A Surprisingly Powerful Tool to Cure Chronic Patellar Tendonitis
by Brian Patterson
on May 11, 2012
518
updated April 17, 2023
I’ve been battling chronic Patellar Tendonitis (aka ‘Jumper’s knee’ and some forms of ‘Runner’s knee’) for over two years now. I’ve written before about my problem in a post about Egoscue therapy, as I was exploring that as a treatment option for my ailment. Ultimately that wasn’t the right treatment for me, but I do now think I’ve stumbled upon a surprisingly simple ‘hack’ that has a profound impact on Patellar Tendonitis.
What is Patellar Tendonitis?
Patellar tendonitis, also known as jumper’s knee, is caused by repetitive stress to the patellar tendon, which connects the kneecap (patella) to the shinbone (tibia). This stress can result from a number of factors, including overuse, improper training techniques, or biomechanical issues.
Overuse is a common cause of patellar tendonitis, particularly in athletes who engage in repetitive jumping or running activities, such as basketball players or sprinters. When the patellar tendon is subjected to repeated stress, it can become inflamed and weakened, leading to pain and discomfort. Improper training techniques, such as sudden increases in intensity or frequency of activity, can also contribute to the development of patellar tendonitis. In addition, biomechanical issues, such as flat feet or tight calf muscles, can place additional stress on the patellar tendon, increasing the risk of injury. Understanding the underlying causes of patellar tendonitis is crucial for effective treatment and prevention of the condition.
Being Diagnosed with Patellar Tendonitis
Before I get into my little discovery, first some backstory on my problem: About 2 years ago, my knee felt really stiff after a playoff softball game. There was no pop or pain during the game, I just noticed some tenderness and pain when I pushed off. I figured it was no big deal and that it’d go away in a few days like most other small injuries, but it didn’t.
Sporting a knee brace to keep my knee warm and restricted during sports. I really wanted a treatment to make the injury go away, not just treat the symptoms.
After giving it a few weeks, I decided to make an appointment at the family doctor to see what was up. He did some remedial tests and diagnosed me with Patellar Tendonitis. He sent me home with a printout of some stretches and exercises I could do to make it go away, but those unfortunately didn’t help at all. To make a long story short, I doubted the family doctor and went to see an orthopedist who specializes in knees. An x-ray and MRI later, the family doctor’s diagnosis was confirmed (sorry for doubting, Dr. Cohn!).
Patellar Tendonitis/Tendonosis Statistics
Patellar common is a frustratingly common injury. It happens to thousands of athletes each year, and yet we still don’t have definitive guidance on the best course of treatment.
- It is estimated that patellar tendonitis accounts for up to 20% of all knee injuries in athletes. (PubMed link: https://pubmed.ncbi.nlm.nih.gov/27582758/)
- Patellar tendonitis is most commonly seen in athletes participating in jumping sports such as basketball and volleyball. (Source)
- Risk factors for patellar tendonitis include overuse, poor training habits, muscle imbalances, and anatomical factors such as patellar malalignment. (Source)
- The incidence of patellar tendonitis is highest in males aged 15-25 years. (Source)
- The risk of patellar tendonitis is significantly higher in athletes who have a previous history of the injury. (Source)
- Conservative treatment for patellar tendonitis is effective in approximately 90% of cases, with surgery reserved for refractory cases. (Source)
- Long-term outcomes following surgical treatment for patellar tendonitis are generally favorable, with a return to sports reported in 75-90% of cases. (Source)
Trying Different Treatment Options
Ok, so I’m gonna wrap up this backstory. I don’t want to get surgery; Patellar Tendonitis does not have a good track record of getting cured via surgery. So I’ve been exploring and testing all my options… literally all of my options. These are my tests thus far:
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- 8 Weeks of Physical Therapy – unfortunately this didn’t help, and it wasn’t fully covered by my insurance, so it was pricey for something that brought about no change
- Iontophoresis – These are little patches that use electricity to put Cortisone deep into the tendon. These did relieve pain temporarily (4-24 hours), but there was no long-lasting improvement
- Cortisone Injections – the relief from these injections were instant, but lasted only 8-12 hours. I know these are a miracle drug for some, but it was only a superficial healing for me and it faded away rather quickly.
- Prolotherapy – This is similar to PRP (below)… basically they inject a glucose solution into the problem area. The theory behind this is that the solution irritates that area so much, that the body sends new (and lots) of blood to the injury, thus restarting the healing process. Sounds good in theory, and there are a lot of people who claim to have had amazing success with this, but no such luck for this guy.
- Platelet-Rich Plasma (PRP) – I only did this once, so I can’t give a fair review here. This treatment is really popular right now, and you’ll hear a lot of professional athletes (Tiger Woods, Troy Polamalu, LaRon Landry) talking about the success they had with it . What they did is draw my blood, then that blood went through several spin processes to separate the plasma from everything else. Finally just the plasma was injected back into me, but this time directly into the problem area of the knee. This was really, really painful for the first 24 hours. The plasma seriously irritates the knee, and it hurt. I decided a few months later that I was going to put this treatment option on hold and explore a few other things first. I haven’t completely abandoned it, I’m just not so sure it’s the right solution here.
- Egoscue – I mentioned that I was trying this out, but ultimately I couldn’t keep up with the demand of following my ‘e-cises’ 4-5 a week, at an hour each day. I do think that Egoscue is great for improving posture and overall health, but I’m not so sure that it is a specific tool for healing this precise injury.
- Cissus – I read about this in the 4 Hour Body book by Tim Ferris (which is great, by the way). It didn’t work for me, but I didn’t have high hopes for it anyway.
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So all of those treatments, no solution, still painful Patellar Tendonitis. No running, often fitful sleep, discomfort when sitting down (think driving, plane rides, and even just relaxing on the couch), just general restlessness as I’m always searching for the next comfortable position to put my leg in.
Finding the Secret?
While doing another scan online, I stumbled across a study that compared the healing results of eccentric exercises vs surgery in treating and defeating Patellar Tendonitis. Their conclusion?
No advantage was demonstrated for surgical treatment compared with eccentric strength training. Eccentric training should be tried for twelve weeks before open tenotomy is considered for the treatment of patellar tendinopathy.
The eccentric part of an exercise is the part when you are elongating the muscle, not contracting. For instance, in a push-up, the eccentric part is when you are lowing yourself down. This study and some other literature seem to point to a healing power that eccentric exercises can have for this injury.
Selecting a Slant Board
I figured this was absolutely worth a shot. The eccentric exercise for the knee requires just a slant board, which run about $60. A few days after purchasing this ‘Fitter First’ one on Amazon, I got to Tweeting with Kelly at Flex-N-Go, who makes a solid, fixed slant board. She sent me to test one out along with my board from Amazon.
Well, first off, which board was better? My preference was the fixed slant board. Its super sturdy, light weight, and I have no fear while on it. The other board featured the ability to change the angle of the slant, and while this may be useful for some, I didn’t need that feature and the angle-adjustment capability added instability to the board, which is exactly what you don’t need when you are working on a bum knee. But in the end, get whatever board you can get your hands on quickest to start your rehab training.
The Secret Exercise
At first I thought I was doing things wrong. Doing the eccentric squat, basically squatting down, was really painful right in the spot where I can pinpoint the pain of the Tendonitis. I didn’t realize that I should be feeling pain there, so I thought I was doing something wrong. Well, after even more digging, I found that I was definitely supposed to be feeling it because it is literally isolating my knee/tendon on the board so that it has to do all of the work – the slant board basically takes away the hamstring and quad’s ability to help lower me down.
So what I did is I stood on the board with both feet, placed 90% of my weight on my left leg (the one with the tendonitis) and lowered myself down on a slow 4 count. Then, once at the bottom, I switched my weight over to my (good) right leg and straighted myself back up. The result of this is that my injured knee does most of the work in the eccentric (down) phase of the squat, and my unaffected knee does most of the work in the concentric (up) portion of the squat. Here is a simple video detailing what I did:
I slowly scaled myself up over the course of 3 weeks from just 1 set of 10, to 2 sets of 10, and now 3 sets of 30 per session. I shoot to do this in the morning when I wake up, and at night before I go to sleep, but sometimes I only get one session in. The beauty of this is that it is so fast, just a 5 minute session and you are done. And, the equipment is really small, so I just keep it in my bedroom where its really convenient to do after waking up and before laying down.
The Results
I can say that about 70% of my pain pain from the Patellar Tendonitis is gone. It honestly feels like the more that I do the exercise, the more stable my knee becomes and the less pain and irritation it has. I highly recommend looking into eccentric exercises if you are dealing with any sort of foot or leg injuries, from Plantar Fasciitis and Achillies Tendinitis to chronic leg cramps.
I’m thankful for this experience because I learned a lot about testing and researching treatments, which is valuable experience to have, particularly when you are dealing with something much more serious than an inflamed tendon.
Are you dealing with Patellar Tendonitis? Or have you used a slant board before? Let us know about your experience in the comments!
Yes, in my right knee. Current treatments include not using it, ice, and a McDavid strap.
Love this idea, though. I’d like to be rid of it.
Does your knee hurt during runs? Mine usually don’t, because I don’t push off much.
But tennis? Ouch!
Hey Tyler, I forgot to mention that I tried the strap as well, but that really had no impact at all. Does it help you?
When I try to run for speed I definitely feel it and it hurts, bad. If I’m using good form and just running to enjoy it, I can make it a mile or so before I’m done.
The odd thing is that I can play basketball for 30-45 minutes or so before I have to call it quits. My brain is able to block out the pain a descent amount when I’m chasing a bouncing ball around. Eventually the pain catches up to me though, and it takes a solid 2 days to get the swelling down.
I have been running, walking, hiking barefoot for over three years. It has changed my life for the better. I am curious if you think this stretching board is better than the good old heel drop on the stairs calf stretch. My knees, hips and back have been pain-free since I adjusted to barefoot and minimalist life (I rarely wear footwear to run, walk or hike, but do own some flat skateboard shoes and a pair of Sockiplast socks), but I have nagging Achilles Tendon pain. I just got The Stick and hope that will help. I soak in epsom salts, use ice and heat, but that ACL is sore almost every morning—-I stretch upon waking up, gently, on the stairs, dropping my heels for 30 to 60 seconds, on my way to turn on the coffee maker. Anyway, hoping The Stick will help. Love your site.
Hi Will, I’m not sure how it would compare to stretching on the stairs. In theory, they should be pretty similar, but in practice there could be small motions that make a big difference.
My issue was with the Patellar tendon, so I’m not sure of the effectiveness of the stretch on the ACL, but it has basically been a miracle for me.
I would say to try the stick for a month and see where it gets you. If nowhere, stop using it, and try something else. The more you test things in isolation, the more you will learn about your body and what is working for you. Good luck!
