Jul 29th, 2014
Hi, I hope you don’t mind if I ask a couple of sports injury related questions:
Thanks for taking the time to look at my questions.
Jul 29th, 2014
Great questions. I’m taking it that you’re not a sporty 80 year old, who binge trains and lives like a teenager!
1. When was the cycle ride? How long is long and did you do enough training?
Where your pain and swelling are located thankfully nails it down to only 1 or 2 like things. Either an irritated infrapatella fat pad or a patella tendonopathy. I think likely to be the latter as up and down stairs are painful, rather than just the going down – and if it was fat pad locking your knee back is also sore.
This is why the time since ride is important with what to do next. If it was only a few ago, the rest through the reactive phase. If it was a month+ ago then it needs to be respectfully loaded. Certainly eccentric loading (as below) may be of benefit. If your patella tendon has been over loaded due to the ride then you’ll most likely need releasing elsewhere to help speed you along.
2. Courtney is a great doc [sports physiotherapists for sports injuries London] – and if he thinks you’re got a Haglunds deformity then that’s good for me at the moment. But (and there always is) insertional tendon issue don’t always like being loaded eccentrically – they prefer isometrically (just hold/hover in the air, heel of the ground, knee bent and straight) and they really don’t like being over stretched….
Haglunds always have a boney bump, and it’s over this boney bump you run into trouble with your achilles. Get your GP to refer you for a plain X-ray in the first instance, and then report back….
Will replied to the Guru with some more information:
Thank you very much for taking the time to reply to my message. No, I’m not an 80 year old! I’m a 33 year old man, otherwise fit and healthy.
1. The cycle sportive was on 29th June. It was 70 miles and hilly in the Brecon Beacons, Wales. I’ve been cycling for a few years now, two or three times per week. My normal rides are 20-30 miles in Surrey or Richmond Park, but I’d done a couple of 40 and 50 mile rides leading up to the event. So my training was ok, but not brilliant. I have done rides of over 100 miles in the past, although nothing of that length since last summer. My knee has never caused me a problem before though.
Is patella tendonopathy the same thing as ‘runners knee’? I think I came across the term when googling knee injuries.
The injury is a month old now. You mentioned in your email about respectfully loading the knee, maybe eccentric exercises and about ‘releasing elsewhere to help speed you along’. Could you elaborate on these please, are there some exercises I could try at home? Or is this something that I should come to see someone in person about?
2. I was lucky that Dr Kipps had a clinic at my GP’s surgery. But unfortunately he no longer does the clinic and I’m not sure I could afford to see him privately. He thought that Haglund’s Deformity would be worth investigating as my Achilles tendon issues are so persistent and he did refer me for an X-ray. There was a bit of a debacle at the hospital though, as the consultant radiologist refused to do the x-ray saying that he didn’t think it worthwhile! I tried to go back to Dr Kipps to explain the situation, but he had moved on from the clinic by this time. Anyway, I think you’re right that I should try to see my GP again and try to get someone to do an x-ray – I’m sure it would help to get an idea of what’s going on under the skin there.
Thanks again, Will.
The Guru responded:
…I’d have put you at 34 😉
I think it’s the hilly bit that’s the key. Richmond park is great for speed and distance but part from 2 short hills, it just doesn’t give the required wattage, cadence or grunt of the Beacons.
I think patella tendonosis sounds on the money, as long as the pain is centred under the patella. The mechanism fits, location fits and description fits.
Runners knee is much more patellofemoral (kneecap) in nature. It generally doesn’t swell, is felt under the patella or grossly around the knee and is made worse but the things that make you worse (downstairs is commonly worse) but also things like sitting down for 40 minutes or kneeling down or full squatting.
Because you’re now +1 month, you will have started to adapt your movement patterns to try to get around the pain. In doing so you will overuse some bits of tissue and disuse other bits. Things that generally need releasing (and not necessarily stretching – rolling, massage, deep tissue release etc) are quads, calfs, the front of your hip and your patella. Getting. Your gluts to do more is no bad thing either – small controlled, single knee dips.
Keep your wattage down on your bike and keep in higher gears. Ice is still good and sometimes patella straps can help (they can also hinder too!)
2. Great idea re your GP – keep badgering him. Or Ping Courtney an email. He’s super diligent and conscientious and I’m sure he’d pleased to help get you in the right direction.
I've had ongoing knee issues for a number of years due to overall wear and…
Very punctual, thorough, explanatory and lovely knowledgeable staff.
Jeremy Parker is a genius he diagnosed my condition and cured me with just 2…
David Tieppo has given me very good physiotherapy. He has also been very helpful in…
Couldn't better the treatment that I received. Clear diagnosis,good communications & clear treatment pathway
So relieved to be able to see a physio during lockdown, especially as it was…
Both Matt and Rachel have been extremely helpful and pleasant at the same time!!
Very happy with all the process with Six Physio, from appointment booking via email that…
High quality, effective physio delivered within the framework of an efficient & friendly admin team…
Very thorough and constructive discussion on my injury and potential next steps.
Highly recommend Neil Gallagher the Physiotherapist at Six Physio, Neil was recommended to me by…
I had a great experience with Jenny and and the staff at the reception. Jenny…
It’s so easy at SixPhysio. So easy and relaxed, welcoming and warm. Camilla is amazing.
Diagnosed and fixed my issue in one session!! I couldn’t walk the day before!
Highly recommend Six Physio and especially the Pilates. They always manage to sort me out…
Great overall! Quick to get an appointment with your women’s health specialist who was so…