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Patellar Tendonitis – What worked for you?
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Over the past few years I have had reoccurring/chronic patellar tendinitis. I am committed to getting it fixed for the long term and not falling into the trap of upping activity too quickly. I’ve done a ton of research and have stopped running completely and am on a rigorous stretching/strengthening/foam rolling routine with eccentric exercises that many have said helped them.

I know the tendonitis is a symptom and not the cause and that there could be a number of contributing factors: overuse, muscle imbalance, tight muscles, misaligned/weak hips and or ankles, poor running form, bad tracking ect.


I am looking for insight from those of you that have gone through this and come out healthy. What activities did you feel helped/hurt. Did you only do exercises when you had no pain or did you do them as long as the pain was dull (ie 3/10). Were you able to walk/bike/elliptical? How long did the rehabilitation take?
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Re: Patellar Tendonitis – What worked for you? [ABrunner] [ In reply to ]
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I suffered through PT for 3 three years and tried numerous "cures" until finally an "experimental" solution from a Sports Med Doc, which was using nitro glycerin patches normally used for heart patients placed on the knee daily for 2 months (the theory behind it was that it would open up the tendon to better blood flow, resulting in the healing of the tendon) combined with physiotherapy concentrating on weighted drop squats on a sloping board. My physio had done his Master of PT and this was his "paper". I am not sure if it was the patches or the drop squats or a combinationof both that finally cleared up the tendonitis, but after 3 years it was gone 2 months after starting the patches/squats, and 5 yrs later it has not re-appeared. FWIW.
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Re: Patellar Tendonitis – What worked for you? [ABrunner] [ In reply to ]
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I did and still do lot of leg extensions in the gym and really focus on the last 1/3rd of the lift, it strengthens that muscle on the upper inside of the knee, that really helped me and now PT is not an issue at all.  I ahve done several marathons, 3 IMs and a few ultras with no knee pain.
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Re: Patellar Tendonitis – What worked for you? [ABrunner] [ In reply to ]
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http://thesock.com/

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Re: Patellar Tendonitis – What worked for you? [wpcouch] [ In reply to ]
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wpcouch wrote:
http://thesock.com/


I think you are a bit confused.....or I am.  I thought we were talking PT....not PF.
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Re: Patellar Tendonitis – What worked for you? [IRONwolf] [ In reply to ]
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Oops!

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Re: Patellar Tendonitis – What worked for you? [ABrunner] [ In reply to ]
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On the bike - make sure your saddle is level, and also at the right height. Too low, and that will aggravate the knee. If it's titled downward, constantly having to push yourself back up will also aggravate it.

Generally, stretching the hammy's and calves a lot, as well as foam roller-ing them helps. I wouldn't bother stretching the quads at all - though you can roll away all you want.

If you're a heel striker/ overstrider, then that's the source of your problem - your leg is braking every time you take a step and the knee is absorbing all the impact. Make sure your foot is landing underneath your center of gravity. You should have a slight lean almost and feel like your falling forward. Your heel can touch the ground, but it should be your forefoot that iniates contact - not your heel.

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Re: Patellar Tendonitis – What worked for you? [ABrunner] [ In reply to ]
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x2

I've been training myslef to stop heel striking and I have noticed a big difference in PT and other knee issues.


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Re: Patellar Tendonitis – What worked for you? [frogonawire] [ In reply to ]
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almost nothing. i've had minor PT symtoms for 1.5 years. going strong. i wear a strap around my knee and that is it. it has never affected my training.
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Re: Patellar Tendonitis – What worked for you? [ABrunner] [ In reply to ]
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What helped me was to ice the knee after every single run where I had any sensation at all, and for weeks and weeks that was every single run. After showering, I put on an old cycling knee warmer and stuffed a flexible cold pack in there, then got dressed; I wore it for at least a half hour. You don't have to get completely undressed to remove, just drop your trousers, fish out the cold pack, then hitch up your drawers.

Brian

Brian

In a way, I can't help but feel responsible, I always knew that you were insane
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Re: Patellar Tendonitis – What worked for you? [ABrunner] [ In reply to ]
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This was my worst nightmare. I was not able to run more than about 3 km without run-stopping pain, for about 3 years. I saw an orthapedic, sports physicians x 2, physios and an ostepoapath in the search to get it fixed. I tried rest (3 months no activity), ice, NSAIDs, Nitro-Dur (glyceryl trinitrate) patches, stretching, taping, and anything else the physios threw at it, without improvement. I also tried, as instructed, eccentric exercises, squats, leg extensions, etc.

