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patella tendonitus

kevin_stephenskevin_stephens Posts: 184
edited November 2011 in Training, fitness and health
I have sufferd from this for a while on and off and now does not go away, despite drastically reducing my cycling this year and then only to flattish low intensity rides. however rest does not seem to be making much diference

I think the injury originally occured a few years ago from mashing up a local hill in too high a gear trying to max out my HR. This year maybe re-tweeked it in a mild skiing fall back in January.

My main sport is rock climbing, which is not effected (apart from sometimes walking to/from the crags). But lack of regular cycling is making it hard to keep my weight down.

Can anyone recommend a magic cure, or failing that a sports physio in NW England good with knees?

Or is it just something I'll have to learn to live with, being in early 50s?
I want to climb hills so badly;
and I climb hills so badly
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Posts

  • freehubfreehub Posts: 4,258
    Are you taking any anti-inflammatory medication?
  • I've been doing some more research

    according to this
    http://www.physioroom.com/injuries/knee ... y_full.php
    anti inflamatories can be counter productive

    I might try a knee strap as advertised on the links. Has anybody else tried something similar?
    I want to climb hills so badly;
    and I climb hills so badly
  • knedlickyknedlicky Posts: 3,097
    I had these problems a few years ago from the same reason you state (mashing up a local hill in too high a gear) and I ended up off the bike for nearly 12 months. What eventually seemed to help was getting ultrasound treatment at a sports doctor's practice. Not intensive, or even very long (maybe 12 sessions each 10 mins), but an amazing difference after hobbling for months (going up steps at underpasses was a real trial).
  • MarkMcpMarkMcp Posts: 426
    I've had this problem too. I agree that Ultrasound helps, but for me the best thing for me is to make sure I do a LOT of stretching before and after a ride. Especially the quads which I was told by a sports physio were much too tight and were putting too much pressure on the tendon. Stretching and a once monthly visit for a proper sports massage ( which is agony) did the trick.
  • huuregeilhuuregeil Posts: 780
    Kevin,

    What you've got to realise is that patellar tendonitis is likely to be caused either by some muscular imbalance/weakness or tightness. As such, a long term solution to this will involve getting stronger and more flexible by doing targetted exercises (such as squats, etc.) and stretching. Poor quad strength is likely to be the most obvious cause, but it could be a whole range of other things (so do see a physio).

    However - and this is the killer - while it's inflamed and giving you grief, you can't do those strengthening exercises and so it'll never get better! I think you'd be best off stopping the riding until the pain goes. Daily icing is an excellent way of getting the inflamation down. Also watch out climbing too (i'm also a climber) - walking up to a crag with a loaded sac puts a surprising amount of load in this area (quads are the primary walking uphill muscle) and certain moves (rock-overs in particular) and any non-overhanging climbing generally are going to load the quads up.

    Find a good physio (ideally a sportsperson, because they tend to understand where you're coming from, and ideally one who's into manual therapy), get rid of the pain and get a decent rehab program put together, which you'll probably have to stick to for a while. A good sports masseur is also probably going to help loads, and they tend to be quite good at picking up muscular imabalnces.

    If you're worried about putting on weight, swim (but not breaststroke, which is stressful for knees).

    Good luck!
  • freehubfreehub Posts: 4,258
    I think I may have patella tendinitis, I have some sort of tendinitis.

    Above my knee and slightly to the left I have clicks and apparently there is a tendon there? Below my kneecap and just above it I get pain sometimes, the skin above my knee cap appeared pinkish ( I thought this was normal but apparently it is not), but since I have being taking anti inflams it appears the pinkish skin has turned normal and my pain has eased down, I had an MRI scan some time ago, my doctor said she will look at it and if need be refer me to a physio quickly.

    I went for a ride yesterday and was giving it some and it's no worse today, I know about the link you gave but in the long term it's ok to use them IMO.
  • Rich158Rich158 Posts: 2,348
    huuregeil wrote:
    Kevin,

    What you've got to realise is that patellar tendonitis is likely to be caused either by some muscular imbalance/weakness or tightness. As such, a long term solution to this will involve getting stronger and more flexible by doing targetted exercises (such as squats, etc.) and stretching. Poor quad strength is likely to be the most obvious cause, but it could be a whole range of other things (so do see a physio).

