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View Full Version : INJURY OF THE WEEK....knee pain/patellar tendonitis



Flex500
11-11-2005, 07:09 AM
The topic at hand for this thread is going to be patellar tendonitis. There has been at least 10 threads made in the past 3 or 4 days with people complaining of knee pain. Patellar tendonitis seems to be the cause for most of the people who started the threads. And also a problem for many of us....including me.

Anatomy:

The patella (kneecap) is a small bone located in front of the knee. The strong Quadriceps muscles on the front of the thigh that straightens the knee, attaches to the upper portion of the patella by means of the Quadriceps tendon. This tendon covers the patella and continues down to form the Patellar tendon. The Patellar tendon in turn, attaches to the tibia (the shin bone). Thus, the Quadriceps tendon is attached to the tibia, via the Patellar tendon. The Quadriceps muscles straighten the knee by pulling up on the patella, and the tibia, via the Patellar tendon.

Symptoms:

1. pain and tenderness in the patellar tendon just below the knee joint.
2. pain and/or "tightness" in the knee when squatting, bending, or straightening the leg.
3. pain in the knee when jumping or running.
4. swelling in the front of the knee, and the area just below the knee joint.
5. a feeling of weakness in the knee.

Treatment:

Protection: by gently limiting the movement of the Patellar tendon during all knee movements, healing will occur more quickly.

• Rest: just about every activity we engage in requires us to bend and straighten our knees. While we cannot completely stop all knee movements, we need to reduce those movements which aggravate the Patellar tendon most; and, these movements include:
- walking up and down stairs
- running and jumping
- squatting
Whenever possible, sit with your leg extended straight, and avoid bending the knee.

• Ice: helps to reduce pain, swelling, and inflammation. Ice should be applied to the patella and the area below it, for 20 minutes every 4 hours. The ice should not be applied directly to the skin (place a cloth over the knee before applying the ice). The ice should "cool" the knee and be comfortableŠdo not freeze the area.

• Elevation: with the knee straight, reduces the "pull" on the Patellar tendon, and allows it to relax and heal. Elevation will also reduce swelling and inflammation.

If pain does not go away or gets worse see a doctor. You do NOT want to tear your patellar tendon

One of these also can help a lot...

http://www.ourkneedoctor.com/kneepain_pt.php#single

Dominik
11-11-2005, 07:22 AM
Great post Flex. I just wanted to add that my comments about the deluge of "injury" threads lately don't apply to informative posts like yours.

Flex500
11-11-2005, 08:37 AM
Great post Flex. I just wanted to add that my comments about the deluge of "injury" threads lately don't apply to informative posts like yours.


haha yeah I know what you mean

SB100%Natural
12-15-2009, 01:04 PM
The topic at hand for this thread is going to be patellar tendonitis. There has been at least 10 threads made in the past 3 or 4 days with people complaining of knee pain. Patellar tendonitis seems to be the cause for most of the people who started the threads. And also a problem for many of us....including me.

Anatomy:

The patella (kneecap) is a small bone located in front of the knee. The strong Quadriceps muscles on the front of the thigh that straightens the knee, attaches to the upper portion of the patella by means of the Quadriceps tendon. This tendon covers the patella and continues down to form the Patellar tendon. The Patellar tendon in turn, attaches to the tibia (the shin bone). Thus, the Quadriceps tendon is attached to the tibia, via the Patellar tendon. The Quadriceps muscles straighten the knee by pulling up on the patella, and the tibia, via the Patellar tendon.

Symptoms:

1. pain and tenderness in the patellar tendon just below the knee joint.
2. pain and/or "tightness" in the knee when squatting, bending, or straightening the leg.
3. pain in the knee when jumping or running.
4. swelling in the front of the knee, and the area just below the knee joint.
5. a feeling of weakness in the knee.

Treatment:

Protection: by gently limiting the movement of the Patellar tendon during all knee movements, healing will occur more quickly.

? Rest: just about every activity we engage in requires us to bend and straighten our knees. While we cannot completely stop all knee movements, we need to reduce those movements which aggravate the Patellar tendon most; and, these movements include:
- walking up and down stairs
- running and jumping
- squatting
Whenever possible, sit with your leg extended straight, and avoid bending the knee.

? Ice: helps to reduce pain, swelling, and inflammation. Ice should be applied to the patella and the area below it, for 20 minutes every 4 hours. The ice should not be applied directly to the skin (place a cloth over the knee before applying the ice). The ice should "cool" the knee and be comfortable?do not freeze the area.

