How do you know the difference between the two? I haven’t run or cycled in over two months, and the pain beneath my kneecap hasn’t subsided at all. Wouldn’t a tendonitis or tracking issue heal with 8 weeks of rest? Would a bursitis be more likely to persist?
You describe the pain as “under your patella”. To me that says Patello-femoral issue and not bursitis/tendonitis. A bursae or tendon issue would be felt on top of or to the side of the patella and not under.
Do you have a grinding sensation under the patella with walking/stairs/ running?
Burning sensation when the knee is flexed for long periods of time, like driving/sitting in a chair?
And to answer your question, if it is a PF issue just rest might not take care of the issue. If you have been doing therapy for 8 wks then maybe, but again MAYBE. PF syndrome is one of those things that may never totally go away even after you correct what is causing it. Once the cartialge gets roughed up, it heals ver very slowly.
What stuff have you been doing to help this go away other than resting?
Any biomenchanical issue that need to be addressed? Leg length diff/ excessive pronation/ tight hamstrings/ weak glutes/ weak quad/ tight ITB.
Which leads me to another issue with PF pain. There are so many factors that play a role in this kind of thing. Bike fit/ shoe choice/ worn out shoes/ biomechanical issue like I listed above the list is huge.
I feel the pain in the soft tissue directly south of my kneecap. So not UNDER the kneecap, but south, if you know what I mean. I don’t have any grinding or anything like that. When active, I would get a burning pain when cycling or running after several minutes of use that would just get worse and worse until I had to stop.
Two months ago, I had to stop training for an unrelated health issue. In that time, the pain has not gone away. Now that I’m not running/cycling, the only time I feel it is when I have been crouched down for a while (ex: getting something out of the bottom of the fridge) and then I stand up. Sometimes, while walking the pain will set in for several minutes and then dissapear. When it’s painful, I can recreate the pain by pressing into the patella tendon when it’s relaxed.
I would have thought if it was a tracking issue, once the repetition of the run/cycle motion was taken away, the effected cartlidge would heal.
As for therapy, I have been going to PTs. They said my problem was basically lateral tightness. One PT said I had a VMO weakness, while the other said that was not the case. He said the cause of ALL my problems (ITBS on the other leg) were caused by a misalligned pelvis. I dont know what to believe. I just know that after two months of rigorous stretching, strengthening my VMOs, and total rest hasn’t helped either injury.
Ok that clarifies some stuff for me.
Pain south of the patella, directly on the tendon would most likely be a tendon issue. The tem more docs are using these days is tendonosis. Since they have found out that there are no inflmmatory cells around this type of injury it really isn’t an “itis”. Tendonosis is more of a breakdown of the tissue and not an inflammatory issue. There can sometimes be enough breakdown in the tendon that a small area actually begins to become necrotic (dead). Yours does not sound like that though. Tendon pain that is characterized by pain at the begining of activity and then goes away with warm up and then returns after cooling off is basically a stage 1 tendonosis(early stage) and can be reversed.
Since tendons have a relatively poor blood supply they can take quite some time to heal. And I’m wondering what kind of meds you are on if any? (Don’t feel compelled to tell me if you aren’t comfortable doing so over the web.) Some antibiotics and steroid meds (and possibly others) have tendon issue side effects that could complicate healing of an injury like yours. That would be something to talk about with your doc(s)…
But some things you could ask your therapist about would be ultrasound. If they aren’t doing any heat and U.S. ask them to. Also they have found that eccentric exercise helps tendons remodel. So some controlled eccentric quad stuff would be indicated.
Stuff you can do at home. Heat/ hot tub/ warm bath etc… Like I said tendons have a poor blood supply. Since you have a chronic injury you need to stimulate some blood flow with heat. Always ice after activity, but for general treatment use heat right now.
Actually, I did take 35 days of levaquin (a floroquinolone) during the time I was off. That may have slowed the healing process. What I don’t understand is: you described tendinosis as “pain that goes away once the tendon gets warmed up”, but in my case, the tendon doesn’t hurt at rest, and with activity begins to hurt, eventually progressing to the point where I have to stop.
Here are a couple resourses for you to read. They should shed some light on the subject
taken from the 1st article listed Stage 1: Pain occurs only after activity; Stage 2: Pain starts at the beginning of activity, dissipates after warm-up, and recurs with fatigue; Stage 3: Pain occurs at rest and with activity and affects performance; and Stage 4: The patellar ligament completely ruptures
grade of patellar tendonosis http://www.physsportsmed.com/issues/2004/0504/depalma.htm
“itis” vs “osis” article here http://www.physsportsmed.com/issues/2000/05_00/khan.htm