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    Battling Patellar Tendonitis

    Hey guys,

    I've been suffering from patellar tendonitis for a couple of years now. I have been to my doctor and physiotherapist. They told me to foam roll and stretch much more and not to run as much. I train in MMA a couple of times a week as well. I admit, I'm not icing and stretching as much as I should be.

    I have been so frustrated with my knees. This problem holds me back from so much. Is there any answers to this problem? Will this tendonitis ever go away?
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    Originally Posted by Aches89 View Post
    Hey guys,

    I've been suffering from patellar tendonitis for a couple of years now. I have been to my doctor and physiotherapist. They told me to foam roll and stretch much more and not to run as much. I train in MMA a couple of times a week as well. I admit, I'm not icing and stretching as much as I should be.

    I have been so frustrated with my knees. This problem holds me back from so much. Is there any answers to this problem? Will this tendonitis ever go away?
    Had the same issue. I know injuries can be frustrating and if they prevent you from progressing in your athletic journey just drag you downright into depression. Sometimes you gotta take a step back before moving foreward. Give the docs treatment a chance. Ofcourse you wont see any results immidiately especially when it has gone on for years. However dont fall into the trap allowing yourself to think stuff like "nah its not gonna help anyway so I dont really try" and do an half-assed rehab attempt. Injuries and chronic pain can really really mess with your mind.... Dont stop doing sport, but keep workouts rather brief and avoid pain. Be extremely diligent about warming up. Stretch dynamically before and dynamically and statically after the workout....

    Do the icing. Icing really helps to increase the recovery-capacity of soft tissue/tendons but its important to do it constantly. Regularity is absolutel key with stretching/icing. Ice after your workout and 2-3times per day. 15-20mins at a time.
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    Originally Posted by badgenesnogainz View Post
    Had the same issue. I know injuries can be frustrating and if they prevent you from progressing in your athletic journey just drag you downright into depression. Sometimes you gotta take a step back before moving foreward. Give the docs treatment a chance. Ofcourse you wont see any results immidiately especially when it has gone on for years. However dont fall into the trap allowing yourself to think stuff like "nah its not gonna help anyway so I dont really try" and do an half-assed rehab attempt. Injuries and chronic pain can really really mess with your mind.... Dont stop doing sport, but keep workouts rather brief and avoid pain. Be extremely diligent about warming up. Stretch dynamically before and dynamically and statically after the workout....

    Do the icing. Icing really helps to increase the recovery-capacity of soft tissue/tendons but its important to do it constantly. Regularity is absolutel key with stretching/icing. Ice after your workout and 2-3times per day. 15-20mins at a time.
    Thank you for your advice, man! I really appreciate it. I think you're definitely right. I need to stick to the rehab, keep icing, keep stretching.

    As far as running goes, would it be okay to continue running maybe twice a week? Sometimes I jump on the treadmill and as I start a slow jog I feel that pain coming on; and today was one of those days so I just jumped off the treadmill. Would it also be good to do lighter high rep squats and really try to focus on my form? I'm all limbs, so I find sometimes I tend to lean forward when coming out of the hole when I squat.

    I also bought Rogue Fitness Voodoo Floss. I've used this now and then, but once again I think I should continue using them daily and see how it turns out.
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    Aches, if you have had this injury for 2 years you DO NOT have tendontitis. You have tendonosis, chronic degeneration of the structure of your patellar tendon. Research something called the Tenex FAST procedure. It is a minimally invasive mini-arthoscopic procedure that debrides the tendon of necrotic (scar) tissue. Return to activity is a slow process that will take around 3-4 months of taking it easy and PT. You will not see any results at this point with simple stretching, ART, Graston, NSAID's, ultrasound, etc.
    Last edited by Foreigner; 03-24-2014 at 09:38 PM.
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    Originally Posted by Foreigner View Post
    Aches, if you have had this injury for 2 years you DO NOT have tendontitis. You have tendonosis, chronic degeneration of the structure of your patellar tendon. Research something called the Tenex FAST procedure. It is a minimally invasive mini-arthoscopic procedure that debrides the tendon of necrotic (scar) tissue. Return to activity is a slow process that will take around 3-4 months of taking it easy and PT. You will not see any results at this point with simple stretching, ART, Graston, NSAID's, ultrasound, etc.
    I really do not want to take that long off. Perhaps that is what I have. What would be the next step? I'm not sure who would do this procedure where I live? Maybe this is a fairly common procedure...I'm interested.
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    Originally Posted by Aches89 View Post
    I really do not want to take that long off. Perhaps that is what I have. What would be the next step? I'm not sure who would do this procedure where I live? Maybe this is a fairly common procedure...I'm interested.
    The next step is to see a qualified sports medicine doctor that can diagnose the injury via ultrasound or MRI. These tests will show whatever thickening, disorganized fibers, or tears you may possibly have. As for the procedure, see the Tenex health website for a doctor near you that does the procedure. It is NOT a fairly common procedure, but it is FDA approved and is covered by most insurance. It is actually fairly new and has shown very good results in several professional athletes with tendonopathy.

