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patellar tendinitis from biking?
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By Optimistic
From New Paltz
Jun 21, 2014
I'm just wondering if anyone else out there feels like biking might have been the cause of patellar tendinitis for them?

I had assumed for a while that the problem had been caused by running, but lately have been doing quite a high volume of running and essentially no biking, and my knees have been getting better instead of worse. I did do physical therapy this winter/spring as well, so it's possible that the PT is the source of the improvement rather than getting rid of the biking.

If you ARE aware of a biking-patella connection...do you know of any modifications that can help avoid irritating the tendon? I'd like to bike more, but I sure don't want to go back to where I was last year with my knees!

Cheers,
David

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By marty funkhouser
Jun 21, 2014
You did PT over the winter/spring but attribute your recovery to lack of cycling? Did you try stopping cycling earlier (without going to PT) to see if it helped? Usually with tendonitis (tendonosis) there are chronic changes to the structure of the tendon that are unlikely to change by simple activity modification. Ususally some sort of targeted treatment is required (stretching, foam rolling maybe, soft tissue work, targeted resistive exercise, etc.). Here is the only prospective study I'm aware of that studied patellar tendonitis

ncbi.nlm.nih.gov/pubmed/112920...

In it, the authors found that the only variable found to correlate with patellar tendonitis was lack of hamstring and quadricep flexibility. As far as recommended treatments, decline one-legged squats (once appropriate) are currently widely used during the latter stages of recovery. So I guess the take home message is: yes biking could exacerbate your knee pain but simply adjusting your riding position without doing anything else (like stretching) is unlikely to fully resolve your problem.

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By Optimistic
From New Paltz
Jun 21, 2014
jeff lebowski wrote:
You did PT over the winter/spring but attribute your recovery to lack of cycling? Did you try stopping cycling earlier (without going to PT) to see if it helped? Usually with tendonitis (tendonosis) there are chronic changes to the structure of the tendon that are unlikely to change by simple activity modification. Ususally some sort of targeted treatment is required (stretching, foam rolling maybe, soft tissue work, targeted resistive exercise, etc.). Here is the only prospective study I'm aware of that studied patellar tendonitis ncbi.nlm.nih.gov/pubmed/112920... In it, the authors found that the only variable found to correlate with patellar tendonitis was lack of hamstring and quadricep flexibility. As far as recommended treatments, decline one-legged squats (once appropriate) are currently widely used during the latter stages of recovery. So I guess the take home message is: yes biking could exacerbate your knee pain but simply adjusting your riding position without doing anything else (like stretching) is unlikely to fully resolve your problem.


I know I did leave out a bunch of detail, was trying to spare everyone that...

Basically I'd been running pretty regularly but not very far (like 3-4 miles, 2x/wk) for many years. Then in 2012 I started riding more in order to up the cardio in preparation for a trip to the Wind Rivers. I'd do alternate days of riding and running, maybe 4-5x/wk. I started having vague little aches and pains in my knees and distal quads, especially on stairs and when getting up from sitting, and especially from descending steep rocky trails. Last spring this became a real issue out in Vegas (big descents!) but I was still experiencing it more as tentative, weak movement on descents rather than outright pain. Then, in the summer, with the cycling and running in full swing again, my knees really started to hurt and I got a big effusion around the right knee. I thougth I had Lyme, but didn't, and xrays were fine. So I just basically stopped running and riding for about 4 or 5 months, with essentially no improvement beyond the resolution of the effusion. In January I managed to convince a PT that I had patellofemoral syndrome and he treated me for that, with a little bit of improvement but not great. Then he went back to the drawing board and realized that I had very focal tenderness in the tendons themselves and diagnosed patellar tendinosis just as you said. Since then, I'd been doing the decline squats you refer to, as well as some electrostim, balance, and flexibility work.

The reason I'm (maybe somewhat weirdly) picking on the biking is that at this point I've kind of let the PT slip in a really big way, and at the same time dramatically increased my running mileage...and my knees are doing great, even on steep descents. But I've been on my bike about once in the last 3 months, and this made me wonder if it was the addition of biking that was the initial source of the trouble?

