humboldt'sroads

Frustration, anger, listlessness, impatience, sadness, and pain. I've felt them all over the last eight months. Tendonosis - what the hell? I was strong, healthy, active, on the bike and/or running every day, climbing, skiing, backpacking. Now I drag my butt into the gym every day doing exercises as prescribed by my PT with the hope of regaining the ability to do the things I love some supposed day in the distant future. Why is this worth its own thread?

Well, I don't really know. I do know that I've yet to find any first-person testimonials about completely overcoming this condition, so I hope to keep this going while I continue the road to recovery for those after me to reference and maybe even gain some hope or inspiration from because all I see is "I'm not my old self" or "I gave up running" or "This is what has NOT worked" and so on. I'm determined to recover stronger that I was before and am hopeful that my best days are still ahead of me.

My GP and the ortho I saw both failed me. They diagnosed tendonitis, an inflamitory condition that is typically resolved in a matter of a few weeks with ice, rest and NSAIDS. No mention of stretching or strengthening the tendon specifically. I followed their advice for 4 months with no progress before going on my own to a PT. Turns out that nearly every case of "tendonitis" has nothing to do with inflamation (maybe it did at first), but with degradation of the tendon tissue, which cannot be treated with all the Advil in the world.

Its hard to find information out there on effectively and completely treating Patellar Tendonosis. My approach here will be to document what I'm doing, and how I've responded. Please contribute your experiences with tendonosis, including how you dealt with pain, strengthening, depression, and how successful your recover was.

Symptoms showed up 8 months ago, and as recently as 8 weeks ago, I could not so much as walk on level ground without pain. I began with 4 simple stretches:

1) Quad stretch
2) Hamstring stretch
3) Hip flexors
4) Calves

30 seconds each leg, stretching very deep once warmed up, twice through, four times daily. After only a week, I could walk on level ground normally with greatly reduced pain. After 2 weeks, I hit the gym for 4 simple exercises:

1) Hip abductors - laying on my side with bottom leg bent, top leg extended, doing leg lifts out to the side and back. 20x each leg, 2-3 sets.
2) Hamstring curls - started with 60lb. now up to 90. Instructed to do 3 sets of 8 reps each, maximum weight I can tolerate while finishing the set.
3) Leg press (most important) - started with 3 sets, 8 reps each with only 160lb, now up to 300. Again, HEAVY weight being the key. Now am mixing in 1 leg down, both legs up with 200lb. The point being to strain the tendon itself, "shocking" it into generating new collagen cells. Again 3x8.
4) Calf raises - 3x8 between sets of leg press.

I certainly feel stronger now, and have gone on 2 bike rides (both very easy under 25 miles). It feels good to be on the bike a little, and that really helps with the mental mess I've slipped into after months of negative progress. The little things that I used to take for granted...

What's next? I'm going to try chiropractic, as I know there are a host of biomechanical issues that could compound the problem. I've heard even that chiro manipulation of the spine (I believe the L3 specifically) can help with the pain, and can get you back to activity sooner. I'll be trying decline squats (45 deg. decline board) with weight as I get stronger. Again, the point is to strain the patellar tendon here, not just build muscle. My PT said after another few weeks, he wants to try adding some agility drills and plyometrics for 3-4 weeks, then getting me on a program to slowly build back up to running - I mean SLOWLY. I love to run more than anything and I will run again. When I can run, I know I can ski, hike, and do the things I love again, so I'm using that goal as a yardstick for my progress.

That is all for now. More will follow when I see myself being to some "next phase" of my recovery. Again, please share your experience with this condition, as it would be nice to know that others have beat it back and regained their top form.

Thanks for reading.

Carbonfiberboy 

I haven't had a knee problem that hasn't resolved from some combination of saddle adjustment, stretches, and weights. With a little ibuprofen to help it along at first.

I don't know about using the heavy weights. I've always used lighter weights and high reps to condition my soft tissue and get my patella tracking properly. I don't start upping the weight until I can complete 3 sets of 30, all same weight.

