Injury Prevention Strategies

I have been cycling competitively for 3 years now, coming into the sport from Triathlon. Throughout my entire athletic career I have had to deal with nagging injuries that I feel have limited my ability to train and perform.

I have been using trainingpeaks for 3 years to manage my fatigue, stress and recovery and I feel this has made a big difference. With that said I still feel that I am susceptible to overuse tendon injuries more than other athletes I know and train with. I have been dealing with off and on quadriceps tendonitis (left leg only) as well as some Posterior tibialis tendonitis (also left leg). My current pattern is that I will train consistently for 2-3 weeks, then do a big race or ride of ~ 200 TSS with high intensity efforts and aggravate my tendons and have to take time off to recover.

I recently took off 10 days and came back feeling great, only to do a hard race and start the cycle all over again.

Its hard to make a diagnosis because there are so many possible causes for injuries of over use so I will try to sum up my situation:

  • I am 30 year old male with education in exercise physiology
  • I ride between 500-650 TSS during building weeks and 200-300 TSS during recovery weeks.
  • I do functional strength training 2x per week with weights, body weight exercises, core strength and lots of one legged exercises. I also do foam rolling and exercises specific to my tendon issues.
  • I recently had a bike fit on a guru fit machine and am very happy with my fit, in fact ive never felt more comfortable
    *I have 2 rest days per week and prioritize my sleep (always over 8 hours) and recovery
    *I train early morning before work and always in a fasted state (even high intensity work) I have been doing this for 10 years and have not noticed any performance detriments in workouts under 2 hours. (I eat oats pre-ride before races and workouts longer than 2 hours)
    *I have been 98% vegan for last 10 years (occasional fish as my “nutritional insurance policy” :smile:

I am feeling frustrated because I feel as if I am doing everything correctly and am still being plagued by overuse tendon issues. I am writing this post to see if anyone else has struggled with injuries and been able to overcome them. Any suggestions are welcome, especially from the coaches here!

Have you had a professional bike fit? From a fitter that has seen the inside of an anatomy book?

If not start there, a proper bike fit includes cleat position too. If so, let us know and we’ll work off the assumption that your bike is not causing the injury

Yes I have had a professional fit from guru certified fitter. I’ve also consulted a PT to address any imbalances. My pelvis was out of alignment but I used wedges to correct that.

I have not made any adjustments to my cleats. perhaps that is something I need to address, but like I said I feel really good in my fit and use Shimano yellow cleats with 6 degrees of float.

Ok good - how about weight lifting, have you undergone an off season strength training program before? That is a great way of strengthening up your muscles, ligaments and tendons.

Then, how old are you and what training program are you on?

Are you adhering to the rest weeks every 4 weeks ala #FtFP’ing?

I’ll weigh in a little here since I’ve had some similar issues and treat them myself successfully as a sports chiropractor now working in the regenerative medicine space (PRP and Stem Cell). It looks like you’re doing almost everything you can to promote better tendon health but there are still a couple more things you can try. The first part of the issue is recognizing you’ve already had multiple bouts of tendinitis. When you strain and restrain the tendinous sheath you can cause a somewhat permanent change in the integrity and alignment of the collagen fibers. So this is no longer a discussion of injury prevention but chronic injury management. The second you feel a twinge of pain in those same tendons you have to really get after it with some therapy and a few days rest. If you try to train through it, recovery days will turn in to recovery weeks or even months.

Some of the very best therapy I do for patients (and myself) when tendinitis rears its ugly head is Graston Technique soft tissue mobilization (Google it). Look for a good sports chiropractor or PT in your area who is certified in this technique. If the area is very painful or inflamed I’ll pre-treat with US/E-stim combo, acupuncture or even anti-inflammatory creams. After treatment I usually Kinesiotape accordingly for tendon inflammation as well as muscle inhibition (we no longer recommend icing). Once the area is no longer painful to full active range of motion and under body weight movement, rehab with focus on eccentric loading is KEY. For the quads tendons this means the lowering phase of leg extensions. You’re using minimal weight, enough to stress the myotendinous junction but not trying for muscle or strength gains. I also recommend a supplement with Type II Collagen Peptides, but these are derived from animal sources (which means you could already be deficient as a vegan). If you still get problems to the same tendons in the future after all this, it may be time to consider Platelet Rich Plasma injections in the off-season.

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Thank you for the responses!

I have not done a traditional off season weight program. I have been doing my typical weight routine 2x per week while riding through the winter.

I am 30 years old and I just started the Sweet Spot 2 program. This is my first FasCat plan. I am only in the 2nd week and the tendonitis flared up, So i am going to have to adjust the plan or re start it after I get some more rest. I was following the plan perfectly, however on Saturday I did not have a group to ride with so I did a zwift race instead. It was mostly zone 2-3, however one large hill (x6) was a 45 second all out effort. It was that very high intensity that I think set this off. My power numbers for the race were nothing crazy for me though, so I didnt think it would be an issue. I guess that I was not healed from the previous bout and this triggered it.

This is very good advice! I bought a PADO purewave percussion massager that a PT recommended to me which apparently is very effective at breaking up the tissue adhesion. It definitely had a positive effect on my quads tendon. I am going to begin to use it on the achilles area after it calms down some more.

I think you correct in that this is now a management issue rather than a prevention issue. I am going to take some more rest days and get more aggressive with the exercises.

I should also note that I recently (within the last 2 weeks) switched shoes from specialized expert road shoes to specialized s-works 6 shoes. After switching my saddle felt high, so I lowered it 1cm. Perhaps i need to lower it a tad more as plantarflexion at the ankle in the recovery phase of the pedal stroke can put alot of tension on the achilles/PTT.

Switching shoes is HUGE - if your pain started after that there’s reason to believe your shoes changed your saddle height and could be contributing.

Try to get off the trainer - I find that the torque on a trainer for athletes is much higher than outside and this helps mitigate pain associated with forces from pedalling.

In conclusion @dcmaduff said it best. I would add a periodized annual training plan with a full off season break to let your injury heal fully and then a strength and conditioning program in the winter to strengthen