My impression was that normally the bike is what people do when knee problems have stopped them from doing other stuff, and I just wondered if any folks had had the opposite experience...

Thanks for the citation, I'll check that out! Are you a PT, Jeff?

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By rock_fencer
From Columbia, SC
Jun 21, 2014
Myself placing a a blue/yellow offset MC to protec...
Is it possible you were simply overdoing it without enough rest. Swimming might be the best cardio for the lowest stress. But I don't float

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By marty funkhouser
Jun 21, 2014
Based on your description it sounds like biking very well might have 'pushed you over the top'. With a lot of the overuse issues there is definitely a sort of loaded gun issue going on. Your muscle imbalances, inoptimal movement patterns, basic anatomy, etc. load the gun and your repetitive activities pull the trigger....bam (injured).

Knowing nothing about your cycling set-up my only advice would be to make it compliment, rather than simulate your running pattern. Triathletes set-up their bikes to simulate running: seat as far forward as possible, very quad dominant pedal stroke. I would find a bike fitter in your area who works with cyclists (the tour de France or mt biking kind). They tend to position their saddle further back and really emphasize a round pedal stroke where you pull back on the pedals and really use your hamstrings.

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By Optimistic
From New Paltz
Jun 21, 2014
rock_fencer wrote:
Is it possible you were simply overdoing it without enough rest. Swimming might be the best cardio for the lowest stress. But I don't float


Weird, but actually the kick of swimming often really irritates my knees! I don't float all that well either...

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By Optimistic
From New Paltz
Jun 21, 2014
jeff lebowski wrote:
Based on your description it sounds like biking very well might have 'pushed you over the top'. With a lot of the overuse issues there is definitely a sort of loaded gun issue going on. Your muscle imbalances, inoptimal movement patterns, basic anatomy, etc. load the gun and your repetitive activities pull the trigger....bam (injured). Knowing nothing about your cycling set-up my only advice would be to make it compliment, rather than simulate your running pattern. Triathletes set-up their bikes to simulate running: seat as far forward as possible, very quad dominant pedal stroke. I would find a bike fitter in your area who works with cyclists (the tour de France or mt biking kind). They tend to position their saddle further back and really emphasize a round pedal stroke where you pull back on the pedals and really use your hamstrings.


That "loaded gun" idea is an interesting way of putting it...hopefully the PT over the winter has gotten things back on track! I'll have to get together with my therapist and figure out a maintenance regimen to keep things from getting out of hand again.

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By KathyS
From Poughkeepsie, NY
Jun 22, 2014
Me at the summit of Inner Course (5.4) in the Outl...
Typically, cycling is a good exercise for rehabbing knees. It can cause problems rather than fix them if a couple of things are wrong. Someone already mentioned fit. Definitely have a professional look at your position on the bike if you're having problems. I've been riding for over 30 years and have seen a lot of folks with saddles too high or too low. Sometimes, it is the position of your cleats on your shoes and the angle imposed on the knee from there - a good fitter can help with this, too. The next biggest issue is cadence - pedaling speed. A good way to injure knees is to grind away in a high gear at low cadence all the time - especially early in the season. Spin to win. Save the low cadence grinding for climbs or intervals, but unload those knees with higher RPMs at a gear or two lower whenever possible.

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By Kent Pease
From Littleton, Colorado
Jun 22, 2014
There is a very strong connection for me. Donít listen to the standard dogma about knees Ė this is different! Running is helpful and biking causes problems. For many/most knee problems biking is helpful, but for patellar tendinitis it is the reverse. I frequently need to push back on those with good intentions who identify running as a contributing factor. The problem results from improper alignment of the patella as your knee bends. You need to pull your patella back into the correct positions and avoid activities that aggregate the problem. Fortunately this is a problem that responses very well to PT and activity controls. The keys for me are: 1) strengthen the inner leg muscles with running and some other specific exercises, 2) stretch the outer quads, and 3) when biking ride using a very high seat and full leg extension. When biking, high rpm and emphasis on the pull side of the cycle also help. I have managed the problem for many (>15) years, and now that I know what to do it is mostly under control.

Feel free to PM me for details.

