# Long-term Tendonitis



## dmoreau

So I have been dealing with patellar-tendonitis since Christmas time and have had very little luck with it. I was averaging 15 hours a week on my bike and was starting to get really good. I ignored it at first and let it get really bad before I backed off of my riding. I was off of my bike for all of January, did a little riding in Feburary (3 hours a week) then quit riding because of the pain and doctors orders. I started riding again in June and have slowly worked up to 6 hours a week and my knees started to bother me again. I did physical therapy for 6-weeks, had one cortisone injection, and stretch every day.

I have not found any thing positive about recovering from chronic tendonitis and have seriously thought about selling my bikes and finding a new hobby. Is there any glimse of hope for chronic tendonitis? I am 20 years old and will not spend the rest of my life struggling with a medical condition to have fun. From the research that I have done, after 6-months tendonitis is virtually incurable. I want to have things sorted out at the end of the year when I will be transfering to a new college.

What is the best approach for treating this? Tomorrow I will set up another appointment with my doctor and see what he recommends.

Has anyone had any luck with glucasamine/chondroitin/MSM supplements?
UltraSound therapy?

I have given swimming a thought and have swum a few times at the local YMCA. I just can't find much motivation to go to the pool. Any advice on swimming? I really don't like being the noob again. Any other ideas on ways to get exercise? I started unicycling and have had some luck with that.


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## Guest

First, good luck and I hope you heal up well and can continue to ride. And hopefully your doctor can help you out, their advice should be more useful than ours. Have you seen anyone who specializes in sports medicine? 

You might also want to research getting a high quality bike fit done, that may help you some as there could be some root cause for the problem that can be corrected/addressed. Or at least they can help set you up to relieve the stress from the knee as much as you can when riding.

Have you ever tried using one of those bands on your knees, sort of the knee equivalent to what you see people with tennis elbow using? I got some relief from that in the past when my knees were sore from running, most drug stores sell an inexpensive neoprene version. 

Hang in there, my brother had to use both of his patellar tendons to replace his destroyed ACL's and eventually he healed up well enough to be a pretty successful amateur cyclist. Which reminds me much of his rehab after the proper rest was built around strengthening the muscles of the legs around the knee and insuring that any imbalances were addressed.


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## heathb

Permanent tendonitis is very possible in your case.

There's a point of no return when it comes to tendonitis. Dancers, Musicians, Athletes all know this, if you continue to strain a tendon over and over and don't back off immediately when the pain starts you can cause a permanent weakness. 

You may well never be able to push yourself to a high level again. I know people want to believe in happy endings all the time. 

Myself I have permanent tendonitis from playing the saxophone in my index finger, I used to practise ungodly amounts of hours everyday growing up, I practiced through the pain, I got the cortisone shots, they helped, but my index finger has never returned to normal. That was 17 years ago that I first had symptoms of tendonitis. 

When I get knee pain or any pain I take a day off, if it still hurts I take another and another until it's good to go again. 

As far as working out, swimming would be a great workout that you could do until your knees have had a long rest, like months or even a year or two. It's also very challenging, more so than riding a bike if you ask me as I use to swim quite bit. It's the weakness of a lot of tri guys, and you'll finish your workouts faster.


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## fliowa

Who fit you on your bike? What system did they use? I'm guessing you need a second opinion on whether your bike and cleats are properly set up. Find someone who really knows what they are doing even if you have to drive a ways to get to them.


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## heathb

Yes a bike fit would be ideal. A pedal that allowed some float would be helpful. 

Try something like speedplay x-pedals with it's total float. 

Look at your seat height, fore and aft position. Get your knees in an ideal position.

Use shorter crank arms. 170mm or even 165mm. This will reduce some of the strain on the knees as well.


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## dmoreau

I went to get a bike fit done on Tuesday at a local shop that uses the powrfit system. I had a couple of good references and the fitter is an older guy who has been around for a while. I had my seat height set so I could not touch the pedal with my heal when the pedal was in the down position but the fitter raised my seat up about 1.5 cm.

I am using speedplay zeros set at 15 degrees of float and 170mm crank arms. 

I think I can pull through. I rode hard for two weeks after the initial onset before I backed off and since then have done pretty well at backing off once I start to experience any pain. I actually have not been riding much at all this year and have not been on any long rides. My knee has improved significantly since I first started dealing with this and should be better eventually. 