? Elevation: with the knee straight, reduces the "pull" on the Patellar tendon, and allows it to relax and heal. Elevation will also reduce swelling and inflammation.

If pain does not go away or gets worse see a doctor. You do NOT want to tear your patellar tendon

One of these also can help a lot...

http://www.ourkneedoctor.com/kneepain_pt.php#single

Hi Flex,

I?ve been suffering with knee pain for over 2 years and it just keeps getting worse. I am (or rather WAS) a competitive bodybuilder before knee pain ruined everything. The pain occurs when extending the lower leg as seen i squats, lunges, extensions, step ups and leg presses. All these exercises cause me a lot of pain directly under the and about in the middle of the kneecap.

This pain has gradually gotten worse and worse. It has been so bad that I haven?t been able to train legs for about 7 months now. I?ve gained a lot of mass in my legs the past 2 years, but now that mass i disappearing rapidly :(

I?ve tried resting and reframing from training the legs for up to a month at a time. The pain disappears somewhat, but returns almost immediately when I resume with even light leg training again.

I?ve tried just about everything, you name it I?ve probably tried it!

Rest
Anti-inflammatories
Knee supports
Knee braces
Orthodics
Strengthening the glute medius
stretching
Glucosamine and MSM
MRI scan (reveal no obvious problems)
X-Ray (same as MRI)

I?ve used soooo much money on seeing specialists. In the end none of them have even been able to identify what the problem is so treating the problem is somewhat impossible. How can you treat what hasn?t been diagnosed?

I?m desperate for help.

Am I and all the other specialist just dumb and have missed something blindingly obvious here? Any advice would be appreciated :)

Asian_Baller
01-07-2010, 03:18 PM
Hi Flex,

I?ve been suffering with knee pain for over 2 years and it just keeps getting worse. I am (or rather WAS) a competitive bodybuilder before knee pain ruined everything. The pain occurs when extending the lower leg as seen i squats, lunges, extensions, step ups and leg presses. All these exercises cause me a lot of pain directly under the and about in the middle of the kneecap.

This pain has gradually gotten worse and worse. It has been so bad that I haven?t been able to train legs for about 7 months now. I?ve gained a lot of mass in my legs the past 2 years, but now that mass i disappearing rapidly :(

I?ve tried resting and reframing from training the legs for up to a month at a time. The pain disappears somewhat, but returns almost immediately when I resume with even light leg training again.

I?ve tried just about everything, you name it I?ve probably tried it!

Rest
Anti-inflammatories
Knee supports
Knee braces
Orthodics
Strengthening the glute medius
stretching
Glucosamine and MSM
MRI scan (reveal no obvious problems)
X-Ray (same as MRI)

I?ve used soooo much money on seeing specialists. In the end none of them have even been able to identify what the problem is so treating the problem is somewhat impossible. How can you treat what hasn?t been diagnosed?

I?m desperate for help.

Am I and all the other specialist just dumb and have missed something blindingly obvious here? Any advice would be appreciated :)


Hey man,

I know EXACTLY how you feel. I LOVE to play basketball, and I lifted weights 5x a week for months and then one day as I was doing plyometrics I felt a little knee pain. I played through it for the next few days, but then it hurt so badly that I could barely walk!! I went to the doctor, he prescribed ibu. I took that 3x a day at 800mg per serving and then it felt better, but not completely. I went to a specialist- they put me in physical therapy. I went there for 3 weeks, did eccentric strengthening, stretching, etc. I even did ionto patches and soundwave therapy. NOTHING worked and I was getting SO discouraged (ongoing for 6 months, i wasn't able to lift legs the WHOLE time, nor was I able to play bball!!!).

I finally talked to my therapist and I went to go get cortisone injections for both of my knees. They say that it is risky bc it weakens the tendon, but there was absolutely no way of healing for me. I tried all sorts of creams, anti-inflammatories, exercises, stretches, you name it, I did it. You probably feel the same way.

Anyway, I just got it today. I will keep you updated on how it goes. It may be your only hope!

