Sunday, December 16, 2007

Exercise with patellar tendinopathy

While doing the eccentric exercise protocol, I tried to limit other kinds of exercise, apart from stretching. Doing other exercise may negate the positive effects of the eccentric exercise. Also, the protocols used in several medical journal articles have subjects avoid other exercise in the first couple of months.

I do have some advice on exercising with patellar tendinopathy:

-- Swimming. Avoid the breaststroke. It increased my pain symptoms substantially. Instead, do the front crawl stroke.

-- Avoid jumping sports, such as basketball and volleyball.

-- Avoid sports such as curling, which requires one's weight to be placed on bent knees.

-- Bicycling: Avoid hills. Use the easiest gears. Increase cadence rather than increasing resistance. Use clipless pedal systems to increase efficiency. Have a bike fitting done by well-trained professional. The correct bicycle seat height is particularly important if you have patellar tendinitis. Have mountain biking gears installed on your road bike to allow easier gearing if you are doing any hills. Stretch on a daily basis. And, very importantly: ramp up your cycling miles slowly over weeks and months if you haven't been cycling for a while, or if you had taken the winter off from cycling.

I believe a reason I may have developed patellar tendinitis in the first place was due to poor cycling habits, which I have since corrected. Poor habits included the following:

-- I was using more difficult gears and had a relatively low cadence. (I now use easier gears and have developed a cadence of 100 or so.)

-- Four years ago, after a winter of no cycling, I ramped up my cycling miles very quickly once the weather improved. (Now I have a good indoor "bike trainer" so I can cycle throughout the winter. And, when the weather improves, I now ramp up my miles more slowly than I used to.)

-- I used to stretch occasionally. (Now I stretch everyday, twice a day. See my page on stretching.)

In addition to improving my cycling habits, I also had an extra easy gear added to my road bike to reduce the impact of hills on my knee. (Specifically, I had a bike shop replace the rear cassette on my bike so it now has a 32-tooth gear.) I also had a professional bike fitting session after purchasing a new, more efficient bike.


Anonymous said...

Hi Sigfus,

You said we should avoid swimming the breaststroke. Which style would you recommend then?

Sigfús Víkþörðson said...

I only recommend the front crawl stroke.

Unknown said...

Hi Sigfis,
I have been reading your site for the last 4 days and after taking many notes I am going to start the protocol tonight. However before I start I was hoping to tell you a little bit about my knees and also had a question.
I have had knee issues for 2 years now. I am a personal trainer in Queensland Australia and 2.5 years ago I started doing a lot of intense training with out building up to it slowly and correctly. I started with horrible heel and foot pain (which I still also have 2.5 years later) and unfortunately I did not understand the severity of the problem and instead of listening to my physio's and resting, I continued to train myself and clients and did not rest. Six months later my kness began to hurt and unfortunately again I did not listen and rest for another 4 months until I could barely walk, stand, sit or lay with out constant pain. Boy did I learn the hard way! I was initially told I had patella femeral syndrome, then tendinitis, then tendonopathy.
So 2.5 years later after numerous physio, chiropractic, specialists, shockwave and rest, my knees and feet still give me pain on a regular basis. So both feet and both knees and I am still a Personal Trainer and really need my legs for work. Over this time my exercise changed to the odd walk, swim, Pilates and yoga. However these still often stir up my knees.
So I am stoked to have found your website!!
My handy boyfriend has made a 25 degree slant board and I have written notes from your website to start the program. As I am not seeing a physio because I have seen enough and haven't got anywhere I was hoping you could answer a couple of questions to safely send me on my way.
1.As my knees are both injured, do I do the one legged squats with both legs?
2.I did a BIG, fast walk a week ago after a while of rest with my knees feeling ok and have flared them up again. They are still irritated but I don't know if this means they're inflamed? So would I still be ok to start the program or should I wait another week until they are less irritated? In saying that, they feel this way on a daily basis anyway.
I hope to hear back from you. Kind regards Lisa = )

Sigfús Víkþörðson said...

Assuming you have patellar tendinopathy in both knees and no other knee ailment, then I would recommend doing the squats first with one leg and then once you are done, then with the other. However, when you are first starting you can do them with both legs together as you ramp up. I'd recommend you do this under the supervision of a physical therapist who is very knowledgeable about eccentric exercise.
As for your possible irritation after your big walk, I'd assume you could have inflammation and would stay on the side of caution and wait.
Best of luck!

Joseph Miller said...

Sigfus --
First, if I haven't already, let me thank you for the tremendous contribution that you have made! Excellent content, good conservative advice, great photos and videos... it's just been a gold mine for me.

I'm into the first two weeks of your protocol and things are feeling very good.

Question: I'm assuming that fast walking on the flat would be an acceptable exercise while in the midst of rehab? Also, I use a Schwinn Airdyne with an easy cadence.


Sigfús Víkþörðson said...

Hi Joe,
I appreciate your comments. I would avoid doing too much walking even on flat surfaces in the early phases of the Protocol. And, when you increase your distance I'd recommend doing it incrementally.
Let us know of your progress. Best of luck!