Knee pain: Patellar tendinopathy - A break from cycling due to patellar tendinopathy?

Question from TOUR reader Michael G.: I have been diagnosed with patellar tendinitis in my left knee. It was probably not originally caused by cycling (7,000 kilometres last year), but was probably triggered by a few jogging laps during the winter. When cycling, I now need a few minutes to "break in" the knee. But then I get through the training round without having any major pain afterwards. I can also climb stairs without any major problems. Sometimes it just seems to be the form of the day that decides whether it hurts or not. If I understood my orthopaedist correctly, patellar tendonitis heals slowly as the inflamed tendon is poorly supplied with blood and the healing process therefore takes a long time. Apparently there is a risk that the tendon will thin out and even rupture if the inflammation persists and further strain is placed on it. Do you have any experience of patellar tendonitis in cyclists and what advice can you give me?

Answer from Dr Christian Merkl: Patellar tendinitis is a chronic inflammation of the tendon insertion. It is often triggered when a trained cyclist switches to - usually unfamiliar - running training in autumn or winter and overstrains their cartilage and tendon structures. In contrast to cycling, running involves what is known as an eccentric form of loading - in other words, a tensed muscle is stretched during the landing phase. As tendons and bones have different elasticity, this often leads to overloading in these neuralgic zones (patella, heel, hip, etc.). To make matters worse, tendon-cartilage cells are metabolically inert tissue that regenerates more slowly than muscles. This is why problems with tendon-cartilage structures tend to become chronic.

As a therapy, it is recommended that you significantly reduce the amount of training and limit it to concentric exercise without body weight - you should refrain from jogging for the time being. In addition, osteopaths and physiotherapists can treat the often pathologically tense muscles and, for example, loosen fascial adhesions. In chronic cases, treatment with so-called shock wave therapy is also the method of choice. However, the body needs around two to three months before a completed series of treatments can be considered a success.