Smok_Em
01-18-2010, 10:25 AM
daaaamnnn ive had this pain for just over a year now and ive found that taking Nurofen (ibuprofen) three, sometimes four times a day/night just to relive the pain and ive been taking it for almost 9months now and im fed up with taking it because the pain has been getting worst and had no difference, also wasting my money on boxes of this stuff,sick of seeing the doctor/specialist because they dont do **** to help, the stretching exercises dont do anything.
The weird thing is that this pain is nicknamed "jumpers knee" but i dont participate in any sport, but i used to skate for about 2years and stopped then the pain started sometime around 8months after i stopped skating so is it possible that i could get an injury after i have stopped that kind of activity? maybe my knee has not been used to all the jumping and exercises from skating i used to do.

This pain sux real bad, wakes me up from sleeping every night so during the day im always sleepy from not getting enough sleep.

anyone else out there get this too?

Muckle_Ewe
01-18-2010, 10:57 AM
I've been on the receiving end of a knee injury in the past few months and I'm now wondering if this is it...
I injured it squatting, let it heal for a few weeks, went back to weights then injured it again at a staff christmas party (rugby tackled over a chair...). I took about a month off weights (just legs) again and when I started I felt fine but it's recently come back...

The pain I get isn't that bad, doing a set of squats or lunges causes no worse pain than walking up stairs. The only time (since it happened) that I've had really bad pain was when I was doing Bulgarian split squats. The weird thing is though, it's my left knee that's sore, and it was my left leg that was elevated at the time. I had just done a set with my right leg elevated (i.e. most of the weight on the left leg where the sore knee is) and I had no problems.

Think I'll give it another rest... Would you guys also advise not doing things like barbell rows that require knee bending?

SB100%Natural
01-18-2010, 02:38 PM
daaaamnnn ive had this pain for just over a year now and ive found that taking Nurofen (ibuprofen) three, sometimes four times a day/night just to relive the pain and ive been taking it for almost 9months now and im fed up with taking it because the pain has been getting worst and had no difference, also wasting my money on boxes of this stuff,sick of seeing the doctor/specialist because they dont do **** to help, the stretching exercises dont do anything.
The weird thing is that this pain is nicknamed "jumpers knee" but i dont participate in any sport, but i used to skate for about 2years and stopped then the pain started sometime around 8months after i stopped skating so is it possible that i could get an injury after i have stopped that kind of activity? maybe my knee has not been used to all the jumping and exercises from skating i used to do.

This pain sux real bad, wakes me up from sleeping every night so during the day im always sleepy from not getting enough sleep.

anyone else out there get this too?

I hear ya man! I?d back off the pain killers if I were you. Long term use of them is probably not the best for you. My pain doesn't wake me up at night but it gets quite bad in the one knee if i am seated for more than a half hour with a bent knee. The docs/physio still havent managed to diagnose this problem. They want me to go for a second MRI scan at a private clinic, but this will cost a hell of a lot!

Good luck with you problem, I?ve kinda given up hope now. Pain is just worsening and none of the so called experts have got a clue. At least not in my experience.

braindx
01-19-2010, 04:10 PM
Good stuff man. There's a lot of stuff you didn't cover though.

Here's a more detailed protocol (physical therapy perspective) on tendonitis:
http://www.eatmoveimprove.com/2009/08/on-tendonitis/


For you guys with knee issues that haven't been solved, PM me and we'll discuss unless you wanna discuss here in which case you should PM me so I'll come back this thread.

Depending on where the pain is and/or if you have some systemic dysfunctions it may just be one link in the chain. We'll see.

Need pics of where the pain is, what movements hurt, acute/chronic, what aggravted it, injury history, etc.?

SB100%Natural
01-20-2010, 02:14 AM
Good stuff man. There's a lot of stuff you didn't cover though.

Here's a more detailed protocol (physical therapy perspective) on tendonitis:
http://www.eatmoveimprove.com/2009/08/on-tendonitis/


For you guys with knee issues that haven't been solved, PM me and we'll discuss unless you wanna discuss here in which case you should PM me so I'll come back this thread.

Depending on where the pain is and/or if you have some systemic dysfunctions it may just be one link in the chain. We'll see.

Need pics of where the pain is, what movements hurt, acute/chronic, what aggravted it, injury history, etc.?

Hi braindx

Thanks for offering assistance, I will PM you soon.

low blow
01-20-2010, 06:44 AM
Hi Flex,

I?ve been suffering with knee pain for over 2 years and it just keeps getting worse. I am (or rather WAS) a competitive bodybuilder before knee pain ruined everything. The pain occurs when extending the lower leg as seen i squats, lunges, extensions, step ups and leg presses. All these exercises cause me a lot of pain directly under the and about in the middle of the kneecap.

