Patella Tendonitis

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30/12/2008 at 18:19
Patrick, I have been running with my ASICS 2120's since October and no problems so it was Nimbus that caused the foot injury. You are right about weak muscles supprting the knee as this is what my physio said. The exercises I am doing are making me a stronger runner as my legs feel good during and after long runs. If you want to test how strong or weak your supporting muscles are try doing 1 legged squats without holding on to anything. I have been doing 3 sets of 15 each side for 6 months now and as well as lunges holding 6kg in each hand my legs are gradually getting stronger. If you don't get any joy with the podiatrist try a physio that specialises in running. Good luck.
30/12/2008 at 21:30
I thought I had this, I ran New York and didn't rest after, carrying on training where I left off, then suffered with my right knee, which has now kept me off running for six weeks.  An MRI scan showed some tenderness, but a bursa within the IT band.  It seems the IT band is the cause of my woes, I'm currently having physio on it but have no idea when I'll be running again.  I'm currently causing myself untold pain twice a day courtesy of a foam roller!
31/12/2008 at 19:00

Hi Moscow, sorry to hear about your ITB problem. I had this training for my first marathon in 2005 because I was new to distance running and did not know the mechanics of the lower body. I saw my doctor and a private orthopedic consultant neither of which knew what the problem was and had an MRI scan - Total spent £800. I was told to see a physio who found the problem in 5 minutes so went once a week for 6 weeks. ITB is caused by week glutes which make the ITB tight so I was given glute strengthening exercises and shown how to stretch the ITB. The treatment I received was ultrasound and acupuncture in the ITB. I think the acupuncture may be as painful as the roilling pin.

After all this I had not run for 10 weeks but started gradually and have not had an ITB problem since so it is fixable with the right treatment and exercises. Good Luck.

03/01/2009 at 12:37

smeagol

whilst scouring the net for a solution for my continuing pelvic rotation and knee pain i found some interesting literature. It shows that forward pelvic tilt and generally bad posture can assist in overprontation and most types of knee pain from itb to jumpers knee, its has made me think as to how my posture could have influenced my knee and pelvis problems, anyway have a read and hope it helps in any way, also iv found a web site that helps with a good efficent running posture.

good luck

http://www.chirunning.com/shop/pages.php?tab=r&pageid=18&id=37

http://betterrunning.com/train_tips_posture.php

http://www.runnersweb.com/running/rw_news_frameset.html?http://www.runnersweb.com/running/news/rw_news_20051025_PRP_Pronation.html

06/01/2009 at 19:52
Patrick thanks, these are uselfull tips. Now I have to adjust my running which I hope will help.
01/06/2009 at 05:13
I got patella tendinopathy, diagnosed through MRI, training for an ironman, 3 months out from the race, back in December, 2006. I was unable to run again in training due to the pain, but disregarded it, with the help of a cho pat strap, to finish the ironman. In hindsight, if I’d known I would still not be able to run 2 ½ years later, I would have skipped the race.
In that time I have seen an orthopaedic surgeon, 2 sports physicians, numerous physios and an osteopath. I have rested for 3 consecutive months without physical activity, stretched all associated muscles daily, iced the knee up to 4 times per day, used Aspirin as a NSAID for a month, diligently applied anti-inflammatory gel, taken glucosamine daily, used 3 boxes of glyceryl trinitrate patches, had hip and spinal manipulation and now use a custom orthotic. But up until about 4 months ago, the pain was worse than when I first incurred the injury. Even stretching hurt, as did 5 eccentric unloaded squats.
At that time I concluded that the tendon must be repaired and inflammation free, especially with all the anti-inflammation treatment I had applied. The tendon has most likely been poorly repaired with an irregular matrix of fibres, which will only be straightened through eccentric squats and exercise.
I had been unwilling to persist with these exercises, because of the belief that any pain was associated with further degeneration of the tendon. None of the medical personnel I consulted made the distinction between treatment of initial and chronic patella pain. I was told to perform eccentric exercises until the point of pain then stop and ice the knee. I see this as being more relevant to acute tendinitis, or during the initial phase of tendinopathy. 2 years into it the point of pain for me was 5 squats, followed by 3 days recovery – which is hardly going to facilitate drastic tendon restructuring and recovery.
Medical papers describing this condition state that inflammation is almost non-existent in chronic patella tendinopathy (meaning I spent many hours icing, taking Aspirin and applying anti inflammatory gel, with no benefit). Also, Glucosamine is for osteoarthritis and provided no benefit to my tendon repair
I now ignore the pain, and perform a program of regular eccentric squats. I have now done 22 successive weeks of eccentric squats, 3 x 20 each leg, twice per day, on a homemade decline board. I have made the board steeper with recovery, as well as the squat deeper and increased the number of times per day up to 3. Consistency is important, to stress the tendon to the same level each day, allowing it to remodel, without further degeneration. Skipping sessions, doing it when if fits in to your day, on different slopes and steps, etc, seems not to crack the back of it. These exercises will also help strengthen your quads, core, hip and gluteus max muscles if done in a slow controlled manner.
I can now sleep, sit, walk up and down stairs, bushwalk, kneel on the floor, crouch, ride everyday, rowing machine, spin class – all without pain. BUT, no matter how solid it feels, I can’t run more than 20 minutes without the bloody thing reminding me it’s there and requiring 3 days rest. There is hope, due to the enormous progress I have made in returning to other sports, but why running still irritates a tendon that appears solid is a mystery.
I am tempted to get another MRI to see how the initial degeneration compares to today. I am also just starting a program of barefoot running – to strengthen the feet, ankles and calves and to provide a different sort of impact on the knee to see how it comes through. Looking at the barefoot running websites, blogs and forums, the spruikers would have you believe it cures all running ailments – I love it! It will certainly enforce a change in gait, and if it works for me I will be a convert for life.
01/06/2009 at 19:11

