Anyone ever completely recover from patella tendinosis?

I had it before cross country last year. I ended up take 4 weeks off right before season started. Once season started I iced it about 4-6 times a day. I also used a PT band that goes below your knee while running and this was extremely successful for me. I was completely fine in about 3 weeks.

sounds like tendinitis NOT tendinosis if it healed that fast

Eccentric squats.. do them even if there is pain every other day. or only if there is no pain

is that a question?

I heard that eccentrics help sometimes but I don't know if you are supposed to do them only if you can do them without pain, or if you are supposed to do them until you get pain. I'm not a PT but I hear they work.

wet blanket wrote:

I heard that eccentrics help sometimes but I don't know if you are supposed to do them only if you can do them without pain, or if you are supposed to do them until you get pain. I'm not a PT but I hear they work.

I'm also wondering this ^

I'm also wondering if others who have had success with the strap eventually were able to take it off and run OK, as I seem to have developed some sort of dependence on it

I feel I've written this dozens of times because I probably have.

Anyway, early 30's male, now almost at 5 year mark. Root cause was excessive running with a hip imbalance and/or functional leg lenght issue. In any case, got it on one knee only (trust me, road crowning wasn't a cause). I pronated a bit less on the bad leg, heel struck a bit harder. Over a few months it got worse. Eventually got some calcification or whatever on the tendon which, to this day, hasn't gone away and I can feel/hear a painless click in that knee. I'd LOVE to know if any of the "I did cure my tendinosis I had for a few years" people have ever had this buildup on the tendon and how it worked out for them.

Anyhow, saw many docs, had two MRIs. Last one a couple years ago found a possible minor tear of the patellar tendon, but I think that's the hard nodule/bump they found.

Here is what I have found and I have read/studied this a *lot*, taken diligent notes myself. In honesty I've never in my life consistently approached something like this because it on a daily basis irritates me; a life goal is to solve this thing and as such I am quite evangelical about it. I want to get back into some degree of competitive running/triathlon and this holds me back. I feel it deserves far more attention than it gets from the medical community and affects far more people than the MC acknowledges:

- rest (long periods, like months) makes this better but knee is still symptomatic. Conclusion in myself and literature: rest will not solve this condition but merely arrests its progression and/or makes things a bit better

- ice seems a waste of time

- anti-inflammatories a waste of time (at best; may even make it worse)

- surgery is a last resort and probably won't help much

- most caregivers don't have the first clue what this is. Not a single PT or sports doc I ever saw mentioned the word tendinosis to me. As such, all who saw my "mild to moderate" symptoms and mostly clean MRIs were nonchalant about it, thought recovery would be easy, basic "runnres knee" but ignored the key point that I had had it for months

- although rest doesn't help this much neither does continuing to run. Important to cut back or cease running and only gradually get back to it. BTW, other activities can cause this, too, like cycling in some cases

- some less invasive alternative therapies like cold laser or prolotherapy injections (*not* cortizone shots--do not do these) may help but are not terribly well studied

- some have reported benefits from ART or graston technique. Personally I found on difference with graston

- Best therapy for tendinosis, including to achilles, is eccentric exercise. With patellar, use a 25 degree decline board (I made one out of wood and glued some 80 grit sand paper to it) and do one-legged squats down to 90 degrees (not deeper). These *should* hurt when you do them. Not a ton, but some pain is generally actually desired. Fact is, at the beginning it will be possibly impossible to do them without pain, but then it's impossible to do much of anything without pain! As your knee tolerates a given load more, increase it so that if possible you're stressing it each time to the point of some discomfort.

- obviously some people have severe flexibility or balance issues. I know that until a couple of years ago I had never in my life touched my toes (absurdly tight hamstrings). Sitting in an office chair for years on end does horrendous things to form and posture

Anyway, where I am today:

1) Run 2-3 times week but only a few miles. I have studied running mechanics a lot and do these runs in minimal shoes with a mid-foot type strike. Knee is mostly asymptomatic during these fairly short runs

2) My knee used to be very tight. These days it is a little tight only, rarely very tight, occasionally feels no tighter than the other

3) Pain is much better than it used to be. I can bike almost indefinitely (certainly not possible a few years ago) and going up and down stairs rarely hurts. I am biking several hours/week. Also I bike with thigh kept close to top tube to try and put forces through ball of foot

4) I do stretch lower legs/hips but probably not enough; I still feel imbalanced. I have tried heel raises but to no apparent great effect. I likely need more yoga