This pain has gradually gotten worse and worse. It has been so bad that I haven?t been able to train legs for about 7 months now. I?ve gained a lot of mass in my legs the past 2 years, but now that mass i disappearing rapidly :(

I?ve tried resting and reframing from training the legs for up to a month at a time. The pain disappears somewhat, but returns almost immediately when I resume with even light leg training again.

I?ve tried just about everything, you name it I?ve probably tried it!

Rest
Anti-inflammatories
Knee supports
Knee braces
Orthodics
Strengthening the glute medius
stretching
Glucosamine and MSM
MRI scan (reveal no obvious problems)
X-Ray (same as MRI)

I?ve used soooo much money on seeing specialists. In the end none of them have even been able to identify what the problem is so treating the problem is somewhat impossible. How can you treat what hasn?t been diagnosed?

I?m desperate for help.

Am I and all the other specialist just dumb and have missed something blindingly obvious here? Any advice would be appreciated :)

Maybe obvious but have you tried strengthening your Vastus Medialis Obliqous? Try get a place that will use EMG (electromyography) on your quadraceps/glutes during contraction, comparing your injuried and non-injured leg. This can show where your functional deficiency is

SB100%Natural
01-20-2010, 09:42 AM
Maybe obvious but have you tried strengthening your Vastus Medialis Obliqous? Try get a place that will use EMG (electromyography) on your quadraceps/glutes during contraction, comparing your injuried and non-injured leg. This can show where your functional deficiency is

Would extension of the lower leg be classified as strengthening the VMO? If so then I have tried that... I'm a bodybuilder, I've tried most exercises for the legs/body. Problem is I cannot do any type of leg extension exercise anymore due to the pain they cause me. Same with all squat type exercises, presses and lunges.

low blow
01-20-2010, 03:26 PM
Would extension of the lower leg be classified as strengthening the VMO? If so then I have tried that... I'm a bodybuilder, I've tried most exercises for the legs/body. Problem is I cannot do any type of leg extension exercise anymore due to the pain they cause me. Same with all squat type exercises, presses and lunges.

no, see what it sounds like to me is you have whats called a functional problem - not structural. Typically tendonitis will subside after 2-3 months of complete rest, or if you have tendinosis it should come up on an MRI (but again depends on the radiologist).

http://www.youtube.com/watch?v=IBTNCDZaqm8

try this taping technique to see if it improves your condition.

Now the reason I said to get EMG done is because, if their is a VMO deficiet, then no amount of leg extensions will correct the problem as it just continues the inappropriate activation. Of course rather then spend months on activation exercises (that may also cause pain), you can confirm if you have this condition with a surface electrode EMG reading.

An example of a VMO exercise is literally a 1/5th squat - the knee does not go past the toe and you make sure the knee travels over the toes, or in between the big toe (called the first toe) and the 2nd toe. Doing this exercise you greatly feel the tear drop activate.

besides that I have you had a gait analysis? A good podiatrist can see if you've got an issue there.

Remember, try the taping technique and report back.

SB100%Natural
01-21-2010, 02:31 AM
no, see what it sounds like to me is you have whats called a functional problem - not structural. Typically tendonitis will subside after 2-3 months of complete rest, or if you have tendinosis it should come up on an MRI (but again depends on the radiologist).

http://www.youtube.com/watch?v=IBTNCDZaqm8

try this taping technique to see if it improves your condition.

Now the reason I said to get EMG done is because, if their is a VMO deficiet, then no amount of leg extensions will correct the problem as it just continues the inappropriate activation. Of course rather then spend months on activation exercises (that may also cause pain), you can confirm if you have this condition with a surface electrode EMG reading.

An example of a VMO exercise is literally a 1/5th squat - the knee does not go past the toe and you make sure the knee travels over the toes, or in between the big toe (called the first toe) and the 2nd toe. Doing this exercise you greatly feel the tear drop activate.

besides that I have you had a gait analysis? A good podiatrist can see if you've got an issue there.

Remember, try the taping technique and report back.

Hi again,

Thanks again for your assistance. My physio tried a similar taping technique on me before which involved cutting the tape and placing in vertically "up" the knee either side of the kneecap. I did not help at all unfortunately.

