Patellar Tendonitis and ITBFS

[Splash]

According to my PT, I have developed patellar tendonitis in the front of both knees along with a touch of ITBFS (iliotibial band friction syndrome).

I have stopped cycling for nearly 2 weeks for rest to alleviate the pain.

This pain is only felt when climbing or descending stairs at work. This pain is now reduced with that rest and associated sports massage therapy.

I understand that the RICE method and massage therapy is recommended to alleviate any future outbreaks of this pain. In addition, stretching and muscle strengthening is noted as a form of rectification to this pain.

Can you please advise what forms of stretching and muscle strengthening is required to eliminate these symptoms from re-occurring.


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[topflightpro]

I partially tore my patella in late 2012. I couldn't race again until early 2014.

I went through three rounds of PT to deal with it. I now spend 45 min. every morning stretching. This includes working my calves, quads, hamstrings, hip flexors, and IT band. Bascially, I stretch everything from the waist down.

As far as strength work goes, I do a lot to keep my core strong, as well as glutes and hip flexors. I also add in work on my hamstrings and quads, but those are less important.

[Splash]

Thanks of response. Sad to hear of your tear.

Can i ask how you tore your PT and describe the sensation or pain?

Do you then train after your daily 45min stretch?


SPlash

[FlashUNC]

For the IT band? A foam roller is about to become your best friend. You might even name it. I call mine Kevin.

[Derailer]

I know this is non-responsive to your question, but have you looked at fit issues?
I had a terrible bout of IT band issues that were resolved by (a) raising the saddle height (after a pro fitting) and (b) switching to speedplay pedals. My knees like float for whatever reason.

[MattTuck]

Didn't your PT give you some exercises?

Being sidelined with chronic stuff like this is really frustrating.

[Splash]

Thanks Guys.

The PT mentioned using a foam roller on my side.

He also said I should review related youtube videos.

I should look at bike fit now.


Splash

[Pastashop]

I had something along the lines of your diagnosis. My actions:
1. Rest & Advil
2. Stretches (plenty of info on the 'net for ITB stretches, etc.)
3. Strengthening exercises (Partial one leg squats with heel elevated helped a lot)
4. Massage / acupuncture
5. Slowly restarting to ride and slowly building up gear inches.
6. Reducing gluten & carbs (seemed to reduce overall inflammation in my body)

[Fivethumbs]

I have patella problems. I found that wearing knee warmers helped. I got some that provided support not just warmth. I wear them even on warm days and they work pretty good.

[topflightpro]

Thanks of response. Sad to hear of your tear.

Can i ask how you tore your PT and describe the sensation or pain?

Do you then train after your daily 45min stretch?


SPlash

Yeah, I overdid it with the Plyometrics. I felt a sudden, sharp, stabbing pain in my knee. I knew immediately that things were bad.

After that, I could not walk up stairs or get out of chairs. Doctor diagnosed it as a likely partial tear. We did not bother with an MRI because, as he said, the treatment would be the same.

A patella strap helped make things more manageable.

Once the swelling subsided some, I started PT. First round lasted about 12 weeks. I was very diligent about doing my PT work at home in between my sessions. I was cleared to ride and race. First race back, knee blew up like a balloon again.

Went back to PT for another 12 weeks, again stayed diligent about my between session work. Cleared to ride and race, and same thing happened, knee swelled up huge after one crit.

Back to PT for a third time. Decided to give up the idea of racing for the rest of the year. During the third round, we did Graston regularly to reduce some of the scar tissue in my tendon - by then it was pretty noticeable to the PT - as well as did some PT work while I was on the bike. Basically, I redid my fit, dropping the saddle and sliding it back a lot to really force my glutes to work.

The stretching just helps me keep limber. My PT noted I was not terribly flexible, so I do the daily stretching, which was part of the PT, to keep things loose and keep muscle tension off the knee. I do this routine every morning before going to work.

