Patella Tendonitis

I have also experienced this problem.  I talked to my family doctor who tried cortisone injections, which did nothing at all.  I started wearing a knee tension bandage and that helped, but the pain never stopped - even when I wasn't running.  I tried stopping altogether for about 6 weeks and nothing changed - stairs were very painful. 

 I finally saw a sports doctor who identified the problem and suggested I do some physio to stretch my hamstrings (which are amazingly tight).  I'm not crazy about physio, so I started doing some stretching on my own and concentrating on building muscles around my knee instead of sitting around hoping it would go away. 

It took about 18 months, but I am now completely pain-free and this problem doesn't bother me at all.  Yes, it's a long haul, but if you really enjoy running, keep at it and don't give up.  At the same time, don't ignore the problem and keep running despite the pain - there are treatments that work!!

I have suffered this injury  2 years ago while playing football.  Initially It was misdiagnosed and treated with strong painkillers which not only dulled the pain but me also.  Physio and ice didn't help and when my employer found out the extent of the pain I was immediately offered private treatment.

The orthopeadic surgeon was able to pinpoint the exact nature and propsed an MRI scan.  After this he advised me that the type of injury I had received was at the top end of the scale and would require surgery.

I had an operation during January 2007 but have to concede failure.  I am still in the same position as when the injury was sustained despite being promised full recovery in 12/13 weeks after the op.  I have had further consultation with the surgeon.  He is reluctant to conduct more surgery due to the initial failure, higher risk of permanent damage and likelihood of another failure.

 I sought a 2nd opinion and was given the same answer.  I am resigned to the fact that my knee will never be the same again.

I am still using painkillers and anti inflamatories some 2 years after the injury.   This has also had a pshycological effect.

 I am sending this post so that all you folk who may read it  never ignore a knee injury.

Hi, I have patella tendon pain and have been struggling to get it better. I got it after being diagnosed with patelofemoral pain for the last 6 months, apparently this can then cause a problem with the knee tendons.

After lots of reading I have decided that the way forward is:

A large rest from activities that cause pain, I've read 9 - 12 weeks works best as the tendon takes a long time to heal.

Whilst resting encourage the tendon to heal eg, applying heat, ultrasound.

Massage (cross friction/deep tissue) to the tendon to get rid of scar tissue and align the healing fibres, maybe using deap heat as this heats the area too.

Eccentric exercises such as going down into a squat.

Am I on the right track? I massaged my tendon last night and it was more painful this morning, does anyone know about tendon massage? Also I have tried doing squats and they don't hurt when I do them but seem to make my knee more painful afterwards, does this mean I should do less?

Also I get sudden pain in the tendon under the knee cap like when I go up a stair, is this pain causing more damage to my tendon?

I would love to hear from anyone who has recovered from patella tendonitis, its so depressing being injured for so long!

Well - I'll tempt fate and say that I'm pretty much through it.

For me it started as a slight lateral maltracking back in march 06, when I upped my miles for a marathon. I live in a pretty hilly area and the long runs had virtually no flat sections, so the malalignment just got worse and the patella tendon was goosing me. I got my gait checked and started on the Quads exercises, both to realign the patella tracking and strengthen my muscle tone.  As long as I did them religiously (100ish/day) the pain was only really apparent on steep downhills + fell runs, but this didn't really get rid of it.

Over the last 6 months I have done thousands of miles of cycling, seeking out the local hills, and I think that this has been the key to getting better. Initially I noticed that 'brick sessions' (running straight after a 40 mile bike ride) were painless (knackering, but the knees didn't hurt at all), then that running a day after a long ride didn't set it off either. I now cycle pretty much every day, either up hills (because of where I live) or on the turbo trainers (high gears/increased resistance) and am finally able to run long without any comeback from my knees. I assume that the cycling is basically eccentric exercises, but many thousands of them on a long ride, rather than 3-4 sets of 20 squats, and that this is why the process has been accelerated.