Hey Will, let me share my experience. I suffered with terrible Foot pain. The heel drop exercise is great. The board enhances it and perfects it. You will be amazed.
Interesting article. I had patellar tendonitis about three years ago and it slowly went away after about four months… Unfortunately, it has returned this year (in full force). I cannot seem to shake it. I know for a fact that mine is drawn from impact on a hard surface – as it developed both times from playing on the exact same indoor field. No other indoor field has led to the issue.
Anyway, I play competitive Ultimate Frisbee, and it requires a lot of starting/stopping for change of direction as well as plenty of hard sprints and jumping. This year, I have tried taking a few weeks off. Currently, I’m trying to floss my quad and the area regulary. I am also doing eccentric squats, but I haven’t had much results year.
What is the best treatment?!
Hi,
I’ve had achilles tendonitis in both my legs and eccentric loading has completely banished the pain. I no longer feel it as much, but if I do it’s very minimal, like it’s never there.
Eccentric loading works!
I had patellar tendonitis for years at varying degrees. I learned this technique from an Active Release practitioner, and it works to clear it up every time. I always work up progressively and methodically, and within a week it’s mostly gone. Now, since switching to VFFs exclusively, I haven’t had any issues with it in almost a year.
Hey Brian!
My name is Sam Saccomanno and I think I have the same knee problem that you had. I am a senior in high school and during my sophomore year in track (spring season) I developed my knee pain. I’m pretty sure I developed it from sprinting and lunges (i would do 1/4 – 1/2 miles lunges a week). At first I didnt do anything and I kept sprinting and jumping on it. After a month I had to stop because it hurt so bad. It has almost been two years now and I still can’t run. Ive gotten an MRI, X-Rays, PT, Chiropractor…and I might do Prolotherapy. I have been told that I don’t qualify for surgery because it isn’t internal. One doctor said I have chronic tendonitis. Now, I swim and power walk and ice. It is SO frustrating because I love sports and being active. I just ordered 5 fingers and the Flex-N-Go board from your video. Any other options?
Hi Samantha, I think FiveFingers and the Flex-N-Go board is the way to go… at least that is what worked for me after several years of dealing with this.
I can’t give medical advice, but I would say that if I was in your shoes, I might hold off on prolo for a few weeks and give the slant board a try, scaling up using it over a couple of weeks.
Best of luck, and please post back and let us know your results, good or bad!
Hey Brian thanks for the video, i’ve been dealing with Patellar tendonitis for 6 months and i’m now doing a similar exercise to the one you’re showing except im doing it on a chair.. My question for you is doesn’t this exercise make your knees worse thought? I don’t know about you but my knee starts hurting after i’m done a little bit but sometimes i feel my knees are strong after doing them thought.. But did your knees hurt after doing it?
Hey Brian thanks for the video, i’ve been dealing with Patellar tendonitis for 6 months and i’m now doing a similar exercise to the one you’re showing except im doing it on a chair.. My question for you is doesn’t this exercise make your knees worse thought? I don’t know about you but my knee starts hurting after i’m done a little bit but sometimes i feel my knees are strong after doing them thought.. But did your knees hurt after doing it?
Thanks for your reply Brian.. I just had a few more questions:
1. So did you get rid of patellar tendonitis? If you did, how long did it take you to get rid of it with this exercise?
2. When you had Patellar tendonitis did your knee make a crackling/cracking noise when u bended it?
3. How come this exercise is good for Patellar tendonitis if it makes it hurt?
Thanks again in advance Brian
Hi Omar,
Here are the answers to your questions:
1. It took a few months of religiously doing this to get almost completely better… but I did get some good results pretty early on.
2. No, I didn’t have any crackling sounds in my knees. My wife has that, but doesn’t have any knee issues, so I’d check with a physician to see if the sound is related to the injury (my uneducated guess is that they are not related, but I don’t know)
3. Good question – I don’t know why the exercise is effective overall, so I’m not sure why there is some pain/discomfort involved. The eccentric piece is still a mystery to me, but it worked in my case. I’ve come to appreciate the pain in the exercise. But again, I’m not a doctor or expect, so consult one first before trying this all out.
Thanks!
Brian
I inadvertently responded to Omar’s post above via email rather than a comment. Here is what I shared with him:
Hi Omar, thanks for your note! I can’t give medical advice, but I can tell you what I would/did do. But you should consult a medical professional before copying anything I say.
My knee definitely does hurt during and after the eccentric exercise. At first I thought it wasn’t working or that I was doing it wrong or something… but after researching more it seemed that it is supposed to cause some discomfort, and that things should really start slow and don’t push too hard. But for me, yeah, it does hurt. But that goes away after a few hours and I’m better the next day.
Thanks,
Brian
Thank you!
I just want to know, when i bend my knee back and forth and straight it out i crack something in my knee. Is this a good idea?
I don’t know the answer to that. I think the best thing to do is just check with a doctor and get their opinion on everything. If your body is telling you ‘no’, don’t do it.
Wait?
How many reps/sets/sessions you do a day of this workout?
Oh and do you still have pain or did you get rid of it and you’re back to your activities pain free?
Hey Brian forget about the other questions. I just want to know did you do any physical activity along with using this slant board or did you take time off from all physical activities and only use this? And how did you build your leg muscles?
I took time off of anything I didn’t have to do. I didn’t run or play pickup basketball or soccer for several weeks while I focused on getting my knee better.
Granted, I did this for every different treatment option I tried.
If I were you, I’d take it really easy.
I have muscle imbalance on my tendonitis leg and it is smaller than my other leg. When i work it out at the gym on the leg press, it feels strong but later it feels weak.
Hi Brian. I play Australian rules football semi professionally and over the last year or so, I have battled tendinitis quite badly. It has affected my speed and balance. Sometimes it is so bad I even cannot run on grass. I am very interested in giving this a go. How long till you first noticed a result
I think it took a couple of weeks before I had a noticeable improvement (its been a while so I don’t remember exactly).
Let me know if you do end up trying it and what your results are.
I have been battling Chronic PT for over 2 years. Did not know what it was or how to treat it until I had reallly damaged it and made it chronic. Now Im trying to overcome it. Mine was originally an overuse injury from basketball. Now I cannot hardly play at all because I have injured it so much repeatedly. Doctors are of no use. Im stretching constantly and that is helping. Im also doing lots of strenth training on quads, hams, calves, etc. I just ordered the slant board and I hope the eccentric exercises work. I will say the stretching is a very key component. I believe that these large tight muscles really overstress the tendon. I even get immediate relief from stretching. However, I hope to get it healed and maybe the slant board will help accomplish this. Also going to a diet of anti-inflammatory foods. This condition is very frustrating to people who enjoy sports and working out.
I think the muscle imbalance and instability is a big issue with PT. I have noticed with intense stretching that my bad PT leg has a lot less flexibility than my other leg. I think constant stretching of these large muscles is critical, along with daily icing, independent strength training of the less flexible leg to fix the imbalance you describe, and then the Eccentric Exercises which I am going to start when my slant board arrives.The worst thing I have done is to do nothing with PT. It will not heal without you prompting it but you also cannot keep reinjuring. I had to totally quit playing basketball. However, no activity was as bad as the activitiy inself. As a result, strengthen the legs and improve your flexibility to stimulate the healing process. I am also trying an anti-inflammatory diet.
It’s a pain in the ass Robb.. I feel bad for you man that must be annoying as shit. For me i have pt in my right leg and i noticed that the quads on my right leg are smaller than my left. And when i workout my legs on the leg press i noticed that i get sudden relief and it feels strong and doesn’t hurt.. But at night i feel discomfort in my knee.. I think strength training is very important but i don’t know if its bad for the knees itself. I’m working out my legs along with this board.
It’s great to see all of the comments on this site. I’ve been dealing with patellar tendonitis in both knees for over two years. I first tried physical therapy but I was working a job that required me to run so it wasnt effective. I then had once knee scoped which although it was successful, didn’t cure the tendonitis. I’m now in physical therapy again working strength/flexibility. I’m not having the results I’d like and its crazy expensive. I’ve seen this used before and your story has motivated me. I’m going to get this board and hopefully reclaim my active life.
Hey Brian, i’m 14 years old and i’m not sure if I have Patellar Tendonitis but the symptoms are very similar! I have been skateboarding for 2 years. Very recently I smacked my kneed against my metal bedstead and i’m afraid this has affected my knee strength. I used to skateboard every day, and only after 3-4 hours my right knee (my knee for popping) started to hurt. I assumed this was from skateboarding for too long. But now after the bang from the bedstead, I can barely walk, I cannot jump or take part in P.E. Bearing in mind my injury happened about 2 weeks ago. Would the Flex-N-Go benefit me? Or do I just need to rest my leg for longer. Please reply soon! Regards, Josh.
Hi Josh, I’m really not the right person to diagnose this for you, I’d recommend talking with your parents about going to see a doctor. A family practitioner (family doctor) was able to diagnose my problem, and the orthopedic doctor simply confirmed it. So I’d go see your family doctor and have them diagnose it.
Best of luck, and update us on how it went.
Thanks!
Brian
I’m curious as to how big it is – how tall is it? How deep front to back?
The Box dimensions vary as each box-board is built by hand. However they do run close to 8″ high 17.5″ long & 12″ wide. Thank you.
Just bought the Flex-N-Go and I’m trying your exercises. I’ve been down all the avenues you have with my patellar tendonitis; physical therapy, hot and cold packs, massage, and PRP (which cost me a ton!). The success rate of surgery is low so I opted out of that. Thanks for posting this information. I have high hopes for these exercises and will let you know how it goes. Also, check out the Rumble Roller. I discovered it on this website http://www.fix-knee-pain.com/injuries/patellar-tendonitis-knee-tendonitis/ along with some great exercises for strengthening your legs.
On another site, which I can’t find right now, another person started “loading” on the slant board, after they had progressed a ways on the slant board with just eccentric exercises. Basically, they wore a backpack while doing the exercises, slowly adding 5 lbs at a time, with fantastic results. Could change YOUR healing from 70% to 100% maybe….
Hey Brian, when you did the lowering/eccentric part on the board, you said you’d lower to the bottom on a count to four. How far down is “the bottom”? Did you work up to going all the way down or did you go half way for a while? Also, how much pain should be felt going down? I get 1/2 way and I have to take some weight off because of pain.
Thanks,
Chris
Hi Chris, I just lower as far as I can comfortably go… pretty much to the point when it transitions from discomfort to pain. I don’t want pain, but some discomfort is ok.
How low I went increased over time. It went from a not-very-deep squat to maybe a 90 degree angle.
Again… not medical advise, I’m not qualified to offer that… just what I did.