    As for taking time off, educate yourself on the healing process of injured tendons. It is very slow and involves many steps from the inflammatory phase to the rearranging of collagen fibers. Time off is a must. The minimum is usually 4-6 months for complete healing. You will often hear 6 weeks, but I've found this to be very farfetched. Premature return to activity will cause re-injury. You can potentially speed the healing process up and improve the quality of healing with PRP (platelet rich plasma) or stem cell (bone marrow and / or adipose) injections. Although expensive, I've found them to be extremely effective.

    If your doctor recommends rest, ice, and NSAID's do yourself a favor and go somewhere else. This is not going to do anything for your condition. Most doctors are very uneducated about tendonopathy and are absolutely clueless on how to treat these types of injuries. The first step in all of this is to see what the injury is and how severe it is. If you have a lot of necrotic tissue then Tenex FAST will probably be recommend. If you have slight thickening and disorganized fibers, then a PRP injection, ART, and physical therapy may be the best first step. It all depends on what your doctor recommends.

    Good luck, I've been through several such injuries (both elbows, shoulder, and achilles) and PRP / stem cells and Tenex FAST has healed them all 100%.
    Last edited by Foreigner; 03-25-2014 at 12:00 PM.
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    Originally Posted by Foreigner View Post
    The next step is to see a qualified sports medicine doctor that can diagnose the injury via ultrasound or MRI. These tests will show whatever thickening, disorganized fibers, or tears you may possibly have. As for the procedure, see the Tenex health website for a doctor near you that does the procedure. It is NOT a fairly common procedure, but it is FDA approved and is covered by most insurance. It is actually fairly new and has shown very good results in several professional athletes with tendonopathy.

    As for taking time off, educate yourself on the healing process of injured tendons. It is very slow and involves many steps from the inflammatory phase to the rearranging of collagen fibers. Time off is a must. The minimum is usually 4-6 months for complete healing. You will often hear 6 weeks, but I've found this to be very farfetched. Premature return to activity will cause re-injury. You can potentially speed the healing process up and improve the quality of healing with PRP (platelet rich plasma) or stem cell (bone marrow and / or adipose) injections. Although expensive, I've found them to be extremely effective.

    If your doctor recommends rest, ice, and NSAID's do yourself a favor and go somewhere else. This is not going to do anything for your condition. Most doctors are very uneducated about tendonopathy and are absolutely clueless on how to treat these types of injuries. The first step in all of this is to see what the injury is and how severe it is. If you have a lot of necrotic tissue then Tenex FAST will probably be recommend. If you have slight thickening and disorganized fibers, then a PRP injection, ART, and physical therapy may be the best first step. It all depends on what your doctor recommends.

    Good luck, I've been through several such injuries (both elbows, shoulder, and achilles) and PRP / stem cells and Tenex FAST has healed them all 100%.

    Wow man, thank you so much for all of this information. This has got to be one of the most frustrating injuries I have ever dealt with. It holds me back from so much. I know you mentioned any stretching or icing won't really help now, but I've started doing hot yoga to help build strength and flexibility in my legs. Physio originally said they believe I'm more hip dominant and that is what is causing me knees to ache like this. They gave me a bunch of different exercises and told me to not run as much and to avoid exercises that irritate it for awhile until it gets better; unfortunately, I was too stubborn and kept pushing forward.
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    No problem, like I said I've delt with it and felt the same as you. As for what caused the injury originally. I'd bet on it being overuse and possibly muscle imbalances. I've done a lot of reading on kinesiology (http://www.exrx.net/Exercise.html) before getting back into things. The best thing to do when you return to working out after this injury is to incorporate and strictly follow a de-loading schedule, stretch, and every so often if you can afford it for maintenance purposes get ART (active release technique). Prevention is always better then having to go through the above.
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    I've dealt with patellar tendinopathy on and off for some time now and the only thing that has helped has been PRP and prolotherapy shots. I had 3 PRP shots and my knee felt like new again. I aggravated it doing yoga and now after 3 prolotherapy shots my knee feels so much better. I can walk and squat pain free now and it feels so stable. I've done physical therapy 3 times to no avail, and the shots are what did it in the end. Even though they are not covered by insurance I highly recommend them.
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    I agree with alot what foreigner said, but definately not with all of it. First the things I do not agree with:

    The correct name for this kinda tendinopathy is tendinosis ofc, tendinitis is an acute condition. I didnt really deem it neccessary to point that out, but foreigner is right. However there are alot of conditions you could be suffering from, Chondromalacia patellae, edema in the tibialhead, all kinda stuff really. Differential diagnosis is often complicated cause many middle aged patients display often several degenerative conditions and its often hard to find out whats really the cause for the pain.