The combination of glucosamine sulfate, MSM, and selenium has helped or at least done no harm.

My stretches, all seated:

Hamstring stretch
Heel in crotch and stretch
Hurdler's stretch
Tailor stretch
Calf pulled to chest
Hamstring stretch again

At the gym, I only do multi-joint lifts. Hard to sort out just leg stuff, since it's all connected. This time of year starting at 1 set of 30, working up to 3 sets of 30, circuits.

Leg sled
Seated rows
Back machine
Barbell squats
Pushups
One-legged calf raises, toe on block
Roman chair
Lat pulldowns

I don't think single joint exercises are helpful, may be harmful.

I don't believe in chiropractic. I know no one whom it's helped. Chiropractors I know all have neck, shoulder, or back problems. And it's not from the heavy work.

NateDieselF4i

Maybe to clear up some of your initial confusion and frustration (you've probably seen this info by now but just in case)

Tendinosis(what you have) vs Tendonitis (inflammation related)
https://www.elitesportstherapy.com/te...vs--tendonitis

late

The leg press is one of the less desirable exercises. I forget exactly why.

Squats are king, if you can do them.

Then there are several good exercises that can sub for squats, mostly single leg
exercises like lunges.

Dfarlow

Wow - I feel like I could have written this original post based on my exact same experience. Several doctors, several different recommended therapies, until I finally went to one of the nation's foremost knee/join experts (Dr. Thomas Myers - Harvard). He has worked with several professional athletes. Long story short, my patella tedonitis was really impacting my cycling, to the point I couldn't ride on back-to-back days. I was looking for a magic pill, and laughed at all the hokey PT exercises...until I actually tried them. The key is to build up your VMO - and the PT prescribed for me focused just on that. But the weightlifting is all with very light weights, nothing heavy, which is where your approach differs from mine. While it may have worked for you, I was told this is the worst thing you can do and wil only make your condition worse. Along with the light weights, the primary focus is on stretching, with some of the same exercises you have listed.

Now that I stopped doing all of this, and winter base miles are starting to kick in, I'm noticing the same problem all over again (knee pain)....so I will definitely pick up the PT routine again and this time will keep it going even after the pain is gone.

Oh, and lastly, I go to the Chiropractor weekly. Good call!

humboldt'sroads

As a follow up to my initial post, one thing I didn't mention is that I've always kept myself on a light weight training routine and that my PT did several strength tests before prescribing the weight I'm lifting. I know that leg press with heavy weight will raise some eyebrows among cyclists, runners and other more endurance-oriented athletes. However, I cannot overstate the difference it has made in the 6-8 weeks I've been putting up heavier weight (again, specifically prescribed to "shock" or "strain" the tendons in such a way that they replace the damaged cells faster). I was always quite skeptical of both weight lifting and streching, but due to my progress will continue to drink the kool-aid my PT's serving up until my results lead me astray.

nkfrench 

I had problems with patellar tendinitis during my adult recreational (beer league) soccer days. Icing and NSAIDs did not help.
The orthopedist said that my kneecap wasn't tracking straight due to my Q angle (female pelvis is wider, slightly knock-kneed) and well-developed lateral quad muscle.
He did a lateral release procedure where the quadriceps is loosened from the lateral aspect of the knee. It was to intentionally weaken the strong muscles that were pulling the kneecap off track.
Post-op, I did several weeks of physical therapy to strengthen all of the knee muscles and get them more balanced. It seemed to work great.

A few years later I hyperextended my knee and the weaker area wasn't strong enough to prevent a total knee dislocation. It was a massive traumatic injury with complete tear of the ACL PCL LCL; 2nd degree sprain of MCL; tore all the muscles off the bone in the back of the knee, nerve damage resulting in foot drop. Several repair/reconstruction surgeries were needed so I could walk. I was in physical therapy 10 hours a week for 5 months and had to wear a full leg brace 24/7 for a year. The injury retired me from most activities even as simple as bowling or dancing. My tibia and fibula are fused and the knee is full of bone spurs. The surgeon said it's basically scar tissue holding the knee together; and I am doing exceptionally well to have avoided a total knee replacement in the 21 years that have followed.