5) Been doing eccentric work for almost three years. I feel it's very key. I only do it perhaps five times/week now but when things are bad can be stepped up to twice/day. I hold two 30 lbs dumbells and rarely have any knee pain when doing these. When I started back in 07 even light dumbells did hurt

6) Bad knee's strength is definitely better and musculature better. Probably as coping or perhaps as a root cause my VMO muscle was noticeably weaker in bad leg a few years ago. Back in 07 before starting eccentric I did engage in an aggressive general leg strengthening program (one legged squats and lunges) and it was *very* helpful. I remember one day my knee seemed to be better than the day before for some weird reason and has never gotten as bad since

There are many different causes for this but the solution for me, as far as I've found (and as mentioned I am not healed yet but I do seem still to get better from year to year):

1) Stay active. Even when the knee hurts do something, whether it's a workaround or a light bike ride. Apathy is antagonistic

2) If running, be cognizant of form. I've gotten into the minimal running idea

3) Flexibility

4) Strengthening. This one ties into 1). A weak leg is a bad thing, beef that bad boy up.

BTW most of the responses in this thread are helpful. People talking about recover with a few weeks off or whatever, sorry, guys (or congratulations) but you absolutely did not have tendinosis.

its all about strengthening for everyone, but flexibility can be an issue for some people. youll know if its not when your foot is easily touching the middle of your butt when doing quad stretches.

ive been doing strengthening literally every day for 5 months, dedicating 40+ minutes a day to one leg squats with increasing weights (in a backpack or with dumbells) and relevant stretches (quad/ham/calf(to a lesser extent)). i dont have any symptoms except when the tibial tuberosity is pressed on. heres the best part: you can continue training (maybe 66-75% volume and low workouts) as you strengthen. heres how to do it:

all steps: you need to focus on the eccentric motion (your leg lengthening/moving away from the joint). go slowly when going down, and fast when going up (concentric contraction). progress every 5 days if pain is not increasing, from 3x10 to 3x15, then to the next step

1. 2 leg squats, unweighted

2. 2 leg squats, some extra weight, like 30 pounds

3. 1 leg squats, unweighted

4. 1 leg squats, progress weight up by 5-10 lbs each time you progress

4a-z. increase by 5 pounds, or move to the next step, then progress by 5 pounds

5. do 1 leg squats on a 30 degree decline, as in:

|\ your foot on the decline here

| \

|__\

doing them on the decline will take the gastroc/soleus out of the picture, and will allow the quads and patellar tendon to be strengthened. dont think because your quads are strong, that your patellar tendon is also strong. the exercises may feel easy on the quads, but let your patellar tendon make adaptations.

theres a nice textbook, if youre into reading scientific material out there, called "Tendon injuries: basic science and clinical medicine" by Nicola Maffulli, Per Renström, and Wayne B. Leadbetter. theres also some website with a lot of the material from that textbook on there, i think its eccentric-exercises.blogspot.com

hope this helps everyone, patellar tendonosis SUCKS FDD, but its definitely cureable if you are resilient about fixing it.

eerrrrr... left out some important stuff

tendonosis is chronic tendon degenration. any tendon pain longer than 4-6 weeks can be assumed to be tendonosis rather than tendonitis. SO, you are not targeting inflammitory processes. you are attempting to realign the collagen in your tendons in the best way possible, which is gradually increased eccentric exercise.

therefore...

1. exercises should be painless, albeit a little uncomfortable, for the first 2x10 or 2x15 reps. it is okay if it is more uncomfortable or painful on the last set

2. generally, do squats to around 100-115 degrees (not a full squat), but full 90 degree squats are okay if they feel comfortable

3. if 2 legged unweighted squats hurt, you probably have a partial tear in the tendon. you need to do nothing, and take a course of 3 days of 2x1000mg ibuprofen a day. beyond this, NSAIDs are not helpful. icing will also be more beneficial during this time. you should take 1-3 weeks of NOTHING but swimming, with the arms isolated, before making a new attempt at strengthening

3a. doing squats about 115 degrees are generally less painful; you can start with those as well

4. WEAR A TENDON STRAP WHEN YOU RUN! something like a cho-pat strap is nice. i cannot emphasize how much these straps raise your quality of life. continue wearing it for a while even after the tendon is painless.

if you have had tendonosis for a really long time, message me about it or something (if you can do that on this site?) or post it on the thread. ill try to help ppl individually because i really, really hated when my tendonosis was severe (walking down stairs made me cry).

hey i know this thread is old but I'm just recovering from i surgery i had for my patella tendinosis, after 13 months i was given the option of steroid injections or a surgery where they take out the damaged tendon as well as a small piece of bone from the bottom of the knee cap.