For me, after all this time, it was a combination of 2 things that allowed me to run again:

1. eccentric eccercises, performed consistently, 3 x 20, twice per day, at the same speed, depth and angle. It was never stressed enough by any of the experts how important it is to push through the pain when you do these. I was stopping at the point of pain, which was sometimes 3 reps - which is hardly going to facilitate tendon restructuring. The pain is not degenerative, and if you accept this you will be able to push through it. A tendon needs stress to remodel it, else it will remain its same stagnant, misaligned self. Rest and half-arsed eccentric work will not do enough, and I read about cases where people in the studies had it for 8 years. I made my own sloping eccentric squat board out of timber. Make it solid, smooth, with some grip and a little lip to help catch the shoe, and sit it in your lounge room. Do the same thing morning and night, to the same point of stress. No need to ice as there is no inflammation in tendinopathy

2. I changed my running style. When I first started to push out a few kilometers, I was so paranoid. I looked to run as light as possible - forefoot, high cadence, small steps. Changed from that day on and never looked back. I now run with minimalist shoes, and I'm sure this has helped restore muscle balance in my lower legs.

Back into the IMs and marathons now and still doing the eccentric squats morning and night. Sometimes my knee will feel a bit funny after a few consecutive days runnings, so I just remind it who's boss with a few slower eccentric squats, which are more stressful. This usually resets it for the next day- I find this strange but it works for me so I don't question it

During the 3 years of not running I was able to do swimming, rode to work every day, and did a lot of RPM/ spin class which seemed not to make it worse. Elliptical would be fine, stair climber probably a bit harsh. Rower I found a bit harsh also.

For me it involved 2.5 years of half efforts, and following bad advice, with no improvement. Then 3 months of consistent effort, following good advice (step 1 above), with enormous improvements. Then started running whilst keeping up the eccentric to allow longer running for the last 1.5 years.

It was not a bike setup or run style tat caused it, nor would a change in these things fix it. For me it was overuse - too much running up and down gorges and really steep hills. But, unfortunately, unlike other injuries, there is no way this symptom is going to go away just because the cause is removed
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Re: Patellar Tendonitis – What worked for you? [ABrunner] [ In reply to ]
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This is patellar tendonitis, not quadricep tendonitis right? So it's below the knee cap....

I had this for my entire high school running career.

My self-treatment consisted of all of the following:

- leg extensions once a week...I made it a serious thing... 10 sets of 10-20 reps. Actually used some weight, not too light.
- Ice after every run for 15 minutes
- Extra quad stretching
- NSAIDS (I suggest Aleve)
- Avoid running down hills. If on a smooth road surface I would turn around and run backwards down hill.
- Softer training shoes
- Stay off pavement and hard surfaces for as much running as possible
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Re: Patellar Tendonitis – What worked for you? [ABrunner] [ In reply to ]
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strengthening glutes + TFL.

Proud member of Fishtwitch and the ST Grammar Police
disclaimer: PhD not MD
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Re: Patellar Tendonitis – What worked for you? [charlesn] [ In reply to ]
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Sorry to revive an old thread, but a question on the eccentric squats. I see decline eccentric squats pretty universally recommended for patellar tendonitis.

I am just looking for someone to clarify the eccentric vs. concentric motions. Are you standing on both legs when you do this, allowing the injured leg to support most of your weight on the way down (eccentric) and then relying on your good leg for most of the force on the way up (concentric)?

Or are you doing them single-legged on the injured leg and going down very slowly and then upward with both legs so as to not force the bad leg to do all of the concentric work? Single-legged up and down? Some other variation?

Just looking for some details, thanks.



Portside Athletics Blog
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Re: Patellar Tendonitis – What worked for you? [SwBkRn44] [ In reply to ]
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Initially down on the injured leg and up on both. But after a short time down and up on single leg only.

The important thing is to lower down slowly, maybe 4 or 5 seconds. Going back up doesn't matter, 1 second on both legs if u like. The reasoning is that maximum stress is placed on the knee during eccentric movement, lengthening the quad muscle under tension. If you do 5 really slow drops, maybe lower than is comfortable, you will physically feel the knee being stressed. It doesn't take that much. I can murder my knees with a really conscientious eccentric session, but they bounce back ok, so it is not a degenerative stress. I wrote earlier that it is the consistency of performing these exercises that will solve your problem - morning and night, every day, same no. of reps, performed to the same level of stress

Over time, You could slow it down, to a count of 5+ and go lower if you felt you could handle it
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Re: Patellar Tendonitis – What worked for you? [ABrunner] [ In reply to ]
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had this bad...here is what worked for me...mine was so bad I couldn't even do one body weight lunge without pain...now it is gone, pain free...run all miles in the Nike Frees (I will say I run on trails, track, and treadmill) I stay off the road for the most part except to race.

