# Prepatellar Bursitis / Patellar Tendonitis



## wangamachang (Feb 12, 2009)

Hey MTBR!

I fell on my knee about 3 months ago. I took a jump wrong, and rotated in the air, landing straight on my knee. It was pretty much square on my knee cap, and blood / fluid flowed out of the cut real good. About 2 weeks before that, I was going up a switchback and was too tired (sigh) and fell over on the same knee square onto a rock. I was fine after 10 days. 

I have taken x-rays (thank God for college health insurance), and there are no fractures / torn ligaments. About 4 weeks ago, I took my normal bike ride (12 miles) and was fine. I decided to play some football (flag), and after that my patella tendon felt soooo damn tight. I could barely bend my knee all the way without it hurting! 

I went to the doctors, and they said it was prepatellar bursitis, but there seems to be little / no inflammation above my knee. The patellar tendon is still tight after I bike / walk around for a little bit (i.e. walking to class). 

What helps:
Massaging the tendon (making it as relaxed as possible)
Wear a patella stabilizer (only after I wake up / walk around -- helps a little after exercise)
NSAIDs BARELY help...

What doesn't:
Mountain biking...
Running...
Standing / walking for a while....
Especially picking up the bike (being clipped in) with my feet like I am lifting the rear of the bike over a curb / root / etc...

Is the pain correlating for those of you that have had prepatella bursitis? or is it the same for those of you who have had patella tendonitis???

How long will it take for me to get back on the bike??
(important question as I am turning soft)

Other things I should do?
Thanks


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## AndrwSwitch (Nov 8, 2007)

If there's nothing structurally wrong with your knee, which you need to the doctors to tell you, it's just a matter of recovery. The inflammation itself, even if you can't see it, can really mess with your knee's ability to move. If there's a lot of scar tissue in there now, that will have a similar effect and interfere with regaining normal function.

When I screwed up my knee, I was off my bike for about six months. But mine was an overtraining injury, and the bursitis was just one of a couple of problems. (IT tendonitis was the main thing, but I also had chongromalacia, which can be caused by IT tendonitis. The tight IT band can lead to IT tendonitis and chongromalacia if you're not careful with it.) So you can probably recover more quickly.

It sounds like this is preventing you from doing your normal activities and has been for a while, though, so you may need to get physical therapy prescribed to help speed your recovery. The ultrasound machine can be quite helpful. See a different doctor if the first one won't prescribe PT. At my college, chances were I'd get a different person every time I went to Urgent Care, so if I was trying for a specific answer, I could just go until I got the one I wanted. Like asking Dad for permission to do something Mom has forbidden. 

For now, try to go walking. Stop if it hurts, and stretch afterwards. If you have to carry a bunch of stuff to class, use a good backpack with a waist belt, not a messenger bag or a backpack over one shoulder. If you can walk for half an hour without ill effect, you can move on to other activities. Be conservative! When I decided to become a high-mileage cyclist again two years ago, I only increased my miles by 10%/week. It doesn't sound like much, but it's actually an exponential growth function and you'll be back to your normal rides surprisingly quickly; much quicker than if you hop on your bike and go for a two hour ride that sets you back to the beginning again. Which I'd know nothing about, of course. 

Do you have any stability problems, or just pain? I had a lot of exercises related to stability that I did when I was recovering from mine, but overtraining injuries are a little different from trauma injuries like yours.


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## wangamachang (Feb 12, 2009)

Well when I walk around initially with my patella stabilizer, my knee feels supported, but it will still hurt after walking around eventually (my knee). I'm fearing that since I have been wearing my knee brace, the strength of my knee is getting worse. 
I walked around without my knee brace yesterday to and fro (from class), and there wasn't much pain walking, just a feeling of lack of support. It is like I wanted my knee to "pop" like when you crack your knuckles. 

I did play some street football on Sunday (duh!, Super Bowl), but it was minor, but it definitely made my knee hurt in a manner that biking / running doesn't. I think it is when I "cut" or change directions real quickly. I was also wearing my patella stabilizer.

I can exclude football from my exercise regiment, but I definitely do not want to take out biking. I only bike very short distances as of now anyways, and the pain after biking is very minimal. 