I'm currently 2 weeks post surgery and recovery has been fast ( as it was a keyhole surgery) they estimate 6 weeks till full function again. i know my sport doesn't have as much running as a marathon but it still pretty intense on the knees so at this stage i'd recommend anyone getting surgery as opposed to putting up with it for years.

Some of you who think you have patellar tendonitis may actually have arthrosis in your patellofemoral joint, which is why it isn't getting better.

Apologies for bumping this old but very important thread.

I was a 400/800 varsity athlete from 2008-2010 until I tore my hamstring. It took nearly 6 months to recover from this grade 3 tear. I started running recreationally but was never able to get back into form due to the onset of patellar tendonitis/patella femoral syndrome. I was still running about 300 minutes a week (coach kept track of volume in minutes instead of miles) however I could never increase my mileage comfortably. I visited a chiro/physio and received about 5 sessions of ART to no avail. I decided to cross train on the erg and eventually transitioned over from track to rowing in spring 2011.

I sprained my wrist on a power clean during dry land training in February 2012. I panicked and joined the varsity track team in effort to salvage my fitness as I couldn't row. My knee's felt unstable however I could still run, and had virtually no pain during practice. I trained with the team until I started working in the oil patch in May. For some reason the uneven ground and steel toe boots aggravated my knees and I had a massive flare up. I don't know the exact reason of onset but after a month of working I couldn't run, squat, or even walk without irritation on the anterior of my knees.

Now I'm back in school this winter, I've mediated symptoms on my left knee by performing hip strengthening exercises, however my right knee is plagued constantly with pain and snap, crackles, pops randomly. I'm undergoing physical therapy and performing prescribed exercises daily. Mostly hamstring strengthening and quad stretching. However I have yet to see results.

It's absolutely brutal having pain during a simple movement such as walking or getting up from a chair, even sleeping! It makes no sense. My quads are strong however they could be imbalanced, finding this imbalance is nearly impossible. It's been 8 months of rehabilitation and I'm tired of doing weightless squats, single legged half squats, single leg lifts. My right knee feels imbalanced and aggravated when doing these exercises however I experience no fatigue what so ever. I feel the nature of this therapy is painfully tedious. Small ROM to avoid aggravation, no resistance to avoid aggravation. Athlete's aren't limited in these areas yet all the exercises are limiting! So far doing Physio I have lost range of motion by performing half squats and have lost strength by using no resistance!

I've resorted to self assessment. I was a kinesiology student for 2 years so i do have a base of knowledge. The process is slow and I have not seen results. Athlete's who have tendinosis know it's demoralizing. There is no research or treatments available and usually at this point it seems as your knee is beyond repair. My grades and social life have suffered due to this injury only because the burden of rehabilitation is on myself and where do I start? Do have to get a PHD in the biomechanics of the patella femoral tendon? I'm already in a demanding civil engineering program and now this is on my plate without the stress relief of physical activity. Truly Demoralizing.

Sorry for the long post. I vented a bit. I know it's not the end of the world. I've been consumed by sport my whole life and now that it's gone I have to rewire myself to realize that there is more to life.

Here is all you need to know:

http://runningwritings.blogspot.com/2011/09/injury-series-tendon-remodeling-part-ii.html

Cliff notes: *prospectively* the only predictor is poor hamstring and quad flexibility. The only clinically proven treatment is decline eccentric one-legged squats to parallel.

I had it. For two years, I couldn't run more than three miles. Finally, I went to PT and got orthotics. That was 12 years ago. Since then, I've run two half-marathons and two marathons, and have never been injured.

Based on my own experience, I agree completely with the posters recommending one-legged squats on a decline board.

My story: runner for 27 years. In retrospect, I realize my knees would hurt at the beginning of runs for several years, but I never thought much of it. Eventually, though, it took a turn for the worse, becoming more intense at the beginning of runs, hurting after runs, eventually hurting all day, etc. My MD referred me to a "sports medicine" clinic, where my knee was X-rayed and pronounced fine, and I was told basically to take a bunch of anti-inflammatories and if that didn't help, just accept that I was in my late 30s and knees don't always last forever. I tried the anti-inflamms (Naproxen), helped for a while, but not permanently. I realized I couldn't go on like that, so I quit running. Luckily I was already cycling a bit, and I was able to do that relatively pain-free, so I still had an outlet. I discovered the one-leg squat deal on YouTube, started doing them, first with 2 legs, then with one leg, then with one leg and a weighted backpack, gradually increasing the weight up to maybe 20lbs. I still do this routine almost daily, 3 sets of 15 in the morning.

