Patella Tendonitis, keep runni

I have suffered the above for about two months now. I stopped running and did some quad strengthening exersizes. I recently visited my long term physio who is great, but he advised me not to stop running and that I should keep the area moving, stop the risk of further atrophy and accompany the running with stretches, lunges and other strengthening exersizes. When I run I have to say I dont really feel the knee, but when I am sitting down I notice it continues to be very tender at he bottom of the knee cap and I keep wondering whether to continue running is providing further aggrevation to it? Unfortunately I can only visit my physio 3 weekly at present. Anyone got any thoughts?

Hi Simon,

Have a look at this: http://www.mayoclinic.com/health/pat...initis/DS00625

Stopping/continuing running is a personal decision; if it was me I would stop but try to keep fit with a "patter routine" and swimming - I would also stretch all muscle groups around the hip/knee/ankle, and do eccentric quads exercises as long as these were not painful - for example single leg squats, concentrating on the down phase; going down over 4-5 seconds, not letting the heel come up.

Good luck.

Simon,


I can only give you the benefit of my experience. Nineteen months ago I underwent a procedure on my knee called a micro fracture. When I received my report from the consultant about a month later it mentioned the fact that I also suffered from "Patella Tendonitis", he said the pain was probably being masked by the more serious problem with the knee. I took 4 months off then back very steady, ie low mileage 12\14 miles per week, which I never exceed even now.

At times the pain was pretty sharp, but I continued running, hell at my age I've not a lot to loose. Most of my runs are now almost pain free, in fact I have days with no pain. I did the Stretton Skyline mid September and never had a moments discomfort, and nothing subsequently. So there is hope you may recover as I did, just go easy on the miles, and stick with the excersizes.

Good Luck.

Thanks Mike and John........I am really hoping I never get to the surgery stage of things, but strangely John I seem to run pain free the tenderness is most apparent when I am sitting at my desk or on a bus or something similar?

Simon

Simon, I had a summer of this after the Three peaks fell race in 2008. The pain was always worst after getting out of a chair, or similar. Eventually after around three months I went to a good local physio who said my knees were extremely inflexible and my quads were weak. I incorporated squats into my trains (loads of them) plus did I did regular lunges and it cleared over six to eight weeks. Keeping the knees warm helped. I think you have to really get stuck into any strengthening exercises. Really attack them and think of surgery as the very last resort. I got quite down for a while and thought I'd never run again but my knees were the best they'd ever been afterwards and I get no pain from them now. Good luck! Andrew

Hi Simon

We are in the same boat.I think my problem was just overuse - borrowdale, steel fell and howtown inside a week not a good plan. I've laid off the running and done a lot of cycling (which keeps the knees mobile but doesn't put sudden stresses onto the tendon) and also done eccentric contractions initially with both legs together and latterly with single leg.These work by standing, toes down, on an incline of about 30 degrees ( a plank on the bottom step of the stairs) and doing a very slow squat till your knees reach about 40 degrees. This is the eccentric contraction as your quads are contracting although at the time they are actually getting longer! then stand up as fast as you like and repeat. I started with eight reps three times daily and worked up to twenty with both legs then went back to ten reps with each leg singly and again built up to twenty. this has definitely helped and although, like you, I don't really notice much pain when running I now have no pain doing anything else either. Altogether it has taken about four weeks to get back to this position. Hope this helps.

Quote:

---

Originally Posted by mykind

Hi Simon

We are in the same boat.I think my problem was just overuse - borrowdale, steel fell and howtown inside a week not a good plan. I've laid off the running and done a lot of cycling (which keeps the knees mobile but doesn't put sudden stresses onto the tendon) and also done eccentric contractions initially with both legs together and latterly with single leg.These work by standing, toes down, on an incline of about 30 degrees ( a plank on the bottom step of the stairs) and doing a very slow squat till your knees reach about 40 degrees. This is the eccentric contraction as your quads are contracting although at the time they are actually getting longer! then stand up as fast as you like and repeat. I started with eight reps three times daily and worked up to twenty with both legs then went back to ten reps with each leg singly and again built up to twenty. this has definitely helped and although, like you, I don't really notice much pain when running I now have no pain doing anything else either. Altogether it has taken about four weeks to get back to this position. Hope this helps.

