If, like me, you get laid up for ages by this condition - you are going to need some kind of exercise to keep sane. I have (despite all my preconceptions ) found yoga (in particular
Astanga yoga) to be fantastic. I think Astanga suits me because of the flowing, moving cardio side to it and also a number of the poses provide lengthening (i.e eccentric) strengthening of the legs - just what you are after for tendinosis. The format of the classes (I got nowhere without an instructor) lends themselves to taking it gently and not over-reaching. I was amazed by how physically tired I got during/after these sessions and found them an amazing workout as well as leaving my muscles and tendons feeling warm, full of blood and well stretched.
I had always (as a runner, gym, bike, swim enthusiast) been a bit dismissive of yoga - but I'm a convert. You would need to find a class that suits your mindset, age, gender etc - and I would suggest that Astanga might be a good choice to suit the mindset of sports-mad people?
Go on...find a class, give it a try....at least you'll be off the sofa doing something..and you never know...you might catch the bug. I really like this poster (credit:
http://dailycupofyoga.net/yoga-resources/) and love some of those bent knee standing poses - great eccentric strengtheners (but take it easy to avoid a flare up!)
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Just came across your blog... Reading it is both refreshing yet depressing at the same time. I've been suffering from quad tendon pain for 4 months now. Im a 25 year old competitive cyclist and am very worried that I may never ride at the same level again. Your descriptions, symptoms, and rehabilitation efforts sound very similar to mine in many respects.
ReplyDeleteI originally injured my right quad tendon (above the kneecap) during a normal training ride and a 1 hr race that afternoon. I was then diagnosed with a strained distal quad tendon and prescribed PT. I decided (probably a bad idea in hindsight) to do PT on my own cause my insurance wouldn't cover it. Basically, I was seeing very little improvement but the orthopod didn't seem to give me any details on diagnosis or recovery. 2 months later I was still having symptoms (primarily pain from walking stairs and standing up or doing any type of squats) and had acquired awful hip and knee popping. Went to a new orthopod and had an xray and mri that both (apparently???) came back negative for any strains or tears. So, she sent me to PT again and whisked me away with no help, incite, or proper diagnoses. Went to PT once and have been doing exercises for 5 weeks now, plus swimming, and some eccentric squats with no or little result. Stretching offers some relief but it is painful as my tendon seems to have lost its elasticity. I stretch and do my exercises like clockwork, in addition to ice and heat when needed, compression, elevation, rest, massage, and foam roller.
What now!? My plan at this point is to continue my basic PT exercises and go back to sports medicine in a month or two if things stay the same. from there i have no idea. from what i've read it seems like shitty tendons remain shitty tendons. I guess I just can't fathom that one episode on my daily training ride has compromised my entire future as a bike rider/racer!!!!??? It just seems ludicrous to me.
If you've made it this far, I appreciate your concern. I much appreciate your blog and efforts to keep it current and quite informative. I wish you the best of luck on your return to being a marathoner. I hope we are both able to compete at such a level again soon!
jayabolofia@gmail.com
Hi Jay,
ReplyDeleteSorry for the delay in replying - was off on hols last week. So sorry to hear about your problems and know exactly how you feel. Here are a few thoughts....
(1) It probably was not that single episode that caused it - more likely an ongoing over-training problem that took a while to get to the point of pain. That is where I went wrong - I started a new training programme but at the intensity of the 20 yr old me - when I'm in my mid 30's :) I can remember the race when it started to hurt - but in retrospect I had niggles and indicators for a while before.
(2) You have age on your side (to an extent) tendon problems seem to become more prevalent and harder to heal in your 30's than in your 20's
(3) An MRI can show tendinosis (as we all as structure problems) but my consultant said they were harder to spot and were often missed if the film was not read by an expert also familiar with the case history and looking for it - worth rechecking ?
(4) Quad tendons are 'easier' to heal than patella - since the pat one is really a ligament and very poorly supplied by comparison with the quad tendon
(5) You may want to look at some other treatments; blood injections and shockwave. I have not tried these but have put some info on the blog. But you would want to be certain that PT and RICE had not worked - so your plan sounds good
(6) Be sure to start the eccentric protocol at very very low loading - see the wealth of data on this important point at : http://eccentric-exercises.blogspot.com/. It only worked for me when I started at a tiny, tiny level and built slowly - you really don't want to cause more scar tissue....
(7) My PT warned me off swimming (grrr another thing I cannot do) since the foot is not planted this can lead to lots of movement and stress (oddly she has recently suggested a bit of cycling now that I am improving - just what caused your problem in the first place!)
(8) I got a lot of benefit out of the eccentrics up to a point - but still have a stubborn pain spot that they have not got rid of. I would definitely recommend that protocol but I think I will probably still need to have a 'decompression' of the tendon (surgery) to get to that last stubborn area. I'll put up some info on what my consultant suggested
Hopefully you will be able to make some improvement in your condition. Also (and I know this sounds trite, and I would have ignored it earlier on in my problems) - don't be defined by what you cannot do, be defined by what you can do. I have spent a long time 'being a runner who cannot run' and it's not a helpful mind state. I guess now I'm starting to accept that I won't really run much in the future - but there are tons of the other outside things within my reach if I can carry on improving. You still have lots of options (including surgery) and I'm sure you will get back to cycling - but do think about the mix of sports, the intensity of training etc - if was not a sudden 'oh shit!' type of injury like a tear - then you probably do need to heed what your body is saying and train smarter rather than harder.
I really hope this helps you a bit - please keep in touch and let me know how you progress - its always good to let of steam to fellow sufferers....
Cheers
Kit