Would you recommend the 1/5 squat technique to be done bilaterally or both legs simultaneously? I tried the single leg version before in the smith machine but even that was very painful in the knee.

This problem seems sooo difficult to cure because I still have not gotten a diagnosis from the physio yet. It seems like this is just going to be a process of trial and error that will go on for years.

The EMG idea seems logical, but I am not even sure if that treatment is available where I live. I will ask around.

Thanks man.

low blow
01-21-2010, 08:51 AM
Hi again,

Thanks again for your assistance. My physio tried a similar taping technique on me before which involved cutting the tape and placing in vertically "up" the knee either side of the kneecap. I did not help at all unfortunately.

Would you recommend the 1/5 squat technique to be done bilaterally or both legs simultaneously? I tried the single leg version before in the smith machine but even that was very painful in the knee.

This problem seems sooo difficult to cure because I still have not gotten a diagnosis from the physio yet. It seems like this is just going to be a process of trial and error that will go on for years.

The EMG idea seems logical, but I am not even sure if that treatment is available where I live. I will ask around.

Thanks man.

somebody, somewhere should have a surface electrode EMG machine (they arent extremely expensive).

Try the taping technique described in the video which moves the patella closer to
midline just in case...never heard of an "upwards" pulling taping for the patella.

try both legs at first, then if you can progress to unilateral - its a "feel" exercise. You SHOULD feel your vastus medialis contracting and fatiguing much more then your vastus lateralis (basically inside contracts harder then outside). Remember, knee (specifically patella) travells between big toe and 2nd toe though just vary this around. Another exercise you can try is leg raises (for the illiopsoas muscles).

Work on just getting a contraciton going now, even if that means basically using both legs and using your upperbody to lighten the load (hold on to a nearby table or something).

Another diagnostic test which you've probably already done is you lay down on a table with your legs dangling off and compare how much higher the injured leg is to the uninjured one - it can show if their is a shortening of the rectus femoris muscle.

Try do a very thourough warm up as well before you exercise the knee, complete with foam rolling and stretching of the surrounding region.

I read where you described the pain

look im no doctor or physical therapist yet, but your class is a classical VMO deficiency.



Also though going on to braindx's train of thought, this could just be an adaption to a problem higher up (say in the hip musculature).

I understand your frustration though, been injured for around 3 years now and things are only just now getting better. My advice is research,reasearch, research people in the area that can help and try them out until you find the right person - some times only they can help with 1 problem or so. Try find a sports medicine specialist in knee syndromes

an interesting read is here as well if you have some time

http://www.injuryupdate.com.au/injuries/knee.php

just general articles on knee injuries and such, maybe you can find something useful in them + the forum links at the bottom

braindx
01-21-2010, 10:20 AM
If you have particular aggressive tendinopathy especially in the lower limbs I would strongly suggest reading this:

http://www.eatmoveimprove.com/2009/11/shoes-sitting-and-lower-body-dysfunctions/

SB100%Natural
01-22-2010, 12:28 PM
somebody, somewhere should have a surface electrode EMG machine (they arent extremely expensive).

Try the taping technique described in the video which moves the patella closer to
midline just in case...never heard of an "upwards" pulling taping for the patella.

try both legs at first, then if you can progress to unilateral - its a "feel" exercise. You SHOULD feel your vastus medialis contracting and fatiguing much more then your vastus lateralis (basically inside contracts harder then outside). Remember, knee (specifically patella) travells between big toe and 2nd toe though just vary this around. Another exercise you can try is leg raises (for the illiopsoas muscles).

Work on just getting a contraciton going now, even if that means basically using both legs and using your upperbody to lighten the load (hold on to a nearby table or something).

Another diagnostic test which you've probably already done is you lay down on a table with your legs dangling off and compare how much higher the injured leg is to the uninjured one - it can show if their is a shortening of the rectus femoris muscle.

Try do a very thourough warm up as well before you exercise the knee, complete with foam rolling and stretching of the surrounding region.

I read where you described the pain

look im no doctor or physical therapist yet, but your class is a classical VMO deficiency.



Also though going on to braindx's train of thought, this could just be an adaption to a problem higher up (say in the hip musculature).

