Shockwave Therapy for patellar tendon pain? alternatives after seemingly having tried everything to solve ITBS/PFS for 6 months?

Triathlon Forum
1

I developed ITBS in my left knee back in December after an increase in running intensity/volume. I quit running entirely. I foam rolled, used a trigger point ball, stretched, performed strengthening exercises, got dry needled, deep tissue massage, and finally found some relief after about 10 ART sessions. I started running again, slowly. After my second run back, I developed ITBS in my right knee around April/May. Kept running 2-3 miles every few days, but started again with ART, dry needling, massage, etc. Now, 6 months after my original injury, it is still lingering, my right glutes are still tight (despite dry needling) AND I’ve developed patellar tendon pain when running. I’ve been consistently training on the bike and have seen no negative impact on my cycling or swimming.

At my wits end, I found another practitioner who provides shockwave treatment. I underwent my first session yesterday with a follow up session on Friday.

First: it’s incredibly uncomfortable on my tendon. It feels like someone repeatedly hitting my knee with a small hammer.

Second: any experience with this treatment? I’m looking for anything at this point, and I have spent thousands of dollars in trying to fix this. Suggestions for what else I can try?

2

I have tried it for Plantar Faciitis—back in '08 or so. They put me to sleep for it. Didn’t work. Hurt like hell when I woke up, and for days after. Felt like someone had repeatedly slapped the bottom of my feet with the principal’s paddle—hard!

I gave up running/racing for 10 years instead of trying that again. The stats for it with PF weren’t great; something like 1/3rd success rate for first treatment, and decreasing from there. I don’t know the stats for treating knee tendons—but I would ask before doing it, that’s for sure.

I have been down your path before with almost the same sequence of ITBS on one side, to the other side, to PFS, to Patellar tendonitis. Its insideous, and incredibly frustrating…not to mention expensive, often with limited results even from skilled specialists.

I’m not a Doctor, or any other type of medical professional. Most people tell me I’m too conservative. But, here is what has worked for me:

stop running. Replace it with walking. Vow to never run through pain, ever again. Don’t run while taking any type of pain killer (NSAID or tylenol)–those just make it possible to run through pain…you might not “feel it” but it is still happening (see above). Take the drugs if you need them, or are told to. Just don’t run while taking it.

I was given static stretches to do. the “lean into the wall” stretch, and the “cross your legs and touch your toes” stretch. Never stretch to cause pain. If it hurts, back off. tightness is good, pain is bad. Be gentle, and patient. I was told to hold each position for 30s, and repeat 3x. I know I was given strengthening exercises, but I don’t recall. I’d just keep doing whatever you were given.

After you are asymptomatic, and you ready to return to running: Start with very small amounts. I started with 5 minutes. And VERY gradually added single minutes week by week. It sucks, and it takes a long time to get “back”. Maybe there is a faster way, but I never found one.

If you EVER feel a twinge of ITBS coming on, STOP, and stretch. There is a reflex arc that happens, your ITB starts to tighten up as the pain comes on. That tightness causes more rubbing and pain, etc. So, stop and stretch. Let the ITB relax, then resume running…cut it short, and go home. when I was going through this I would basically do very short loops close to home so that I could just walk home, if needed. I did that until I was confident that I was over the hurdle and back to “normal”.

My rule for overuse injuries is: take 1 week off the first time it happens. if you try to train through it again…take two weeks off. Take an extra week off for every time you train through the same injury.

3

I really appreciate the insight, but man, that is depressing.

4

I suffered from a terrible bout of ITBS (along with Plantar fasciitis). I also had PFS at the same time. This was all post build and completion of IMC.

Like you, I tired every frickin’ thing in the book. All the stretches, insoles, PT, taping, etc. Nothing helped after months and months. I was just about to give up running forever.

I’m sure I’ll get lit up by some PT or Doctor on here for saying this…but

I had a great PT finally tell me that I’m beating up the patient with all the insoles, taping, massaging, rolling. She suggested I rest from running FOR AS LONG AS IT TAKES and give the tissue a break. Ditch the insoles and let me feet get strong by walking around barefoot as much as I could do pain free. At first this was just maybe while I did the dishes. Then I started walking around my grass a bit.

In the meantime that I couldn’t run I lifted weights. I don’t mean PT style exercises. Her suggestion was to go get the workout I was jonesing for by lifting weights. Strengthen my posterior chain, work on form,agility, balance, and most of all stay sane and as active as you can.

About 10 weeks of replacing all my run workouts with cross-training and I was able to start doing short (1/2 mile) runs pain free. I was also using the time to be a better swimmer/cyclist. I slowly built my running back from there using the old 10% rule.

The 10+ weeks might seem like an eternity, but you can 100% stay in shape so that you don’t have to build up your aerobic endurance again WHEN you return to running. This was a few years ago, but when I came back after healing I had the best running season I have ever had.

YMMV, but I learned a few things

  1. Insoles/taping/support shoes were doing more harm that good while running. I needed a flatter shoe.
  2. Once I stopped thinking of lifting weights as PT, and started thinking of it as a run workout - mentally it felt better.
  3. Listen to your body. The pain is a warning sign that something is wrong. As other people have said, STOP when it hurts. Even a training niggle is your body either saying I need time to adapt or that something is wrong.

Just my .02. Just try and stay positive and realize that even 6-12 months off of an activity can be mitigated and recovered from.

5

Have my second shockwave tomorrow for PF. First one on Tuesday was ‘interesting’ and seems better since then, but certainly not instant cure. Of the 2000 impacts I had in session 1, then probably 15 were really sharp, the rest either nothing or minimal, with another 50-75 fairly sharp. Kinda like being electrocuted (I know it’s not electric, but the feeling was like that).

Certainly no increase in pain level after.

So different experience to those above. Perhaps gives balance/hope. And I’m certainly not suggesting my experience is any more likely than others.

6

I have a recurring problems with ITBS. Everytime it flares up I add yoga session every other day. Works like magic. What is interesting that for me its not leg stretches that fix the problem. I need to stretch side of torso and hips. Overall best bang for buck is parighasana.

7

Interesting: just had this done yesterday for PF, 15 min, yes it hurt but if it works I am good with the pain!!!

Second round Friday, will run today. I have not been able to fix my PF since it started in Dec but I have kept running on it.

8

I have long suffered ITB and tried everything

It appears to be glutes that need to be constantly stretched

What about ITB release?

9

I’ve had lots of shockwave all over my legs, one of my physios was big on it, never helped for anything. Nor did dry needling, cold laser, frequency patches, voodoo dolls, chiro, osteopath, etc etc.

Only thing that has ever helped my various injuries, tears, etc was to rest it and more importantly strengthen all the areas around the injury. For example, for my high hamstring tendinopathy, after a year off running which did nothing to help, strengthening the glutes and calves is what finally made the difference for me.

YMMV…