---

Interesting. What is the thinking behind doing it on an incline?

Quote:

---

Originally Posted by Corniceman

Thanks Mike and John........I am really hoping I never get to the surgery stage of things, but strangely John I seem to run pain free the tenderness is most apparent when I am sitting at my desk or on a bus or something similar?

Simon

---

Simon, similar problems here. Have little or no pain running, but can struggle after sitting for a while, driving, pushing a shopping trolley (!?) etc.
Have had this on and off for years and I have come to the conclusion that this is related to:
a. overuse and particularly anything that will cause an imbalance in muscle e.g. cycling.
b. weak and/or inflexible calfs, quads
c. bad luck that my body is so bio-mechanically rubbish!

Symptoms are usually eleviated by ice and massage and keeping active though maybe at a lower level if the pain is not too bad. Any sharp pain and its ice and rest for a while with a gradual return. Ibuprofen if particularly bad.
A patella band I also find helps.

Prevention:
Basically everything else people have eluded to i.e. strengthening (esp. vastus medialus) and stretching. Also learn what your limits are (though keeping to them is the big problem for me!)

Quote:

---

Originally Posted by Mike T

Interesting. What is the thinking behind doing it on an incline?

---

The idea here is to stop the calf muscle making any significant contribution towards the control of the slow squat. flat footed squats can allow the calf to influence the rate of descent and thus make the whole thing less effective - I think!

I can see that on a flat surface the tension in the calf as the knee bends would tend to make the quads do less work.

A further couple of points on squats:

1/ do not let the knee(s) bend in towards each other - you should be able to just see the side of your big toe as you look down the inner side of your knee

2/ it is the initial taking up of tension that particularly strengthens tendons, so if going lower is difficult/painful, even those first few degrees of bend are beneficial.

yesterday I did countless single leg squats, Lunges and also a 6 miles steady run. I have to say I think there is a little improvement today. It will be interesting to see what happens after a day at my PC and sitting in meetings!

Over the last two days I written my self off. very sore knees, wobbly, cracking, unable to get up. Had a business meeting today where they have a top physio. Over heard aphone call where a guy had just cancelled his imminent appointment. erm if you've nothing to do... So in my suit in I went.

2 problems a bit of arthritis which was no surprise.but also diagnosed with Patella tenonitis.

no running for 4 weeks. There goes my fast Trigger:(
first week icing and anti inflammatries then stretching and squats...
some useful stuff above

Good luck Ian! Hit the squats hard. I had this in 2008 and they sorted me after I thought I'd never be right again

Quote:

---

Originally Posted by Derby Tup

Good luck Ian! Hit the squats hard. I had this in 2008 and they sorted me after I thought I'd never be right again

---

Partial one legged squats with weight and loads of stretching working for me. Promised the dog a decent run on Saturday, been that long i don't think she quite believes me:rolleyes:
Attachment 6675

I've done three runs this week. last nights head torch session I put some effort in to some of the sessions. feel unfit still but no pain this morning but i'm very slow on the descents as thats where the pain is.
At least they aren't cracking like they were.
Hoping to get through the Trigger but I think it will be a big ask. I'll do one leg at a time.....No pun intended....Slowly

Quote:

---

Originally Posted by Derby Tup

Good luck Ian! Hit the squats hard. I had this in 2008 and they sorted me after I thought I'd never be right again

---

Hi DT, Loads of questions! I have been doing squats now for some 5 months and although I can run there is still soreness in the knee cap especially kneeling down or just poking around in it. Happy to run abit more but wish it would completely clear. Did your go? Did you keep up the squats after the injury cleared and lastly.......how many squats were you doing a day?

From IDP ("I've done three runs this week. last nights head torch session I put some effort in to some of the sessions. feel unfit still but no pain this morning but i'm very slow on the descents as thats where the pain is.
At least they aren't cracking like they were.
Hoping to get through the Trigger but I think it will be a big ask. I'll do one leg at a time.....No pun intended....Slowly ")

Ian has your PT now cleared. I wonder too if I have some arthritis in there. I had to stop climbing due to arthritis in my elbows but hope that PT will be a seperate issue?