Hi Claire, thanks for stopping by. I love the Flex-N-Go, it is so sturdy. It sounds like you tried all those other treatments as well, so hopefully you’ve found something that will finally work for you!
Thanks for posting about the roller. I also have IT bands that cause issue from time to time, and I use a foam roller to work those loose. It hurts so good!
Agreed on the loading, I should be doing that! Thanks for pushing me. Gotta find a backpack.
Brian
Good luck, Ian. Circle back and let us know how it worked out!
Hi Brian!
I completely understand your frustration with you knee. I have been struggling with chronic patellar tendonitis for the past year and a half. Treating tendonitis is slow going and requires a lot of hard work and patience. Traveling from PT to the doctors is not fun. The doctors originally gave me a knee strap and that helped to take the pressure off the kneecap and made running pain free. However, I soon learned that the strap was only aggravating the problem and further weakening the knee. Every time I took the strap off after practice the inflammation, stiffness and pain would be worse. The knee strap also caused me to put more stress on my uninjured knee and now I have tendonitis in both knees. I have learned that the knee strap is not a permanent solution to tendonitis, but rather an aid to recovery. I have been in and out of physical therapy this year and I have been doing exercises to help strengthen my legs. In physical therapy I have also been working on “fixing” my stride. Pronation of the foot can lead to knee and hip problems. PT has helped some but I believe in addition to PT your exercises might be the key to treating my tendonitis! Already I am having some success and my knees are feeling better. I was wondering if you knew any more eccentric exercises to help my recovery.
Thanks,
Kat
Kat, i had a question for you:
You said that already you’re having some success and my knees are feeling better. Are you having success and your knees are feeling better because of physical therapy OR because you tried the slant board exercise?
Hi Brian
Thanks for all the info. I’ve been plagued with knee trouble my whole adult life but PT has been the most frustrating for me. My other injuries got surgery and I recovered fully but this injury has pretty much ended me sports wise. Football (soccer) is my sport. I’ve taken a 3 month rest and haven’t healed a bit. I went to the cinema the other night and was in agony! That kind of pain after 3 months of complete inactivity? Not looking good.
So I’m going to try a slant board, I’ll return and post my findings in a few months. I’ve nothing to lose. Granted I’m not young anymore, just turned 41 but before the PT I was the fittest I’d ever been in my life.
So to anyone else resting and not healing, you’re not alone! This injury is a real pest.
If the board fails to help I’m afraid it’s game over for me. Fingers crossed. Good luck to you all facing this injury, I wish you well.
Thanks again for the tips Brian.
Kindest regards
Graham
Graham, just a thought that might help you. I have had patellar tendonitis in the past 9 months and i started physical therapy on december 27 up until now.. That’s about 18 days in and i’m already feeling better. I asked my physical therapist about the slant board eccentric and he too said that he think it would be a great addition to my physical therapy exercises and that i should try it. But he also said that the slant board might work and also might not work because it depends on the person because everyone’s body is different and it can be different things triggering the tendonitis for different people. My point to you is that you should definately consider physical therapy because it can do wonders for you along with this eccentric slant board exercise.
Hi Omar
Thanks for your advice. I have put off going to see my physio, I figured all I needed was some rest and recuperation. The pain I endured the other night though has me changing my game plan. I will indeed make an appointment and physical therapy is definitely on my agenda.
Hopefully therapy along with the board will speed my recovery. I’m of the thinking I’ll never truly be rid of PT but if I can be comfortable enough to play then I’ll be content with that.
Good to hear you’re doing well with your own recovery. I’ll return and update my progress in the spring. If we benefit from these techniques it’s good for others who are unsure. I’m hoping to be one of the benefactors!
Kind regards
Graham
I shattered my Patella in a fall. I have surgery & now the four pieces are trying to knot. The J pins are trying to pop out & now I have trouble even bending the knee to 40 degrees. any suggestion in how to walk normally again.
BTW, I am 8 weeks since surgery & doing PT.
I am 65 years you g as well!
Thanks for any advise.
Hi Millie, wow, that sounds like a tough injury! That is beyond my experience, and I’m afraid I can’t offer much advice as I really only know a bit about Patellar Tendonitis. I do wish you the best of luck, though, and let us know how your healing goes.
hi i have been having pronlems with both of patellar tendons and i am a avid basketball player. I was just wondering if it is bad to have it in both legs.
Hi Stephanie, thanks for the comment. I’m not sure if it is worse in terms of the healing process, but I’d imagine it will take longer. One is bad enough, I can’t imagine having it in both knees.
I played basketball this morning for an hour, and Wednesday night (2 days ago) for 2 hours, so relief is possible.
Again, I’m no doctor, but if I were you I’d probably give the slant board a try. Since you have it in both knees, I would think you don’t even have to balance on one knee on the way up, you could still use both.
Best of luck,
Brian
Hi, could this help chondromalacia? I have pain right under my knee cap but it’s minimal.. Where exactly was your pain?
Hi Omar, sorry, that isn’t something I’m familiar with.
Mmm ok, but can you tell me where exactly your pain was?
I feel the pain right underneath the kneecap, fairly close to the surface. I can press on it from the outside and it hurts… and God forbid I bump it on something because that hurts like crazy.
But, all that said, I am so much better now than I was a year or so ago.
Just to let you know that is exactly what chondromalacia is.. It’s softening of the cartillage under the knee. I think they mis-diagnosed you just like they did with me..
Hey, great article. I’ve been dealing with patellar tendonitis for the past year and a half and it has been a real burden. I play baseball and I feel it every time I throw and land on my left knee. It has subsided a bit but every once and a while it will flare up and I need to shut down. I’ll try this out though, hopefully it can work.
That is certainly possible, although I don’t think it is the case based on the MRI, X-Rays, and doctors who looked at it. I could see the inflammation and what looked to be damage on the tendon in the MRI.
Hi Tyler, best of luck to you! Please circle back and let me know if it works for you.
thanks.will give these exercises a try. i am long time marathoner battling pt for over a year..tried most of what people have mentioned here,short of surgery..gotten some relief from pain but my knee is so weak i cannot run more than 2 miles at a time. my running career,such as it was, may be shot but i am not giving up yet!
Hey all!
I am having the same issue as you all! Except I have now, after being busy with school and not being able to work out a lot, developed some atrophy! =(, its not terrible, but enough to notice that when i walk, one glute and thigh muscle feels weaker than the other…
I have been on a workout regimen (for my legs) of bike or elippltical for 15 mins, then lunges (boy wieght and occansionally 10-15 lbs weights), leg press (just started and doesn’t hurt at all!), and resistance training with a band.
While the muscle in the leg appears to be bigger, it is not STRONGER persé…any ideas on how to REALLY strengthen that leg more?
i have added ankle weights and sqauts (with the ball against the wall) to about 45 to me regimen as well!
I really want to be back to normal by Mid March (I am joining a flag football league!) =)
Hi Brian
Thanks for this website. Really good info.
When I’m doing these squats, I find the first 10 really sore and then my knee totally loosens up and the last 10/15 to the point where there is ver little pain. Did you experience this when u started these exercises? I’m basically looking for encouragement that this exercise is working for me and I’m on the right track.
Cheers
Andy
Brain, Your story is very similar to mine beside the fact you finally found something that worked. I’ve tried physical therapy two different times for 12 weeks at a time and the symptoms never seems to go away. It has been almost 2 years now and I am getting to the point where I am willing to try ANYTHING to get rid of this issue. Just like you said I am constantly moving my Left leg around trying to find a comfortable position but it seems like there isn’t one. I am going to order this slant board and try what you did but I have a few questions. After you did your exercises on the board did you use ice or heat or just stick with pain medication? Is this the only exercise you did while using the slant board or did you also do any other quad strenthening exercises? Where did you order your slant board from? I want to make sure I do this exactly like you did.. any information you can provide will be much appreciated. Thank you -Ricardo
Awesome article
Hey dude, thanks for posting your experience on your jumpers knee, i too have the same problem for about 2 years and have tried most of the things you have aswell, prp, cortisone etc .. just wondering if you were able to do this rehab while still playing basketball (obviously limiting minutes) i just cant bring myself to sit out and not play. your thoughts on this would be greatly appreciated.
Where was this six months ago? I’ve been doing this exercise for a week now & the pain went down from 10 to 6. About my history I’m a 10k runner. Six months ago I’ve increased my running distance to 21 km & did it way too fast which resulted into Patella pain. I had an MRI done, xtray done both showed nothing. I’ve tried chiropractor~~~ waste of money the pain did not go away. Physio ~~< didn't help either.
To add to that I’ve also tried hot yoga the pain went away for a day.Cortisone~~ inject to your knee made the pain worse. Dr. recommended surgery which I refuse.
hey Byran.. im a fighter of mma .. well when i first hurt my knee it was about 3 months ago,,an i’ve been trying every thing i cant to heal properly because i also use to train hard when it came to endurance for later rounds..but my main question is when can i begin tho simple sqwats you did to heal.. cuz i read on one of your coments to someone that when you play 40 or more min of b ball you wont go more well for me.. i like to train an train well for hours i really miss my gym an was hoping to hear back thanks dude..
Hi Brian .I have PT for about 10 months now Im a tennis player an beach tennis player .
I had diagnosed before 3 months on Pattelar tendonitis on both Knees wich became tendinosis.
I had ACL and two miniscus sergery on my right Knee before 3 years after an accident.with my DH bike.
Im a very high level active person and that seems to be my payment on all that thinks that I love to do..
I made physio Therapy about 2 weeks sessions .But nothing worked Im again on Physio for some friction /massage therapy It seems not working again after 2 weeks and a half on Ph.Th.
So a had read about eccentric squats and im doing them about 2 weeks now but with out ths slant board .I will make on and I give it a try on it. Im foam ROlling an streching every night before my bed time,It seems to relax me . Heat /cold pack its a day habbit for me now …
I used to have tendinitis in my “strong” leg from playing tons of basketball, and it didn’t help that I switched to Muay Thai when I graduated college (knees don’t really like heavy bag kicks).
The way I got rid of mine is to strengthen the whole leg. How does one strengthen the whole leg, with tendon pain? Door-assisted single-leg squats. Full range of motion really beefs up the leg. Eventually you want to progress to unassisted single-leg squats (also called pistols). Check this out: http://www.beastskills.com/one-legged-squat-the-pistol/
Note, you do NOT under any circumstances want to do the limited-range progressions on that website. For example, you don’t want to do the ones where you put a box under you — the sort of tension on the knee holding it above a box really aggravates the tendinitis, and I know from experience.
Use a counterweight or a door or a band or a bar to pull yourself back up, but absolutely do use full range of motion. It will take a month, but you’ll be a freaking beast afterwards and won’t get anymore leg problems.