I believe they no longer do the lateral release due to the loss of knee stability and increased risk of trauma.

If I were to do it again, I would look harder at biomechanical factors causing the kneecap problems and see if I could improve my posture and joint alignment. My orthopedist did a quick check of my overall joint flexibility and told me I never should have participated in soccer or other contact sports - I have loose joints with relatively long limbs, strong muscles, and I am a very heavy girl. He said I was an accident waiting to happen. While I loved the social aspects of the adult rec sports, they were very hard on my body. In addition to the knee problems I also had a dislocated shoulder (a couple of surgeries to fix that), ankle sprains, etc. I would have been better off sticking with lower-impact fitness activities. Of course cycling has its own hazards too.

Carbonfiberboy 

Many years ago, when I had a case of patellar tendonitis, I saw a orthopedist. He examined me, and among other things, measured my knee angle. He told me basically that I was malformed and should just stay away from anything athletic that involved my legs. Of course I was over 50 and had been running and skiing off and on since I was a little kid. I fled his office as fast as I could and got to work strengthening my legs and improving my kneecap tracking. Problem went away.

The knee is a complicated joint. There aren't many doctors who know anything about the knees of athletes. There aren't many physical therapists with enough experience in treating the knees of athletes to be of any help. Mostly both professions get it completely wrong. That's not particularly helpful, I know. My message is to be conservative, look around, try different things, see what works, and never stop doing that. I've been consciously working on staying healthy for about 6 decades. It's mostly just an endless lot of work doing the right things. As it is said, it never gets easier.

late

Strong butt muscles seem to help. I thought it was the hams, but I got into
butt exercises like deadlifts and one leg RDLs. Seems to be balancing
off the quads.

humboldt'sroads

So at long last, my first real update: I'm at about 2.5 months of truly treating my condition as an injury and all is going as well as I'd hoped. I still have better days and worse days, but the bad ones are never really that bad any more. I haven't had any intense localized pain as I had before, just general soreness that seems more associated with progressing my gym routine.

I've expanded on my leg press routine, adding in one-leg press and am still increasing the weight. Also added in single leg deadlifts with dumbbells, and goblet squats. Like late said, strong butt muscles definitely seem to help - my girlfriend is loving all this! Now I'm working on adding in a lot more core exercises and lots of upper body dumbbell work. Still streching like its my job too.

Saw my PT again and he's got me on a plyometrics routine with bosu ball and agility ladder work and jumping exercises to simulate the kind of impact I'd get running, which is kind of a yardstick of my progress. So far I've done a couple plyometric routines and some jumping (front back, side to side, one leg, both, etc.) with no pain; encouraging for sure. If all goes well for the next few days, I've been given the go-ahead to start a walk-to-run program. Again, running is my foremost addiction and I've been without it for over six months so I'm pretty determined! Also ski season is fast approaching - all the more motivation.

Finally, I've had massage that has helped some, and have a chiro appointment for next week and figure to have her check my gait, posture, foot shape, etc. before I buy my next pair of running shoes. Can't hurt, right?

While I still feel like I have a very long way to go to get back to my old form and confidence in my knees, I must say that the track I'm on feels like a good one. I'll post more when I've got news on progress/setbacks.

531Aussie

How did they diagnose tendonosis?

tjkoko

I'm a bit prejudiced here (former chiro) but a competent chiropractor (I said competent) or weight training instructor (community college) or PT would have zeroed in on your ailment immediately and have been able to provide some exercises.

asiamj

You need to check this blog out: https://eccentric-exercises.blogspot.com/

humboldt'sroads

So as to not abandon this thread, I suppose I'm long overdue for an update... The cliffs-notes version: More ups and downs. Injury persists (now at a full 10 months since onset of symptoms and 5 months of accepting it as a real injury), progress remains slow.

