Topic: PATELLA TENDINITIS

[leighton richards]

I've been suffering with patellar tendinitis for ages, so thought I would search on the subject and found this old thread which I thought I would resurrect.
Interesting about the power cleans and power snatches being possible culprits.
I am a power jerker, and I notice my knee is at its most painful after a power jerk session, much more so than squats.
Not sure how I can stop power jerking though, as it is impossible to split jerk in my garage due to low roof situation.
I could try to learn how to squat Jerk!

Good info from Paul, I have a couple of questions.
- What kind of stretching do you recommend, just quadriceps stretching where you stand on one foot, grab the other foot with your hand and bend your leg as far as it will go?
- Also how do you do deep friction massage?

Its impossible for me to do leg extensions as I train in my own garage and don't have leg extension equipment.
I do have knee sleeves, and I might try some "Deep Heat" balm also.
Icing after every weightlifting session I can do.
Ibuprofen, I take fairly regularly, but not a good long term solution due to risk of stomach ulcers.
The patellar strap might be worth looking into also.

Anyone ever tried Cissus?

Sorry for the brain dump here.

[Matt Rupiper]

Leighton,

Here is a research article on patellar tendonopathy.  Since you've been fighting it for so long, it is probably now classified as a tendonopathy and not tendonitis.  The evidence shows that working through pain may be more beneficial that plain ol' rest.  I would be careful with the stretching. 

A quick test of quad length is to lay on you're belly and have someone take your ankle and touch it to your butt.  If you notice your hips coming off the ground, you're rectus femoris (a quad muscle) may be tight. Give it a stretch.  If your hips don't move and your ankle can get to your rear end, i would not stretch.  It'll probably just irritate the tendon.  The research is still up in the air on treatment for tendonopathy as of now.

As for deep friction massage....get something fairly firm and some lotion and rub in a perpendicular line to the whole tendon.  Also, work on your patellar mobility....get in an extended position where the patella moves around and just make sure it moves well up, down, medial and lateral...compare it to the non-painful side. Hopefully they move the same.

Hope this helps

[Robert Kazuk]

Over the past year I dealt with persistent patellar tendon pain, more acute in on leg (incidentally, my forward leg in the jerk and the more flexible of the two).  Self-diagnosis and subsequent treatment led me to most of the suggestions presented thus far in this thread:  Light stretching of the quadriceps, cross-friction massage of the tendon, cryo-massage/icing post-workout, thorough warm ups, use of neoprene knee sleeves, limiting the aggravating movements, NSAIDs, negatives w/ leg extensions ...so on and so forth. 

Results?  Yes, the pain became manageable, but did not dissipate over time.  If anything, the pain and inflammation became even more acute when I lapsed in my treatment on days where I was unable to get in adequate stretching/icing/massage time.  Lots of "vitamin I" allowed me to continue an abbreviated training schedule, albeit with some level of pain.  For someone who did not have many chronic injuries over the past 15 years, this really stunk.  I conceded my efforts to be a loss and scheduled an appointment with a sports doc.  Diagnosis: Patellar tendinopathy, exacerbated by old osgood schlatter's calcification at the tibial tuberosity.  The translation into laypersons terms was that any new tendon grown at the damaged ends was laid down like a plate of spaghetti, not linearly like "old" tendon.  When stressed, this "young" tendon was damaged - broken vessels, inflammation, etc - and this was the stuff that was hurting.  Fair enough. 

The cause?  Not a monstrous squat routine (nothing about my squatting is big), nor lots of power movements (although they did aggravate the affected area).  X-rays showed a clean underside to the patella, no bone fragments to irritate, but they DID show that when flexed, the kneecap was tracking towards the outside of the joint.  Many years of neglecting myofascial release, or really much stretching at all of the ITB/TFL/glute max and min/piriformis/everything else in there caused the doc to remark that my ITB's were "like the floor".  All this adhesion and tension translated into a lateral pull on the tendon, resulting in an unhappy lifter.  It wasn't the ITB as much as it was everything surrounding and attached to it - the band itself is rarely the problem, and in my instance, the cause of the pain wasn't even near the knee at all.

Remedy:  I foam rolled alot, especially the quads.  I stretched the hip flexors, glutes, quads and hamstrings.  I used a cho-pat (patellar strap) for a few workouts but found it too restrictive.  I laid off heavy lifts for a couple weeks.  Most importantly, and I know I've heard this elsewhere, I made a very, very conscious effort to maintain a flat foot through the pulls, and to keep my weight on my flat feet/heels in the squats and full lifts.  To accomplish this, I needed more ankle mobility, so I built a small wedge board to carry around to work and back, just so I didn't have an excuse.

By being diligent with mobility, stretching, and rolling exercises, I've been lifting without pain for five months now.  Hope this helps.

Robert 

[Paul LaDuke]

Leighton, to answer your question, yes.  Stretch the quad by grabbing the foot in the opposite hand and pull it up behind you.

Some great insight Robert! 

I have learned some new things in the past months since posting my original treatment and I would look at the joints above and below the knee (ie. hip and ankle) for the underlying cause.  I have become a big fan of rolling using the foam rollers or "The Stick" in the training room.

Any changes from the normal biomechanics of movement in the lower extremity can change how force is transferred through the patellar tendon.  The patellar-femoral joint is a very particular articulation and any number of things can cause problems and in 3 dimensions!  So, keep rolling, keep stretching, keep using the full range of motion.  I have also found stop squats to really help me out instead of the negatives on the leg extension.

Hope this helps!

[leighton richards]

Thanks to Matt, Robert and Paul for all the info.
I have a lot to look into now.
Leighton

[AaronBell]

Robert,

I felt like you were describing the same exact symptoms that I have.  I've been experiencing pain for a long time (6 years or so)  but it has gotten progressively worse over the last few months since I really hurt it at a competition.  I'll go with the foam rolling and stretching and hope things get better. 

[Alexander Poptodorov]

Ice, stretching are key in not getting and healing it faster.
As far as NSAIDs, they only work temporarily and are not good for healing. If anything they prevent the proper realigment of the tendon fibers, so the tissue never heals completely.
The best I found was to use natural herbal extracts.  I use a curcumin based supplement called BCM-95.  Along with EnflyZyme by new chapter pharmaceuticals.  All natural and herbal.  I also have found great success for stiff and sore muscles and tendons to rub on a lotion I get from a chinese health clinic where I live.  I will look up the name and let you guys know what is the exact name.  It is strong and works great.

[Leighton Dougall]

Leighton you have a cool name.

My cure for patella tendonitis? Experimentation! I've had bouts of chronic tendonitis over the years, but the good news is just cos you've got it now, doesn't mean it's only gonna get worse, even if you've had it for a long time. The best change I made was a change in squat technique, moved my stance to point toes out further, so feet are pointed outward on more of an angle, and throughout the movement push your knees out like you're trying to be bow legged. My belief is that if you've got bad tendonitis then either you're training beyond your capacity, or your technique needs adjusting. Remember, push those knees out!

Leighton