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Patella Tendonitis

post #1 of 17
Thread Starter 
Lisamarie and others,

For years I have had one sore knee. Typically it doesn't hurt until it's mildly loaded and I begin to squat on one leg. Lunges, done well, don't hurt. In the event I land on the front of my foot or my upper body is not aligned over my pelvis it hurts a good deal. If I warm up, and watch the tracking of my knee, I can do one legged squats with no pain. Watching in a mirror my knee sure looks wobbly. Knock on wood, I have never had an ACL or MCL problem.

I have done a little work on an inflated disc and attempted to strengthen my hamstrings. Clearly my leg muscles are unbalanced with my quads being larger than my hamstrings.

Both knees have been MRI'ed and x-rayed. Doc's say they look fine. THEY SOUND AWFUL IN THE MORNING GOING UP AND DOWN THE STAIRS. RICE KRISPIES MAKE LESS NOISE!

Is R.I.C.E. the only cure along with Aleeve.
post #2 of 17
Hi Rusty! Don't shoot the messenger! Anything "itis" denotes inflammation, which usually implies an overuse. So in many cases, simply resting from the activity will lessen the symptoms.

To oversimplify due to time restraints, patella tendonitis is related to the landing mechanisms involved in any impact sport.
As we know from ACL injuries, both the hamstrings and the quads are involved in landing, but if the hamstrings are weak, the quads will over work. It may be helpful to do some extra hamstring work. Post rehab from patella tendonitis also involves emphasizing the eccentric phase of a contraction.

As far as tracking the knee goes, I have an AWESOME series for that, but it does not translate well into words. I will be showing it at the Academy, though! [img]smile.gif[/img]
post #3 of 17
Thread Starter 
It's funny. It does not hurt to run. Just hurts to lunge or squat on one leg. I can really tweak it bump skiing.

What do you think about leg extensions with a limited range of motion and with the foot in varying positions? It's hard to describe online, however, by a limited range of motion I essentially mean by sitting and lifting a very light weight, high reps, with the leg almost fully extended....moving the foot only three or four inches or so.
post #4 of 17
Yikes! Uh oh! I always get people angry when I talk about leg extensions, but here goes. Recently, there has been a ton of research done on leg extensions in relationship to various knee injuries. Studies have found over and over again that open chain exercises such as the leg extension machine actually make the knee more susceptible to injury. I have gone into this is major detail in any of the ACL threads, so you can take a look there.

The exercise you describe is one that we used to use to work the vastus medialis. You can do the same thing on the leg press.

Remember, many knee injuries happen because the quads overwork in comparison to the other leg muscles. The leg extension is one of the only machines that actually isolates the quads.

But since the quads are already overworking, why shift the imbalance even more?
post #5 of 17
Yep LM
The Sports Medicine Specialist I saw when I tore my medial ligament HATES leg extensions for knee rehabs/training.

same story - need to learn to stabilise knee & that doesn't happen in isolation
post #6 of 17
Thread Starter 
What about leg curls?
post #7 of 17
Ham curls are not as bad as extensions, since ethe shear force is posterior, going in the opposite direction of most knee injuries. The best choice is a stability ball bridge, which is listed on many topics in this forum.
post #8 of 17
Rusty Guy:

Do you actually have a diagnosis of Patellar Tendonitis or is this a self-diagnosis?

You said the Docs have imaged the knee but proclaimed it normal. You have cracking and popping in the knee and some instability on your own visual examination, but there is no instability when the Docs mechanically examine the knee. Do I have this right?

If you do not have a specific diagnosis of patellar tendonitis, any advice given for that condition might not be effective and may be injurious. If you do have the diagnosis, what were the Docs recommendations? Have you had steroid injections? Or has your care been more conservative? Have the Docs ruled out patellar misalignment or cartilage damage (particularly patellar cartilage)?

I suggest you see a knee specialist and ask for a diagnosis and specific exercises or other therapies (R.I.C.E) for the problem.

post #9 of 17
Good question! I assumed that since you have had an Xray and MRI you were given a diagnose, but if you have not been diagnosed nobody is qualified to give you any advice whatsoever about what exercises to do. Also, since you are currently working with a trainer, it would be best to have them observe your form while performing specific exercises so they can determine what causes the pain.
post #10 of 17
Rusty Guy, sounds like patellofemoral dysfunction or chondromalacia patellae. In English that's inflammation under the knee cap which is aggravated by squats, stairs, etc. Realistically, a patellar brace may help as might glucosamine sulfate. Check with your doc if these are ok options in your case. In really severe cases MRI will tend to show wear and tear under the knee cap. As Lisamarie said, rest is often important. Noncompliance can lead to worsening the condition. Have someone perform Clark's test on you. skidoc
post #11 of 17
I don't know, folks... RG describes something that I experienced my first season after left ACL reconstruction. My orthopod (king of ACL recons -- trust me!) diagnosed patellar tendonitis.

the solution prescribed for me was fully intensive strengthening of the surrounding stabilizing musculature. essentially, my patellar tendon was taking on too much of the load that normally is assumed by the muscles.