singe leg quarter squats...stand on the edge of the stairs and hang one foot/leg off the edge with the other one firmly planted on the ground. Lower your leg about 4 to 6 inches and then come back up...(the VMO (tear drop of Quad) is responisble for the last part of this leg extention (VMO can atrophy significantly with a lot of high volume...probably a lot of runner in general without some strength training)...This gets the PT tracking poorly causing pain. I did this 3 times per week 2 sets of 20...this will start to get your knee tracking properly almost immediately...make sure you keep your weight on your heel when doing this exercise as it will take the pressure off the knee cap...You should't feel any pain while doing this exersise...if you do make sure your core is tight and the weight is on your heel...don't go down quite as deep...then gradually over the course of a week or 2 you will be able to go down lower and lower...Stop gonig lower once you start activating other muscles...keep the movement isolated...this exercise is 10x's better than leg extentions (plus much more fuctional)...

After that move to split squats (single leg lunges in place) I will attach a link from a top strength coach that has great information on range of motion and muscle balances...

My routine now is strength trainin 2x's per week including bodyweight squats 2x20 (perferct form focusing on range of motion), single-leg leg press (2x10 to 12 reps)...better to put a little more weight on here than trying to squat a bunch of weight like a power lifter (too much room for error)...However, I believe you do have load your body with some weight because it maintains muscle balance, increases bone density, and tendon strength...You don't have to do anything that is going to take away from your swim, bike, run recovery/workouts, but you need to stay strong and powerful...

Lifting won't neccessarily make you faster (swimming, biking, and running more does that)...but it will def. keep you healthy and pain free...If your body can't handle the swim, bike, running that you are attempting to do than you can't get faster!

Here is the link

http://www.strengthcoach.com/public/1298.cfm

There are videos that go along with this to show proper from!
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Re: Patellar Tendonitis – What worked for you? [ABrunner] [ In reply to ]
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For me I started wearing a brace and this helped; however, I think that after awhile I think it made things worse because mainly because the extra support allows you to use less of your leg muscles. By worse, I mean that I found that I kept running slower and slower and it took less distance before my knee started aching.
I don't know if I "cured" myself, but I think that certain changes helped.
First, I weaned myself off the brace and started doing more walking at first. I would run a few minutes without the brace, put the brace on, and then alternate every few minutes. As months went on I slowly added more time running and less time with the brace. Finally, a few months ago I did my first half marathon without a brace at all. As time went on I realized that my natural tendency was for my left leg to curve in slightly while I ran and would want to land more towards the outside of the foot....the right leg didn't due this at all. I realized that for years I was unconsciously "correcting" to land more toward the middle of the foot. So, I started to concentrate on just letting myself land where it wanted to even though it wasn't the same as the right foot. Keep in mind this is pretty slight and it isn't like i suddenly looked like I was from the Ministry of the Silly Walk. Also, I realized that I was slightly over striding and wasn't following through quite enough.
Combined, I haven't used a brace in 4 months and have been mostly brace-free for about 7-8 months. In the meantime, while I am still slow, I am actually running faster than I ever—even though it is still slow from ST standards. Safe to say, cut about 3-4 minutes per mile (keep in mind I got really slow by the end). I have It had gotten to the point that in most races I had pretty much given up by the run because I knew I would be it too much pain to run too hard...not surprisingly, I quit for several years partially because of it.

Also, I started doing slow runs up hills—mainly because it hurt less. As time went on, I think the hills helped to reinforce a better running gait by reducing over striding while requiring more push off.
Last edited by: gj: May 2, 11 18:35
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Re: Patellar Tendonitis – What worked for you? [Big] [ In reply to ]
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Quote:
this will start to get your knee tracking properly almost immediately...make sure you keep your weight on your heel when doing this exercise as it will take the pressure off the knee cap

was your issue more chondromalacia, which is a tracking related issue?

Patella tendonosis/ tendonopathy is not a tracking issue, it is a breakdown in the otherwise regular matric of the patella tendon.
From all my advice and research it is best to raise the heel, on a phone book or a decline ramp, so as to reduce the contribution of the calf muscle in straightnening the leg - thereby providing maximum stress to the knee (cap). The tendon needs stress in order to realign the irregular fibres. It won't happen as a result of rest or cotton wool treatment, nor from a comfortable session of knee exercises
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Re: Patellar Tendonitis – What worked for you? [charlesn] [ In reply to ]
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Leg extentions and hamstring curls helped immediately for me and I still do them. My problem was weak hamstrings.
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Re: Patellar Tendonitis – What worked for you? [vtlars] [ In reply to ]
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I don't think the Physical Therapist and/or Ortho's ever really could pin point what the issue was...Other than MRI's showed no tears...and it was a tendonitis issue...

