Physiotherapist Lucas Owen discuss Tendinopathy in Cyclists – Causes and Treatment.
Written by Lucas Owen.

Cycling by its very nature is a highly repetitive activity, with an average cyclist performing around 5000 pedal revolutions per hour. As a result cyclists are prone to developing overuse injuries of structures such as the patella tendon and the Achilles tendon, especially if there has been a rapid increase in cycling duration or intensity.

The structure and strength of connective tissues, including tendons, develops as a direct reaction to the load or stress that is applied to that connective tissue. As shown in the diagram below, after any activity that loads a tendon, there is both degradation and synthesis of collagen fibres within the tendon.

Tendinopathy In Cyclists

It is important to note that initially there is a ‘net degradation’, during which time the tendon has a reduced tolerance of further loading. Tendinopathy can develop when excessive or repetitive loading, such as cycling, is applied during this period of net degradation.

Overuse injuries that affect tendons are still commonly referred to as tendonitis (‘itis’ means inflammation), but recent research indicates that inflammation is not a primary factor in the cause or perpetuation of this condition.

The research shows that there is in fact a breakdown of the normal structure and arrangement of the connective tissue in the tendon, resulting in pain and restriction of movement and function, and the term tendinopathy is now accepted as a more accurate description of the underlying pathology.

Why does that matter anyway? Well, because effective treatment can only be provided if we know the underlying cause, and it is now recognised that the past emphasis on the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as Nurofen or Voltaren will be ineffective, as it is not an inflammatory condition.

The optimal treatment is now recognised to be the avoidance of compressive loads on the tendon, including stretching, combined with graded loading and strengthening, which may include specific eccentric strength exercises.

Strengthening of connective tissues such as tendons occurs in response to ‘overload’ – that is, a load that exceeds previous or normal loading – whilst reducing the load below normal levels will result in a gradual weakening of the tendon.

An essential component of rehabilitation of any tendinopathy, including patella tendinopathy and Achilles tendinopathy, is to initially only apply load every third day, which corresponds with the period when the tendon synthesis exceeds the degradation, and the tendon is more tolerant of load than it was before the previous episode of loading.

It has been recognised that the level of pain in the morning is the best indicator of a progression or regression of the condition, and close attention to this ‘morning pain’ provides an essential guide as to the optimal frequency and intensity of the graded strengthening exercises.

As the normal structure and arrangement of the connective tissues in the tendon is restored then the magnitude of the loading can be gradually increased, and then finally loading can be applied more frequently.

As well as a rapid increase in cycling duration or intensity, there are a number of other factors including age and general health status that influence the development of tendinopathy in cyclists, and the level of recovery, so it is essential to have your injury assessed and managed by a qualified health practitioner.

Lucas Owen is a physiotherapist that specialises in treating cyclists and is based in Melbourne. For more information please contact him using the following information:
Cycling Physiotherapy Centre
52 Templestowe Road
Bulleen, VIC, 3105
(03) 9852 1618