    However - and this is the killer - while it's inflamed and giving you grief, you can't do those strengthening exercises and so it'll never get better! I think you'd be best off stopping the riding until the pain goes. Daily icing is an excellent way of getting the inflamation down. Also watch out climbing too (i'm also a climber) - walking up to a crag with a loaded sac puts a surprising amount of load in this area (quads are the primary walking uphill muscle) and certain moves (rock-overs in particular) and any non-overhanging climbing generally are going to load the quads up.

    Find a good physio (ideally a sportsperson, because they tend to understand where you're coming from, and ideally one who's into manual therapy), get rid of the pain and get a decent rehab program put together, which you'll probably have to stick to for a while. A good sports masseur is also probably going to help loads, and they tend to be quite good at picking up muscular imabalnces.

    If you're worried about putting on weight, swim (but not breaststroke, which is stressful for knees).

    Good luck!

    +1, sound advice

    I've had Patella Tendonitis for ages, the first time it was treated with ultrasound etc and it went away, although the underlying cause was never treated. When it came back I tried a different physio who saw the imbalance in my quads, and gave me a series of strengthening exercises, and stretches which have done wonders for me. It still flairs up occasionally if I push things too hard, especially when running, but soon calms down again. When I look at how imbalanced I was I wonder how I ever managed to walk upright :shock:
    pain is temporary, the glory of beating your mates to the top of the hill lasts forever.....................

    Revised FCN - 2
  • thanks for the advice folks I started physo today; an ultrasound session then passing high frequency current through my knee apparantly to help align my healing tendon fibres :?

    Sounds like mumbo jumbo to me but I look forward to seeing some progress
    I want to climb hills so badly;
    and I climb hills so badly
  • timdanahertimdanaher Posts: 120
    Kevin --

    Would you mind keeping us posted on your progress? I've got exactly the same problem, and I've had it the best part of nine months now. Agree with other posters that rest doesn't seem to be doing much good.

    I also did it in almost exactly the way that you describe... I was going up an incline, but ironically I was trying to keep the pressure off my right knee, which I'd hurt in a fall. I want to try and give ultrasound a go when I'm back in the UK at the end of this month.
  • timdanahertimdanaher Posts: 120
    Kevin --

    If you don't mind, could you tell us how much you pay per session for treatment?

    BTW, did a bit of rooting around and found this article:

    http://www.pponline.co.uk/encyc/how-sci ... pain-39583

    I'm wary about doing the recommended exercise, though...looks like it'd make it worse. :?
  • Tim

    Standard charge is £32 fpr a half hour session. My physio recommended the squats, but only one set of 5 morning and evening, rather than 3 sets of 15 :cry: morning and evening as in your link.

    I think I'll split the difference and see how it goes..........
    I want to climb hills so badly;
    and I climb hills so badly
  • timdanahertimdanaher Posts: 120
    Thanks, Kevin — and best of luck!

    (FWIW, I'm finding that the quad stretches—pulling the foot up behind your thigh—seem to be doing some good.)
  • Rich158Rich158 Posts: 2,348
    thanks for the advice folks I started physo today; an ultrasound session then passing high frequency current through my knee apparantly to help align my healing tendon fibres :?

    Sounds like mumbo jumbo to me but I look forward to seeing some progress

    Sorry to be the bearer of bad news but I went through that 18 months ago and it didn't do mauch for me. The only thing that worked for me was a series of stretches/exercises to redress the imbalance in my quads, which worked wonders. Seriously if you're not happy with your physio look arround for a different one, they all seem to have a different approach and it's a question of finding what's right for you. I'd never go anywhere alse now I've found one that works with me, and my desire to get back on the bike asap. She always treats the underlying cause as well as the symptoms which is far better in the long term.
    pain is temporary, the glory of beating your mates to the top of the hill lasts forever.....................

    Revised FCN - 2
  • mcdavid 421

    try and get the thinner version (red inside the knee support)

    had knee problems for years, and now, i can ride again....wooohooo

    also, stretch them hamstrings!
  • huuregeilhuuregeil Posts: 780
    Rich158 wrote:
    thanks for the advice folks I started physo today; an ultrasound session then passing high frequency current through my knee apparantly to help align my healing tendon fibres :?