Thank you for writing this, Brian. As a longtime explorer of the body-mind connection, an avid yoga practiioner, power walker, and recent martial arts student – I am just now coming into the home stretch of an 8 month knee tendonosis recovery journey, it was great to finally find your post.
Knee tendon overuse injury & its accompanying stiffness reduced mobility is not only physically painful but also emotionally hard – it’s scary to have stiff joints that aren’t changing fast. It’s scary to feel like you hobble down the stairs and are prone to falling over easy if you’re in pain. And, taking a break from one’s usual physical workouts in order to rest the tendons, can really alter your brain chemistry with a depressing psychological effect and fear of premature decay of the joints, etc. This is not helped by reading conventional M.D./orthopedist perspective on knee pain (cut open the leg to move stuff around, or inject it with steroids) – it makes it even more depressing.
My personal healing of knee tendonosis has been a revelation of longstanding biomechanical issues that I didn’t know I had. I discovered them after utilizing my best, highly-informed self-care (including eccentric slant board work – but it made things worse for me pain-wise, and I stopped in order to wait for pro feedback) with not much progress. By chance, I happened to get a new job with generous health insurance, and was able to start working with a unique physiotherapist lady (a triathlete with a PhD focused on A.R.T., not just the typical P.T. or chiro who completed one weekend workshop and proclaims they know & practice A.R.T.). She sourced my tendonosis as coming from scar tissue adhesion of my rectus femoris quadricep – and my TFL. Adhesions go back to childhood/adolescent injuries that happened during growth spurts followed by sedentary post-injury habits that made the tramatized tissue stick to the femur. I had many injuries as a kid (falling down stairs, a huge bicycle crash, skiing falls, to name a few) – and, living in a mountain town that was winter about 6 months of the year – I did do the sedentary post-injury thing, being a bookworm type. So, interestingly, my case history is one that correlates well with adhesion-based tendonosis – while other folks may have other root causes of their own knee pain.
Some people don’t know that A.R.T. is not passive bodywork – you have to slowly move the area while the practitioner is doing bone-scrapingly painful deep release on it, so the CNS gets retrained. It’s very hard work, yet also wonderful for brain chemistry – lots of endorphins get released. It would be fascinating to study the similarities between eccentric squats and A.R.T. – as they both involve willingly going into pain and opening up properly aligned full range of motion!
Anywoo, that and a nightly routine of prone, deep quad stretching, thrice a week supported squats/wall sits (like Cocotal said), and doing a temporary 6 week routine of wearing compression socks (the kind that go over the knee are fab) during my deskjob days, are giving me new legs! The compression socks are awesome for reducing edema and assisting with removing wastes from injured tissues – you can find them in black. I had tried T.K. knee sleeves as well as Zensah calf sleeves, but the P.T. explained that the compression action needs to include both the entire ankle and knee. They feel great on, too.
ROM is completely restored, and I am just working on being able to load, build, and nourish this fledgling mobile RF quad muscle. The RF often has deepest adhesions where it attaches near the hip, and this affects the entire track where attaches below the knee, many people don’t understand how huge a role this plays when it is deformed or malfunctioning.
So, different body structures and personal histories create different knee tendonosis… Some people may have beautifully functioning upper quads and have knee pain due to foot/ankle/gaits probs or one leg being longer than the other, for example. Other people who are over 40 & super healthy like myself, still have the hormone fluctuations that come with normal aging and can make for a slower recovery journey and a longer time of it.
Recovery and full healing is indeed possible. You don’t have to go down the rabbithole of steroids and surgeries, it is indeed possible to heal and strengthen the leg so that you become an even better athlete in the end.
Hi Brian
I got my tendonitis from dead lifting. One day I did deadlift then next day woke with pain in left knee. Below and bottom right side of knee cap. So rested lot of inflamation then after 3-4 days the other knee started to hurt.slowly progressed and I went through MRI ,PT and stuff. But no progress the weakness and inflamation was gone after 2 months.but lot of pain while walkin below knee cap little bit above knee cap. Have been resting a lot doctor told its tendonitis. I can’t walk or stand without pain. My question is should I start doing this. Did it hurt your knees while walking?what do you recommend? I am walking through pain. At least small walks.
Alright so I received my slant board exactly two weeks ago (thanks again Kelly) and I began using it immediately. but I do two legged squats not one legged. I started off doing one set of 10 once per day for the first week and immediately noticed a significant decrease in pain. The second week I started doing two sets of 10 once a day plus various exercises including leg lifts and calf raises along with stretching twice per day (Morning and night). I have not had to ice my knee or take pain meds since I begin doing the eccentric squats with the flex-and-go board. I estimate my decrease in pain to be about 15-20 % less in just two weeks. I honestly feel like this is the best thing that I could be doing to relieve my Patellar Tendonosis and I have tried MANY different options. I am so glad I stumbled upon this article. Thank Brian!
Well I’ve finished with my physical therapist and while it has helped some…I’m not quite where I’d like to be. I will say that in PT they have really strengthened by glutes and thighs which provides support, but not quite enough. I have just ordered the slant board and will give it a shot. I can’t knock my PT but I’m hoping this will carry me the rest of the way in addition to their program.
Your experience sounds very similar to mine, which I have been dealing with for nearly 3 years. I also injured myself lifting too heavy in the gym and not listening to my body. Similarly, I can’t stand or walk without pain and really sympathize. I went through 5 months of PT which has helped some but not quite enough. I’m going to give this board and exercise a try because I have seen and read numerous success stories. I say give it a go man. If you’re knees hurt like mine do then leave no stone unturned and pay any price for potential relief. You can email me at gibbons.ian@gmail.com if you want an update.
Hey guys,
I have had this problem for two years. I have done prolotherapy, pt, chiropractors, xrays, MRIs….everything. I HIGHLY recommend acupuncture and staying away from wheat/gluten/dairy. I have noticed a huge difference since I’ve done these things!
25 years old and been diagnosed with patellar tendonosis. Been dealing with injury for over 1.5 years. It came on gradually 2 years ago, but the last 1.5 years it hurts just to walk especially any distances. The only thing I think could’ve caused it was driving a car with a clutch. I sold my car 9 months ago and still dealing with significant pain at times. I’m considering this, I’ve done pt for several months with no great success. Is it possible i got my tendonosis from the clutch in my car? If I got this board, what’s the goal of how many should be done a day?
hi brian,
i’m 16 yrs old and i’m also suffering chronic patella tendonitis(both). its almost 11months when i fall while playing basketball. in the 1st to 2nd month after the fall i can endure the pain and in the 3rd to 5th month the pain is being worsen , but i dont want to go to a orthopedist. because i’m afraid that there is probability that i will be sidelined and miss the season. so i decided that after the season i will go to a orthpedist. in the 7th month i been diagnosed and i attend 13 sessions in almost 2months and the pain was subsided for about 70-80% and my rehab doctor said i just need to rest for about 2months. after 2months there still little pain. so i decided to go back to my orthopedist and he request for an MRI. after my MRI its still patella tendonitis so my doctor said i need to have a physical therapy again for 8sessions. after 8sessions there still the little pain.
now that there is just little pain is that good to try the essentric excercises or got a shots of prp? or other options?
all advice can be helpful
Thanks!
Brian, you convinced me to buy the slant board. I had been doing one leg at a time with automotive wheel chocks — a little scary.
I was wondering if I could use my patellar strap to help support my tendon while doing the exercises?
–Joe
Hello,
I am writing from the UK. My son has been diagnosed with PT and has had now for 18months in both knees. He is now 16 and I think it started due to over training for cross country running. He finds he has a dull pain when walking upstairs and cannot train on roads anymore.
He stopped running for a year and has made a come back in the last three months. There has been some improvement in terms of pain but still struggles running up hill.
He has had plenty of attention from specialists but no exercise has really helped. He has rested and we hoped that it was partly down to growing pains- but he really hasn’t grown in the last two years.
My question is, is it common to have this problem in both knees?
He had some blood tests recently which recorded a below average platlet count, will this mean that the healing process in his knees will be retarded?
The whole problem is really frustrating as he was in the top ten in the country for his running, but last week he came 170 in the National Cross Country.
David
Hi Brian,
My story is very similar to yours including treatments and lack of results. Just got the Flex-N-Go today and started with the exercise. My questions are:
1) have you also used the foam roller as on this website that also advocates eccentric exercises on the slant board:
http://foamrollers.com.au/how-to-use-the-foam-roller-for-patellar-tendonitis/
AND 2) do you ice your knee?
Hi there, I enjoy reading through your post.
I like to write a little comment to support you.
Hi there, im 17 years old and I play competitive basketball almost everyday of the week. I also have osgood schaltters.
About 6-7 months ago I was playing a game of basketball and went for a layup and my knee started to hurt a bit more than usual. I thought it was just the pain of the osgood so i kept on playing. This pain continued for months to come but as i thought it was just pain from the osgood it didn’t phase me because i was so used to the pain. This last month the pain worsened and it got to the point were i couldn’t even run anymore. I went to the physio and i have been diagnosed with PT. I have done all the exercises, all the stretches, Iced it, Heat packs and strapped my knee yet the pain continued!
Is there anything i can do to stop the pain without having weeks-months off?
Hi Mia,
I am also a runner/athlete…i was a college gymnast.
How long did it take you to feel healed? Did you completely heal yourself of it? And how many reps did you do? weights at all?
Sorry to barge you with this but in May of ’13, it will have been a year i have been dealing with this issue…
Thanks!
Hey Guys,
It’s great to see all of them comments on this site. I’m 20 years old and I’ve had Patellar tendonitis in both knees for exactly 1 year now. I was a college volleyball player and the tendonitis developed over a period of 2-4 months until it hurt so bad that I couldn’t play anymore. One year later, I have been through 4 months of physical therapy, 2 of which included ART, I had PRP in each tendon which was super painful, I’m not sure how much it helped.
My problem stemmed from extremely, extremely tight quads, glutes, hamstrings and calves. I feel immediate pain relief from stretching after foam rolling (I have a normal black roller and a black RumbleRoller), however keeping up with the amount of rolling and stretching that makes me feel better is absolutely exhausting and it takes so much time.
Since my injury I have not played any sports and it really, really sucks because I am a hugely active person, and to see this part of my life put on hold indefinitely is really bad for my soul. Confronting aging and stiff joints at 20 years old is not where I saw myself in my life. I fear I have done irreversible damage to my knees…
Anyway, I’m going to try that board technique, it seems like a good one.