I understand your frustration though, been injured for around 3 years now and things are only just now getting better. My advice is research,reasearch, research people in the area that can help and try them out until you find the right person - some times only they can help with 1 problem or so. Try find a sports medicine specialist in knee syndromes

an interesting read is here as well if you have some time

http://www.injuryupdate.com.au/injuries/knee.php

just general articles on knee injuries and such, maybe you can find something useful in them + the forum links at the bottom

Thanks man,

I will try the taping technique in the video again (have tried before). I will try the laying on the table with legs hanging off, that has never been suggested to me before. Not sure if it will show "an injured leg" as both knees are pretty much equally as bad. I have never had an injury per say, just the pain that started in both knees several years ago and has progressed to the present day were all I think about all day is knee pain whilst trying to be Mr happy personal trainer.

Ive been to several different doctors, seen 2 physios, 2 different chiros an osteopath, a foot doctor, tried complete rest, anti-innflammatories, glucosamine, taping techniques etc. You name it I have probably tried it. Nothing has helped even slightly. I even recently tried something called pressure wave treatment which was absolutely excruciating. Did not do jack. I am now into the thousands of dollars spent on sessions with specialists that lead nowhere. I must admit I am starting to lose faith in the "experts." Seems I get some more intelligent suggestions on these forums to be honest.

What is it may I ask that is typical of a classical VMO deficiency? I asked my physio about this and he said this was very unlikely in my case because I had well developed leg strength and significant hypertrophy of the vastus medialis and quadriceps in general.

Like you said, research, research, research! I will continue to do this, but its very un-motivating to come up blank every time.

Anyways, thanks for your suggestions, they are appreciated... the people on this forums at least seem interested in my frustrating and depressing situation, unlike the docs.

braindx
01-22-2010, 06:22 PM
SB100%Natural,

Get back to me once you have evaled yourself!

low blow
01-22-2010, 06:30 PM
Thanks man,

I will try the taping technique in the video again (have tried before). I will try the laying on the table with legs hanging off, that has never been suggested to me before. Not sure if it will show "an injured leg" as both knees are pretty much equally as bad. I have never had an injury per say, just the pain that started in both knees several years ago and has progressed to the present day were all I think about all day is knee pain whilst trying to be Mr happy personal trainer.

Ive been to several different doctors, seen 2 physios, 2 different chiros an osteopath, a foot doctor, tried complete rest, anti-innflammatories, glucosamine, taping techniques etc. You name it I have probably tried it. Nothing has helped even slightly. I even recently tried something called pressure wave treatment which was absolutely excruciating. Did not do jack. I am now into the thousands of dollars spent on sessions with specialists that lead nowhere. I must admit I am starting to lose faith in the "experts." Seems I get some more intelligent suggestions on these forums to be honest.

What is it may I ask that is typical of a classical VMO deficiency? I asked my physio about this and he said this was very unlikely in my case because I had well developed leg strength and significant hypertrophy of the vastus medialis and quadriceps in general.

Like you said, research, research, research! I will continue to do this, but its very un-motivating to come up blank every time.

Anyways, thanks for your suggestions, they are appreciated... the people on this forums at least seem interested in my frustrating and depressing situation, unlike the docs.


A typical VMO deficiency is the condition you exactly describe (patella pain) and can be further diagnosed with EMG.

look while you do have "significant hypertrophy" in those muscles, it does not mean they are functioning better. If a guy can bench 600lbs and only row 300lbs, well both are extremely strong lifts but their is still an imbalance - which is why you do diagnostic checks rather then "I see this, therefore this can't be the case". I've been taught to consider the VMO to be seperate to the vastus medialis, as their is a genicular branch of the femoral nerve that inserts right into the lower aspect of the vastus medialis. Also the VMO isnt a "power" muscle, its a muscle for function similar to the diaphragm - it has a job it needs to perform but doesnt not need to generate much force in doing so.

VMO rehabilitation is just another thing to try, I'm not saying it will definately fix it.

Also it being in both legs could is a bit odd, those with VMO problems have it only in 1 leg...when you went to the podiatrist did they do a gait analysis?

SB100%Natural
01-23-2010, 02:59 AM
A typical VMO deficiency is the condition you exactly describe (patella pain) and can be further diagnosed with EMG.

look while you do have "significant hypertrophy" in those muscles, it does not mean they are functioning better. If a guy can bench 600lbs and only row 300lbs, well both are extremely strong lifts but their is still an imbalance - which is why you do diagnostic checks rather then "I see this, therefore this can't be the case". I've been taught to consider the VMO to be seperate to the vastus medialis, as their is a genicular branch of the femoral nerve that inserts right into the lower aspect of the vastus medialis. Also the VMO isnt a "power" muscle, its a muscle for function similar to the diaphragm - it has a job it needs to perform but doesnt not need to generate much force in doing so.