    Sounds like mumbo jumbo to me but I look forward to seeing some progress

    Sorry to be the bearer of bad news but I went through that 18 months ago and it didn't do mauch for me. The only thing that worked for me was a series of stretches/exercises to redress the imbalance in my quads, which worked wonders. Seriously if you're not happy with your physio look arround for a different one, they all seem to have a different approach and it's a question of finding what's right for you. I'd never go anywhere alse now I've found one that works with me, and my desire to get back on the bike asap. She always treats the underlying cause as well as the symptoms which is far better in the long term.

    +much!

    Kevin - when I read your post, I raised a small eyebrow. Having been to physios in the past who just hook you up to ultrasound/inferential current mahines and leave you too it, if a physio tried to do that to me in future, I'd look for another one. That's not to say it might not be appropriate for you - and ultrasound does have its place - but only in the context of a much wider approach. As Rich158 says, it's the rehad that really counts and you need to find a physio who's exceptionally keen to get you in the gym (with one-on-one sessions to check you're doing it right and to make you work to the limits of your capability!) ASAP and working on a very structured exercise program. And, as I said, physios who use or advocate manual therapy and massage tend to be so much better. And massage therapy can work wonders for patellar tendonitis, because the quads are a physically massive muscle group with much potential for tighness, inbalance, etc. which a massage therapist an address directly.

    To put this in context, I know two physios I really trust (having been to many over the years!). One I know for a fact hardly uses ultrasound at all (cos we had a long discussion about it while on the treatment table!) and the other treated someone I know well with patellar tendonitis without ever going near an ultrasound machine - he had her doing exercises from day one, with massage and icing to manage the inflamation. Both physios have been/are involved with top-level sport. (If you want recommendations in the London/Bedfordshire area, PM me!),
  • Thanks for the heads up. I understand the physio for my first session was a stand in and quite young. I'll see what the main man at the practice has to say when he is back for my second session on Friday.

    Any recommendations in NW Mcr/Mersyside region?
    I want to climb hills so badly;
    and I climb hills so badly
  • My opinion - only 1 thing to do - MRI scan and a knee specialist. I am seeing Prof David Barrett (Southampton so not too good if you're up north) and it was not until I had a scan that I realised my own knee problems. If there is any clicking at all you will likely need to have it cleaned out, and you're just making it worse by going on with it. If it is swollen do not train on it - this makes the fluid in the knee less viscous and it has less cushioning ability.
  • alienalien Posts: 54
    http://eccentric-exercises.blogspot.com/

    I know people following that exercise protocol and it appears to do the trick for them.
    I agree that finding a quality physio/practitioner is also a key part of treatment for this issue.

    good luck.
  • Hi Kevin & everyone else who's replied,

    As many of you have suggested there are numerous reasons for muscular pain & finding a good practitioner to help with your rehabilitation is key.

    I highly recommend finding a C.H.E.K practitioner to carry out a full nutritional, lifestyle, postural & muscular test/s.

    Unless less ALL of your body has have been accessed you will get limited results at best.

    I specialize in nutritional & orthopedic rehabilitation & sports performance & can assure you that 99.9% of the time the "problem" is rarely where it hurts, where you have pain is nearly always secondary to other imbalances (nutritional &/or physical)

    Check out my website for more details:

    http://www.markjohnson-coaching.350.com/home_page.htm

    Regards

    Mark
  • Update

    I saw a more experienced physio at the same practice today. This time we idendified an imbalance in my quad, which seems to be concentrating force in the injured part of the tendon, quad on outside of leg fine, on inside soft and not firing. This is wierd because the injusry and inbalance is on what I understood to be my strongest leg (the other one has a trashed ankle from a rock climbing acident).

    First step is some specific exercises to recruit / build up inside quad to sort the imbalance before progressing to inclined foot squats. In the meantime contunuing with ultrasound and will try some icing.

    OK to get back on the bike for flat rides but definately no hills or out of the saddle, not even hump back bridges. At least I can work on base miles in preparation for next year if I heal in time. Also no hill walking so my rock climbing will have to focus on overhanging roadside crags with lower off/abseil descents. I may get away with a gentle and sunny on-piste ski trip, but will leave it till last minute booking.