I’m sending healing vibes to all of you…
I have had some kind of patellar tendonitis for 17 years. It has been better at points and worse at times. It has stopped me from running. I recently went through PRP, and things have been much worse since then. My pain is not terrible. It’s mostly a matter of weakness and now since the PRP tenderness if I were to kneel. The doctor has suggested surgery as the next treatment. I want to give your exercise a try. I have tried just about everything, too. It’s depressing.
Tried some of the exercises. Wow, my knee really hurts now. Did you find there was more hurt before the healing came?
Good blog. I have had right knee patellar tendinosis for approaching a decade now (from running). First doctors I saw all misdiagnosed it. I finally figured out on my own what it was and eventually a great sports doc confirmed it, including on an MRI.
In my case daily slant-board eccentric work makes a large difference. I will never run again and I don’t expect to ever be able to walk/ride a bike without some degree of pain (I’m in my mid 30’s).
Regular slant-board work, however, does bring me to the point where pain is fleeting or non-existent for regular activities, like just moving around and doing stairs. Unfortunately, last year I developed an IT band issue doing these and thus the only way to avoid its pain is to not do them, which introduces the patellar pain again!
My MRI shows an otherwise healthy joint, and the MRI shows “mild tendinosis”, so nothing crazy, but it’s a chronic very bothersome problem.
I may go for a round or two of PRP, but the stuff isn’t cheap. However, other than eccentric training or surgery there is very little else showing, in actual real medical studies, much efficacy.
Considering how common tendinosis is it’s really just a damn shame so many doctors know nothing about it. I had achilles tendinosis not long ago and the specialist I saw about it put me on anti-inflams, a demonstrably incorrect approach. So many docs waste people’s time on ice and stretching and just rubbish. Rest is very useful obviously, but once the recovery stalls something else needs to happen.
“Tried some of the exercises. Wow, my knee really hurts now. Did you find there was more hurt before the healing came?”
Personally, yes, a little. Eccentric work should hurt a little bit, and chances are it will if your tendons are even more than a little hurt anyway. Push through the pain a bit. Normally it will only be peaking right after or for a few hours, at least in my case. Within a couple of weeks you may find a decrease in pain, so then you keep at it and see where it gets you.
Hello Tendon Man, Just a quick note. If you go to the FLEX-N-GO website and click on the instruction tab in the column, there is a free downloadable PDF for Achilles tendinosis as well as many other lower leg & foot problems. I am assuming you own a slant board already. Best of luck, Kelly
Thanks. I actually built a slant board a few years back. Just a piece of wood with some gritty sandpaper on it and another piece that keys into a slot in the back to create the desired angle :)
I should probably get to this achilles with more attention. Unlike my patellar tendinosis it has actually almost recovered entirely by itself. Occasionally it will flare up and just one set of calf raises helps it a great deal immediately afterward. Eccentric exercise does seem to have an anesthetic impact.
hey brian,
i was wondering…i have an inclined hill in front of my house. it’s not a slant board–it’s kind of bumpy and lumpy, but will that work? or should i purchase a board?
This board looks really well made. Unfortunately no shipping to UK? Help??!! Really need it for exactly the same problem!
I have had the board for about 2 weeks now and YES it VERY high quality. Worth every penny.
I saw one other protocol which at one point calls for switching to an entirely one legged squat (as contrasted with Brian’s video demo which indicates simply a shifting of weight). I’m going to stick with Brian’s method for the time being as I feel that my bad leg just isn’t quite strong enough yet to handle the squat on it’s own.
–Joe
Hello Steve, There is a company that will ship to the UK, it is called MyUS.com
We have had a number of people from around the world order through these folks. Feel free to contact us through Kelly@FLEX-N-GO.com for more info
Hope this helps, Kelly
Joe, Thank you for the kind words. We are thrilled that you found your board to your liking. Keep us in the loop as to your progress! Kelly
Hey Brian, thanks for this article. Ever since studying abroad a year and a half ago, and walking/biking more than I ever had in a semester, I’ve been struggling with Patellar Tendonitis.
I’ll be trying out your method, but I’m curious if you stopped doing other exercises that stress your knee while you were doing your eccentric squat therapy? I’d like to keep up my jogging schedule, but am not sure if that would just undo any good from the eccentric squats.
Hello everyone,
I bought the slant board to help my patellar tendonitis however it turns out that I have Chrondomalacia Patellae, SO I want to sell my slant board. If anyone is interested in buying my slant board please email me
sam.saccomanno@yahoo.com
Continuing to jog while having this is an absolutely AWFUL idea. Trust me. You need to respect this. I didn’t and I’m coming up on a decade of knee pain and my running days are long since behind me now. This is a very serious issue and you need to commit to a minimum of several months to get over it. Even then you’ll likely be predisposed and it’s absolutely crucial that you avoid antagonistic activities, which I presume for you running is.
Hi there it’s me, I am also visiting this site on a regular basis, this website is actually fastidious and the visitors are truly sharing nice thoughts.
Update : 2 months of doing this excercise I’m pain free. I highly recommend stopping all activities that cause pain. I stop running for 6 weeks as an avid runner it was so hard to do instead I switch to swimming. Patella pain comes with inflammation –(mine was inflame) & my Dr. told me to take aleve (No way)seriously I google all antiflamatory food and came up with blueberry ,celery, apple & sorbet ( I put that in my diet). Worth it
Thanks for sharing your experience with this affliction (dramatic)! But seriously, I have been dealing with patellar tendonitis off and on for about 2 years. It was dormant for the last 6 months, but it’s back again. You interested me in the eccentric squat, and, luckily, my gym has a slanted board that is almost identical to the one you use. I did a few low rep sets (fought through some pain), and it felt awesome afterward! I also used a roller to loosen up my hamstrings and quads as part of a new stretch routine which may have helped also. Anyway, thanks for everyone posting on here!
This is a great thread! It is nice to see others dealing with this, not that I want anyone to have to deal with this, but it’s nice to feel not alone. It seems odd that one little tiny spot under my kneecap can cause so many problems! I have moderate arthritis in my other knee, and I have now come to see one as “the good knee”! It’s the one I can kneel on. It doesn’t hurt when I sleep or go up or down stairs.
I plan to try these exercises and I’ve known about them for some time, but like Brian in the beginning, I thought I couldn’t do them if it hurt so much. I will just start with less of a squat. I guess I will stretch, too, esp quads.
One thing that DID not help, and actually made things much worse, was prolotherapy. The doc then recommended PRP, but I don’t want to try anything like that again. So much new scar tissue!!
That was in the fall. In Jan I started with an ART certified Chiropracter. He has helped a lot to break up the scar tissue. He also told me about icing frequently, which I still do. My orthopedist thinks the prolo (done by a sports doc) and the ART are just a bunch of bunk… I spoke to another knee specialist who said he only knew of one other person who got worse after prolo. So I’m not surprised I didn’t get better, but I think it’s rare to get worse, which is why I decided to give it a try. I’m not keen on giving surgery a try, though! But part of me thinks, “If they could only take out the bad piece of tendon and heal back the rest, I’d be OK” Not sure if that can really happen… will have an MRI to determine how bad it really is.
So I second the ART, the ice, and I think the slantboard (will update after using it for a while). Oh, and a prosthetic and brace guy suggested a type of sleeve brace with a donut area to support the patella (its a really tight sleeve, not like the little lame patellar opening that other knee braces have). This is only palliative, though.
Oh, and I forgot to thank Brian for the great article and your great answers!
Hi Tendon man …may I ask you something ?
how old are you and whats your sport backround around your tendinosis problem that you have
I think you’re right–if they could take out the bad, you’d be good. I have seen the guy widely believed to be the best in my city at this kind of thing and he has a pretty good success rate with surgery for tendinosis, but nothing is guaranteed, so I’ve really tried to put it off. He also practices PRP, which unlike prolotherapy actually puts back your own platelets instead of sugar solution (I think that’s what prolo is). He cautiously recommended, it mainly cautious because he knows the science is still not really out, although there have been a number of studies showing a stistically significant benefit to PRP.
I would still probably try PRP before surgery. It is almost a grand a pop unfortunately, as insurance rarely covers it.
I still like to think and hope it’s not too optimstic that a new therapy will emerge that has a much better track record than existing ones.
In my case my knee is a roller coaster. Today it barely hurts at all and I Just mowed the lawn with a 1/10 pain scale and now it’s 0/10. However, on Monday I may be at work and it will be 2-3/10. Nothing crazy, but just sitting there bothering me.
I think it’s very important to find the correct level of activity for joint health and it’s a personal thing. I absolutely think total rest is a bad thing for tendinosis, from my own experience and from reading others’.
Well Hello everybody!
I play Australian Rules Football in the Ruck, and I developed Severe Tendinitis last season. Anyway, I am managing it right now with physical therapy and while I had to take off two months of sport, it was certainly worth it because now, while I can still feel it, it is MUCH better then it was.
However I was wondering whether there was more feedback from people who have had success with this board before I consider getting it myself.
Thanks in advance,
Fraser73
I agree. I gave my knee 1.5 months off during the off season, and I came back to school with my knees in worse shape then when I left. That said I wasn’t completely inactive, but my knees would have been a lot better if I had continued my PT
I also had the clicking. Apparently, so the specialist tells me, it’s a problem with the knee cap tracking; because of the patella injury you (often unwittingly) use the various leg muscles in different ways to compensate for the patella injury. Consequently, one of those muscles exerts greater force on once side of your patella, causing it to become slightly misaliged from the “grooves” on which it usually tracks. The clicking is when the patella clicks back into the grooves.
At least that’s what the physio and specialist told me.
My 2 year anniversary with PT will be at the end of this month and just wanted to provide a little input. I stumbled upon this form of concentric exercise in a youtube video early on in my injury but when I tried it I experienced a little discomfort so I quit doing it. Long story short… about 1 1/2 years, visits with the family Dr., visits with a knee specialist, an MRI, and weeks of physical therapy later and still totally floored and frustrated with this injury I found this thread and decided to give it a go again and I think I may have had a break through. What I have learned from this site is to keep doing the exercises despite a little irritation or discomfort. It is very important to know the difference between pain and discomfort. Only you can decide what the difference is for you. When I was at rock bottom after ignoring the injury because it didn’t really hurt that bad at first, I had pain radiating down my shin bones when I pushed on the pedals of my bike. I have been sticking with this routine for about a month now and at first had a little irritation but kept on with it and it didn’t get any worse (if your discomfort gets worse or manifests into pain by all means STOP) and now seems to be getting slightly better. The most important thing I learned is that if you don’t get on top of this early and run it into the ground like I did, rest and anti-inflammatories alone WILL NOT get you better. I think my cause and for many others for this injury is muscle imbalances causing patella maltracking. Hope this adds a little to this valuable thread.
Hi Brain! I’ve had patellar tendonosis for 2 years now and nothing has worked. Beginning eccentric exercises with your recommended slant board.