VMO rehabilitation is just another thing to try, I'm not saying it will definately fix it.

Also it being in both legs could is a bit odd, those with VMO problems have it only in 1 leg...when you went to the podiatrist did they do a gait analysis?

Hi. The podiatrist didn't pay any particular attention to my gait no. I have been back to him several times to get my orthodics adjusted after testing them for several months with no success. I Have very flat feet, I have done for years. They are overpronated so the orthodic soles I have are supposed to oppose that from occurring to an extent.

I Have done a lot of calf work, i.e. raises standing and donkeycalf raises and seated calf raises for quite a few years and have sometimes noticed pain under my foot whilst performing them. This is just a wildcard guess, but could the source of my knee pain be due to an injury of the plantar fascia? I am thinking an injury here could lead to a deformity of the foot and thus lead to overpronating and the finally lead to knee pain? An over stretched plantar fascia would greatly reduce the ability of the foot to do its job. What do you think? Possible?

With regards to what you mentioned about imbalance between muscles you could be right there. When I could train my legs I was always way, way stronger in posterior chain type exercises like straight leg deadlifts and normal deadlifts than I was in the squat or lunge. I could normally deadlift 50-60% more than I could squat... lol now I cannot even sit down with my own bodyweight without a lot of pain.

I will ask my physio about EMG.

low blow
01-23-2010, 06:38 AM
Hi. The podiatrist didn't pay any particular attention to my gait no. I have been back to him several times to get my orthodics adjusted after testing them for several months with no success. I Have very flat feet, I have done for years. They are overpronated so the orthodic soles I have are supposed to oppose that from occurring to an extent.

I Have done a lot of calf work, i.e. raises standing and donkeycalf raises and seated calf raises for quite a few years and have sometimes noticed pain under my foot whilst performing them. This is just a wildcard guess, but could the source of my knee pain be due to an injury of the plantar fascia? I am thinking an injury here could lead to a deformity of the foot and thus lead to overpronating and the finally lead to knee pain? An over stretched plantar fascia would greatly reduce the ability of the foot to do its job. What do you think? Possible?

With regards to what you mentioned about imbalance between muscles you could be right there. When I could train my legs I was always way, way stronger in posterior chain type exercises like straight leg deadlifts and normal deadlifts than I was in the squat or lunge. I could normally deadlift 50-60% more than I could squat... lol now I cannot even sit down with my own bodyweight without a lot of pain.

I will ask my physio about EMG.

I could sit here and bull**** you but honestly I have no idea - I am extremely lucky to have finally found a PT that actually knows the workings between various injuries and body parts. I mean what changed that your knee's just started to bother you at some point? The pain under your foot is probably related to the collapsing medial arch, but if you start performing calf raises with an emphasis on arching the foot (and strengthening the main muscle for the arch - the tibialis posterior) then it could go away.

If you're podiatrist didn't do a gait analysis, I suggest finding another who will.

This is why I mentioned researching those who are top in the field in your area - the difference can be like night and day.

My old pod just watched my walk down the hall and gave me these ****ty weak plastic styrofoam soles...they sucked.

the new pod I see did a real time and video's both my standing, walking and running gait with a very sick analysis of each and he even picked up on problems i hadn't mentioned.

BTW have you tried cortizone injections? I would be curious to see how they go if it is a tendonitis issue...though at this point it is probably more like tendonosis (or a mixture of both if you're still using the muscle.)

braindx
01-23-2010, 01:53 PM
Calf raises by themselves won't really do much for the arch when the plantar aspect muscles are all inactivated.

You need to strengthen the 4 layers of muscle on the bottom of the foot with toe curling exercises (towel pickups, scrunching up newpapers/towels with the toes, etc.) + balance work. All barefoot. This is in addition to the massage that should accompany these exercises (for proprioceptive activation of the muscles).

From the PMs of what he's told me, I do think that there's some systemic disruption of stuff in the knees from the flat feet & hallux valgus in addition to some hotspots in the IT band and quad.

Haven't gotten word back on the tissue quality of the rectus femoris, and hip flexors but may be some stuff there as well that I don't know about.

May also be some problems with tight hammies + proper activation of the hammies.