    I'll update you as things progress
    I want to climb hills so badly;
    and I climb hills so badly
  • timdanahertimdanaher Posts: 120
    Good to hear you're making progress, Kevin...

    I've been trying the thigh & hamstring stretches for nearly a week, now, and the difference is night and day.

    The twinging when I walk up and down the stairs is largely gone, and I've been cautiously building up the load on the turbo trainer. To think that I've been suffering with this since last November! I am now a confirmed stretcher (never really thought about it before...but bloody hell, those hamstrings first thing in the morning...)

    Still going to get it checked out back in the UK, though.
  • freehubfreehub Posts: 4,258
    My doctor is referring me to a Physio at the hospital, do you think I'm going to get any results from seeing this physio? Will they be able to identify imbalances in muscles and all that?
  • huuregeilhuuregeil Posts: 780
    freehub,

    As will all things like this, it very much depends on the individual you see. You may be lucky and get someone great. However, the reality is that most NHS physio departments are focused on relieving short-term symptoms only, and dealing with post-op physio, which is a very different mindset/apporach (and requires very different resources!) to the long-term handling of active sportsmen. Try it and see how you go, but I personally think it's worth finding someone good and paying for treatment as and when you need it - having had a couple of reasonably long injury periods, nothing is worse than not being able to participate in the sport you love, and a good phyiso can make a significant impact on your health.

    Regards,
  • Rich158Rich158 Posts: 2,348
    huuregeil wrote:
    freehub,

    As will all things like this, it very much depends on the individual you see. You may be lucky and get someone great. However, the reality is that most NHS physio departments are focused on relieving short-term symptoms only, and dealing with post-op physio, which is a very different mindset/apporach (and requires very different resources!) to the long-term handling of active sportsmen. Try it and see how you go, but I personally think it's worth finding someone good and paying for treatment as and when you need it - having had a couple of reasonably long injury periods, nothing is worse than not being able to participate in the sport you love, and a good phyiso can make a significant impact on your health.

    Regards,

    +1 to that, the first physio I saw, although not NHS, definately operated in that sphere. My current physio specialises in sports related injuries, and takes a much more holistic approach, correcting posture, imbalances etc, and this has proved to be a far more effective course of action in the long term. If you're not happy with the treatment you're getting don't be afraid to change, and it is worth paying for.
    pain is temporary, the glory of beating your mates to the top of the hill lasts forever.....................

    Revised FCN - 2
  • well a year on and no real progress, wiht hinsight the physio I saw last year didn't really understand cycling.

    Can anyone recomment a cycling physio in the NW?

    I'm also considering orthotic inserts for my shoes based on "gait assessment" offered by Davenport House in Stockport, hoping that this may address some of the imbalance that has contributed to my tendonitis. Can give any comments or advice on this ?

    Many thanks
    I want to climb hills so badly;
    and I climb hills so badly
  • i had problems with my right knee for years, after trying many different things, turns out my right leg is longer, and therefore working harder. I now use inserts and all is well, it's stopped a lot of back problems too!! :D
  • otlawrenceotlawrence Posts: 54
    im not too sure how orthopedics will help as it is kind of un weight bearing.

    It sounds like you have had a very unfortunate time with it as have many people by the sounds of things.

    The only thing i can suggest to anyone who may be reading this also is that any inflammation injury will not get better without reducing the inflammation, rest, ice, stretching......and then strengthening through a solid regime.

    Kevin are you back at square one now in the sense that you know what you have wrong with your knee but no closer to curing tyhe underlying problem>?
  • otlawrenceotlawrence Posts: 54
    also it may be worth looking into finding a sports therapist othr than a physion as he/she should look at the biomechanical needs of the sport and potentially be able to find out what it is that is causing it and take it from there, their number one goal will be getting you back into the shape you need to be to be back on the bike which is not something a physio will necessarily strive for (depending who you are lucky enough to get)
  • huuregeilhuuregeil Posts: 780
    +1 otlawrence

    Kevin, what exactly have you done in the past year? E.g. what were the physio sessions like, what did they get you doing, what's your current exercise/stretching regime? Any massage session? As I said in the original post, either strength or flexibility or both is likely to be the root cause of this, and if you haven't fully addressed either, then the problem is not going to go away.
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