Wow, thats a good assesment Charles. I hope you progress well.

I have increased the weights at the gym for my leg exercises and this appears to be working as I have been getting less pain and recently got a pb in a half marathon.

02/06/2009 at 00:12
Smeagol
run me through your weights program if you can, as I don't know if I can push the eccentric exercises any more than what I am currently doing.

Which exercises, what weight? reps? how many days/week?
In conjunction with eccentric exercises or stand alone?
Do you feel any pain when doing them?

I would love to run a half marathon again
02/06/2009 at 19:39

Ok Chris, here we go. I do weights 3 days a week on alternate days to running and they include upper body in the same workout as well.

3 sets of 15 reps leg press on 60kg.

3 sets of 15 reps adductor (I can't remember exactly what it is called but basically you have your legs straight spread out wide and push in until they touch) 3 sets of 15 reps on 50Kg.

3 sets of 15 reps half single leg squats with no weights but use a wall to help keep your balance.

3 sets of 15 reps lunges carrying 7.5Kg weight in each hand.

3 sets of 15 leg extensions on 35Kg

3 sets of 15 hamstring curls on 45Kg

All this and upper body and adominal / core strength exercises takes about an hour with a 10 minute warm up.

I do feel a bit of pain in the Patella like I do when running but it does not last. My physio said you have to strengthen the muscles that support the knee and these exercises are doing that. I plan to increase the weights further because I noticed an improvement within 3 weeks of the last increase.

Hope this helps.

03/06/2009 at 00:51
Smeagol
you look a bit puny in your photo so it's not working!

Seriously, though I will start a similar program based on what you have posted.
Thanks a lot for that
02/10/2009 at 15:18
Guys,

Today I have been diagnosed with Patella Tendonitis after various MRI's and X Rays. I ve been running nearly 13 years and never really had any problems till now.

I run mainly on roads (Which according to the doctor has not helped!) and for the last two months have had pain in my RIGHT KNEE cap which has got so bad it has been hard to walk.

After reading alot of the replies on here its pretty depressing stuff. I ve been adavised to swim and use a cross trainer to minimise any impact on it, but running is out, at least for two months whilst I have physio, if that doesnt work I ve got to have the steroid injection.

Does anyone have any advice/training tips on swimming and other stuff to help maintain that running fitness in the meantime.

I can only say I am mega depressed by this as I like everyone on this site loves their running and its all a bit doom and gloom really.

Ed A
05/10/2009 at 23:29
Ed
it seems tendon injuries don't heal unless stressed. ie. rest doesn't remodel the stagnant structure of an injured tendon. There were some medical papers I looked at where 1 guy had had the problem for 8 years. But, the 2.5 years I lost from running should not be the case if the injury is well managed.

It seems that a lot of medical people don't fully understand what is required either. If you look at my previous post you will see that only eccentric exercises have worked for me and only when done regularly to a consistent level of stress. I have become so familiar with these exercises I can recognise the point when I have gone too far, and would then expect a bit more pain for a few days.

Regarding cross training, swimming was no problem, bike riding mostly no problem, unless I pushed too hard or climbed a steep hill. core work and weights filled the gaps as well

don't be too depressed though because if you attack the knee in the right way it could be just a few months for you to see strengthening and recovery. I reckon I lost 2 years not knowing what to do, with 0 improvement and 6 months of fantastic progress, when I did know what to do. I have now changed my running technique, started by running barefoot, then switched to minimalist running shoe. Currently using Nike Free 3.0, with high cadence, small stride length and a very light step. Building up to a marathon, my knees still give some pain, but as Smeagol said, it doesn't last, and causes no cumulative detriment (which to me is the most important thing)
06/10/2009 at 10:00
Charles  many thanks, good to know there is light at the end of the tunnel despite what the doctors say!
14/10/2009 at 12:19
Can I have some views please.I did The Berlin Marathon 3 weeks ago and Boston in April.I had no problem in training for these until I started my taper for Berlin 3 weeks out when I noticed a sort of dull ache under the front of my right patella.When I did Berlin I was aware of this ache but after a few miles it disappeared .Since then it has been constantly there and though it is not painful if I press the tendonsunder the front of the knee cap and the inner front edge of the knee cap, pain or tingling is caused and they are very tender.Iget slight pain going up and down stairs.I have done some running since and it gets worse on hills and I am aware that its there constantly.Theres no swelling.Icing helps but does not fix the problem.
I am seeing a physio tomorrow but am worried as its just not progressing or improving.
My feeling is that there are tears in that area and overnight they heal and then retear the next day.I had achilles trouble a couple of years ago and tried total rest which didnt help then used eccentric exercises and returned to running and it sorted itself out.I note your exprience Charles and think maybe I should do the same again but I dont want to make it worse by doing the wrong thing.In the meantime I am thinking about my GFA place in London next year. Suggestions please?
19/10/2009 at 03:17
2old,
I'm no expert, so the following is based purely on my experience and may not be applicable to all.