Simon

Quote:

---

Originally Posted by Corniceman

Hi DT, Loads of questions! I have been doing squats now for some 5 months and although I can run there is still soreness in the knee cap especially kneeling down or just poking around in it. Happy to run abit more but wish it would completely clear. Did your go? Did you keep up the squats after the injury cleared and lastly.......how many squats were you doing a day?

From IDP ("I've done three runs this week. last nights head torch session I put some effort in to some of the sessions. feel unfit still but no pain this morning but i'm very slow on the descents as thats where the pain is.
At least they aren't cracking like they were.
Hoping to get through the Trigger but I think it will be a big ask. I'll do one leg at a time.....No pun intended....Slowly ")

Ian has your PT now cleared. I wonder too if I have some arthritis in there. I had to stop climbing due to arthritis in my elbows but hope that PT will be a seperate issue?

Simon

---

Hi Simon
Knees feel reasonably good now but to be fair I've had some thing else to think about. the Patella it's self still remains sore if I kneel down or bang it but it's not painful when I run. I've found out that alot of other club runners have the same problem and most of them just "live with it" I suspect it's going to be the same for me.

I think when you've just got to manage it, certainly strengthening the muscles around it make a difference. One thing that has worked for me is when you come out of the squat/knee bend to continue slowly until you can't straighten it any more(almost hyper extend)and then pull up on you quad(tense the quad) if that makes sense. This pulls the tendons into their normal grooves...

Quote:

---

Originally Posted by IanDarkpeak

Hi Simon
Knees feel reasonably good now but to be fair I've had some thing else to think about. the Patella it's self still remains sore if I kneel down or bang it but it's not painful when I run. I've found out that alot of other club runners have the same problem and most of them just "live with it" I suspect it's going to be the same for me.

I think when you've just got to manage it, certainly strengthening the muscles around it make a difference. One thing that has worked for me is when you come out of the squat/knee bend to continue slowly until you can't straighten it any more(almost hyper extend)and then pull up on you quad(tense the quad) if that makes sense. This pulls the tendons into their normal grooves...

---

Thanks Ian, thats really re assuring as I think I am in a similar position to you in that I can now run but when I bang it etc... I will go for the hyper extensions of the quads and hopefully strengthen the knees supporting muscles more.

Simon

How are the knees Simon and Ian?

Quote:

---

Originally Posted by Derby Tup

How are the knees Simon and Ian?

---

Not too bad but then I've hardly run since the trigger. Hope all is ok with you Andy

Quote:

---

Originally Posted by Corniceman

Thanks Ian, thats really re assuring as I think I am in a similar position to you in that I can now run but when I bang it etc... I will go for the hyper extensions of the quads and hopefully strengthen the knees supporting muscles more.

Simon

---

DT, they are similar to how Ian describes his. i can run but there is a tenderness if I kneel down or bang the knee cap accidently. Are you still doing squats to avoid the injury returning and do you still have that residual tenderness?

Quote:

---

Originally Posted by Corniceman

DT, they are similar to how Ian describes his. i can run but there is a tenderness if I kneel down or bang the knee cap accidently. Are you still doing squats to avoid the injury returning and do you still have that residual tenderness?

---

Sorry, I've only just seen this. I don't really do any squats now and haven't really had any knee pain since. From memory, it took several months for my problem to clear up. I was doing around 200 to 350 squats per week typically in 3 or 4 sessions

So mines back again, this is the only injury I have struggled with over the past few years.

Since Oct '10, I have struggled with it 6 times, each time having to stop running for a least a month. Since the first time I had it I have only managed 4 months training without this problem before it returns, maybe this is what I just have to get used to?

So frustrating, as each time I get over the injury and start running again I keep reducing my running mileage to prevent this.. to the point where I am only running 35mi - 40mi a week within 4-5 runs.

All my shoes are pretty new-ish and haven't done many miles so can't be that, haven't done anything different in training, not big mileage increase etc.

Knee is too sore to even start doing squats.. I thought my quads would be pretty strong as I'm on the turbo trainer 3x a week doing some hard interval stuff.

Was meant to be doing my first fell race of the year this weekend!

Quote:

---

Originally Posted by Will-Moorlands

So mines back again, this is the only injury I have struggled with over the past few years.