I still get that little twinge that RG described -- but only when I've neglected my training.

just my thoughts, I don't even play an orthopod on TV
post #12 of 17
Originally posted by Rusty Guy:
There are a couple of supplements that are reputed to help creaky joints. They are 'Glucosamine Sulfate' and 'Chondroitin Sulfate'. Web sites state that clinical research shows that these ingredients are important in supporting and maintaining healthy joint structures and functions. I believe they can help lubricate your joints, might help reduce the rice krispie noises.

If you search on these names you will find plenty of info. In the past a few Bears have mentioned been taking them for creaky knees and joints with some success. Visit your local health food shop to purchase some, most product ranges have them in one form or another.
post #13 of 17
Sounds like my knees. They make a racket when going up or down stairs, sort of a scritching noise.
I've had mistracking kneecaps for some years, caused by a muscle imbalance, the kneecap is being pulled by the outside quad muscle.
I used to do some exercises - sit on floor, prop a rolled up towel under quad/knee connection, raise foot while contracting inside quad muscle, hold for ages, repeat. then start putting weights on teh foot and increase.

It also hurt a lot to ski, so my physio taught me how to tape the kneecap, you actually grab it with the tape, move it inwards, and tape into place. Hard to do this in the US as I coudln't find the tape you need, it's very strong and sticky, it's not for wrapping, but for using in short lengths to hold things in place. All they seem to sell in the US is the less sticky stuff you have to wrap. (I bring the tape with me now).
I've found that if I tape for the first few weeks of skiing, I don't need to do it after that, the knee stops hurting. But the noise continues!
I also use anti-inflammatory ointment on it, and sometimes take Naprosyn 1000.
post #14 of 17

are there some past posts that illustrate how to train while avoiding aggravation of that area? are you recommending Leg presses, etc?

I also have a rough underside of my right kneecap. I live near Wash, D.C. so I will not be able to go to any sessions, academies, etc.

would you mind either posting some links to old topics covering this? or a maybe basic outline of what to keep in mind when training?

I have stopped biking, running, etc. so as to avoid further excessive wear of the kneecap and now I feel like a FatBas..(Austin Powers)...you get the idea. [img]smile.gif[/img]

I am hoping to get some swimming in and some basic cardio, also losing 25lbs wouldn't hurt, but that will take time.

thanks in advance for any feedback.
post #15 of 17
I've had the same condition (chondromalacia patella) for 30 years. The first 3 doctors I went to said don't do any sports or exercise for a year. The fourth (who treated a lot of athletes) gave me lots of ibuprofen (which was new then), and told me I could do anything I want as long as I could stand the pain. He also told me to wait for the inflamation to go away and then strengthen my quads, first with isometrics (which don't put any pressure on the surface of the kneecap), then with squats. At the I was riding road bikes a lot, using low gears to be easy on my knees. That turned out to be wrong, so I started doing intervals in high gears a couple of days a week to strengthen my quads. Running also seems to exacerbate the problem because it creates an imbalance between your quads (weak) and hamstrings (strong).
Anyway, after 32 years I still ski moguls (usually) without pain, and there is no restriction on any activity. So my advice is don't be discouraged, and find a doctor/trainer/physical therapist who understands how important skiing and an active lifestyle is to you.

post #16 of 17
MRI shows I split cartilage under one patella at end of last season, and now it's bone-on-bone. As a result I'm much more aware of what aggrivates, or alleviates, the situation. I wound up "canting" my water ski bindings to align how my my knee tracked as it flexed. Huge differance! I also really notice more discomfort when if I run out of my daily cod liver oil or glucosimene/condroitan combo and wait 3-4 days to restock, I do feel these really help. I also reciently started taking gelatine caps and they semm to reduce knee pain as well.

I sit at a desk all day and stairs have hurt since my spring knee ding. But I reciently got a recumbent exercise bike that I set up to work leg length at max extension/min flexion and spin at low-med resistance. Supprise, the next day, less pain. After a coupe weeks now (3-4 spins a week) stairs are ok.
I'm planning to continue this spinning into my winter schedule and have less aprehension about how the knee will cope this season.

Although, I've always marveled that my various ambient aches diminish in the winter when I am very active, skiing 5-7 days a week, if only for a few hours each night. I've been told that as we get older our joints take longer to respond to activity and produce somthing called (?)synovial(?) fluid that lubricates our joints. My guess is that frequent low intensity spinning on a cycle, or nightly skiing, generates the stuff and my joints get lubed up, and stay lubed longer from frequent activity, vs. drying out from inactivity. Maybe some expert here could elaborate on validity of my asumptions about this process.

My new mantra:
"move, lube and arc, or sit, dry up and park"

[ November 22, 2002, 12:50 PM: Message edited by: Arcmeister ]
post #17 of 17
I've used stiff-legged deadlifts to strengthen my lower back, glutes and hamstrings with excellent results. You really have to be careful with technique tho, bending only at the hip joints and maintaining a slight arch to the back during the movement.
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