Question from reader M. Beck: I have had knee problems on both sides for a year now, mainly when cycling, sometimes also when standing for long periods. It's not a real pain, more a discomfort that travels from the tip of the kneecap via the tendon to its attachment point on the shin. The discomfort comes and goes when cycling, regardless of the load; at rest I feel nothing. The base of the tibia was swollen at times. The medical diagnosis was patellar tendinitis - supposedly not problematic and fine again after two weeks of rest, but unfortunately this was not the case. Manual therapy and osteopathy didn't help.
Expert Dr Merkl: Judging by the symptoms, I also think it is patellar tendinopathy - a chronic irritation of the patella (kneecap) tendon attachment at the lower edge of the kneecap. This is very often associated with a cartilage defect behind the kneecap, which can exacerbate the symptoms. However, I think a fourteen-day rest period is too short - patellar tendinitis tends to become chronic unless the mechanics change under stress. Even if the therapy is successful, recovery times of around six months are not unusual.
A key aspect of treatment is to reduce the generally increased tension in the hamstring extensor, as this causes the excessive tensile load on the tendon. Firstly, stretch the front of the thigh and secondly, strengthen the back of the thigh (this reflexively reduces the tension in the opposing muscle). In addition, avoid peak loads due to over-intensive training - a major risk, especially at the start of the season - and make sure you recover sufficiently.
Also important: check your position on the bike. Knee problems often arise because the saddle is too low or too far back. An incorrect pedalling position also contributes to mechanical stress. However, only change your position in small steps. The muscles in the front of your entire body may have become imbalanced, which can be corrected by the above measures and osteopathic treatment. The latter affects the connections between muscles and tendons. However, healing is only possible if you also change the mechanical stress on the bike and thus eliminate the causes.
Shock wave therapy, local physiotherapeutic measures such as transverse friction, acupuncture of the tendon or injections into the tendon insertion with Traumeel (a homeopathic complex remedy) also help.
Photo: Medical Picture