Since Oct '10, I have struggled with it 6 times, each time having to stop running for a least a month. Since the first time I had it I have only managed 4 months training without this problem before it returns, maybe this is what I just have to get used to?

So frustrating, as each time I get over the injury and start running again I keep reducing my running mileage to prevent this.. to the point where I am only running 35mi - 40mi a week within 4-5 runs.

All my shoes are pretty new-ish and haven't done many miles so can't be that, haven't done anything different in training, not big mileage increase etc.

Knee is too sore to even start doing squats.. I thought my quads would be pretty strong as I'm on the turbo trainer 3x a week doing some hard interval stuff.

Was meant to be doing my first fell race of the year this weekend!

---

Will. Real sympathies to you. from the above you say knee is too sore to even start doing squats? Does it get that sore suddenly or do you gradually reach the level of pain you are describing? The reason I ask is whether you could do the remedial physio, eg squats, lunges before the acute level of pain really hits? Otherwise does your pain subside after a little rest and ibuprofen etc? if so can you commence a gentle and building regime of physio/remedial action then? With mine, I hated the pain( but it doesnt sound as bad as yours) so initially I rested. my physio advised I should do some light jogging and X training to avoid atrophy of the quads and that gave me some confidence. I aslo couldnt understand why I should have weak quads when like you I am constantly working them and was racing great when the injury forst struck. The answer I was given was that PT occurs like many injuries due to minor micro tears and that as these become more frequent the injury begins to show itsself, therefor your turbo sessions might have been causing those micro injuries that then you began to feel as the acute pain when you felt the onset of PT. Your injury sounds quite chronic now and you might need help in breaking down scar tissue on the underside of the knee cap which as you know will imopede recovery or as with all scar tissue is weaker and less flexible than good tendon. Have you seen a physio yet? I know alot of you Leek based guys are consulting Mike P from Stoke, you might know him and at least he's a fell runner which is always good. Jon W from Moorlands should be able to give you Mikes contact details? Good luck with it and as DT has said, those squats do work and kind of keep it manageable if not a total cure.

Simon

Quote:

---

Originally Posted by Will-Moorlands

So mines back again, this is the only injury I have struggled with over the past few years.

Since Oct '10, I have struggled with it 6 times, each time having to stop running for a least a month. Since the first time I had it I have only managed 4 months training without this problem before it returns, maybe this is what I just have to get used to?

So frustrating, as each time I get over the injury and start running again I keep reducing my running mileage to prevent this.. to the point where I am only running 35mi - 40mi a week within 4-5 runs.

All my shoes are pretty new-ish and haven't done many miles so can't be that, haven't done anything different in training, not big mileage increase etc.

Knee is too sore to even start doing squats.. I thought my quads would be pretty strong as I'm on the turbo trainer 3x a week doing some hard interval stuff.

Was meant to be doing my first fell race of the year this weekend!

---

I've been out for about a month with mine. I've been using a hot water bottle twice daily and NSAI gel once daily, along with 2 sessions of infra-patella friction massage per day. My physio has tought me how to locate scar tissue by feeling around the patella and work it away; a stubborn area can clear in about a week with intensive work but you have to allow the repair processes to take place and not bash it relentlessly.

I'm on 2x40 squats each morning now, but by the end of the week this will rise to 4x30. I've also identified the rowing machine as a good route back in. It has been suggested to be that i can use shallow squats with a fair amount of weight on to work the deep quad muscles.

One other thing that i have found is that static quads exercises makes a leg less prone to PT. My bad knee, which has had nearly a year of static quads, has cleared up far faster than my left.

Will, be prepared to cut your milage down significantly if that is what is required. It took me longer than i can recall to come to the harsh truth that you cannot beat an injury by running; whether that running is training, racing, 'running through' the injury call it what you like it doesn't work. Restructuring your running pattern might be all you need to get more rest days. I went through a lot of misery and soreness by being stubborn.

I had this quite badly about a year ago. I did no running for about a month and hit the bike instead. High cadence, low resistance (mind numbed) on the turbotrainer was what the physio ordered. I started running about once every three days (cycling others) and built up over the next month to the point where I was running most days two months out.