    What I dont agree on is that icing is useless. It is absolutely not, its just used for a different reason. In acute injuries like tendonitis that are treated following the PRICE principle the ice is used to combat inflammation. In degenerative injuries its used to increase the bloodflow to the tissue etc, to speed up the healing. Heat can be used aswell (which should absolutely NOT be used for tendonitis). However the icing has to remain in the 15-20min timeframe, applying it longer is even detrimental .

    Careful stretching is never useless, specially in case of patella dysfunction. Mantaining a healthy range of motion a and adress alignment issues is neccessary to treat the cause for your injury and restore optimal glising of the patella.

    NSAID´s are used for pain-control.

    Total rest is totally contra-indicated in patients with tendinosis. I dont think thats what foreigner meant, just wanted to underline that. Avoiding pain on the other hand is critical.

    Now what I agree with:

    You should get a MRI
    Physical therapy is paramount.

    Cant really comment on the invasive techniues foreigner was talking about due tolack of knowledge.
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    Originally Posted by badgenesnogainz View Post
    I agree with alot what foreigner said, but definately not with all of it. First the things I do not agree with:

    The correct name for this kinda tendinopathy is tendinosis ofc, tendinitis is an acute condition. I didnt really deem it neccessary to point that out, but foreigner is right. However there are alot of conditions you could be suffering from, Chondromalacia patellae, edema in the tibialhead, all kinda stuff really. Differential diagnosis is often complicated cause many middle aged patients display often several degenerative conditions and its often hard to find out whats really the cause for the pain.

    What I dont agree on is that icing is useless. It is absolutely not, its just used for a different reason. In acute injuries like tendonitis that are treated following the PRICE principle the ice is used to combat inflammation. In degenerative injuries its used to increase the bloodflow to the tissue etc, to speed up the healing. Heat can be used aswell (which should absolutely NOT be used for tendonitis). However the icing has to remain in the 15-20min timeframe, applying it longer is even detrimental .

    Careful stretching is never useless, specially in case of patella dysfunction. Mantaining a healthy range of motion a and adress alignment issues is neccessary to treat the cause for your injury and restore optimal glising of the patella.

    NSAID´s are used for pain-control.

    Total rest is totally contra-indicated in patients with tendinosis. I dont think thats what foreigner meant, just wanted to underline that. Avoiding pain on the other hand is critical.

    Now what I agree with:

    You should get a MRI
    Physical therapy is paramount.

    Cant really comment on the invasive techniues foreigner was talking about due tolack of knowledge.
    Badgenesnogainz, I completely agree with most of your points. I am not a doctor and did not diagnose Aches89. I simply said if he has had patellar tendonitis for 2 years, then it is no longer "itis", but more then likely at "osis". Diagnosing it should be fairly simple. If his pain is isolated to the patellar tendon, then ultrasound will be very effective at showing the extent of denigration or damage. If the patellar tendon is fine, then an MRI of the knee will probably be requested to get a better picture of all structures of the knee.

    Icing is very beneficial for sports injuries, but obviously not for tendonosis, which as you said is a chronic condition. Also, I am a very big advocate of NOT using NSAID's for sports injuries for several reasons. The first being that inflammation is a natural process that is actually beneficial to healing. Even during the initial "itis" stage the inflammatory response only lasts a week few weeks before the tendon structure begins healing. Inhibiting this process can delay healing. Secondly, pain is a good thing. It lets you know something is wrong. Too many people pop a few NSAID's and hit the weights. Lastly, it's absolutely awful for your stomach and liver. Although, in most normal dosages that one would take for a headache or minor cold its perfectly safe.
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    Originally Posted by Foreigner View Post
    Badgenesnogainz, I completely agree with most of your points. I am not a doctor and did not diagnose Aches89. I simply said if he has had patellar tendonitis for 2 years, then it is no longer "itis", but more then likely at "osis". Diagnosing it should be fairly simple. If his pain is isolated to the patellar tendon, then ultrasound will be very effective at showing the extent of denigration or damage. If the patellar tendon is fine, then an MRI of the knee will probably be requested to get a better picture of all structures of the knee.

