How to Beat Patellar Tendonitis?

I’ve been fighting patellar tendonitis all season and have lived with the pain by taking ortho prescribed anti-imflamatories all year long. Yes, he told me to take some time off this summer, but I just didn’t want to miss any races. Since my season ended after Clearwater I knew I had to take some running time off to try to get the tendonitis taken care of. I’ve been to the Ortho and had MRI’s done and there is no other damage other than the inflamed patellar tendons in both knees.

I haven’t been on a run since Clearwater and I’ve been icing and stretching regularly and STILL have pain in both knees. I’ve been on a few rides but have kept them at higher cadence to not put pressure on my knees at all. I prepared myself mentally for 3 weeks off but it’s very depressing as it’s now been 3 1/2 weeks and they still hurt. I feel like I’m losing all my run fitness. I know this is the off season and I planned on some down time but if the pain is not gone after next week I feel like I’ll just have to deal with the pain again next year.

Any advice from anyone that’s gone through this? I’m all ears. I REALLY want the pain to go away but not sure how much longer I can stay away from running. What else can I do to make the tendonitis go away?

Been there. Surgery fixed me. I’ll never be 100% pain free like before I became a runner, but I only rarely have bad days.

It’s tertiary at best but check to make sure your bike saddle is level or just a degree or two nose down. If it’s too far down in the front and you’re sliding forward a bit it will exacerbate the situation.

Heal quickly, Ian

I don’t want to waste your time by comparing apples to oranges, but I’ve had a similiar issue with my achilles tendon. Same basic story, different tendon. I thought 3-4 weeks of rest would take care of it, but it took about 7 weeks. It was really, really difficult when I wasn’t healthy after the 3-4 weeks that I thought it would take. My biggest issue was overcoming the mental anguish of wanting to work out, but being busted up. I finally wrestled that demon and realized that being healthy is the only way to compete. I made my complete healing my new “race” and training and focused solely on healing. I did alot of Yoga (easy), Pilates and concentrated on my nutrition, including natural foods to suppress inflammation. I didn’t try to sneak any workouts in because it only delayed my healing. Admittedly, nothing beats working out. Period. But, I came to enjoy my little break in routine and my new challenge. The great news for you is that it’s December, not June. You CAN afford to take a break. My injury was 2 months before IM CDA and I was freaking out. However, I found that altough I didn’t gain any fitness, I didn’t really feel like I lost too much. I competed healthy and it was worth it. Good luck with it!

I was diagnosed with patellar tendinitis a year after having knee surgery for two meniscus tears and a torn ACL. I thought I was due for another surgery.

Jumping and deep squats and I guess improper running form or bad shoes will make it worse. You should avoid those at all costs until things start to get better.

My new orthopedic surgeon (who is a triathlete) got me the right physical therapy who gave me a really easy exercise: while seated on the floor, cross your bad knee under the bridge of your other leg and just lift it 10 times 3 times a day.

That combined with hard massage right in the place where it hurts and regular surface icing cured me well enough to run without problems as much as I want. It still hurts when I don’t stretch or run on it cold, but it’s never debilitating like it was before.

Also, I have found that e-stim helps me a lot for pain reduction… but your mileage may vary on that.

I had the same issue last year around this time and it took until March for the pain to fully be gone. It sucks but you have to cut the running off for the time being if you want to fully heal. I tried to run a little and it just hurt. It definitely hurt my season this year as my run fitness was not fully back but it also made me ramp my running up slower this year and has allowed me to put more miles in each week (currently up to 50 a week) than i ever have. Seated leg press with only a slight bend in the knees (no where close to 90 degrees), Leg curls with light weight and one legged half squats with no weight was what the PT put me on along with a number of stretches. It is depressing to not run when you are used to it but look at it as a chance to catch up on other things for a short time and it is not so bad.

At this point your condition is likely no longer tendonitis but tendonosis. I’m sorry to hear about your problem, as you’ve likely set yourself up for a very prolonged recovery.

I have tendonosis of my biceps tendon in my left shoulder from swimming. For a long time, I swam through it thinking it was an inflammatory condition. The reality is that I was repeatedly damaging the tendon, changing the characteristics of the tissue. I went to PT but they didn’t give me anything to treat the tendon itself… I did some research and found that a combination of friction massage, ice, and weight training have allowed me to get nearly pain free (after about 6 months of effort.)

In friction massage you basically strum across the tendon. If you are sore, this will probably be painful, but I found that pain would usually be decreased after massage. You’ll also need to do some stregnthening that targets the tendon. The rule of thumb I used was to do enough to feel some pain/soreness, but not so much that the pain could be felt the next day. This stimulates the tendon to grow stronger rather than to degenerate further.