I have a couple of other issues that I have been dealing with in addition to the tendonitis. My medial plica in my left knee is giving my problems, this can be solved with a quick outpatient procedure. However It's very managable and has become only an occasional nusaince. I also developed a muscle imbalance in my left leg because of the way I was favoring that leg. This caused mild PFS which has gone away since I've become more active again.


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## Guest

I have heard before of riders with knee pain having some success by raising the saddle a little bit, hopefully that will help your situation.


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## heathb

What about getting the cadence up as opposed to grinding out higher gears.

How long have you been using the speedplay pedals, were you using them before the tendonitis started and did you have them set to max float?


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## grayson

I've had tendonitis in my left hamstring for about 3 years now. It has gotten better, however. It's no longer 'clicking' when I extend my knee, or giving way. I didn't cycle at the time, though. I was more into weightlifting and running.

I stretch after every ride, and you said you did this as well, that's good. Ice will help with inflammation, as well as a massage/foamroller/thestick.

I'm trying out some supplements. I found Glucosamine Sulfate (don't get HCL) with MSM, Cissus Q, and Celadrin.


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## dmoreau

> What about getting the cadence up as opposed to grinding out higher gears


That is one problem that I've been working on. I have always had a slow cadence but I have been working on speeding it up. My tendontitis has been improving but will flare up from time to time if I push it a little too hard on a ride. I'm hoping by next year I'll be able to do longer rides and start running again.


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## heathb

The important thing Dmoreau is to let your body talk to you and listen. If it hurts there's a reason and most of the time it needs to be addressed. 

Unfortionately when it comes to tendonitis if it's the real thing it creates a permanent weakness. There will always be a limit to what it can take before it starts acting up, even if you were to let your knee rest for a very long time. Best approach is to always end your workout before there's any pain at all and of course look into all the things that make cycling easier on the knees, one of the reasons I like shorter cranks as well. 

As for running, I wouldn't mess with that as the loads are going to be greater and the risk of hurting your tendon again is much greater. The beautiful thing about cycling is that many of us with knee problems came from running to cycling, that's what I did and I haven't looked back. 

I think we all get these big plans in our head, we make goals and sometimes really high goals, then an injury sets in and screws everything up, we have to back off. Takes a lot of wisdom and self control to learn when to rest before it's too late.


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## shanabit

http://www.cptips.com/knee.htm


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## heathb

shanabit said:


> http://www.cptips.com/knee.htm


That's a great link, thanks.


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## twinkles

Have you tried a chopat type knee strap. I had a knee making me crazy a dozen years ago and the knee strap was instant relief. If the strap helps, I was told by Andy Pruit to wear it except when sleeping. I still wear it biking on that knee cause my knee feels wobbly if I don't, but my knee has been abused and cut on, so It's a small price to be pain free and wobble resistant.


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## kramteetop

Sorry to revive a slightly old thread, but I have been dealing with right knee tendonitis for about 3+ years now. It first flared up from overtraining when I first got back into the sport. Being the impatient imbecile that I am, rather than just rest it up and let it heal, I start doing all sorts of things to my bike fit, such as raising my seat to incredible heights, to relieve the pain. As a result, hip pain ensued and knee cap started tracking poorly. Then put on LeMond wedges, which just exacerbated knee cap tracking errors to the point I developed chondromalacia patella syndrome. 

Went to three different PTists, none of which healed it. Went to two different bike fitters, all of which lowered my saddle height substantially...but hey, that goes against common thinking, right? Higher saddle = lower tendinitis pain. So, when the "pain" didn't go away within a week, I jacked that saddle back up to where my knee was locked on every down stroke and hips rocking a bit - again, I'm an idiot. Finally went to a third fitter who, once again, lowered the seat quite a bit. Switched to speedplay zeros with good deal of float. For some reason, this time around I just said screw it, I am going to keep the seat this low for a long time and see what happens.