    Icing is very beneficial for sports injuries, but obviously not for tendonosis, which as you said is a chronic condition. Also, I am a very big advocate of NOT using NSAID's for sports injuries for several reasons. The first being that inflammation is a natural process that is actually beneficial to healing. Even during the initial "itis" stage the inflammatory response only lasts a week few weeks before the tendon structure begins healing. Inhibiting this process can delay healing. Secondly, pain is a good thing. It lets you know something is wrong. Too many people pop a few NSAID's and hit the weights. Lastly, it's absolutely awful for your stomach and liver. Although, in most normal dosages that one would take for a headache or minor cold its perfectly safe.
    Yes absolutely.I think the dangers of NSAID´s are certainly awefully underrated. Atleast when taken continously for a long time! I do think that NSAID´s have their place. For example impingement type tendonitis (where mechanical friction is further facilitated by thickening of the tissue)especially in elite athletes. If accompinied by appropiate adjustments of training volume and intensity the downtime can often times be drastically reduced. Its probably not the healthiest way to go about it (and maybe detrimental to an athletes longevity) but its pretty effective. And for professional athletes who HAVE to perform a few days/weeks downtime prior to peaking can be devestating.

    If someone wants to hate on my for saying this thats fine but thats just the ugly reality of elite sports...pills and performance>health

    Derailing the thread....accomplished ;
    Last edited by badgenesnogainz; 03-26-2014 at 07:06 PM.
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    Originally Posted by badgenesnogainz View Post
    Yes absolutely.I think the dangers of NSAID´s are certainly awefully underrated. Atleast when taken continously for a long time! I do think that NSAID´s have their place. For example impingement type tendonitis (where mechanical friction is further facilitated by thickening of the tissue)especially in elite athletes. If accompinied by appropiate adjustments of training volume and intensity the downtime can often times be drastically reduced. Its probably not the healthiest way to go about it (and maybe detrimental to an athletes longevity) but its pretty effective. And for professional athletes who HAVE to perform a few days/weeks downtime prior to peaking can be devestating.

    If someone wants to hate on my for saying this thats fine but thats just the ugly reality of elite sports...pills and performance>health

    Derailing the thread....accomplished ;
    Thanks for your input as well! Do you think doing some eccentric exercises will help this injury, maybe 2-3 times a week? Can I continue running now and then, MMA, and squatting (lighter, working on form)? I will call my doc and schedule to have an ultrasound or MRI. What I fear about that is the waiting list for one...
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    Originally Posted by Aches89 View Post
    Thanks for your input as well! Do you think doing some eccentric exercises will help this injury, maybe 2-3 times a week? Can I continue running now and then, MMA, and squatting (lighter, working on form)? I will call my doc and schedule to have an ultrasound or MRI. What I fear about that is the waiting list for one...
    I've done a fair amount of research and talking to physical therapists and orthopedic docs and they all say that eccentric decline squats are the best exercise to cure patellar tendinitis. You can use a curb, but ideally you would use a slant board and do a slow squat down with your bad leg or with both legs while favoring the weak one, and then stand up using your good leg.
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    Originally Posted by Aches89 View Post
    Thanks for your input as well! Do you think doing some eccentric exercises will help this injury, maybe 2-3 times a week? Can I continue running now and then, MMA, and squatting (lighter, working on form)? I will call my doc and schedule to have an ultrasound or MRI. What I fear about that is the waiting list for one...
    Wowowow man, I think there´s a misunderstanding here. I absolutely did not recommend to numb your pain with NSAID´s and continue what you are doing if thats what you think. I was talking about a totally different situation, namely acute tendonitis due to impingement thats treated ASAP.

