This was my worst nightmare. I was not able to run more than about 3 km without run-stopping pain, for about 3 years. I saw an orthapedic, sports physicians x 2, physios and an ostepoapath in the search to get it fixed. I tried rest (3 months no activity), ice, NSAIDs, Nitro-Dur (glyceryl trinitrate) patches, stretching, taping, and anything else the physios threw at it, without improvement. I also tried, as instructed, eccentric exercises, squats, leg extensions, etc.
For me, after all this time, it was a combination of 2 things that allowed me to run again:
1. eccentric eccercises, **performed consistently, 3 x 20, twice per day, at the same speed, depth and angle**. It was never stressed enough by any of the experts how important it is to push through the pain when you do these. I was stopping at the point of pain, which was sometimes 3 reps - which is hardly going to facilitate tendon restructuring. The pain is not degenerative, and if you accept this you will be able to push through it. A tendon needs stress to remodel it, else it will remain its same stagnant, misaligned self. Rest and half-arsed eccentric work will not do enough, and I read about cases where people in the studies had it for 8 years. I made my own sloping eccentric squat board out of timber. Make it solid, smooth, with some grip and a little lip to help catch the shoe, and sit it in your lounge room. Do the same thing morning and night, to the same point of stress. No need to ice as there is no inflammation in tendinopathy
2. I changed my running style. When I first started to push out a few kilometers, I was so paranoid. I looked to run as light as possible - forefoot, high cadence, small steps. Changed from that day on and never looked back. I now run with minimalist shoes, and I'm sure this has helped restore muscle balance in my lower legs.
Back into the IMs and marathons now and still doing the eccentric squats morning and night. Sometimes my knee will feel a bit funny after a few consecutive days runnings, so I just remind it who’s boss with a few slower eccentric squats, which are more stressful. This usually resets it for the next day- I find this strange but it works for me so I don’t question it
During the 3 years of not running I was able to do swimming, rode to work every day, and did a lot of RPM/ spin class which seemed not to make it worse. Elliptical would be fine, stair climber probably a bit harsh. Rower I found a bit harsh also.
For me it involved 2.5 years of half efforts, and following bad advice, with no improvement. Then 3 months of consistent effort, following good advice (step 1 above), with enormous improvements. Then started running whilst keeping up the eccentric to allow longer running for the last 1.5 years.
It was not a bike setup or run style tat caused it, nor would a change in these things fix it. For me it was overuse - too much running up and down gorges and really steep hills. But, unfortunately, unlike other injuries, there is no way this symptom is going to go away just because the cause is removed