One of the great things about being a triathlete is that your chances of a career-stopping injury are quite small. The prevalence of traumatic incidents, such as a torn ACL or concussion, is relatively low. Overuse injuries, resulting from repetitive motion over long periods of time, are the most common reason triathletes seek medical care. As a multi-sport athlete, you generally have an injury advantage because you train in three different body positions, but there are a few areas of the body that are susceptible to overuse problems such as tendonitis. Because both running and cycling ask a lot of your knees, the patellar tendon is at particular risk for becoming a pesky source of pain.
Also known as jumper’s knee, patellar tendonitis is an injury to the small, tendinous band that connects the kneecap (patella) to the shin bone (tibia). Pain typically occurs in front of the knee, but can also be felt underneath the patella, and increases with one or more of these activities: jumping, running, cycling, squatting, knee bending or straightening. Swelling and tenderness to the touch may also be present.
If these symptoms sound familiar, you need to know what not do to, so that your tendon can heal as quickly as possible and stick with your training plan. Here are five things not to do if you are suffering from patellar tendonitis:
- Jump or climb stairs. While most triathletes don’t make a habit of running stairs or doing plyometrics, the rainy off-season is prime time for mixing up routines with things like Circuit classes and Stair Climbers. Even low-impact jump roping, burpees and other types of hopping will increase stress on the patellar tendon and delay the body’s healing process.
- Rely on a patellar strap. Patellar straps seem like a fast and easy way to keep you in the game, but, unfortunately, tendonitis knows no quick fix. While straps that apply pressure to the patellar tendon can alleviate pain in some individuals, they can also shift the position of the patella and create more inflammation. More importantly, straps and braces do not address the root cause of the injury, which is typically a combination of muscle weakness above or below the knee joint and improper alignment during running or cycling.
- Continue your regular training. Scientific studies have shown that tissue damage occurs before pain is felt. Even severely damaged tendons can be pain free! Therefore, pain levels are not a good measure of how much to push yourself when it comes to patellar tendonitis. Because of their poor blood supply, tendons require weeks, and sometimes months, to heal properly, even when proper training modifications are made.
- Rest too much. Yes, you read that correctly! While rest is important, it is not the remedy for patellar tendonitis. Unloading the tendon (e.g. rest) makes it weak over time. Just the right amount of training – which can be a tricky thing to find on your own – is your best bet for optimal healing. Over and over again, eccentric quad strengthening has been shown to be the most effective treatment for patellar tendonitis. Specific hip strengthening exercises with modified aerobic training will also help the tendon heal. In short, the message here is to keep active, but with specific rehabilitative exercises and aerobic training modifications.
- Pick up where you left off. When your knee starts feeling better, resist the urge to jump right back into wherever you were in your training. A gradual return to your normal routine will allow continued healing of the tendon without setbacks. Remember, pain is only part of the picture. Returning to running and cycling with new awareness about your running form/cycling position and understanding how to achieve ideal hip and knee alignment are just as important as being pain free.
When your knee hurts, it wants and needs your attention. Take care of it by resisting the urge to run and ride through your pain and avoiding these five things so that you can enjoy many more years of being a pain-free triathlete!
Not sure if it’s patellar tendonitis? Wondering how to choose the best eccentric exercises for you? Unsure about how much training is ok when your knee hurts? Come by one of our 8 South Sound clinic locations for a free consult with a Board Certified Physical Therapist. Visit www.outpatientpt.com for locations and contact info.