My knee was in such a bad state that even after a month or so of no running, it still hurt most of the time. Gradually, after starting the squats, the pain subsided. About 6 months later I started running again. I was cycling semi-seriously, so I would just slip in the occasional mile or two of running, eventually working up to being able to do a 5 miler after a couple of months. The knee didn't feel perfect, but it would recover in between runs. I increased very, very gradually, running about 600 miles total my first 6 months back. Eventually I was able to work up to my present level of 40-50 mpw, which is all I want to do anyway.

Present time (4-5 years later) The pain is still "there", in the sense that I can feel it a little when I do the squats, and especially if I try to start running without having been moving around first. However, it no longer limits my mileage or my ability to do speedwork, hills, or anything like that. All in all, I am very happy with how I have been able to manage the knee pain with squat exercises.

My conclusions from my personal experience are that with tendinosis, ice and anti-inflammatories are pretty much a waste of time. I also tried a knee strap for a while, and if it made any difference, it was not a noticeable one for me. Swelling, according to what I have read, is not the problem. The problem is more a matter of the tendon cells being deformed.

One other tip - you can make your own apparatus to do squats on. I'm no master craftsman, but I just made a little ramp thingy out of a couple of pieces of 1" x 8" wooden board. I attached a sheet of sandpaper onto the surface so I don't slip. You'll want to make sure it is fairly sturdy, as I imagine you could aggravate the injury if your stand falls apart while you are doing squats.

hey everyone! im hoping someone might have any suggestion for me. back in 2011 the elevator in my building was shut down for five straight months and i had to climb seven flights of stairs on an almost daily basis. prior to this event i already had a long term knee problem with my left knee that was dislocated a couple of times twenty years ago when i was a teenager. i had surgery, my kneecap never jumped out again but of course i was left with a life long on again off again pain in my left knee. my right knee however never, ever had a problem.

when the elevator was shut down i panicked as i knew that i cannot put my left knee thru such a trauma as months of stairclimbing. so in desperation, in order to protect my left knee i began placing all the pressure on my healthy right knee every time i had to use the stairs. meaning, i would only take the steps one by one, always putting my right, good knee first and then just lift the left knee after it and hence avoiding placing any pressure on it. yes, i know it was not a good idea but i had no choice, i couldnt move anywhere else, and before i began this tactic and used both knees [the way one normally goes up and down the stairs]only after ten days of daily stairclimbing my operated left knee was in serious pain. that is when and why i came up with the solution to deal with the stairs in such an odd way. so the rest 4 and ahalf months i spent going up and down the stairs, when i had to, by only "using" my good, right knee.

end of may, in 2011 the elevator was back in service and i thought this nigtmare was behind me. the entire month of june, july and august i had no problem with either knee, and then in september i stared feeling that something was off with my right knee. and then one day, in early october, seemingly out of nowhere i woke up with a sharp pain below and under my right kneecap. both my regualr doctor and then later my orthopedist confirmed,after examining me and especially after hearing about the horrific elevator saga, that i developed tendonitis in my right knee due to the overuse.

ive done resting, icing, months of pt; it's february of 2013 now and i still have daily pain. the good news is that after the first eight months or so the original pain above and under my kneecap has ceased but then in july of last year the kneecap itself, [which hasnt been in pain before] stared to hurt. im trying not to panick, but im up to 16 months of daily pain with my right knee and im terrified that there has been some sort of a permanent damage. im not an athlete at all; never ran, or did any of the amazing things that all the pple on this thread had been doing. due to my left knee injury iv only been able to do some basic workout routine 3-4 times week. i just want my right knee back!! so much!! i already had to accept the fact that i have one bad leg and i alwys relied on having my right leg working so well and never having pain with it. as u can imagine this had been a tremendously difficult time but depite my occasional fear i keep hoping and working that my right knee will be restored to its original pain free existence. never before or since the levataor episode had i ever had to put it through anything similar so i base my hope of full recovery on the fact that while indeed i clearly overused it in those five months , it was not a long term, years and years of putting additional pressure on it. any thought or advice is appreciated!!

nepoks wrote:

Seriously, all you need to do is one-legged squats, 2 sets of 10, every day and it should disappear. Works like a charm, everytime.

^this

started doing this in december and have already had a few 110 mile weeks already