Ultra Marathon Training & Racing with Patellar Tendinopathy

I was six weeks out from an ultra marathon and diagnosed with Patellar Tendinopathy. The next logical step would be to withdraw from the race, focus on rehab and recovery, and research what race to do next. But throwing in the towel would mean I wouldn’t be able to write an article for Fast Bananas about all the things I learned about training (and racing) with Patellar Tendinopathy, so the story can’t end here!

Jokes aside, this was my reality in the middle of May. I was training for the Silver Rush 50 mile ultra in Leadville, Colorado, and after a training run one day, I woke up with serious knee pain. This knee pain caused me to limp around the house and unable to straighten my leg. This setback a month and a half out from my race was daunting and demoralizing. After significant rest and a couple of bike rides, the only thing that kept this race on the calendar were a couple of uncomfortable, but doable runs that provided a glimmer of hope. Once I confirmed with my PT that I did in fact have Patellar Tendinopathy, we put together a 4 week plan to see if competing in this race was still possible. Although I wrote a much more detailed 4 part series about my lead up to the race on LEVER Movement’s website, I wanted to give an overview of what worked well for me and what I learned from training with Patellar Tendinopathy in hopes that it can help someone else out there that is stuck in a similar situation. 

Jumping to the end of the story, I was not only able to race the 50 miler, but I took the win as well. This win meant so much more given the mental and physical effort of the build up. I used a body weight support device called LEVER significantly in my build up, I worked on loosening up my tight quads with dry needling & e-stim, I focused on the types of runs that managed the pain of Patellar Tendinopathy (ie. climbing uphill on soft surfaces), and I trialed and errored until I found a great rhythm of exercising and pain management. My PT gave me the guidance of being cleared to run if these two conditions were met 1) the pain didn’t get worse throughout the run; and 2) my gait was not affected by the pain. I had to quit on quite a few runs in these weeks leading up to the race, but it was mainly in these failed run attempts that I ultimately found the recipe for success.

What worked in the month before the Silver Rush 50:

  • The right rhythm of a training schedule. An outdoor run, an incline LEVER run (85%-90% body weight @ 3-4% incline), a day of cycling, and then repeat. Once I found this rhythm, pain management became much easier. 
  • My training week was focused solely on making the weekend long run feel good. Long runs were my key sessions for these 4 weeks leading up to the race so once I found out what worked on the pain management side, I made sure that the long run was the day I knew the knee would feel the best. 
  • Inclined LEVER runs: once I started testing LEVER runs at a 3-4% incline and activating my quads early in the warm up, the pain nearly disappeared during exercise.
  • Working with a PT! Dry needling with e-stim, red laser therapy, and exercises that activated the quads proved to loosen up the quad muscles and the tendons. I did one PT session a week leading up to the race.
  • Mental preparation. I was not in peak physical fitness for the race, but I used this setback to prepare myself as strong as I could mentally.

Where I failed in this last month of preparation:

  • Back to back outdoor runs. I had to bail on every back to back outdoor run attempt if there was not a LEVER run, a rest day, or a cycling day in between. 
  • Flat running had a much higher pain score than uphill trail running (even flat LEVER runs were not as comfortable as inclined LEVER runs).
  • Speed. Anything low 6, sub 6 min/mile irritated the tendon. 
  • Avoided hard descents. Climbing felt great, but I kept the descents very comfortable.
  • Swimming. Attempted a short swim, but the kicking during freestyle was painful.

Lastly, I said it before but I will say it again, if there’s just one person out there that can benefit from this information, then documenting this journey was well worth it. Experiencing an injury or a setback in the final weeks of race preparation is brutal. It takes a massive toll physically and mentally. However, my hope is that people can find hope in this story. As the Cofounder of LEVER, I receive stories from customers constantly that are similar to mine. Finding out what builds your confidence while in the middle of a setback is the key that will unlock your greatest potential. For me, it was discovering a pain management rhythm that got me to the starting line healthier than I could have asked for. If LEVER can be your key to confidence, we’d love to hear from you ([email protected]).

By: Brad Miles, Cofounder of LEVER