ice will reduce the pain, but have no effect on long term healing, as there is no inflammation.

Re: 'healing and re-tearing', I would think not, as the tendon is short on blood supply, so healing is a very slow process. I would say that you have some damage, now stagnant, that will not go away without remodeling the tendon via eccentric exercise. Re pain, there are not many nerves in the tendon either so the damage is not always overly painful

I now realise that I had chronic, low level pain, tendonopathy, not unlike your own, for a year or so before I stopped running. It was only after a ramp up in training through some mountain running races, that the injury worsened dramatically and became a show stopper.

Eccentric exercises don't have to be overly stressful, if done a bit quicker and without lowering too far. I would do 3 x 20, twice per day, but real quick and easy, and see what you feel. If OK, keep it up and make them slower, which is where the real stress is applied.

Else, I would identify a window (say 3 months) somewhere in your race schedule where you could perform a strict and consistent period of eccentric exercises, with the expectation that you may have to break the tendon down a bit to rebuild it.

After you have been doing the exercises for a while, you can include both running and tendon remodelling in your schedule simultaneously. Currently I ease back on the exercises the week before a race, just so the tendon is a bit more stable when I need it to be. It is sore for a day or 2 after a race, after which time I hammer the eccentric exercises again
19/10/2009 at 12:48

I developed Patellar Tendonitis years ago after my ACL reconstruction op and they used a piece of the Patella Tendon as the graft. I was so eager to get back training I took short cuts I hadn't recovered properly I was back racing Road and Fell in less than 8 mths It wasen't long before I developed Patellar Tendonitis. I was on and off running for the next 18 mths untill I bought myself one of those Patellar Tendonitis strap. I cant remember what they are called its just a small simple strap that goes around the bottom of the knee cap to keep your Tendon stabile.

I've haven't had much problems with the Tendon since.

19/10/2009 at 14:32

Thanks Charles the worrying aspect of your history is that despite the eccentric exercises you still get pain whilst running. My physio is massaging the area to break knotted fibres in the hope they realigne as they heal and I feel worse after it.I will stick with it for a few weeks and assess progress.The trublesome area is under the main ligaments which protect it but as      I run they seem to rub over it and irritate it.

Good luck with your recovery.Dewi does your problem sound similar to mine?Do you think its the strap or the eventual effect of the op thats doing the trick?

19/10/2009 at 19:02

2old   The strap has done me world of good I dont need to use anymore only on occasions when my tendom feels inflammed when i've been doing a lot of running. If I had known then what I know now I wouldn't of let them use the patella tendon as a graft although it is the form of graft.

19/10/2009 at 23:04
The support strap is called a cho-pat strap, and for me it provided some delay in the onset of pain during a run

the pain I mentioned is not unexpected as I am still in my own recovery process, and it feels more like a stirring up of the tendon, rather than a degenerative pain.

sounds like the physio is doing the right thing stirring it up, but what about eccentric exercises? Massage works well with muscles as it lets the blood flow in between the muscle fibres providing nutrients and flushing out the damaged waste, but as I understand it, there is hardly any blood flow into a tendon and unless pulled by the correct amount of stress the fibres won't realign themselves. have a look at some of the medical papers online, some of which have images showing good tendons and damaged tendons. a similar analogy would be a damaged rope, which doesn't become taught and nicely aligned from poking it, unless pulled tightly from each end

sounds like your injury is manageable so you don't need to get too drastic. just keep in mind my experience if you did have a worsening of the injury (and note, 1 study I read, some poor bastard had the injury for 8 years)
11/12/2009 at 02:50

I've had tendonitis in both my knees for about 3 years now, i tried physio, orthapdeic inserts in my shoes and electro therapy and friction therapy and  the best way of treating it in my opinion (besides medical procedures, like ultrasound injections, which aided me in getting rid of it to an extent) is icing it daily with the application of dyfene anti inflamitary gel. I've also found that weight exercises such as deep squats and one legged leg press help strengthen it up and plenty of hamstring weights like dead lifts and leg curls, stay away from the leg extension machines and lunges, also plenty of hamstring stretches before during and after exercises, followed again by icing and dyfene. 

Hope this helps, I know how frustrating it can get. 

James 

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