Patella Tendonitis

[Bradders]

I've been receiving physio for a few weeks and had a few weeks enforced rest with patella tendonitis in the right knee. Over time it has made my left quad bigger than my right and inparticular the vastus mediallis muscle in my left leg, which is noticeably bigger than the same muscle in my right leg. This seems to be due to the fact I was subconciously putting more effort through my left leg when running to protect my right knee, and this was certainly borne out by the fact my left quad seemed to always get fatigued much quicker than my right.

I'm fairly sure from past experience that if I started running again tomorrow the knee would start becoming quite sore again fairly quick. I need to strengthen the right quad so as to even out the effort when running between my legs and thus hopefully stop the problem. The trouble is its difficult to do this i.e using squats etc, without making the knee sore again. It seems a bit of a catch 22 really.

Has anyone else had a similar problem and if so what did you do to try and get rid of it? Would be great to hear from anyone who got rid of it permanently.

[detritus21]

Ideally what you need to do is get your patella tedon as near as pain free as possible prior to starting mega strengthening as you'll just flare it up again. When it does come to strengthening take it slowly to start with and gradually build it up. You'll probably have to do lots of end range (inner range) quads work. If you type inner range quads exercises into google you should come with a few exercises

[RVN]

i wouldn't do squats if it hurts, or only do them in the pain free range (and properly), loads of non weight baring work you can to build strength in quad, as previously stated google search is the way forward! rec fem stretching might be good but if your seeing a physio, keep going with that.

[Swoop]

Welcome Christopher Leigh - 500th member!!!
What's your real name?

[niceguydave]

be careful if you are going to any physio that refers to patella tendonitis as tendonitis, its actually tendonosis, a deterioration of the tendon rather than an inflammation of the tendon, this might highlight they are out of touch with modern practice

[Georgerunner]

I had a bad case of this a few years ago and a physio sorted it. I was amazed when he demonstrated that my "weak" leg had become much stronger than my formerly "strong" one, due to overcompensation.
The trick was to strengthen the quads (both of them!), just stopping short of actual pain in the tendon. I did lots of simple leg extensions and iced them afterwards to get any inflammation down.

Its flared up a couple of times since, each time caused by running out of gas a long way from home and shuffling on with no spring in the quads. I suppose this proves the quad strengthening theory.

Before I went to the physio, I saw an orthapaedic surgeon who bunged cortisone in the knee. This did not work, hurt like hell and has left me with a lumpy kneecap. Always see a sports physio first and avoid w.....s who get paid a fortune to give injections...

[Bradders]

Thanks for all the input from everyone. Following a conversation with Chris last week I have been doing 1 set of leg extensions on my bench each day, on my bad leg only, with 30kg on, which allows about 20 reps. I've been doing this with an ice pack strapped to the knee over the tendon to stop it from inflaming while working it. I've been doing 20 mins each day on the cross trainer also with the ice pack on.

I've had no ill effects from this and the tendon is completely pain free so I'm going to try a short run with the ice pack on tomorrow and continue the leg extensions also. Hopefully after 2-3 weeks the strength difference between legs will start to even out making a recurrence unlikely.

[Gambatte]

I've been doing this with an ice pack strapped to the knee over the tendon to stop it from inflaming while working it

This is wrong. Ice AFTER exercise, not during. During exrcise tendon and musles must be worm, so more flexible and smooth. If cold, they are also tigher stiffer shorter, so inflamation is more likely.
If exercising gives you inflamation either you are doing it with wrong biomechanics or you are simply not ready yet to do it.
Can't believe your physio told you to ice DURING exercise.

20 mins each day on the cross trainer also with the ice pack on.

same!

going to try a short run with the ice pack on tomorrow and continue the leg extensions also.

same!

[detritus21]

Been watching this thread with interest.

Point 1 being related to nice guy daves comments about being out of touch with practice if physio calls it tendonitis. A decent physio should be able to tell the difference between tendonitis and tendonosis. Patella tendons can suffer from both I myself have witnessed them throughout my practice and you can have both together which make things interesting. Granted most patella tendon problems are tedonosis related but there are many that aren't and are tendonitis.

Point two in relation to the ice application during exercise. I myself wouldn't advocate this as there will be periods during exercise where the tendon will have non existant blood flow due to what is know as vasoconstriction. Ice application during exercise may also give a false immpression of pain free movement as Ice acts as a pain reducing modality.

The patella tendon is a relatively avascular area therefore I wouldn't want to exercise it whilst reducing the blood flow even more. Ice will also increase stiffness to as area as correctly said.

There is however some evidence to suggest that Ice application prior to exercise is effective as it reduces inflammation to the area but again risks increase as movement may become painfree as it is just masked by the effects of the ice.

I can't find enything to say exercise with ice on is right or wrong but the concensus amongst my colleagues is that they wouldn't.

My method of treatment would be along the lines of reducing local inflammation through Ice or other modalities. Stretching Quads, Hamstrings and ITB when painfree. Strentghening involving functional stregth exs eg mini squats, lunges any weight bearing strength exercises within painfree range basically. Assessment of Biomechanics is an important area as excess biomechanical abnormalities will exacebate and often cause the problems.

Anyway I've waffled quite long enough

[detritus21]

Concensus and will of the majority don't show a definite truth quite correct but using physiological principles that tendons and ligaments are elastic structures elasticity is reduced by cold therefore theoretically making these structures more susceptable to injury due to reduced elasticity.

I do agree though not everything on paper works and not everything that I do is on paper but I know some of it works.

I was just saying to air on the side of caution as exercise with ice seems to go against the physiology of the body the way it functions through Ice application but then what do I know