    I´ve said it a cuple times now. If it hurts, dont do it! Thats really a no-brainer. Again I know what you are thinking, I myself have an awefully hard time to reajust training/stop training when injured due to my obsessive personality. I am not able to say what you can and can´t do, thats different from person to person. Take it easy as foreigner said, and AVOID PAIN at all cost, for the quadrillionth time I know you´re looking for some legitimization to continue doing what yu are doing, but thats not gonna happen. not from me, anyway. The only thing I said is some movement is good, aslong as you avoid pain!!!!
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    Registered User Foreigner's Avatar
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    Originally Posted by Aches89 View Post
    Thanks for your input as well! Do you think doing some eccentric exercises will help this injury, maybe 2-3 times a week? Can I continue running now and then, MMA, and squatting (lighter, working on form)? I will call my doc and schedule to have an ultrasound or MRI. What I fear about that is the waiting list for one...
    I would certainly try to see a doc as soon as possible. The best feeling will be knowing what your issue is and how to treat it, versus just limping along injured. I'd avoid doing anything ATM until you know for sure what your injury is. After that, per recommendation by your doctor and / or PT you can start doing exercises as directed.
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    Originally Posted by badgenesnogainz View Post
    Had the same issue. I know injuries can be frustrating and if they prevent you from progressing in your athletic journey just drag you downright into depression. Sometimes you gotta take a step back before moving foreward. Give the docs treatment a chance. Ofcourse you wont see any results immidiately especially when it has gone on for years. However dont fall into the trap allowing yourself to think stuff like "nah its not gonna help anyway so I dont really try" and do an half-assed rehab attempt. Injuries and chronic pain can really really mess with your mind.... Dont stop doing sport, but keep workouts rather brief and avoid pain. Be extremely diligent about warming up. Stretch dynamically before and dynamically and statically after the workout....

    Do the icing. Icing really helps to increase the recovery-capacity of soft tissue/tendons but its important to do it constantly. Regularity is absolutel key with stretching/icing. Ice after your workout and 2-3times per day. 15-20mins at a time.
    Hi there,

    I was in immense pain for 5 years and it brought me down both physically and mentally. After years of trying different treatments I finally found the cure that literally got me back into training within a few months. No treatments worked and I honestly did not see a light at the end of the tunnel.

    I have just finished writing a book about it that will be available in July. See the site below:

    howtocurepatellartendonitis. com

    It changed my life and it’s like a weight has been lifted and I can train again without pain.
    SHUT UP AND TRAIN!!!
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    Post Pattellar Tendinosis

    Hey man, I actually just got a PRP/SCP and Platelet Lysate injection at this place called Regenexx. I’ve had chronic patellar pain/tendinosis for over a year. My exact diagnosis was “mild proximal tendinosis (No tear) and a Minimal subcutaneous edema noted at the level of clinical concern overlying the tibial tubercle and distal patellar tendon” I got the PRP injections just last week, so I’m still waiting on the results. But what’s your opinion on my condition? I’m really hoping the PRP helped.
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    Originally Posted by Foreigner View Post
    The next step is to see a qualified sports medicine doctor that can diagnose the injury via ultrasound or MRI. These tests will show whatever thickening, disorganized fibers, or tears you may possibly have. As for the procedure, see the Tenex health website for a doctor near you that does the procedure. It is NOT a fairly common procedure, but it is FDA approved and is covered by most insurance. It is actually fairly new and has shown very good results in several professional athletes with tendonopathy.

    As for taking time off, educate yourself on the healing process of injured tendons. It is very slow and involves many steps from the inflammatory phase to the rearranging of collagen fibers. Time off is a must. The minimum is usually 4-6 months for complete healing. You will often hear 6 weeks, but I've found this to be very farfetched. Premature return to activity will cause re-injury. You can potentially speed the healing process up and improve the quality of healing with PRP (platelet rich plasma) or stem cell (bone marrow and / or adipose) injections. Although expensive, I've found them to be extremely effective.

    If your doctor recommends rest, ice, and NSAID's do yourself a favor and go somewhere else. This is not going to do anything for your condition. Most doctors are very uneducated about tendonopathy and are absolutely clueless on how to treat these types of injuries. The first step in all of this is to see what the injury is and how severe it is. If you have a lot of necrotic tissue then Tenex FAST will probably be recommend. If you have slight thickening and disorganized fibers, then a PRP injection, ART, and physical therapy may be the best first step. It all depends on what your doctor recommends.

    Good luck, I've been through several such injuries (both elbows, shoulder, and achilles) and PRP / stem cells and Tenex FAST has healed them all 100%.
    My MRI said I have proximal patellar tendinopathy and states I have a mild thickening and increased intrasubstance. Do you think PRP is the best option for me to look into?
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    Originally Posted by Diti07 View Post
    Hey man, I actually just got a PRP/SCP and Platelet Lysate injection at this place called Regenexx. I’ve had chronic patellar pain/tendinosis for over a year. My exact diagnosis was “mild proximal tendinosis (No tear) and a Minimal subcutaneous edema noted at the level of clinical concern overlying the tibial tubercle and distal patellar tendon” I got the PRP injections just last week, so I’m still waiting on the results. But what’s your opinion on my condition? I’m really hoping the PRP helped.
    hey could I get an update on how the prp injection went for you? I am most likely gonna get it, I have a very similar diagnosis as you (proximal pateller tendinopathy with no focal tear)
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