Tendons

[peetee]

I am a returning cyclist as some of you may know from other posts on this forum. 30 years ago when I was riding regularly and occasionally competitively I reached a reasonably level of fitness but always felt held back by persistent tendon pain. My muscles were up to the job but the tendons above my knee couldn’t take the strain. Part of the issue was poor foot position (More on this later) but this was only on one leg and both knees were suffering. I have always been long and lean and never developed the ability or habit of pushing a big gear.
I have been back in the saddle since October and my fitness and strength are improving. I can now sustain 13-14mph average for a couple of hours on hilly terrain. My foot position been addressed with a pedal spacer but now that the power in my legs has improved the tendon issue is returning which is disappointing because I want to make further progress but feel this may be impossible.
Am I stuck with this? Can ‘weak’ tendons be treated with anything other than rest? Do they repair themselves stronger like muscles can?

[Jdsk]

Do they repair themselves stronger like muscles can?

Different, but not hopeless.

Am I stuck with this?

Not necessarily. If you want to follow the NHS route I recommend talking to your GP and discussing referral, might be to a podiatrist, or an orthopaedic surgeon, or a physiotherapist, or a sports specialist.

Usual advice: make a written note of your story and the questions that you'd like answered. It's easy to forget stuff during consultations.

Jonathan

[PhilD28]

Eccentric exercises are the most essential part of tendon rehab. Rest alone will mitigate pain but without the correct rehab protocol the problem will return and get worse. Tendons strengthen up at about 1/6th of the speed of muscle so take six times as long to match your freshly developed muscle strength. This is why it's essential after a long layoff to come back very slowly to allow tendon strength to develop.

Plenty of stuff on protocols for quad tendon rehab on you tube, do a search.

You need to go slowly and diligently to get over this which will mostly be done off the bike with eccentric exercises and cross friction massage to re align the tendon fibres and closely targetted at the problem area. Without doing this work look forward to ongoing problems.

[NATURAL ANKLING]

Hi,
Phisio exercises
I do them every day, for my ankles.
Unstable ankles
Repair times with no intervention?
Muscle damage five days.
Tendons six weeks.
Ligaments?

Edited for clarity

[NATURAL ANKLING]

Hi,
I have been under lock down unable to leave the house for some months.
But am venturing out a few times a week, when I started back the first thing I noticed was tendon pain above the knees
Never had that at all in all my years (54 Y riding) (Running walking cycling)apart from the last few days on my coast ride which I put down to the 43" gear.
But no the saddle have crept down some 10 mm (whether this was the tail bag or the paint in the seat tube I don't know).
Anyway I seemed to have dropped the knee tendon pain which was minor and all is fine.
I think its early days for you to toughen up if you have been off a bike for decades.
If its that painful when riding and assuming that you have fixed your feet then a physio or some exercises off the net might help somewhat.
My average cadence is still low I put that down to my poor muscle dynamics through meds, just stopped one after talking to GP.
Cadence avg 55 - over 3hrs 15 - bike is a MTB weighing 1/2 cwt but still managing over 13mph avg on old railways, HR avg is 80%....................about my limit as I am fading on most rides and couldn't turn the pedals on one ride coming home, not helped by riding at 2 o'clock in the morning

[peetee]

Thanks everyone. Looks like I stand a good chance of keeping on top of this by continuing my stretching regime and adding in a strengthening program. I am sure any professional advice would start me off with the same but I can go that route if the routine fails to eliminate the problem.
Cheers

[PhilD28]

I'll say it again, the only way you will get it sorted is by very specific eccentric exercises targetted at the problem tendons and it will take time.

I have a long history with one particular quad tendon (since my racing days), have had debrediment surgery on it and have seen one of the best knee surgeons in the country along with his physio, they were both very clear that the eccentric exercise regime coupled with fibre re alignment by cross massage is the only thing that works long term for tendon injuries.

There is plenty of supportive research available on this problem and plenty of help online for free these days.

[peetee]

I'll say it again, the only way you will get it sorted is by very specific eccentric exercises targetted at the problem tendons and it will take time.

