises and stretches (found ones which also included the ones that my physio had recommended) and it worked. March – May 2018
I used the AskDoctorJo video https://www.youtube.com/watch?v=rRRV9MfGIFE&t=358s
This video for IT stretches (particularly the 2nd one) https://www.youtube.com/watch?v=MO2ZNz03YEI

Once I felt I was there I stopped doing the exercises and stretches, back on my bike without issues, did the Yorkshire 3 peaks in July. I do a lot of slalom Waterskiing in summer and towards the end of summer I was noticing it starting to be aggravated when waterskiing. I’m sort of now back to 60% (ie I can feel it sometimes when on the stairs and on the bike etc), so now looking at having to start the exercises again. I’m thinking that I might have to keep doing this exercise/stretch regime for the foreseeable, rather than thinking I’m fixed and stopping.

As above do not underestimate this and do not resume cycling activity just because you think you are better. ‘Tendonitis’ turns to tendonopathy and can become severe and chronic.

Tendons don’t react well to total rest either. It is basically your body telling you that it isn’t conditioned to cope with the load you have put it under (the tendons). To condition it you need to strengthen the muscles and the capacity of the tendon (this is what the incline squats that I think you are referring to are all about).

Recovery is about progressive loading and monitoring of reaction – minor reaction is good as it is indicating adaptation to load and therefore strenthening. Prolonged severe reaction to load (essentially what you have experienced via MTB is bad).

Also need to consider whether this is just a biomechanical issue, or also contributed to by bike set up.

I think Martin Koban’s vids on youtube are very good as they explain the progressive loading, reaction monitoring, and things to avoid (i.e. too early return to activities).

Good look with it.

I’m just reading ‘Bulletproof your Knee’ and interestingly it says that stretches should be at least 30 seconds but any more is a waste of time, and doing more than one stretch is also a waste of time.

The guy uses peer-reviewed research papers to draw his conclusion.

p.s. I am speaking from experience of tendinopathy and causing knee issues (not the same as yours). I have been following a programme over the last few months involving hip strengthening, flexibility work with regular foam rolling, lower body strengthening, trunk / core exercises, and upper body strengthening. I have reduced the riding whilst progressing.

MTB puts a significant load on the body. If you are not conditioned for it then it can result in injury (the none falling off and hitting a rock type injury).

Thank so far for the tips. The Dr Joe videos seem decent as well

I’m struggling with rehabbing my quad and patellar tendons after a partial knee replacement 6 months ago.

To be fair given the op i might just need more time. I can stand on the pedals and very carefully pedal standing a hand full of times, but its not great. Any eccentric activity is where I get the pain and going down hills/steps is tough, up is OK really.

I’m doing quad, ham and calf stretches for stretching, plus a sun salutation series.

For strengthening wall sits and body weight squats from about 30* to 90*, single leg balances including single leg Romanian dead lifts, body weight ham curls, and step downs on the stairs. Step downs are the real killer with the eccentric loading its hard to control the last inch or two decent, also hard to start the single leg push back up.

It is improving but it very slow going and I still have a lot of numbness in the front of my knee.

Be interested to hear from anyone else who’s gone through it due to knee replacement rather than over use injury?

Struggled with ‘Patella Tendinopathy’ in both knees for almost 2 years, wore loads of different braces, straps and supports. Was diagnosed by a doctor and prescribed countless hours doing physio, stretching, strengthening etc never got anywhere with it, I could barely ride.

In desperation found a book called The Mindbody Prescription by Dr. Sarno about the brains effect on chronic pain symptoms, particularly through suppressed stress and anxiety.

Sounds crazy but a few chapters into the book I was already feeling better. Over a month or so I drastically adjusted my way of thinking, I stopped all the stretching etc and just started doing what I wanted to do (biking, hiking, running down stairs at work etc etc) at the same time I also did an online course based on a modernised version of Dr Sarno’s theories.

3 months after opening the book I was back riding mtb at 100% with no pain at all.

Theres loads of online reading related to mindbody theory and I recommend it to absolutely anyone I meet who complains of chronic pain…

Had that problem on both knees 2 or so years ago when I was deep into olympic weightlifting. Doing 3 or 4 heavy squat sessions a week can do that to you.

At one point was having enough patella tendon pain to have trouble going up and down stairs and to sleep. Felt like a hero when warm at the gym and like an handicapped everywhere else.

After some time with painkillers and massages, etc, a physiotherapist recommended me this:

How to Do Eccentric Slant Board Squats for Patellar Tendonitis

Started doing so once a day and after a month I was good to go. By all means try it.
Also stretching helps, a contracted muscle pulling an already sore tendon is never good