I have some isometrics that are to make the muscles above the knee (hamstring, quads) stronger, but I don't think that is an issue (i'm a mountain biker!). 

I will mention that the pain (when it does hurt) is a very very sharp pain coming right below the kneecap only when I try to bend my knee I'd say when it gets less than 45 degrees (referenced from hamstring to calves).

I do need to walk to class.
Thanks again


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## ilostmypassword (Dec 9, 2006)

See a physio.

My tips though

1. Start wearing knee pads when riding
2. Rest for a week or two
3. Gym work to strengthen abductors, hammys and quads


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## wangamachang (Feb 12, 2009)

I am doing some stretches and isometrics for the knee and it definitely helps. my mountain biking breaks are about 5 - 7 days. 

i am very careful in putting pressure on my knees (like kneeling), so when I go riding I have been wearing my pads even on very low difficulty trails (just in case). I guess i really need to rest the knee...(rather unfortunate).


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## AndrwSwitch (Nov 8, 2007)

wangamachang said:


> I have some isometrics that are to make the muscles above the knee (hamstring, quads) stronger, but I don't think that is an issue (i'm a mountain biker!).


Patellofemoral problems are actually quite common for us and for runners. As I understand it, the issue is that one of the heads of the quadriceps doesn't tend to engage until the leg is at around 90% extension. Most of us have our saddles too low to get to that point, so some of us may have problems with underdevelopment of that part of the muscle. It's needed to exert a lateral force on your knee in opposition to the other muscles down there, so if you keep riding your mountain bike and don't do your exercises, you can exacerbate the problem.

If they take too long, tell your PT to give you a shorter list. He'll grumble, but if you make him understand that you're having trouble complying because of how long the exercises take, he ought to help you.


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## rufflesurf (Sep 8, 2007)

i`ve been struggling with what my doctor thinks is patella tendonitus for over a year now,i`ve kept riding all the way through this as i asked my doctor if it was ok and he said it was.i ride 2/3 times a week for 1/2hrs a time,and afterwards/day or two after i get a dull ache from the top over the front of my knee cap to the bottom.i`ve had physio which made it worse,ultrsound helped but did`nt totally cure it.
have been back and for to the docs 5/6 times and i`m getting nowhere fast! really getting on my nerves now.
any tips or pointers would be great guys,`my job also dos`nt help,i`m an electrician and i`m allways kneeling(but i do wear knee pads) walking,carrying,climbing ladders and walking stairs,so resting is`nt really an option.
i`d be interested to hear what streches you guys do
any info be great
rufflesurf


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## AndrwSwitch (Nov 8, 2007)

rufflesurf said:


> any tips or pointers would be great guys,`my job also dos`nt help,i`m an electrician and i`m allways kneeling(but i do wear knee pads) walking,carrying,climbing ladders and walking stairs,so resting is`nt really an option.


I don't think I know anyone who's worked in the trades or construction and not destroyed some joints.

I think the right footwear is really helpful. It helps me a lot to wear shoes with a supportive insole, so my foot's not rolling when I'm on the job (I'm a stagehand.) I usually wear sneakers with a microwavable insole, although sometimes I wear work boots, with the stock (but pretty supportive) insole. I also try to be conscious of carrying loads on alternating sides - I think that helps with both back and lower leg pain. I'm not sure how much you have to carry, but even a lot of little loads add up eventually. Too bad it's really hard to use a drill left-handed...


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## rufflesurf (Sep 8, 2007)

i`ve just got myself some insoles for my work shoes,i have to wear protective boots,hopefully these will help.
as with carry`ing stuff,its pretty much every day,i work in a university,so its up and down stairs and a lot of walking around the campus.i`ll try switching side when i carry stuff,ned to lighten my tool box a bit also 
should i keep riding though?? i`m trying to train for the mega avalanche in july 
never heartd of microwavable insoles,how are they working out?


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## AndrwSwitch (Nov 8, 2007)

rufflesurf said:


> i`ve just got myself some insoles for my work shoes,i have to wear protective boots,hopefully these will help.
> as with carry`ing stuff,its pretty much every day,i work in a university,so its up and down stairs and a lot of walking around the campus.i`ll try switching side when i carry stuff,ned to lighten my tool box a bit also
> should i keep riding though?? i`m trying to train for the mega avalanche in july
> never heartd of microwavable insoles,how are they working out?