Loud and clear. But not entirely certain if you mean specific to me post-diagnosis because you follow up by drawing attention to generic tendon exercises online.

[Gearoidmuar]

I had a knee problem especially in my right knee due to a torn medial meniscus. Bothered me for more than 2y when I did something drastic.

I started using catalyst pedals which are MTB pedals longer than usual where you aim to get the middle of your arch over the pedal axle rather than further forward.
I went from two painful knees in bed at night etc.,, including some tendon pain, to no problem at all and this has lasted for 6 months. You can use plain pedals of other type but with this position. You'll need cleatless shoes for it.
This is well worth trying.
How does it work?
It seems to move the line of pressure from the front of the knee to the middle of the knee. It's a remarkable result.
I'm 70 and have have been doing serious cycling for nigh on 40y.
Try it. You've nothing to lose.

[PhilD28]

I'll say it again, the only way you will get it sorted is by very specific eccentric exercises targetted at the problem tendons and it will take time.

Loud and clear. But not entirely certain if you mean specific to me post-diagnosis because you follow up by drawing attention to generic tendon exercises online.

There are specific eccentric exercises for each tendon that is a problem. These are normally graduated in terms of difficulty and development. For instance for Quad and Patellar tendons dependent upon severity of the problem, you might start with simple unloaded two leg squats, moving on to single leg squats but two leg lifting back up. Progression would normally move you onto Bulgarian squats, increasing reps with time and then onto Bulgarian squats with dumbbells. It is the lowering element that is critical to strengthen tendons and why cycling doesn’t work well to rehab tendon injuries, it has little eccentric loading.

From the generic information you provide that’s the best I can do in terms of an explanation. There are many exercises for tendon problems and the cross friction massage can also an important component dependent on the nature of your condition.

I know it’s difficult at the moment to see a physio. But the best thing you can do If cycling is really important to you is to consult a “good” sports specific physio and get an accurate diagnosis of your condition.
I can recommend John Dennis of Physiohaus in Jesmond he is an expert in cycling injuries and bike fit. He acts as physio and bike fit expert to several top pro cycling teams. He is doing online consultation during the coronavirus crisis.

Here is a link https://www.physiohaus.co.uk/physiotherapy-team

Good luck, it is possible to resolve it, I went from having to stop cycling altogether with a tendon injury to extensive long distance multi month tours all over Europe doing many consecutive 100+ mile days without pain in the space of 12 months focussed rehab. It’s hard work and it might cost you a bit for some expert diagnosis and advice, but worth it.

[peetee]

Thanks PhilD28. Jesmond was local many years ago but, alas, no longer.
For what it’s worth, it’s this tendon that gives the most trouble (Right leg shown).

[Syd]

As a young teenager back in 1983 I severed tendons in my left hand after falling on a broken Irn-Bru bottle. I remember the recovery period being in the order of years and I still have occasional problems even now.

Tendons are a complete.... nuisance... when they get injured.

[PhilD28]

Thanks PhilD28. Jesmond was local many years ago but, alas, no longer.
For what it’s worth, it’s this tendon that gives the most trouble (Right leg shown).FFE1EF63-A71A-49AC-9F4F-2FBC03E13396.jpeg

Ok, it’s looking like a classic quad tendon overuse problem. You can still do an online consultation with John and he’ll give great advice on how to proceed, I strongly recommend this to ensure you don’t do any further damage, he will provide you with a graduated exercise programme to suit your exact condition.
In the meantime, I would suggest still cycling but limit it to low gears easy stuff that doesn’t cause any discomfort or pain after the event.
You should start to rehab it with some basic two legged unloaded squats only going down pain free. This is better done on a board inclined at about 25 degrees and ensuring that your knees never go past the front of your toes, the inclined board loads the tendon. Three sets of ten daily for a couple of weeks at first. You could also do some pelvic thrusts laid on your back to strengthen your glutes. If you can build up over a few weeks to doing bulgarian squats too, they can be pretty tough on the quad tendon so build up to them slowly.
Here’s a couple of basic links to get started https://youtu.be/8n7aepxLpW8

https://youtu.be/a6FLSXUnEuY

Above all get a good diagnosis.

[peetee]

Thanks very much.