Also, I’m getting PRP done this Friday.
Would you not recommend it overall? Did you find any improvement for the PRP treatment?
Thank you!
Hi everyone, I’m glad I found this website and thread. I’ve been dealing with chronic knee pain since 2004 and had to stop running and most other intense exercise all together since that time. I still remain active and work out as much as I can, but even walking every day is painful in both of my knees. I’ve tried physical therapy (twice), icing, stretching/yoga, NSAIDS, the works. I’m getting another MRI next week…hopefully the doctor will finally have a diagnosis, though my symptoms sound just like patellar tendonitis. It’s been so many years, it’s hard to believe anything will work at this point–and I’m not even 30! If he tells me it’s tendonitis, I’m definitely going to try these exercises. Good luck to everyone. All feedback welcome.
What is a good degree slant for a slant board?
Hola!
Emily, I have the same story as you. The not even 30 part really gets to me so I totally feel your pain. I am going to build myself on of these slat boards right away (I am living in Venezuela and cannot order one) and get going on the exercises. I’ve been battling this is both knees for a year and it was brought on by cycling. Ill be sure to post my results. Buenos suertes!
Hello, Bobby: Our boards are 25 degrees. My email address is above; drop me a note, and I would be happy to give you a little advice regarding your board. :-)
Emily, my tendon pain was from running in late 20’s. I struggled for years and finally gave up running, now 35, but the tendinosis never went away. The first several docs I saw–including having two MRIs–all misdiagnosed. It is really frustrating having a sports doc look at an MRI and conclude that your knee is basically fine, despite you know the fact that even walking can hurt. I had to diagnose myself, as pompous as it may sound, but a third MRI and consult with a better doc finally confirmed what I thought I had, just from voracious internet reading.
If your doc tells you to do NSAIDS or rest or whatever, at this point they don’t work, so ignore his advice. It’s mind boggling how many physicians just seem completely inept over this common problem.
“bio mechanically challenged cyclist”
It is quite difficult psychologically and extremely unintuitive to work _into_ discomfort/pain, as you’ve found and so many of us have, and yet what you suspect is true in a lot of cases: working through that discomfort is the only resolution. Although my personal response to eccentric has been positive but not mind-blowing (didn’t resolve it, is more of a helpful pain management thing), I think back to a shoulder injury I had a few years back. Rest had plateaued and it was not getting better. I went to a PT, we worked through exercises with very mild discomfort and it wasn’t long before that joint finally healed up, now it’s good. I am completely positive without exercise it wouldn’t have healed as quickly.
Hello Ive been dealing with chronic knee pain for the past 2 months. I’ve been to many different doctors and no one can seem to tell me whats wrong. I’ve gotten xrays and an MRI from an orthopedics surgent and they said that my ligaments were fine. He didn’t said say anything about my tendons. I later went home and did research on my own and pinpointed the pain and basically am configuring its patellar ten….
I’ve been scared to walk on my leg for the past 5 weeks because of the pain and the swelling when I was walking on it. I also had hott and cold feelings radiating out from my patellar tendon. My doctor thought it could be a blood clot so he told me to go to the ER.
I know have had no results from any professional and havn’t been walking on my leg. Thee hardest part of my injury is trying to find a professional to help diagnos me, so I can know what to do to heal it. Like is it better to try and walk or would it make it worse to walk. I’m curious your thoughts on my situation and have truly appreciated reading your information, thank you for sharing.
If you have any advice for me, that woud be greatly appreciated.
Thank you.
Kayla
I’ve been dealing with chronic patellar tendonitis (or tendonosis depending on which ortho you ask) for about 2.5 years. It started out only bothering me running and skiing. Then it started to flare up hiking later on, and now flares up under low and no impact activities like swimming and biking which I can’t do anymore either. And now its to the point where often walking around the house or office is pretty bothersome…
So far I’ve been to 3 different orthos, failed physical therapy twice, tried PRP, tried Ionpheresis, no luck. I’ve read several place including here that eccentric squats are the way to go and have been trying it, but at least at the moment it causes me too much irritation. I can let my knees rest for several weeks, do several sets of the eccentric squats and the pain/irritation ramps up to where I limp around for a week straight. I tried, maybe mistakenly to stick with it daily for a week straight, and that was a total failure and set me back at least a few weeks.
I guess my question is, while you said the eccentric squats are uncomfortable, how long does it typically take for the pain/irritation to go away after you’ve done the eccentric squats?
Hi Scott, that sounds like a tough issue! I don’t remember mine being close to that bad. I think I maybe had to skip a day or two at most if my knee was really irritated from the board. So… maybe it isn’t the right solution for you? Or maybe you have something else going on in your knee as well?
I saw recently that Danny Granger, an NBA player on the Pacers, and surgery because of his Patellar Tendonitis. He makes his living jumping, and I’m sure he chose the best route for him. Maybe you could explore what he did, who he saw, and if it would be a treatment path for you? http://www.huffingtonpost.com/abby-sims/patellar-tendinosis-knock_b_2090055.html
Disclaimer: Again, I’m most certainly not a doctor so I can’t give medical advice. Ask a doctor before you do anything!
Hi Kayla, sorry to hear about all your troubles, I know how frustrating it can be! Your case seems to be much worse than mine.
I like really close to the Redskins training facilities, and so a lot of the doctors in this area treat these professional athletes for various injuries. Some are known as “the back guy” or “the ankle guy”.
I’d recommend that you keep getting professional opinions, and see if you can find “the knee guy”.
Brian
Hey Brian,
I have had chronic patella tendonitis for around 6 years. I played many high level sports including football and basketball during my late teens/early 20s, so I had no time to slow down and eliminate the problem. I am now 23 and it has become a real issue, I cannot sit for long periods of time or if its cold my knees hurt like hell.
I have recently received PRP and can confirm it does help after around 2 weeks. The point of PRP isn’t to fix the tendonitis, its too heal the tendon so you can start strengthening. I really like your advice on here and will buy this board. I also recommend cycling as another form of strengthening. I will let you know how I go with the board!
Hi sir, my name is Ron, I just wanted to say that I have PT for about 4 and a half months now it’s been bothering me the whole 4 months so pissed. I think that Patellar Tendonitis occured to my right knee when me and my friends played whole court basketball then walked for about 4 miles (back and forth) then the day after my right knee feels discomfort. After searching the net i found out about patellar tendonitis and do some squats and straight leg raise from a site I just saw. But it has no result. So now i just wanted to try this eccentric exercise and to see if it will work. I just wanted to add becuase im from philippines(which is other country than yours which is USA) can I find this slant board in some sports outlet?. And also there’s a try out for varsity in our school and I would like to participate but the coach said that we will have to run for 10 mins, Jog for 10 mins, and walk for 10 mins. Should I participate or just continue exercising my knee? any advice will help. BTW great article and I HATE PATELLAR TENDONITIS
As a former runner, healthy young woman I was diagnosed with Pt. Also been going to Physio for 2 months. Had acupuncture , ultrasounds, shock wave therapythose were Temporary results.. So far the only exercise that help is GYM.I hired a personal trainer I told him about this knee pain. The reason for this could be weak quad, weak glute(very common for women),weak leg, tight quad.The gym that I go to has one of this board he showed me how to used them. Also been doing weight lifting on my knee. So far a month into the exercise this helps a lot .The only time I feel pain is when the weather changes. I don’t even look at the weather channel anymore my knee will tell me.Maybe it’s something else so I’m going to see the DR.
This is great! I’ve been dealing with tendonitis in my knees for a little over 13 years now due to running track in high school! I’ve tried stretches and all I can say is, they’re not working at all:-(. My doctor informed if those stretches! But I’m definitely going to try the exercises with the slant board! You and I have the same problem and the results for you as I can see have worked well! Thank you so much!!!
Hi Brian,
Great information thanks! I’m 61 and had surgery on both knees (Physio tells me they no longer do this surgery it is now fixed with exercise to strengthen muscles)over 40 years ago as both knees dislocated constantly. My knees no longer dislocate but I have always had reduced mobility in my knees and an almost paranoid fear of them dislocating again(was terribly painful). One year ago I started Physio as I had been diagnosed with osteo arthritis in my knees. I started stretching exercises to strengthen my glutes, squats etc. All these helped but not long after, my son who was terminally ill, was hospitalised and for the next 3 weeks I spent every day at the hospital. This involved climbing numerous stairs daily and the exercises went out the window. Sadly, my son passed away and I found my left knee was now so painful that I had to go to Accident & Emergency myself. I had a huge lump at the back of my knee and after xray and ultrasound I was told I have a huge Baker’s cyst and Chronic Patellar Tendonopathy.
I have been referred to an Orthapaedic Surgeon but that TERRIFIES me as the surgery I had 40 years ago was extremely painful and it’s the last option for me.
I feel that your slant board and eccentric squats are exactly what I need now that the stiffness and swelling has reduced right down. Only problem is the Baker’s Cyst is still there and it feels like a golf ball in the back of my knee. I guess I’ll wait to see the surgeon first and see what he says but your option is looking good to me rather than surgery. Thanks for all the information that will help me make a more informed choice. Really appreciate everyone’s comments. Thanks heaps Brian and everyone!
Is it best to do this exercise with bare feet on the slant board?
Hi Sandy, I go barefoot whenever I can. I don’t see any good reason (for me) to wear shoes or VFFs on the slant board, so I don’t. However, others may feel the need to wear them. You can give both ways a try and see what works best for you.
Great, I hope they work! I got some generic stretches from my doctor as well. They were just a printout from some website, so I didn’t get the feeling he was providing a lot of value by giving me those.
I’ve been exploring for a bit for any high quality articles or blog posts in this kind of house . Exploring in Yahoo I finally stumbled upon this web site. Reading this info So i’m glad to show that I’ve an incredibly just right uncanny feeling I found out exactly what I needed. I so much without a doubt will make sure to do not forget this web site and give it a look on a continuing basis.
Thanks for you quick response Brian! One more question, I looked at the slant board and it says it’s at a 25 degree angle. Is that correct? It looks more like 45 to me.
Hello Sandy, It is 25° no worries
Hey Brian. Great article!! I too have been suffering from bilateral patellar tendonosis for about two years now after running through some injuries in the past. I also think that this might have been compounded by very tight IT bands (I had the left one surgically released earlier this year). My question is did you ice after doing the eccentric exercises and how much discomfort did you feel while doing the exercises? Also, were you able to continue doing non-impact cardio such as the Arc Trainer while doing the eccentric exercises. Thank you so much!!!
I heard that EMS shock wave therapy) is a new treatment for pattelar tendinopathy …I will give it a try and I let you know.