Incidentally - my physio told me not to rest under any circumstances - you will just make the quads weaker.

Best of luck with it

Hi Blimeythatsbendy!

Did your tendon used to get sore after walking or was it only certain activities like running, going up/down steps, coming up from a squat?

When you first hurt your tendon did you have trouble doing squats? I can't do any as I get a pain in my tendon as I come back up, even if I only go down a bit into a squat.

Sorry for all the questions but I'm desperate to get out of the injury cycle I'm in right now. As soon as I start to recover from one injury another one starts. its now got past frustrating!!

Hi Roberts

Yes - at it's worst I was only really pain free when sitting down with my leg straight out - even driving hurt when I put the clutch pedal down.  Persevering with the squats was the beginning of getting better for me - although I felt every single one of them initially, and still do if I go a millimetre too low. Don't let it put you off - I was told that pain is inevitable, but not a bad thing as it is caused by degerate/scar tissue cracking up under the load, which is what you want it to do.

Top tip - get out on your back step if you have one, with both heels on the step and your toes outside - ie slightly lower than your heels - sort of on the way to tiptoes but not quite. Then bend your knees an inch or so. Try to keep your hips going vertically up and down, no leaning forward or back (use the doorframe as a guide) and keep your hands on the doorframe so you can help yourself up without relying on your knees if you misjudge it. The bend should be very slow indeed - and you should feel it all the way down and up.

Then try 2 inches down, then 3. You don't need to bend any further - the progression is in how many reps you can do while the pain slowly settles. It's frustrating but keep the faith - you'll get there in the end.

wow thanks that sounds great advice, I will start trying the step thing and see how I get on

Did you have massage to release the scar tissue too? And were you told to stretch lots? I think I'm supposed to be doing the quad stretch where you pull your heel behind your bum but the physio hasn't exactly specified this, he was a bit vague.

I tried going down an inch earlier on the step and it didn't hurt just felt a bit funny and weak, so I will try a few reps of this later.

Oh did you use a tendon strap too? The type that holds the tendon tight under the knee. I have bought the patt strap from america but have been scared to use them as I'm not sure how tight to pull.

Thanks again

I didn't do any massage as such, but the stretches are a good call - heel to buttock then tilt pelvis forward/glide knee backwards.

I did use a pat strap and very helpful it was too - but I know what you mean about tightness. You need the distinct sensation of squeezing just below the knee, with the padded bit making a visible depression in the skin overlying the tendon. Mine has a horseshoe shaped reinforcement to cup the lower surface of the kneecap and stop it slipping. If it's too loose then the strap moves, if it's OK it doesn't, if it's too tight it hurts.

At my worst I wore this all day and ran in it as well - an odd feeling initially but you soon get used to it. In fact one of my best running pics at the Eyam half marathon (hilly as you like, that one) has me with the patstrap in place. I only stopped using it because we had a hot summer and I was getting a sweat rash behind it, and I haven't dared get rid of it yet in case it tempts fate (as if I'm not doing that already...).

Best of luck. It's a common problem - both RW and Fetch seem to be full of treads on it, so if you have any top tips as you go then share them with our fellow crocks!

I would go to a physio just to get a diagnosis of what you have done and some recommended exercises or stretches. You don't have to keep going afterwards but its good to check what you are doing to your knees as you could end up making it worse and instead of a few weeks rehab it could need a few months if you carry on causing damage.

Having got the problem just before the marathon I cut back on training and got physio. Pain was gone for a good part but halfway became a problem. I had to walk the last few  miles and still not running much .  Saw all the feedback from others and it doesn't look like there is a good cure.

Yesterdays paper had an advirtisement on a strap http://www.kneedit.co.uk/ Does anybody has experience with this one? 

I was told about the kneedit as well, I've looked it up on the internet and decided that it was just a glorified patt strap and didn't think it was worth the money. If you do decide to try it you can get it cheap on ebay, everywhere else it was really expensive.