I’m not a doctor or PT, but I have some experience with this type of issue and I’ve done some homework. If you’d like I can send you the article that really got me started on the way to recovery. PM me if interested.

For your information, here’s Knee Guru’s entry on patellar tendinitis that you might find helpful.

http://www.kneeguru.co.uk/html/steps/step_05_patella/tendinitis.html

Patellar tendinosis is a painful condition of the tendon below the kneecap, usually involving degeneration of the tendon substance. http://www.kneeguru.co.uk/assets/images/tendinitis02.jpg
The condition used to be called patellar ‘tendinitis’ or ‘tendonitis’. The term ‘-itis’ in medicine means ‘inflammation’ - a process of irritation, increased blood supply, and infiltration of the area with special inflammatory cells - but these features are not actually seen in patellar tendinitis. So there is a lot of medical literature suggesting that the condition no longer be called ‘patellar tendinitis’ but ‘patellar tendinopathy’ or ‘patellar tendinosis’ instead, implying a degenerative condition rather than an inflammatory one. For your research, you need to search using all of these keywords.
In this disorder the tendon develops a mushy (‘mucoid’) degeneration, which weakens it, causes local discomfort, and may predispose the tendon to rupture.
It is a disabling condition which frequently affects sportspeople: mainly jumping sports insidious onset of pain localised to the area just under the kneecap painful when walking or running up slopes, or getting up from sitting tender to deep pressure underneath the kneecap Management of patellar tendinosis
The condition is hard to treat and frustrating for both patient and doctor. Although stopping the ‘overuse’ activitity is the best approach to arresting deterioration, this is often a major problem as it so often occurs in people who concentrate on a particular sport or activity and may earn their living from it, eg basketball or ballet. A local patellar strap worn during exercise is likely to be helpful (eg. ChoPat strap). Attention to the period of exercise is important in the early stages - increased warm-up time and icing the knee after exercise - but may prove ineffective if the condition is advanced Friction massage is likely to be helpful to reduce the swelling and adhesions that are pulling on the tendon. Attention should be paid to strengthening the quads with mini-squats or eccentric isokinetic exercise and stretching both quads and hamstrings Infiltrating the ‘inflammation’ with anti-inflammatory injections, such as steroids, is not likely to help as inflammation is not the true process, although injecting along the outside of the tendon (‘paratenon’) may. There is some suggestion that infiltrating the tendon itself with steroids (eg cortisone) may further weaken it. Surgically cutting out the damaged portion may be effective in settling the condition.

Eccentric exercise can potentially help treat patellar tendinosis, once the inflammation phase of tendinitis has gone away. But, one must be careful doing eccentric exercise. Through much trial-and-error, a cyclist figured out a protocol for eccentric exercise that reduced the risk of a relapse. He tells his story and gives advice at his blog at http://eccentric-exercises.blogspot.com

Unfortunately, apart from eccentric exercise, he found little success with any other types of treatments.

That is an excellent website. The author’s gradual increase in load during eccentric exercise does describe a similar approach to what I did for my shoulder.

Eccentric exercise is what you want.

If you do indeed have tendinosis and not a tenditis, there is truly no way to predict how long recovery can be. I first came down with it over two years ago and continue to battle it. Months of inactivity do nothing for it beyond a very slow reduction of symptoms. I am currently on a substantial stretching and eccentric squat routine, but God only knows if/when it will be fixed to the point I can run without symptoms. I ran the last couple of summers a little for some sprint tris but was constantly dealing with this and this summer I won’t make the same mistake. Surgery is generally a last resort for this, as its results can be very hit or miss.

The link two above this post to that cyclist is from a guy who’s been dealing with it for 3 or 4 years and is still not pain free.

Time can help, but a functional imbalance will most likely allow your symptoms to return. Of course masking pain doesn’t help much either, but most people got to do what you got to do. The lower extremities are tricky. Functional deficit in one group can screw the whole pooch. I’d start by getting a complete structural analysis of the low back, pelvis and legs. If your standing on a short leg, or reaching with a short leg on the bike, more than likely the whole pelvis will shift altering the function of the entire kinetic chain (joints, muscles, fascia, etc…). Simple stuff like the quads are too strong compared to the hams…typical cyclist problem because they focus on squats and what not in the gym also only one plane of movement. Hams can be too short for whatever reason and they inhibit the quads, etc… Symptoms in the knees, barring direct insult, are often (not always) a result of a primary structural or functional problem above or below. I like the tendinitis vs. tendinosis stuff as well. I’ve heard of different types of doctors dry needling, drilling into the marrow, the transverse friction, eccentric exercises, etc… to jack up the inflammatory process. Kind of a re-boot. Of course I might be a raving lunatic…Good Luck!