Possibly some psychological pain as well.

We can get down to the core of this pretty easily, I think.


Low blow,
I think you would enjoy reading the link I posted up in #16. If you're interested in the physiology aspect of these dysfunctions that basically explains it.

low blow
01-23-2010, 09:57 PM
Calf raises by themselves won't really do much for the arch when the plantar aspect muscles are all inactivated.

You need to strengthen the 4 layers of muscle on the bottom of the foot with toe curling exercises (towel pickups, scrunching up newpapers/towels with the toes, etc.) + balance work. All barefoot. This is in addition to the massage that should accompany these exercises (for proprioceptive activation of the muscles).

From the PMs of what he's told me, I do think that there's some systemic disruption of stuff in the knees from the flat feet & hallux valgus in addition to some hotspots in the IT band and quad.

Haven't gotten word back on the tissue quality of the rectus femoris, and hip flexors but may be some stuff there as well that I don't know about.

May also be some problems with tight hammies + proper activation of the hammies.

Possibly some psychological pain as well.

We can get down to the core of this pretty easily, I think.


Low blow,
I think you would enjoy reading the link I posted up in #16. If you're interested in the physiology aspect of these dysfunctions that basically explains it.

I will, thanks.

also its nice of you to post your insight here as an Md and look at peoples MRI's.

braindx
01-24-2010, 03:02 PM
I will, thanks.

also its nice of you to post your insight here as an Md and look at peoples MRI's.
I'm not an MD. :)

I'm starting PT school this year actually...

Internet is a wonderous thing for learning if you're a critical thinker.

waterboys
02-18-2010, 02:18 PM
Why do people always assume knee pain means tendonitis? More often than not, it's caused by soft tissue..... quadricep trigger points due to overuse.

See an ART-certified provider and lookup the "trigger point therapy workbook" on amazon by Clair Davies. Get a foam roller.

Also make sure you deload often enough.

ubermario
03-20-2011, 03:57 AM
Sorry to bump but, it looks like I have this.

I've been to a doctor 3 months ago and she couldn't really find what it was but thought it had to do with my feet which are quite flat. And the pain was higher up my knee back then. Right now the pain is below my knee.

So I got some good fitting soles but this didn't help with the pain/irritation. The pain seems to come and go, sometimes a few weeks hardly any pain/irritation but then it returns again. Not alot of irritation during the day but mostly at night.

I guess I have to give it more rest by not squatting at all, but can I still do other leg exercises? Such as leg extensions and possibly others?

What about deadlifting?

eduardomachado
01-17-2012, 05:18 PM
Thanks for this...

fslima0
03-14-2012, 07:50 PM
I had been front squatting 3 times a week doing the SS program before I injured my knee. The thing is every time I squatted, I would feel a pain in the back of my knee and couldn't elevate my straight leg off the bed, for example, or completely straighten my leg while standing without feeling pain. It's said that doing only front squats might cause muscle imbalance, because it mainly works the quads and that was all i was doing for legs. Now my right knee feels really bad... I can walk just fine without feeling pain, but once I try to run, it hurts... I can do leg extension, leg curls, and even leg press just fine.

My question is: could this be patellar tendonitis as the pain is really in the patella area? or could this be a tear of some kind? miniscus tear? The pain when walking is almost gone.. only hurts when i run...

Please respond. Thanks

justcallmedave
07-06-2012, 11:53 AM
You should seek specialised help for your knee pain, see this website for more information: chondromalacia-patellae.com/

nevergain
01-31-2013, 03:20 PM
Sorry to bump but, it looks like I have this.

I've been to a doctor 3 months ago and she couldn't really find what it was but thought it had to do with my feet which are quite flat. And the pain was higher up my knee back then. Right now the pain is below my knee.

So I got some good fitting soles but this didn't help with the pain/irritation. The pain seems to come and go, sometimes a few weeks hardly any pain/irritation but then it returns again. Not alot of irritation during the day but mostly at night.

I guess I have to give it more rest by not squatting at all, but can I still do other leg exercises? Such as leg extensions and possibly others?

What about deadlifting?

Bumping this to hear thought on exercises. I was told by doc to rest the knee for a few weeks, but am wondering about exercises such as sldl or even rows since there is still some weight being held up by the legs.

I'm not very impressed I can't squat or ski for a couple weeks, but don't want to stop my whole workout if I don't have to.