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patellar tendonitis - when to resume training?
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Been dealing with patellar tendonitis for about 3 weeks now after doing a 100 mile ride. Without comments about needing a bike fit, I am curious about what other peoples experience has been with when to resume training. I'm less than 3 months away from my first Ironman so I'm kind of freaking out about not biking or running for 3 weeks already (been doing a lot of swimming though). If I really load the left knee (the injured knee) then I can feel some pain. I can feel some discomfort if I walk down stairs or sit stand up from sitting in a chair. Today I went for a very slow and very easy 1.5 mile jog with the dogs and I could feel a little discomfort but afterwards the pain went down to what it has been and it doesn't seem like the easy jog worsened the knee pain. A few months ago I had a pulled hamstring and after a few weeks I was able to start cycling then running and at the time I still felt some discomfort in the hamstring but cycling and running didn't seem to make it any worse so I resumed training and eventually the discomfort in the hamstring continued to get better and eventually completely resolved in spite of still training. I come from more of a running background and I have a pretty good idea on when to resume training from a lot of other sources of knee pain that I have some experience with but I have never had patellar tendonitis before. So, I'm not sure on how resolved my symptoms of discomfort should be before resuming some level of training (do I need to wait till it is completely pain free no matter how much I load up the knee with stress or can I start training with some discomfort as long as it doesn't make the discomfort worse - like my experience coming back from the pulled hamstring). I'm freaking out about not being able to train but at the same time I would rather not train for a week or 2 more and then resume training without fear of re-injuring it rather than resume too early and make it worse again and then have to wait another 3-4 weeks or more before being able to resume training again. I have been icing it a ton and I've been stretching a lot and doing the foam roller on my hamstrings and quads and IT band and resting it. I work with a bunch of orthopedics so I got an informal consult and their basic recommendation was just rest and stretch and ice. Basically there is no way I'm not showing up the the starting line of this Ironman. My marathon PR (3:34) came during my first year of medical school and I didn't run once for the 2 months leading up to the marathon (of course that was about 12 years ago). I'm willing to rest as long as I need to in order to let it heal and I'm willing to face a potentially horrible race day of just trying to survive and finish before midnight if I have to go through an extensive period of no training (except swimming) before the race but I don't want to needlessly hold off on training if I can safely resume training and a low level of intensity and slowly build the intensity back up. Just curious what others experiences have been. I know the obvious answer is probably don't run or bike if it hurts but you all know how it is when your injured and can't train, you are just looking for somebody to convince you it is safe to get back out and resume training again.
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Re: patellar tendonitis - when to resume training? [kaywould] [ In reply to ]
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I had it in my first season of training and it took me out for 2 months. Once it feels better you need to increase the load very gradually (e.g. walk down stairs, graduate to partial squat, graduate to full squat, graduate to one legged partial squat, graduate to easy cycling, graduate to ...., etc). In my case I stopped training at all for 2 months (I didn't enjoy swimming so didn't even bother with that), then got back to easy cycling then back to running.

I sought medical help and they reasoned it was something to do with the tracking of my kneecap or something like that. Had to loosen up the muscles and do some exercises to help with that. If you know it was caused by cycling then a bike fit it probably not a bad idea.
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Re: patellar tendonitis - when to resume training? [kaywould] [ In reply to ]
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I had my early season interrupted by Patellar Tendonitis. Was the 2nd time in the same knee. Frustrating, more than anything...
  • Most discomfort was up/down stairs, up/down chairs.
  • Took 2-3 weeks of the run and 1 week off from cycling. Added cycling back in first, and then running as I could tolerate; but only once stairs stopped hurting and even then was a few days of resting "just in case."
  • Slowly increased run volume starting with 5ks and gradually adding distance as I could tolerate. Sometimes can get frustrating since you often don't know until "the end" of the run whether you've "gone over" or not. When that happens, rest and take it down a notch. If it hurts, or you feel symptoms, stop. Usually this meant having to do most runs near home, so I could safely jog back if it started to flare up
  • Slower pace, higher cadence (midfoot strike) seemed to help somewhat when returning. (though do what works for you)
  • Ice and heat both seemed to help after a run.
  • Above all: get a qualified physiotherapist. Preferably someone who specializes in running/sports injuries to take a look at you. Proper treatment seemed to accelerate the healing process. Also handy having an expert tell you when you can start up again. We internet denizens can only relay our own experience; we can't be prescriptive. :)
Last edited by: timbasile: Jul 27, 15 13:31
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