Hi there
I like your article. I am also dealing with tendonitis on my left knee ( right side of left knee) It happen while cycling. I have been doing long distance cycling since 1998 so i find it doubtful is the sport. I started with bike fit. Went thru medicines, physical theraphy, Iontophoresis . No help. It seems like alot of the excersices from this article with a foam roller helped me. http://www.fix-knee-pain.com/injuries/patellar-tendonitis-knee-tendonitis/. But just for few months. Now i am back at cycling and every time after mile 50 the pain comes back. MInd you i have cycle 400 miles and no pain. Any suggestions are welcome
I just had surgery to decompress my patella tendon. The results and relief was immediate. I walked across recovery an hour after surgery without pain or a limp.
I have read the information on your website and will be your exercises hoping that it will prevent it coming back
Thank you for this… I will definitely try this.. and after reading your article, I search further about eccentric exercises… Evidence supported study…
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971642/
So it’s been over a year since you wrote this. Can you say you are 100% pain free? If not, what percentage (assuming its improved from 70% which you reported already).
Thanks for the advice!
How is your Knee now, is it 100% yet?
Basically I’m 17 Y/O and been suffering from PT for two years now. I took countless weeks off which was very risky of me to do because i play basketball at a high level to erase PT in my left knee, basically this reduced the pain a lot, and i was basically able to start playing at a high level again. 6 weeks later i injured my right knee developing serve tenonditis within that knee, along with my left knee starting to inflame again and i had basically no time to take off to heal this all over again. To my luck in some case i recently suffered a horrific ankle injury thats keeping me out for four months, which is doing wonders for my knees as i cant play any sport at all, im praying that this long rest will completely heal both my tendons and i can be 100% again for the first time in years.. What do you think?
This blog offers all the information you needed about knee exercise to avoid knee pain. I really appreciated this blog,,,it is been really helpful. Keep this up!
I’ve been doing this exercise and the first 5-6 times i bend the knee in the first set it hurts but then i i can do the rest pain-free. Then i feel no pain maybe for 1 hour after the exercise put then the pain emerges again. I have been doing this for 3 days and i see no improvements. And one thing , should your knee go longerthen your toes while bending ?
How long did you stop running for?? I am training for my first full marathon. I have been diagnosed with patellar Tendonitis by the chiropractor that I went to see. He did electro current and ultrasound but its not working. I have no problem running. Infact I feel amazing. It’s after I get home that I can hardly walk and going down the stairs is a killer. I have decided to take the week off from running to try and heal this injury. Please tell me it will go away or that there is no harm in me continuing to run besides pain after and for a few days!!!!!
Brian, one doctor tells me my muscles are too weak to support my body, so he gave me some exercises to do, helped with clicking and imporved a little, problem is that the pain and problem moves from one knee to the other now. Second doctor, finally is giving me an MRT to check if I have a tear. But in the meantime he tells me that I have Patellar Tendonitis in both knees. Not sure which one is right if any of them. Pain without touching is the inner side of the leg in the knee and below the knee area. Pressure applied to the bottom of the knee is painful especially on the right. I am not sure which doc is right. But want I want to ask you is if both knees have Patellar Tendonitis can one still use this slant board to improve the situation? I saw your video and I am not sure how to do it because both knees have problem. Should I alternate per day or per time or 10 on left and then 10 on right and vice versa? Am very interested in your thoughts. Great post and information by the way, thank you for that.
I was wondering if there is an alternative for the slant board if it can’t be afforded or a different type of way it can be done? I go to 24 fitness and I’m sure they have the stay type of equipment that this can be done on .
Hi Brian,
I feel hopeful after reading your story. I have PT for a year now from volleyball playing. my PT has little improvement after seeing 3 physio therapists underling going many types of treatment. Once i feel better and went back to my volleyball games, symptoms come back again. I am going to try the eccentric strengthening exercise you benefited before while continuing my rehab program in stretching and strengthening my targeted muscles.
I’d like to share this clinical publication which I find very insightful. The slant board exercise is recommended in this clinical article.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971642/#!po=11.9048
Thanks
Brian
Hi Brian, I’m really interested in this but have some concerns. I hope you’re able to answer this if not I would love to talk to you through email.
I have tendonitis in both my knees. Would this still be okay to do? I can barely go a mile without it flaring up. Even sitting in one position for too long can irritate it. Thanks!
Gabby, PLEASE stop running until you resolve this. No matter what, no matter if you think you need to run to lose weight, are training for a 5k, a marathon, whatever. Ceasing to run while dealing with this problem is a crucial first step.
UPDATE: Hi all, I last posted about 3-4 months ago when i initially got my slant board. I’ve been battling patellar tendonitis for 3 yrs and would like to share some of my insight:
1. If you have patellar tendonitis then you have to be prepared to CHANGE YOUR LIFESTLYE, potentially for 1-2 years depending on your severity. An inflammed tendon can’t heal if it is continuously being irritated.
2. Once again, depending on severity. REST ALONE DOES NOT WORK. Strengthening muscles around the tendon is incredibly helpful and proper form is CRUCIAL.
3. Persistence and hard work will pay off if done properly.
Now I wish could say that I’m cured….but I’m not. Nor am I a quarter of the athlete that I was 3 years ago but this is real. I CAN say that 6 months ago I was in constant pain during all activities, standing, walking, anything. I lived on knee braces. I am now able to walk around and stand all day without real pain or braces so realistically that’s a HUGE success.
Actually the last month was awesome and I was nearly pain free. I biked, ran, played volleyball and danced…………..which led me back to patellar tendon pain central. However the blame is mine and it reminds me to respect the condition and not RUSH back into things. If I got pain free I can do it again.
I currently do the following exercises:
2x a week in the gym
Lunges
Squats
Hip abductor both in and out
Calf raises
Hamstring curls
elliptical stair climber
1-2x per week home
3 sets of 15 on the slant board.
These exercises helped immensely along with stretching
I hear the rule of thumb is never let your knee go past your toes.
My fight continues but battles have been won. Remember to take it slow and listen to your bodies.
I am an example of a very unlucky person who may never function normally again due to patellar tendinopathy. I will write it down in a timeline so that it will be easier to view.
Late july 2012:
Fell into a hole in the woods. I felt only minor pain during the fall and a physical therapist told me that it probably was a meniscal injury. Pain dissapeared completely after about a month and I assumed with light activities as I was rehabing my other knee (patellar maltraking problem).
April 2013: Felt a sudden pain in the knee while doing leg extension exercise. Since I studied to become a physical therapist myself at that time and wanted to write about patellar tendinopathy in my bachelor project, I learned a lot about the injury and found out that my knee pain actually WAS due to injury to the patellar tendon. I had a possitive palpation test.
Late april 2013: After a few weeks without pain, I tried just simple squats without weights and even that made it a lot worse.
Early may 2013: Reinjured it while cycling.
Mid may: Made it worse doing simple quad setting.. It swelled up a ton and I was forced to walk with crutches for about 4 weeks before I was able to walk again.
June 25th: At the moment I graduated and recieved an A+ for my project on this damn injury I took literally 3 quick steps towards my mom to hug her and then.. BAM! I reinjured it again. Just I quick sharp pain and swelling a pain returned.
July 10th. Tried light quad setting.. Boom! a lot of swelling this time.
July 26th. Dropped an Ice bag right on the tendon and got the worst swelling I have ever experienced. Constand pain for several weeks and forced to lay down all the time and use 2 crutches.
Today (august 17th). These last few weeks I experienced some decreased swelling and was able to walk a bit with 2 crutches. The entire leg has atrophied a great deal and the patelalr tendon in other knee has started to get painfull and well as the right achilles tendon. I fell asleep with knee slightly internally rotated and got light pain again.
I’ve never read this before, but the commuon sence is that the more you reinjure a tissue, the harder it will be to strenthen it again.
Yes, I have been extremely unfortunate and unsmart at times with the injury. I also strongly believe that I am one of those who genetically have weak tendons since I through my life have had more than 10 severe tendon injuries. None as serious as this one though and my bad treatment of it has bitten me in the bud.
In my bachelor project about the injury that included my own tests of 12 basketball players with and without PT, I found some pretty storng evidence that decreased dorsi flexion and increase pronation of the feet can leed to this injury. Several other studies also showed this tendency. And yes, tight quads and hamstrings can also lead to it.
I also want to say, that if you have severe PT, especially if you have pain during everyday activity and if you injured it a short while ago, eccentric squats may be very bad for your tendon! Pain is only okay if the tendon already had got some strength. My tendon didn’t and I paid the price, you don’t have to! So start light and build your way up slowly. A serious tendon injury usually requires 6 weeks on rest before the tendon has built up enough strong collagen fibers so that you can just do light exercises and walk on it. That’s why have (myself encluded) have failed to put the right amount of stress to the tendon that can build it up instead of breaking it down.
Hello
I have PT in both knees equally. How do you suggest I do th exercises on the board?
Jim, you may find benefit by using the slant board between two kitchen chairs, as I have often done. This lets you use the strength of your upper body to assist in the concentric (body going up) portion of the activity.
Mark Handburg, I feel sympathetic to your issue and I hope you resolve it.
What little condolence it may be I also feel I’m VERY suceptible to tendon injuries. Any time I injure a tendon, be it elbow or whatever I know I have minimum of many months of pain. However, you may get better. I hurt my achilles two years ago and it still is healing–it’s better than it was a year ago (which was better than the year prior), but still not perfect. I believe it’s somewhat common for some tendons to take years to get better.
As you’ve no doubt figured out, stop squating if it hurts :) I think step one on a tendon injury is to rest it and, as long as it’s continuing to heal, continue to rest it. If a plateau is reached at which point it stops recovering, then introduce activity.
You may want to see a good doctor. There is one on my area who claims to have a pretty good success rate (80-85%) with tendinopathy surgery.
There’s good info at tendinosis.org and, as its author points out, in just the last decade this issue is gaining a great deal more traction. I’m still very hopeful that a non-surgical treatment will emerge that is highly effective. It seems right now that PRP, other than eccentric exercise, is probably the best one. Not perfect, but most of the therapies have absolutely no proven benefit, once properly analyzed in a meta study.
I hope this will work for patellofemoral pain as well. By the way what was the angle of slant board you used. I will try to build it myself…
Angle of board you used. Also will that work for patellofemoral pain?
Vishal I can only answer the angle question. Our board are 25º. Also we have recently resized the slant board for the purpose of better shipping options. The boards are 16″ length. Best of luck! All these people have the experience to get you where you need to go! Kelly
How steep is the slant board. How deep did you squat also? When you said there was more pain while doing the eccentric squat how long before this soreness decreased?