I've been crazy-busy for the last few days and didn't get to my e-mail...

I have several different pairs of insoles - I tried a couple different things before figuring out what I like.

The ones in my sneakers are Zapz. I bought my first pair for a pair of snowboard boots and liked them so much I got another pair for my work boots. They actually take up quite a lot of volume, which is part of why they're not in my work boots, but my sneakers turned out to have a more forgiving fit and I wear them most of the time anyway.

I can commute, up to about an hour at a time, in my sneakers without ill effects, but I think I notice my knee a little bit if I ride in a different pair of casual shoes. My cycling shoes have a Specialized Body Geometry insole, and I think that out of a pro fit, physical therapy and the insole, the insole and a conservative training program have given me the most benefit.

As far as the Mega Avalanche... Dude, you're crazy.  As far as whether or not it'll destroy your knee, and bearing in mind that I don't have any formal training in this - it's just my experience and my reading that I have to go on - I think that if you can ride for an hour without it screwing you up, you should be fine. From your earlier post, though, it sounds like even an hour is a lot for you at the moment.

Part of the problem with overtraining injuries is that if the weaker muscle gets tired, it's likely to either relax when it should be engaged, or spasm when it should be engaged. So it either allows the patella to slip out of the track, or it yanks it out on the other side. In either case, it needs to be strengthened, which means challenging it, but if it's challenged too much and the knee swells up, it'll totally throw you off your rehab/riding schedule and you won't get nearly as much benefit as if you had gone on a shorter ride and then called it quits.

When I decided I wanted my knee to be healthy and I was willing to make some sacrifices, I cut my ride (road ride, since I was in NYC at the time) down to about a ten mile out-and-back, about a forty-five minute ride, and did it only two times a week. I increased my mileage by 10%/week for about five months, and while I was still cautious in the fall, I could do some cyclocross racing and it was ok. A 10%/week increase is an exponential function, so you start being able to do real rides sooner than you think, but it may not be enough to prepare you for the Avalanche this season either, depending on how bad your knee is and how long you expect to take (and how much pedaling you expect to do) to do the run.


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## BBW (Feb 25, 2004)

1-Stretches EVERY DAY after short warm up (It band, quads, hamstrings and calves)
2- Ice after exercise for 15 min
3- Strenght exercises for quads, hams, calves
4- MAKE SURE YOU DON'T PEDAL WITH TOES POINTING DOWN (puts more pressure on knee) 
see 



5- Knee strap (very helpful to take pressure off patellar tendon)


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## AndrwSwitch (Nov 8, 2007)

BBW said:


> 4- MAKE SURE YOU DON'T PEDAL WITH TOES POINTING DOWN (puts more pressure on knee)
> see


Interesting.

One of the aspects of my pro fit was that they moved my saddle down (over my objection, but time has proven their adjustment to be better.) I'm sure I was pointing my toes more on the previous setup, so I wonder if that contributed to my injury, and the trouble I had reestablishing a regular routine before the fit.


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## BBW (Feb 25, 2004)

AndrwSwitch said:


> Interesting.
> 
> One of the aspects of my pro fit was that they moved my saddle down (over my objection, but time has proven their adjustment to be better.) I'm sure I was pointing my toes more on the previous setup, so I wonder if that contributed to my injury, and the trouble I had reestablishing a regular routine before the fit.


????? its possible


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## rufflesurf (Sep 8, 2007)

cheers guys,i`ve got patella straps which i was wearing everytime i rode,stopped wearing them for a month and my knees got worse,so i`ve gone back to them,i can ride for 1-2hr with no problems,any longer and i ache?? i`m fine when i`m on the bike,its just a day or two later,i have been using ice after every ride aswell.waiting for an apointment for some physio,but i`ve started doing some strenghening exercises,my knees have taken a beating over the years in work,kneeling and stuff,i`m very mindfull now when putting weight onto them,also streching regular,off snowboardinfg in a week,will let you know how it goes


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