My knee didn't get better until I started seeing a really good Strength and Conditioning Coach who is also a P.T. I have never read anything on your joints needing to take most of the stress...I think it is good to lift your heels and squat...but I feel like that is more of a range of motion issue.

If your muscles/body if functioning properly it is your muslces that are suppossed to be stressed primarily...not your joints. I haven't seen the same information as you obviously...I am just saying what worked for me...It really starts up above the knee in the hip/glutes/quads...

I started with the 1/4 squats to make sure my knee was tracking properly be for I moved on to more advanced exercises, because I found out that my body was doing a very good job at trying to find other muscles to deliver force as a way to guard and protect the knees...If you go to that link showed you and can perform all the single leg strength exercises no problem and then can start doing single leg lunges properly...I think you will start to see improvement...If the other exercises you researched are working for you then do them...but I am guessing they aren't because you are on here asking for advice...I am just telling you what worked for me after a lot of research trips to Physical Therapy without enough help... and a pretty extensive back ground in strength and condition...In the end it is about flexibitly, range of motion, muscular and tendon strenght/power, and bone density...

When i started getting strong and getting my range of motion back I started to notice improvements within a week...it didn't take long to tell my body was going to heal...that gave me confidence...I went from thinking i could never run again because of my knee to not even thinking twice about its durability...

anyways..hope this helps...by the way I don't think any of the exercises are comfortable and easy...you would be surprised at how many people are unable to squat properly or do lunges...even with body weight only....and this is a huge reason they can't handle very much training stress...their bodies abiltiy to to apply absorb and apply force properly is very poor...
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Re: Patellar Tendonitis – What worked for you? [ABrunner] [ In reply to ]
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just came across this post - i have case of patella tendonitis - curious if people are able to ride through this - i'm willing to ease off the run but will go crazy only swimming -
thanks
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Re: Patellar Tendonitis – What worked for you? [eappel] [ In reply to ]
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IME yes
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Re: Patellar Tendonitis – What worked for you? [ABrunner] [ In reply to ]
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Did you get an MRI?
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Re: Patellar Tendonitis – What worked for you? [ABrunner] [ In reply to ]
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Forget all of this complicated stuff and just change your shoes. Go with a flat, light, flexible shoe and your knees will thank you. Your calves and ankles might bark but go easy on them for a while and everything will be groovy.
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Re: Patellar Tendonitis – What worked for you? [felt4fun] [ In reply to ]
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I have not done an MRI
I work at hospital and stopped by ORTHO office
Gave me a knee strap and said rest for a while and ice it too
I plan on checking also with the PT guys at the hospital for help
Plan on trying some of the above excercises also
Thanks
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Re: Patellar Tendonitis – What worked for you? [eappel] [ In reply to ]
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Does the knee strap go above or below the knee?

Can I use an ITB band strap?

Ron W.
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Re: Patellar Tendonitis – What worked for you? [rjsurfer] [ In reply to ]
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Patellar tendonitis on right knee in summer 2010 till spring 2011.

MRI showed micro tears and not much choice after thorough research.
My sports doctor mentioned Platelet Rich Plasma injection (PRP), did my homework and went for it in March 2011.
Very painful for me but pain subsided and then almost disappeared within 4-5 weeks. PT + quads strengthening and stretching (the pain will worsen if muscles are tight) ice and common sense helped a lot.

Before the injection, I limped to finish a sprint tri in Sept 2010. Post injection, I Finished a sprint in 1:25:xx with a 23min 5k and most importantly... no pain. (MOP so not great but happy with it after all the trouble)

One year later and 2 Half IM + 1 half marathon I am much better. Now, If I get sloppy and lazy on the stretching, icing or strengthening it hurts a bit but nothing like before.

Hang on man as there is a way out of Pat tendonitis. Patience, your own blood and science are on your side! Feel free to shoot me a question if you want.



Only fools never change their minds and I'll never change my mind about that.
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Re: Patellar Tendonitis – What worked for you? [Bancarel] [ In reply to ]
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Foam roller. Quads, ITB's and calfs. This cured and continues to keep my patellar pain away.
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Re: Patellar Tendonitis – What worked for you? [regnihe] [ In reply to ]
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regnihe wrote:
Foam roller. Quads, ITB's and calfs. This cured and continues to keep my patellar pain away.