After a couple of months (and frequent stretching and foam rolling), 95% of the condromalacia/knee tracking pain is gone; 95% of the hip flexor pain/tightness is gone, and tendinitis is substantially reduced. I can ride base/tempo pace rides for 2+ hours without any resulting knee pain. The only time I get pain is after races (still do 20+ races a year), interval training, or hard hilly rides 50+ miles in length. I usually have to take a day or two off the bike, along with some alleve, before getting back on the bike.

so, I am a case in having screwed things up so much that I will have permanent tendinitis, but through trial and (mostly) error have learned a point where I can live with the pain. As others have said...listen to the body...


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## kramteetop

Also, forgot to add...this winter I am working with a personal trainer for the first time ever to work on strengthening my core. I am hoping better muscle balance and stronger core can help reduce the pain even further.


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## durkind

I have had very positive results in tendonitis in both knees and elbows through acupuncture. My elbows were the worse after my first year of skiing 100+ days and then many hours on bike. A couple of sessions on both elbows and it was gone. It does come back, but never as bad. I get early cycling season tendonitis in right knee and a session helps tremendously. All sports related injuries, I go to my acupuncturist before my doctor.


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## dmoreau

I've been stretching regularly, taking aleve, had a bike fit done, and significantly increased my cadence. I am up to riding 12-13 hours a week including high-intensity rides and mountain bikes. My knees hold up fine as long as I wear a knee strap but they still bother me. They are not perfect, but easily managable.


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## davidka

I once had a profound positive result with a knee inflammation using Celebrex. This is an NSAID category anti-inflammatory. It is mostly prescribed to arthritis patients. I went from pedaling home with one leg on tuesday to hammering up a mountain out of the saddle wednesday. An anti-inflammatory medicine might help the healing process along. 

Also, find a pedorothist or even the best ski-boot fitter in your area, they can help find alignment issues that might be agitating your knee.

See what the doc says. If you're 20, you still have great healing ability.


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## joedawn

kramteetop has it just right. you need to be living on the foam roller and serious stretching. anyplace the foam roller touches that hurts has to be worked over and over. i got a 90% cure after 10 months of tendonitis. again, anytime the knee hurts, jump on that foam roller


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## 800lbgorilla

I'm on the mend from my 3rd episode of patellar tendinitis in the last 8 years. Each has lasted between 6-12 months. This season has been a total washout, but I'm now doing intervals pain-free.

The following steps may help. Most of this I learned from hard-earned experience, although I am an emergency physician when not lurking on the forums. 

1) Stop riding. Now. Trust me, this is the hardest part, but you want to minimize any ongoing damage that you're doing. I've had to spend 1-3 months off the bike with each episode and it sucks. (Imagine pool running to maintain fitness when the pool turns their sound system to the radio at the height of the Backstreet Boys craze).

{Edit} Kramteetop: there's still hope for you. I noticed from your post that you're still able to ride at moderate pace without problem. That's great--you're doing better than I was this spring. If you cut back on the intensity and keep doing everything else you're doing (in addition to some of the suggestions below), you may be able to hammer pain-free by this spring.

2) If you can, see a sports medicine physician. In the short term, there are some things that can help to reduce any day-to-day pain that may come with walking or climbing stairs. This includes regular icing (3-4 times/day), Pennsaid lotion, and patellar straps (that work for some people but not others). Don't let anyone inject your tendons with steroids like cortisone--there's no beneficial effect that has ever been shown and (especially with achilles tendons) an increased risk of tendon rupture.

3) After the pain has reduced somewhat, an aggressive PT program is key. This may include ultrasound, definitely includes stretching, and includes a lot of eccentric and functional strengthening exercises. There's a lot of sports medicine literature on patellar tendinitis, mostly with patients who are dancers, volleyballers or basketball players, showing that eccentric strengthening exercises with a load that produces mild to moderate discomfort result in dramatic improvement over a couple of months.

4)After the pain has reduced a great deal, get a proper bike fit done from someone with a very good reputation/established track record. After getting the bike fit done, start riding again at a slow pace, preferably on a trainer or rollers. Increase pace and workload as tolerated, in consultation with your sports MD or PT.

Best of luck. I feel your pain.


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## dmoreau

Here is a link to a site showing eccentric exercises for strengthening the patellar tendon. The guy who created it is cyclist too. He also covers stretching and some other topics.

http://eccentric-exercises.blogspot.com/2008/02/healthy-injured-patellar-tendons.html


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