The details:
While I'd hoped to be completely healed (if that is such a thing) by now, I am still progressing. I still go through episodes/flare-ups where I'll have 2-3 days of pretty dibilitating pain, and am certainly nowhere close to returning to running as of now (and probably for the immediate future). Fortunately, these "episodes" are becoming further between, though they are almost as severe as before, and more frustrating than ever when they occur.

I finally had an MRI done a couple weeks ago, but it was less-than conclusive. No real signs of tendonitis/tendonosis except for "mild" signal change at the attachment of my quadriceps tendon. It also shows some irritation along my MCL but no significant damage. Had a phone call with my ortho this morning who said she didn't believe that tendonitis or tendonosis is still the primary cause of my discomfort.

I asked her about ultrasound as an alternative to diagnosing tendonosis and she agreed that with a good US technician, it can be useful for diagnosing tendon issues that don't show up in MRI. Unfortunately, she said that the Kaiser Oakland imaging center isn't the best place to get this done (nothing against them, but they just don't specialize in using the equipment for this purpose) so she's pursuing this more with the regional radiology director to see if another facility can help.

Alternatively, it seems entirely possible and a rather optimistic view that my exercise and therapy has greatly improved my tendonosis and that my existing condition is not completely resolving due to something structural or biomechanical. My ortho is going to talk with the knee specialists at the Sacramento-area Kaiser facilities to get me in for proper gait-analysis and examination of my biomechanics to try to address any underlying problems. As others have said, continuing my work to improve balanced leg strength and knee tracking is probably the best thing I can do for now. Perhaps custom orthotics and a better understanding of my foot type and my walking and running gait will ultimately help be get back to jogging, then eventually for running.

The good news (probably the best news) is that being on my bike DOESN'T HURT!!! While I'm still taking it slow, I've been commuting for the last 2-3 weeks and have done 4 rides with a good deal of climbing, with seemingly no adverse effect. As long as I observe the 10% rule, I think I finally have something back that I can challenge myself with! Doctor is stoked that riding doesn't hurt anymore as she said that's what she usually prescribes for athletes dealing with knee pain, and she encouraged me to pursue anything that I can do comfortably. That's encouraging for the mental state. Still havent' been skiing or snowboarding or climbing or backpacking or....meh, nevermind.

Anyhow, I'll try to be better about updating as I continue down the path...

nkfrench & carbonfiberboy - thanks for the personal accounts, it really does help hearing from others who've gone through similar injuries. nkfrench, I'm sorry to hear about the devestating chain of events set off by your surgery - I wish you all the best.

Aussie - they diagnosed tendonosis basically because they didn't know what else to call it. Though it was not visually confirmed by MRI or ultrasound, it was a case of tendonitis that never got better and stopped responding to use of anti-inflamitory meds, which is typically a sign that it's no longer an inflamitory condition (-itis), but a degenerative condition (-osis/-opathy). Truthfully though, so far I've had it called tendonitis, tendonosis, patelofemoral syndrome, runner's knee, and anterior knee syndrome. The frustration is that the last three of those describe a set of symptoms which can have any of a number of ultimate causes.

'Round and 'round - I guess this is what 30 feels like!

Strack

Hey dude, not gonna get into the whole story but basically your story is a blue print of mine, its been almost 2years and I just wanted to know, have you had any luck with the tendonosis?

thanks

alex

Parson

I've suffered similar symptoms in the past and still feel it slightly now and then, but it is much better than it was a couple of years ago. I wasn't getting any progress for over a year and then started to do friction massage (rubbing perpendicular to the tendon) for a few minutes, a couple of times a day. Within a week of starting that is when my symptoms started to diminish. I'm not sure if it's a coincidence, but that seemed to help me. I hope you all feel better soon.

humboldt'sroads

Been about a month so I'm due for another update...

My knees are generally doing quite well, considering where I was a few short months ago. The best news is that I've been back on the bike for a month or so with no real setbacks. I'm back up to 40+ mile rides with a few thousand ft. climbing, so I'm pretty stoked on that. I'll sometimes deal with some soreness, but nothing severe, persistent, or sharp like I had before. I also have my winter sports back, with a couple days skiing, a day snowboarding and a couple days nordic. Yeah, late start and pretty sucky winter but I'm just glad to have some of my life back. Still no running or jumping (or skiing the way I'm used to). Sure I still have a certain "background pain" most of the time, which is pretty dull and something I can deal with.

