Chronic Patellar Tendonitus

[sill]

So I have been dealing with patellar tendonitus in one of my knees for about six months at this point you could say that it's pretty chronic. I've been through the whole sports dr. and physical therepey route with pretty minimal results. I was told that rest and stretching were the only things that would allow recovery, but both have done little or nothing to improve the pain or stength levels in my knee. Time away from climbing and trail running only left me out of shape and without any noticable recovery. I have tried a lot of different stuff to get this thing straitened out and it's getting pretty damn frustraiting. Anyone out there have some suggestions?

Edited January 17, 2007 by sill

[layton]

Strengthening your medial quadriceps muscles, aka the VMO (vastus medius oblique) is a good place to start. There are plenty of exercises online that show you how, i'm sure.

 

Glucosamine sulfate (not HCL)

 

stretch hams and TFL

 

tape your knee medially

wear a chopat strap

 

lots for you to do

 

 

[ronco]

Strengthening your medial quadriceps muscles, aka the VMO (vastus medius oblique) is a good place to start. There are plenty of exercises online that show you how, i'm sure.

 

Glucosamine sulfate (not HCL)

 

snip ...

 

 

Why Glucosamine Sulfate and not Glucosamine HCL? I've been using 1500mg Glucosamine HCL / 1200mg Chondroitin Sulfate from Costco (It's cheap!) for a year or so and my knees are better but not great.

 

I'd gladly pay more $ for the better stuff if it worked better.

 

thanks

 

ron

[sill]

I just started wearing a chopat type brace in the last week while at work and when I work out, havn't worn it climbing yet. It works pretty well. My one worry with that is that I've heard long term use of knee braces can be detrimental. For me though, it allows me to move around with little or no pain. I've been pretty good with the stretching, I just in the last few weeks have been able to stretch my quads without any pain in my knee. What is glucosamine sulfate? I have a fair bit of scar tissue built up, is there any way to decrease that Mike? Thanks for the help Mike, I really have had to educate myself with this thing, cause the p.t. that everyone said was so great was of little help.

[layton]

take a spoon handle, apply a little lotion, and stick it up..

no actually scrape the shit out of the scar tissue in the direction of muscle pull. it won't hurt as much as it sounds. expect some bruising though.

 

glucosamine sulfate is the product tested in the positive research studies. HCL is up for grabs if it works, some studies say no, some say yes... Ever wonder why it's cheaper?

 

Vit C and E are helpful in collagen restoration.

 

Exercises: Squats with a ball between you legs, leg press w/ball b/t legs, one leg squats, leg extension with ankle turned out.

start light...tubing or body weight in an eccentric motion (the muscle is lengthened and resisting...like someone is trying to push your leg instead of you pushing against theirs..understand?) So a slow controlled down phase of the 1 leg squat.

 

Then build up to an "open chain" concentric exercise like leg extensions against resistance...focusing on the VMO.

 

Look in the mirror. Are you knock kneed, bow legged? Is one leg shorter than the other? Do your arches collapse? Does your foot roll inwards too much when you run? Are you timing your toe-off phase correctly when you run? These are some of the things someone should look at to get to why you hurt your knee in the 1st place. Repetitive use in a correct way should strengthen your joints, not hurt them.

[catbirdseat]

If you haven't yet been to see a podiatrist, then there is a place to start. Don't go to just any doc. Find one who treats athletes, not little old ladies with bunions.

[Mountainstyle]

I hate to tell you this, but tendonitus doesn't really ever go away--It is aggravated or less aggravated. I wrecked pretty hard on a mtn bike about 4 years ago, chipped some bone and did some damage to my patellar tendon in my right knee. I ignored the pain and kept up with my usual trail running mileage, until both my knees hurt due to compensation. I ended up going to a bunch of PT (at a clinic that specalized in sports PT) to strengthen my diminished muscle strength in my quads and hip flexors, and to loosen up my tight hamstrings. The PT helped, but the pain has never really gone away in my patellar tendon. Surprisingly a chiropractor can do wonders for you. If you get your spine re-aligned, and possibly also your pelvis, this can provide a lot of relief. But the tendon still hurts, especially after runs. I don't run on pavement anymore. I usually massage the tendon and sometime apply heat after a run for relief. I have gotten to the point that climbing doesn't hurt it much, (over the years that is).

 

I say keep strengthing the muscles. Move through some of your pain, but also listen to your body. It will probably never heal 100%, but the good news is.... you can tell the weather with your knee know; whenever a damp cold storm front is moving in your knee should hurt worse.