This....

It solved my problem. Make sure you're cleats are well aligned and haven't shifted. I also added Ice, topical anti-inflamatories, and they did Cold Laser/ultrasound on it. I think the laser and ultra sound helped the immediate healing because I could tell if I didn't get in 2 times a week. The comment above is what I credit to the lasting fix. Best of luck. Mine lingered until the off season and then faded away.
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Re: Patellar Tendonitis – What worked for you? [regnihe] [ In reply to ]
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regnihe wrote:
Foam roller. Quads, ITB's and calfs. This cured and continues to keep my patellar pain away.


DOT

Was diagnosed PT a while back. Had to take several weeks off of running. Mine was caused by conjunction of overuse, heel striking and ramping the running mileage too aggressively.
Rest and a black foam roller became my best friends.

Came back to running with new shoes that facilitated mid-foot striking and took it easy for the first couple of weeks. I used the foam roller every day religiously, whether i ran or not. So far, it has not returned.

Good luck and i wish you a speedy recovery.

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Re: Patellar Tendonitis � What worked for you? [BayAreaUser] [ In reply to ]
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Been struggling with this almost 2 years. I have an active job and just seems to prevent me making any progress, im trying decline eccentric squats. May have to up the sets and reps but every time I try that it feels like the pain is increasing way too much.
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Re: Patellar Tendonitis � What worked for you? [joshua767] [ In reply to ]
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Everyone a bit different, but knee is hinge joint so work hip and ankle too. I use rumble roller on quads. If I slack off it comes back especially when putting more miles on bike which taxes outside quad and tends to pull patella a tad off. Strap wise I use Tendon Trak until I get it sorted out mobility wise. Weak glute medius is often culprit too. Don't give up trying. I thought 14 years ago my running was over, but battled thru several injuries to knees and back to say things are ok for this geezer. Ketogenic diet pointed out how bad carbs were for me inflammation wise, so when aches and pains start surfacing I get better on diet, but hard to stay ketogenic all the time.
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Re: Patellar Tendonitis � What worked for you? [tyrod1] [ In reply to ]
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Thank you very much. I will look into keto diet and see if that helps. I bought a strap but I am unsure as whether to use it as I have heard mixed reviews. After 2 years off exercise I have taken up rowing only using my left (strong) leg. I am now foam rolling 3x per day and carrying out eccentric decline squats at the end of every day. When I have days off I am fine but when I am on shift its hard to avoid knee pain due to all the stairs. How long did you suffer from it? I will continue to stretch too and hopefully move onto strengthening my glutes and hamstrings when me knee feels up to it.
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Re: Patellar Tendonitis � What worked for you? [joshua767] [ In reply to ]
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I use mobilitywod.com for mobility and mechanic references. It requires a subscription but you get free 10 day trial and can opt for monthly or yearly subscriptions.

Get 10!day free and go to programming button and then to episodes. There are drop downs for body part and pick knee and look for episode 91 knee tendinitis and watch 45 minutes. You have tension in system that impacts knee. This will help u understand what is likely going on. The solutions are suggested but require finding right one. For me distraction with pushing on tibia gives my joint better extension.

Also lots of free stuff on YouTube search kelly starrett knee pain and look at short vignettes on terminal knee extension TKE as reference and pick from multitude of shows. YouTube stuff is good but not as good as pay for website.

Mwod also has directory of PTs in your area that could help.

As reference I am 70 and battled since 55 with knees issues & others likely caused by desk job and poor hip flexors and weak glute medius.

Upright health is another good site too.
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Re: Patellar Tendonitis � What worked for you? [joshua767] [ In reply to ]
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Go see a good PT. I dealt with it most of last year and while I'm not 100% pain free it is loads better. For me it was lack of hip flexor strength and it just cascaded down the line to eventually the knee. Was put on a bunch of leg and balance strengthening daily with low weights/bodyweight and high reps.

Definitely got better because of it. Plus seeing the PT helped motivate me better to stick with the rehab exercises. I did the eccentric squats and it helped but was only a temporary help when I returned to running or cycling.
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Re: Patellar Tendonitis � What worked for you? [loxx0050] [ In reply to ]
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thank you so much for the support, replies and links. I will definetly check that out. I have made great progress in the last week by doing thorough foam rolling of all leg muscles 3x per day. I am doing stretches on the big muscle groups + hip flexors and IT band which I had previously neglected. Taking a big dosage of cod liver oil 2x per day as long as 1000mg of vitamin C. I have also ordered gel insoles for my work boots so I'll see how that goes.
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