Before riding, I generally do a short set of dynamic stretches to loosen things up some, but not the static stretching I do daily. The static stuff is better after riding.

And since my initial problem in Sept. 2012, I occasionally have flare ups. I tweaked my knee somehow back in early May. Had me wearing the patella strap again, but it only lasted a couple of days. Still, I routinely ride with my patella strap in my jersey pocket, just in case.

[benb]

I had patellar tendonitis probably about 4 times in my right knee the first 5 years I was cycling heavily. This was my early 20s, so we're not talking about old guy issues. I've managed to give my self a little bit of cartilage damage on the backside of my kneecap because it took so long to figure it out.

For me there were a bunch of root causes:

- I have a short torso and long legs. To get me fit on stock frames without absolutely massive drop early on everyone was recommending a lower saddle height than ideal, meaning too much bend in the knee.

- Make sure you have enough/correct setback on the saddle, this is almost as bad as the saddle too low, maybe worse. For me this was the same thing.. short torso made it hard to reach to the bars on stock frames, naive fitters kept recommending saddle positions too far forward.

- I have flexible feet.. good cycling orthotics have made a big difference the past 10 years or so. Prior to getting the orthotic situation figured out I was running somewhat asymmetric cleat positions. It seemed like it helped but exacerbated knee/hip/saddle issues and probably contributed to the knee tendonitis.

- Make sure you don't have saddle issues.. for me quite often I was unstable on the saddle and that probably led to activating some muscles at the wrong time to stabilize myself

- Foam roller is definitely really important although once you are well healed and have any asymmetric issues worked out you shouldn't need it nearly as often.

- There are a bunch of stretches that are helpful. For me most of the ones I wasn't doing early on were the hip stretches. I do enough stretches it would be hard to describe them all here. My current routine is heavily influenced by PT recommendations from the last time I hurt my knee (6 years ago). Since working with that PT my knee is rock solid and I haven't really even had the slightest hint of tendonitis.

- Core strength, squats, etc.. are all important too.

I would expect 6-8 weeks setback for a proper return to form after having tendonitis bad enough you feel it walking up and down stairs. 2 Weeks off the bike, do the PT, gradual return to cycling. If you're not real careful you'll re-aggravate it and each time you do the recovery takes longer and longer.

[zap]

edit



I should look at bike fit now.


Splash


I have patellar problem (OSD) and what has helped was raising the saddle a few mm's and ensuring I was behind kops by about 2 cm's. As topflightpro posted, you want to recruit the glutes. Have yet to make the switch to shorter crankarms (175 to 170) but will do so with the next groupo.

I also learned to spin more.

In colder temps, in addition to knee warmers, I use kinesio tape over the insertion point. Not sure if it helps but it sure doesn't hurt.

[giverdada]

these are all very interesting to me.

i had the IT problem a while back from running, took a month off of all activity including riding, did some PT with my aunt, and ran pain-free after that. then i ran a marathon and it started to hurt in the front of the patella, no IT pain, then i ran a couple marathons in a month and now it's back with a damn vengeance. i think the saddle height slipped down a bit on my mtb ride yesterday, so i'll give that a look as the patella flared up after physio yesterday. what the heck. anyway, positioning on the bike does seem key, and stronger hips/glute med/core too. too many systems for me to keep track of, but they certainly seem to remind you when something's not quite right. :crap:

[topflightpro]

Benb - I also have a very short torso and long legs. I can, however, fit on stock bikes. But whenever I tuck in my shirt, I look like an old person who pulled his pants up to his arm pits.

Zap - At one point, my saddle setback was close to 11 cm behind the BB. I'm now down to 9. And I run an Arione, which is a very long saddle. I also agree with the knee warmers.

[yngpunk]

According to my PT, I have developed patellar tendonitis in the front of both knees along with a touch of ITBFS (iliotibial band friction syndrome).