Ive been reading this thread and can only say that i know what all of you are going through, Im still going through rehab since picking up this injury. From what i have found out and studied having this jumpers knee or runners knee which is basically mistracking of the knee cap is very painfull. My injury was all self inflicted. Whilst training for new york i picked up this knee injury which was later termed jumpers knee by the podiatrician that i had been seeing to asses my gait at the time.Two months before new york i was just told to rest and let it heal, and that i could run new york if there was no pain. Long story short still sore i run the marathon and suprise suprise the knee has not improved in over 3 months. Another return visit so that i could have some casts for orthotic devices made as i do slightly pronate on push off, and that this could be affecting my recovery and again encouraged to totally lay off and let the knee heal. later that week id had enough, i knew that there was an underlying problem that was causing this discomfort and preventing the knee from healing. So clutching at straws i booked an appointment at a local sports phsyo, to my shock she got to the root of the problem within 5 minutes of talking to me, my right hip had rotated forward this was then pulling all the quads and the it band with in turn led to my knee cap mistracking, hence the pain!!!!. The hip has now been rotated back by a lovely physo and although it seems to rotate back on its own it will hopefully settle and the damage to my quads will take a good month or so to heal The worst thing is that i know exactly when the hip rotated and its all fault!!! Two months before new york i was going out on my long easy 17miler, but id be getting blisters from a set of new asiscs, so i put on my old set to see if they made a difference. All was good till bout 6-7 miles in. i started getting pins and needles in my feet, never i all my years running had i got this before, i stopped and walked for a while, then about 12-13 miles in i started getting pain in the soles of my feet again ide never had this prop before, looking back it was defo the hard high milage shoes, i now was running with a limp, and like an idiot didnt stop!!! this is where the hip rotated as i changed my gait and didnt stop. so this is where the knee pain started and that was 4 months ago!!!!

so for anyone suffering from this mistracking of the knee cap, please go have your gait checked as this could be leading to this condition, whether its a gait problem or a stupid injury like mine thats leading to a changed gait!!! Although its the knee that hurts it could be something else that causing it!! Im just glad i went to see and get expert advice from a very good sports physio in reading!!

good luck and c u all in new york 2009!!!

PB3, I pulled out of NY2008 because of foot injury caused by running shoes recommended by running physio. This was after having a full gait analysis where I was told that I have high foot arches so I should use Asics Nimbus which are suited to this. On a 14 mile run I started getting pain on bridge of left foot but completed the run, This went on for 2 weeks where a 16 mile run was very painful. I took 3 weeks off running and went back to my old running shoes and have had no problems since.

My other physio said to work on your core and leg strength which meant doing individual exercises for my legs. I have been doing these for 6 months now and things are improving. I still get  pain in the patella but live with it but the exercise prove how week I am in the muscles that support the knee which is where the problem lies.

smeagol.

sorry to here that you coundnt run new york, like your injury running in different shoes that changed my gait was the initial cause of my injury to. i hope the core exercises and leg exercises will help prevent any further knee issues, get some further advice from another running podiatrian about what shoes to use, i think if u over or under pronate nimbus shoes will prop be not giving you the support you need ( see a expert), as i am also resonably high arched and have used nimbus trainers for years with no proplems at all, untill i got a new set of nimbus 10's and just couldnt get on with them, i now use a nike zoom veromo 3 which are a really good neural shoe, with the best cushioning that i have come across.  From what i have read in journals and forums this knee injury can be caused by weak supporting muscles, so working on building up those muscles groups sounds like a good move. Since my pelvis has been put back (3 weeks ago) i have been struggling like hell, prop due to fact that its continuing to rotate back and again pull the knee cap and it band and quads, but am going to phsyio again next week and the podiatrian. im unsure what exercises i need to do to help strengthen my pelvis and core but will try to get some advice from the so called experts!!!!!!!.  good luck