Saw a sports med doctor a couple weeks ago for an exam and review of my MRI, which she agrees looks generally good. No signs of tendon damage so it appears that my tendinopathy has been correctly addessed through strength training and stretching, and it may never have been severe enough to show up in the first place. Rediagnosis is.....of course, runner's knee.

A series of strength tests reveal that my large muscle groups are strong as ever, but my hip abductors and external rotators are still VERY weak and underutilized. I'll be back to the PT soon, but until then I've added the first half of this workout to my routine, and have backed off the frequency and intensity of my quad work.

After all of this, I realize that it would be misleading to consider this an "overuse" injury, while it was not the level of activity that was necessarily the problem, but rather the lack of attention to whole-body fitness, core strength, and flexibility required to sustain my activity. Where my workout was previously over when I got off the bike or home from a run, I now understand that this can no longer be the case. I feel like I'm finally doing well, making real progress and am very close to being able to run again. Not long ago, I thought this may never be the case.

I used to be among the crowd that believed that the only relevant training for running is to run and the only relevant training for cycling is to ride. This is not true. If there's still anyone out there that doesn't subscribe to flexibility, core strength, and total fitness: Get off your "I'm too strong for that" high-horse, and pull your head out of your a$$ before you put yourself in this same position!

four de trance

HERE'S THE ANSWER!!

I had injured the tendons and ligments in the back of my knees from riding on a borrowed bike before I got my own. The bike wasn't a correct fit and I hyper-extended my knees and I rode like a crazy person instead of gradually increasing my milage. I was a runner, so my heart could handle all the miles I threw at it, but my muscles weren't ready yet in addition to not being on the right frame. I battled with thiese injuries for a while and they bummed me out due to not being able to riding for long periods of time.

After messing with multiple, expensive quacks that didn't know what they were doing, I finally found a physcial therapy approach that was out-of-the-box treatment: myofascial release.

I'm now pain-free and riding because of my physical therapist's approach to myofascial release (Google it). It bascially involves the foam rollers, but mainly LOW INTENSITY STRETCHING FOR LONG PERIODS OF TIME. It sounds too simple, but it is the answer. That's the key, not high intensity at short bursts.

Sit down and put the leg up on a footstool lower than your butt and get a nice, even burn on the muscle group of your choice and just read a book or watch TV, etc. My favorite post-ride stretch is to lay down and put my legs up straight on the wall and push my heels up to get the hamstring/ upper calves. The reason I like this one, is because I'm not working, it's all relaxed, laying down stretching! IT'S AMAZING! I can't go into every stretch position because I'd be writing for hours or days, but the goal is to not work hard at low intensity, post-ride stretching. Sitting or laying down exerting little or no effort while get your stretch going. After a while, you don't have to stretch for as long either.

I've fully recovered because of the stretching and a small amount of foam rolling to release the fascia. You can roll around face down on a ball on your abdomen area to release the fascia around there, but I'd suggest you see a doctor so they can explain it better than I can in a post, but I'm not joking, THIS WORKS. It took about 5 visits and now I can do it all at home and on my own, no more pain or injuries. Hope this helps and ask away if you have anymore questions about this method.

oomps83

So just to dig up an old thread, any updates a year and a half later? I have the same issues, and am glad to see this thread.

ursle

The knee isn't a muscle, the tendons connected to it aren't muscles, nor the cartilage attached to the tendons, so don't treat it like a muscle, keep it warm, always use it wisely, and really, it should be the last thing you think about, the muscles attached to it need food, and more food, if they are health, the tendons attached to the cartilage attached to the bone of health, well fed muscle will be as trouble free as the muscle, somebody's asking knees to do something the muscle can't.
Tendonitis is the body saying.......no
Training is the art of conditioning the muscles (etc) so they can.