Patellar tendonitis: Prevention and rehabilitation

Knee pain is one of the most common chronic cycling injuries. In fact, many studies have found that somewhere between 15-33 percent of cyclists involved in endurance cycling experience knee pain or injury at some point during their career.¹ A plethora of knee problems could account for these aches and pains, but one of the more common ones known to hinder cyclists is patellar tendonitis.

What is Patellar Tendonitis?

Patellar tendonitis is the inflammation of the tendon that connects the knee cap (patella) to the shinbone (tibia). A similar condition, patellar tendinosis, is a degenerative condition in which microscopic tearing of the tendon results in scarring and an alteration of the tendon’s normal structure. Often these two conditions are confused or interchanged. It is very difficult to differentiate between patellar tendonitis and patellar tendinosis which is why the all-encompassing term patellar tendinopathy is used to refer to both conditions. Ultimately, all patellar tendinopathies may result in pain and discomfort while riding your bike and may benefit from the prevention and rehabilitation strategies mentioned in this article.

Causes of Patellar Tendinopathies
Patellar tendinopathies are often caused by over-training, a sudden increase in training volume, jumping activities, overloading the tendon, or poor biomechanics as a result of your bike fit.

Signs and Symptoms
Patellar tendinopathy will often occur with a gradual onset of pain and pain when you touch the bottom of the knee cap or the tendon. It is also possible to see slight swelling around the tendon. You may experience pain when pushing down on the pedals or walking down stairs. You may find that your quads feel weak and painful when you try to extend the knee. Finally, in more advanced cases, you may experience a popping or grinding sensation when bending and straightening your knees.

Prevention

Whether or not you currently suffer from patellar tendinopathy, this information can be extremely valuable to you. Understanding potential risks help you to better prevent injuries.

Increase Volume Gradually:
Since one of the main causes of patellar tendinopathy is a rapid increase in training volume, one of the best prevention strategies is to increase in a methodical manner. While everyone is different, a general rule of thumb is to only increase your volume by 10 percent each week.

Get a Bike Fit
Something as simple as dialing in the height of your saddle can make a big difference for injury prevention. Fit specialists are trained to help you optimize power and minimize injury. While bike fits are often expensive, the potential of pain-free riding can be worth the expense. At the very minimum check your saddle height. With your foot at the bottom of your pedal stroke, the knee should have a 25-35 percent bend.²

Increase Your Cadence
The next time you ride, pay attention to how fast you are turning over the pedals. If your cadence is too low, you might be placing too much stress on your knee. An easier gear, turned over at a faster rate will produce the same speed with less stress on your knees. While the optimal cadence is debatable, a cadence of 80 RPM or above should help to mitigate patellar tendon injuries. 

Rehabilitation

If you do find yourself suffering from patellar tendinopathy, here are some simple rehabilitation techniques to help you get back to pedaling pain free as fast as possible.

RICE
This acronym stands for rest, ice, compression and elevation. The goal of this treatment is to decrease swelling. Try icing up to three times a day for 15-20 minutes at a time with your leg elevated. You may also benefit from compression with an Ace Bandage and taking some time off of the bike.

Eccentric Exercises
Some sources suggest that eccentric quadriceps exercises may be beneficial for athletes with chronic patellar tendinopathy. Eccentric exercise is any exercise in which the muscle contracts and lengthens at the same time. An example of an eccentric exercise that would be good for patellar tendinopathy would be the lowering phase of a squat.

Stretching
Create and execute a stretching routine that targets your quadriceps, hip flexors, and hamstrings to help maintain proper biomechanics and joint movements. For example, incorporate lunges, forward bending, and a lying quad stretch in your post-ride routine.

Listen to Your Body

Most importantly, listen to your own body. Pain is the body’s way of telling you that something is wrong. The sooner you acknowledge the pain, the sooner you can work to overcome it and pedal pain-free again.

Sources
1. Bini, Rodrigo Rico, and Alice Flores Bini. “Potential Factors Associated with Knee Pain in Cyclists: a Systematic Review.” Open Access Journal of Sports Medicine, Dove Medical Press, 23 May 2018.

2. Pruitt, Andrew L, and Fred Matheny. Andy Pruitt’s Complete Medical Guide for Cyclists. VeloPress, 2006.