[dmuja]

I have chronic knee pain as well mostly in my left knee - smacked a fire hydrant when I was 12yo and it swelled to the size of a football, never been quite the same (Im 45 yo).

 

Its a pain pretty much right on/in/over my knee cap, and pressing up on that one leg is difficult (weak and painful) at best. Descents (walking straight down hill) are the where the pain really begins though.

 

The following is what has worked for *me* but I don't know for sure the extent of any tissue/bone damage that may be present.

 

What I do to help the thing along is..

 

Cross train - My belief is that without surgery I need to strengthen any and all muscles around the knee to help stabilized it and make up for what ever may be damaged you might say. Spread the stress and avoid imbalances.

 

~ Elliptical trainer - mimics cross country skiing/snowshoeing.

 

~ Incline treadmill - walking and running up hill.

 

~ Cycling - recumbent and or traditional biking.

 

~ Sitting Leg Press - Machine says body weight + 10% x 3 sets

 

~ Supported Knee Dips (aka lunges) - The key here is "supported". Its hard to describe this one but I use a piece of equipment at the gym to support me via arms while I do the lunges. This works the intended muscles and puts the knee thru the range of motion you need for climbing and descents. Can be painful at first.

 

~ Stretching - lots of dynamic and balanced stretching of hams and quads etc..

 

~ Hill climbing - trail hiking in the mountains once a week.

 

~ R-I-C-E and massage - when needed.

 

~ Knee Brace - occasionally I'll use one for descents or when jogging but only when Im feeling some pain in it and I still feel like training.

 

Avoid Leg Extensions IMO (or modify them) - I used to do these and "leg/hamstring curls" as well but found the pain increasing over time mostly from the extensions, not so much from the curls. What I do instead is to reverse the elliptical trainer which then works the front "quads" for 5-10 minutes a session. I also systematically flex the quad muscles when I am on the inclined sit-up bench - again this works the muscle without the stress on the knee joint.

 

[layton]

just be aware that each of you may have a different diagnosis, so what works/doesn't for your condition may be completely different than someone else with knee pain.

[ericb]

I've got a fussy knee from a childhood injury as well, but it hasn't bothered me in several years. While it's hard to pinpoint what exactly has helped it, I have been taking Glucosamine regularly, kept the quads strong with machine extensions, and [wuss] started using trekking poles - esp. on the descent. I'm sure many will argue about the weight, but It does wonders for preserving your knees on steep descents with a pack. I also take pre-emptive anti inflammatories during stenuous climbs.

[layton]

there are safer and more effective knee exercises besides knee extensions - it's all about what imbalance exists, what activity aggravates it, and what activity you want to be doing.

[i_like_sun]

I had a partial tear of my quad tendon a couple of years ago. And yes, its a bitch of an injury! I had almost no improvement until I started doing more strength training. The problem with tendons and ligaments is that they are almost entirely A-vascular (no blood supply). This means that they just take a lot longer to heal than soft tissue injuries. Not supprisingly though, tendons respond to stress in much the same way as muscle tissue. In order for them to heal and grow properly, you have to send them the right signals. This means that a strength program that focuses on full ranges of motion under stress is actually very good for recovery. You just have to be extremely careful not to overtrain the tendon! Also, things like the stationary bike and elliptical can be very good for getting all the tissues around the tendon completely warm and saturated with blood and nutrients. Just try and take it slow. I made my injury last WAY too long by overtraining. There is a fine line between constistant active rest and simply making the injury worse. Good luck.

[downfall]

I also have been suffering the patellar tendonitus for about 6 months now and just talked with my podiatrist about it and all he recommended was the knee strap thing which seems to be helping. Says just wear it when it hurts and eventually it will go away.

 

I've also been trying to do the following things:

1. Fish oil + asprin every day.

2. Eat raw foods (a triathelete who I work out with developed massived tendonitis + calcification of his tendons by over training and over-carbing his diet which is pretty typical advice you see sometimes esp for someone who trains for those sports. Keep eating your meat, raw veggies, and stop that long distance bs unless you are out climbing).

3. Stop jumping until it heals. Its not called jumpers knee for no reason.

4. Ice massage after working out (put water in dixi cup, freeze, peel back and massage away on the tendon).

5. Stretch your hamstrings and lower back. So many people have fucked up lower legs because of these very typical problems. I've been trying to improve these and have seen the results in my knees. BTW, the ability to do a weighted overhead squat is good indicator of the flexibility and functionality of your posteior chain of muscles.