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By Optimistic
From New Paltz
Jun 23, 2014
KathyS wrote:
Typically, cycling is a good exercise for rehabbing knees. It can cause problems rather than fix them if a couple of things are wrong. Someone already mentioned fit. Definitely have a professional look at your position on the bike if you're having problems. I've been riding for over 30 years and have seen a lot of folks with saddles too high or too low. Sometimes, it is the position of your cleats on your shoes and the angle imposed on the knee from there - a good fitter can help with this, too. The next biggest issue is cadence - pedaling speed. A good way to injure knees is to grind away in a high gear at low cadence all the time - especially early in the season. Spin to win. Save the low cadence grinding for climbs or intervals, but unload those knees with higher RPMs at a gear or two lower whenever possible.


Thanks Kathy! I see that you are local: can you recommend a fitter?

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By Optimistic
From New Paltz
Jun 23, 2014
KathyS wrote:
Typically, cycling is a good exercise for rehabbing knees. It can cause problems rather than fix them if a couple of things are wrong. Someone already mentioned fit. Definitely have a professional look at your position on the bike if you're having problems. I've been riding for over 30 years and have seen a lot of folks with saddles too high or too low. Sometimes, it is the position of your cleats on your shoes and the angle imposed on the knee from there - a good fitter can help with this, too. The next biggest issue is cadence - pedaling speed. A good way to injure knees is to grind away in a high gear at low cadence all the time - especially early in the season. Spin to win. Save the low cadence grinding for climbs or intervals, but unload those knees with higher RPMs at a gear or two lower whenever possible.

I don't have a "cadence-ometer" on my bike outdoors, but on the simulator I got earlier this spring, my typical cadence is in the 75-85 range, what do you think of that?

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By Optimistic
From New Paltz
Jun 23, 2014
Kent Pease wrote:
There is a very strong connection for me. Donít listen to the standard dogma about knees Ė this is different! Running is helpful and biking causes problems. For many/most knee problems biking is helpful, but for patellar tendinitis it is the reverse. I frequently need to push back on those with good intentions who identify running as a contributing factor. The problem results from improper alignment of the patella as your knee bends. You need to pull your patella back into the correct positions and avoid activities that aggregate the problem. Fortunately this is a problem that responses very well to PT and activity controls. The keys for me are: 1) strengthen the inner leg muscles with running and some other specific exercises, 2) stretch the outer quads, and 3) when biking ride using a very high seat and full leg extension. When biking, high rpm and emphasis on the pull side of the cycle also help. I have managed the problem for many (>15) years, and now that I know what to do it is mostly under control. Feel free to PM me for details.


Thanks Kent.

Could you explain what you mean by "inner leg muscles"? I know that a major focus for my PT has been the hip ABductors (which I'd characterize as both "outer" and "incredibly boring to strengthen").

I've always had my bike set up with the seat pretty high...do you some objective measure of leg extension that you use?

I don't use clip-in pedals, I ride on a reasonably ancient mountain bike, so can't do much pulling. No great urge to change that ($$), but do you think the lack of clip-ins could be exacerbating things?

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By Kent Pease
From Littleton, Colorado
Jun 23, 2014
Optimistic wrote:
Could you explain what you mean by "inner leg muscles"? I know that a major focus for my PT has been the hip ABductors (which I'd characterize as both "outer" and "incredibly boring to strengthen").


Just above your knee and about 45 degrees to the inside, there is a muscle with the lower end terminating in a distinct wad/pad about the size of your knee cap. Sorry, I don't have time right now to look up the name. I find (and as previously directed by PT's) that keeping this muscle strong is very helpful. However, it is not easy to single it out with exercises: One of the best is probably skating where you push sideways. There is also a piece of gym/PT equipment called a slide board or something similar. I have found that running is helpful, especially trail running where you bounce from side to side. At the gym you can do sitting leg raises (with weights or on a machine), but it is very specific with leg position and you want to focus on the inside not the outside of your leg and if done improperly could lead to other problems, so it would be good to consult a trainer or PT for that one. I've also discovered that standing backwards on a StairMaster works well - better view of the gym too.

Hope this helps

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