This isn't going to be a popular observation on a fell running forum, but one thing that is probably a factor is gradient. You may find that you can run on the flat before you can tackle the ups and (especially) the downs. This was OK for me at the time, because I was marathon training, so I stuck (mainly) to the flat for a while after.

My personal conviction is that a lot of it is down to how you run. The PT was my first significant running injury. I had my "Born to Run" moment and worked at changing how I ran over the summer. I still had minor flare ups occasionally on the downhills but any pain was momentary and didn't stick around - I tried to use it as an early warning system to help me develop my technique. It seemed to work. The flare ups went and over the second half of last year I ran more.

Everything was going well until I developed some foot pain a week or so ago. I diagnosed that to be down to ill fitting shoes, but I think running with the pain affected my form and by the time I had found shoes that got rid of the foot pain I had patella tendonitis again.

I don't know whether the PT would have reoccured had I not had the foot issue. I like to think not, but of course I'll never know. Thankfully it doesn't seem to be so bad this time. Pain walking up and down stairs the day after has now cleared and I'm optimistic that I may be able to run again in a week or two. One thing that's helped is not trying to run through it when it first occurred. That definitely made things a lot worse first time round. This time around I'm also going to try and be more diligent with the strengthening exercises and to keep them up after the injury's gone, as PT evidently is something I'm prone to.

Much sympathy and best of luck to all you fellow sufferers!

well heres a very pleasant surprise. after my heart problem I lost the will to do any thing including my strengthing exercises. I've turned up in the Alps about to go skiing and my knees sounded awful, cracking and quite painfull. Wasn't very optimistic but.......

3 days of skiing, actually 3 days of hard skiing and they feel....well great. no cracking and no pain. still sore if I kneel on them but they feel really good. maybe all that flexing has done the work of the squatts

So after two weeks of complete rest with the usual ice / heat / anti-flam / quad streches things seemed to have settled down slightly, pain has eased so I am able to cycle at a higher cadence. Harder efforts there is pain, same goes for walking up stairs but hopefully it's on the right track.

If I can make it out on the bike a bit more then I'll be happy.

Maybe your correct mr brightside, think I'll try and get out on the bike a bit more to keep the volume up and cut the running but making sure when I do run its quality.

This time I stopped the first time I felt it and not doing what I usually do, going on a number of runs 'testing it'.

Hoping I can get some decent rides in soon then get back running for March as Skyline is still a big target!

Reading all of your accounts is sounding familiar. It's surprising how many of us suffer from knee problems at one time or another. Right knee pain flared up with me in early 2010 after a year or so of slowly increasing niggle when I hammered the downhills, but it only flared up properly when I had to stop running due to a broken foot. Before I knew what I know now - that it was tendon inflammation underneath the kneecap - I thought it was the end. Rest made it worse and sitting was the worst of all. I couldn't keep my leg bent at right angles. My comeback began with the LDWA 100-mile walk/run in Scotland. The long-term gentle exercise and stretching over 34+ hours brought relief I never dared imagine. I could sit in comfort again. Tendons are funny things and they don't like total rest.

I'm still no better, it's just moving from knee to knee. This week my right is terrible and i've had to give up my remedial exercises completely, i've given up on race targets as there is no point being ambitious, i can't swim at the moment without paying for it in pain.

Quote:

---

Originally Posted by BritNick

Reading all of your accounts is sounding familiar. It's surprising how many of us suffer from knee problems at one time or another. Right knee pain flared up with me in early 2010 after a year or so of slowly increasing niggle when I hammered the downhills, but it only flared up properly when I had to stop running due to a broken foot. Before I knew what I know now - that it was tendon inflammation underneath the kneecap - I thought it was the end. Rest made it worse and sitting was the worst of all. I couldn't keep my leg bent at right angles. My comeback began with the LDWA 100-mile walk/run in Scotland. The long-term gentle exercise and stretching over 34+ hours brought relief I never dared imagine. I could sit in comfort again. Tendons are funny things and they don't like total rest.

---

I've had a knee niggle recently which seems to be getting sorted now. I've found this web site- mobilitywod.com really useful. Do a search for knee and all sorts of ideas come up, some interesting ones too.

I've been having shockwave therapy on my kneecaps which seems to be working, and the rowing machine is good for coming back. I've got to go for a 20min jog on sunday, flat.