I have stopped cycling for nearly 2 weeks for rest to alleviate the pain.

This pain is only felt when climbing or descending stairs at work. This pain is now reduced with that rest and associated sports massage therapy.

I understand that the RICE method and massage therapy is recommended to alleviate any future outbreaks of this pain. In addition, stretching and muscle strengthening is noted as a form of rectification to this pain.

Can you please advise what forms of stretching and muscle strengthening is required to eliminate these symptoms from re-occurring.


Splash

Have you considered also using a Cho-Pat stap for alleviating the knee pain from the patellar tendonitis and while exercising?

[christian]

Been there. Foam roller for sure. But moreover, yoga to stretch the hammies and hip flexors.

There's a good series called "Do Yoga with Me" on youtube, but if you just want the perfect cycling hits all in one series, meet your new friend Abi from Pinkbike. This series rocks:

http://www.pinkbike.com/news/how-to-release-tight-quads-and-increase-your-power-abi-yoga-2016.html

[benb]

Benb - I also have a very short torso and long legs. I can, however, fit on stock bikes. But whenever I tuck in my shirt, I look like an old person who pulled his pants up to his arm pits.

Zap - At one point, my saddle setback was close to 11 cm behind the BB. I'm now down to 9. And I run an Arione, which is a very long saddle. I also agree with the knee warmers.

Your personal configuration probably doesn't have much to do with tendonitis as long as your bike fits. I just mentioned my own proportions as an explanation for how low seat/not enough setback were recommended to me when I started riding.

[maxcolumbus]

I did a short trial with Look zero float cleats.
I experienced no issues until a really hard ride last Saturday.
Race pace effort, sprints, and 70 fast miles.
My knees were cooked for most of the week.
Lots of rest worked well. Also did a few short recovery rides consisting of small ring spinning. I made sure not to put any resistance on my knees. Just got the blood flowing through the tendons, allowing them to warm up a little.
This expedited the healing process.
I'm back to grey Look cleats with medium float.

Feel better!!

[hellvetica]

I developed PT during a 400 mile MTB race. About 200 miles in on my single speed 29er. It was like yours, very sudden (coming off a trail, I stopped to put on some arm warmers and almost collapsed in pain).

I couldn't walk up/down stairs without putting almost all my weight on the other leg. Doctor confirmed it was patella tendonitis. I think it took almost 5 months to be able to ride for more than an hour up a hill. Was terrible.

My issues were discovered after I got a fitting. My seat was about 1.5 inches too low. I also had a set back post, when it should have been a straight post. My riding was more mashing than using other muscles (like the glutes).

I now stretch before every ride, and foam roll the ITB band (which is the culprit) after really hard/long rides (another over 6+ hours).

Ibuprofen also helps. Icing didn't do anything for me.

Good luck.

[Splash]

Thanks Guys.

Hellvetica - What was the trigger that let you know that you should not have been using a setback seat post?

TopflightPro - How do you determine the optimal amount of saddle setback you need to really force the glutes to work?

Benb - Why have you decided to reduce your crank arm length?






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[alyosha_s]

For patellar tendonitis, I found that self-massaging around the patella felt nice and helped reduce the inflammation a bit. Also hyper-flexing the knee and holding your foot behind the back was a good stretch for me.
For ITB, crossing your feet and bending down to touch your toes will cause you're ITB to stretch, make sure you do both sides. Also self hand massage and using a massage stick helped in that instance too.

[slidey]

Thanks Guys.

The PT mentioned using a foam roller on my side.

He also said I should review related youtube videos.

I should look at bike fit now.


Splash

Are you per chance paying for the advice this PT gave you?

If so, switch PT's - it helps greatly to have a more keen, hands-on PT, and there are plenty of them around.

And, once you are ready to ride (after pain completely subsides, which I'd estimate would be in a month or so), I'd very strongly recommend seeing a professional bike fitter to sort out your bike fit.

Good luck!