Hello Nick, I can answer the Angle question for you. Our boards are 25º. Also we have recently resized the slant board for the purpose of better shipping options. The boards are 16″ length. Best of luck! Kelly
I’ve had pain in both knees for about 10 year. I was diagnosed as Arthritis around that time. A couple of times I had cortisone injections, but I decided that the injections only took care of the symptom and not the cause of the pain.
A month ago the pain started again in both knees, but the pain on the left knee was much stronger. A new doctor diagnosed my problem as knee tendonitis (no arthritis!).
I refused the cortisone injection, I’ve iced the knee almost every day, to no avail.
I’m going to try the last board you recommend. One question though: will my right knee be OK as a work on my left knee, since a have a milder case of tendonitis on the right knee as well?
I play basketball and just got to where i can dunk it this year, but about december i started to feel the tendonitis in my left knee and it slowly got worse, i let it rest for about a month and it didnt hurt for about another month then it came back but this time there was pain in my right knee too, my left is still alot worse though. ive used ice, medicine, and a brace, but it still has not much effect on the pain. any ideas? it hurts when i jump, try to cut hard, stop suddenly, and do defensive slides.
I play basketball and just got to where i can dunk it this year, but about december i started to feel the tendonitis in my left knee and it slowly got worse, i let it rest for about a month and it didnt hurt for about another month then it came back but this time there was pain in my right knee too, my left is still alot worse though. ive used ice, medicine, and a brace, but it still has not much effect on the pain. any ideas? it hurts when i jump, try to cut hard, stop suddenly, and do defensive slides.
Tony,
Have you been to a doc yet? I have what I thought was tendonitis, but turned out to be a partial patellar tendon tear. It seems to be why my pain is concentrated to a tiny little spot, but it hurts when I do all the types of things you mentioned. So I would try to get an accurate diagnosis from an orthopedic doc. Good luck with it!
Brian,
Thanks for a great article. Would you mind adding an update on how you are and any new treatments you’ve added?
Hi Brian
Thanks for this. I also have been struggling with tendinitis for quite some time now (5-6 years). I play NCAA soccer (playing 6 days a week). I go through phases of bad times and others when there’s little to no pain. I’ve just started doing these slant board exercises, and so far I’ve already felt the benefits. Had a question for you, what do you think about using muscle rub or biofreeze on the tendon prior to playing? Have you tried that out?
Hi all,
I just wanted to give another update and provide some hope to those suffering from Patellar Tendonitis.
This is now my 4th consecutive week using the slant board and I DEFINITELY see an improvement.
My knees hurt less, make less popping noises and I am able to do more with less discomfort.
Last week I went out dancing for the first time in ages and played lazer tag which required a lot of running and kneeling. I planned on taking it easy but having fun I pushed it pretty hard. I spent each day after expecting my knees to explode with pain as they have before and shockingly, they feel better than they did!?!?
It does feel as though the more I do these exercises, the more stable my knee becomes. I AM finding some success and hopefully you are/will as well.
Ian!! Thank you for the update. So happy for you. Dude you have the rest of your life, you don’t have to make up for lost time all in one night! LOL Did I sent you the video on VMO strengthening as well as the link for
fix-knee-pain.com The owner just published a second book. This one specifically for patellar tendonitis. He has a free news letter that is outstanding! His name is Martin Koban. Like Brian, he is very accessible, and concerned about the wellbeing of people. Major congrats Ian! Kelly
Hi Kelly,
Yes things are looking up. You did not send me the link but I would love to check it out. Please shoot it to gibbons.ian@gmail.com
Hi, after 2 years of suffering from light to extreme pain in my right knee, 5 physio’s, an x-Ray, an MRI, 2 GP’s, an Orthopedic Surgeon and an Arthroscopy 8 weeks ago, I’ve finally found a site with people identifying a real fix.
Thankyou for taking the time and making the effort to come up with real options that real people can attempt.
For the first time in a very long time I have something to look forward to and a glimmer of hope. My right knee is now in constant pain and even my surgeon told me that I should just get used to it.
It’s nice to read of people conquering what has been the most debilitating injury I have ever had.
I’ll keep you posted.
Let the training begin!
Hello everyone, I just discovered this website and I am very excited to start the slant board exercises. I’ve been really considering surgery due to having extreme pain in my left knee for well over two years… Anyway, you guys are all giving me hope so we will see how it goes. Good to talk to you guys.
great site.
Are you familiar with Sigfus V.’s eccentric exercise protocol for patellar tendinopathy ?
Hey Ian,
You can check out the book that Kelly mentioned on Amazon:
http://www.amazon.com/Beating-Patellar-Tendonitis-Treatment-Pain-free/dp/1491049731/ref=sr_1_170?ie=UTF8&qid=1380859898&sr=8-170&keywords=knee+pain
Unfortunately, you just missed the free download period that ended on the first of October :-( … Amazon limits the number of days that I can offer the book for free, so I’ll have to wait a couple of months before I can do that again.
The good news is that you can easily refund Kindle titles within 7 days of purchase :-)
Hope you get well soon.
Hi everyone,
I must say that this is a great website with a lot of helpful advice. Kelly of Flex-n-Go slant boards emailed me to say hello and that she saw my name mentioned here recently.
Best of luck to all,
Sigfus
The Eccentric Protocol
I had patelar tendinitis in my left knee for about 2 weeks now and it hurts really bad every time when I play basketball and jump, turn and run. I really want the pain to go away. Do you have any advice for it to heal up? What kind of knee brace or knee sleeve should I wear for basketball?
Hey Kyle, I see you are a terminator fan huh. Since this injury is within two weeks I am hopeful that you can come out of this one on top. As you have read, many of us have been dealing with what this becomes after years of pain. I do have some advice that I believe will be helpful..but you may not like number 1:
1. I recommend taking a break from all sports for a period of at least 4 – 6 weeks. Just to be sure.
2. Go see a sports doctor if you haven’t already done so. They will hopefully put you in touch with a good physical therapist.
3. There are many exercises for patellar tendonitis that you can find online which incorporate many thigh, glute and hip abductor exercises……remember when doing squats/lunges to never let your knee pass your toes.
4. Take it easy man and be patient.
Had I done those things I might not be dealing with what I am now.
Short term sacrifice for long term health.
I know this page is iold but the info is very relevant still.
I am curious if anyone has had Tendinitis flare up from sleep wrong AKA leg bent at the knee all night.
@jeremy yes, i always try to keep my legs straight when i sleep. I can feel some irritation if i don’t.
I have been dealing with PT for 2 1/2 years now and while i’m not better yet, it’s because if this exercise that i am able to manage it, and have slowly returned to cycling after the first 1 1/2 years of not being able to ride at all.
Hi,
This has seemed very useful to me, I also have PT. I am thinking about getting that board, I have tried everything. I have had constant swelling just below the kneecap for over 2 years now. At first I didn’t rest from sports but now I’ve had 8 months of rest (no running, only biking and upper body weight lifting) and the swelling has not gone down at all and pain is still persistent. It also worth saying I was diagnosed with PT, it’s not auschgood slaughter (or however you spell it lol). Would it be worth getting this board if my knees haven’t got at all better these past 8 months? Or is it worth the risk?
Im a Division 1 college basketball player and I have bad tendonitis. Its really affecting my basketball career and im afraid if I don’t fix it then my career will be cut short. We practice 3 hours a day and it just gets worse. I ice it almost 5 times a day and that gets me through the season but I really need to get rid of it. Im in jeapordy of loosing my starting position. These college trainers are good for nothing. all they do is stem and ice. I NEED HELP! please…
KB, there is so much good info here. You can really count on what these folks are sharing here. Please contact me at
Kelly@Flex-n-go.com And I can sent you some follow up info. Best of luck. Kelly
Jordan,
Your experience sounds very similar to mine, which HAS gotten better. I recommend getting board so you can do eccentric squats in addition to weight training focusing on quads, glutes and hip abductors. Those things paired with modifying your activities and TONS of patience will hopefully help you as it did me. I’m far from cured but I’m considerably better than before I took action. Now here’s a question for the group: Anyone try PRP injections? I’m looking into it hoping it gets me back to 100%
Hey Ian,
Brian wrote about PRP in his original post. It didn’t work for him. Based on the research I’ve gone through for my book on patellar tendonitis it seems like a hit and miss treatment approach.
Researchers actually don’t know whether it works and when it does work, they don’t know why.
The most effective treatment approaches are eccentric exercises on a slanted board and heavy-slow resistance training. Eccentrics have the most research in support of their efficacy, although they’re being criticized for a number of reasons.
Im pretty positive this is the reason I’ve been suffering from patella tendonosis. I sleep in the half fetal position for the last 5 years (partner is too warm) and I have suffered from this and hip pain on that same side.
I can’t correct my sleeping pattern as I always wake up back in the same half fetal which I am obviously doing sub consciously. I have been thinking about wrapping my knee to prevent it bending but still loose enough to keep the blood flow.
I think your definitely onto something.
Martin said eccentrics “are being crticized for a number of reasons”. What are those reasons? I have done a ton of research on eccentrics, and have found only some minor complaints, but nothing significant in my opinion.
Has anyone looked into, or has had Tenex’s F.A.S.T. procedure? It is an outpatient procedure using ultrasound technology to break up scar tissue. I am in the process of consulting doctor’s on the procedure. Recovery is approx 4-6 weeks, and requires wearing a t-scope knee brace to keep the knee straight. However, therapy begins right away so the brace is only used in non-therapy hours.
Anyway, it would be great to hear someone’s experience with the F.A.S.T. procedure. I found out about it because Pau Gasol (NBA player) had the procedure done last year. Unfortunately I cannot get a hold of him :)
Patella pain is awful, and being 29 years old I don’t want to live with it for the next 50 years!
Hello Aldo, I am not familiar with the criticism, however I am very familiar with Martin Koban. He is extremely approachable, and I am sure he will be more than happy to pass on to you any information you are seeking. Best of luck, Kelly Reeme
Hey Aldo,
I talk about these things in detail in the book “Beating Patellar Tendonitis”.
Two reason why eccentric exercises are being crticized are because they hide problems with ankle mobility and because they encourage a knee-forward squatting style, which puts high compressive forces on the patello-femoral joint and the patellar tendon.
Left unchecked, both of these factors will increase the chance of suffering a reinjury once you return to your sport.
my cure was ginger root everyday and omega 3 ,no sugar and no flour…i think thats the 30% you missed!
I have had to splint and brace my knee and foot to try and train my body to stop curling up at night. All it seems to take is one night with my knee bent (In a natural position) and it will set off the pain that takes months to heal.
I almost wonder if there is some sort of medical problem causing this on it own, as I also have it happen in my shoulder if I sleep wrong.
Here is another update which I found interesting. First off my knees have been improving slowly since using the slant board for eccentric quats and some other supportive exercises at the gym. I decided to see another sports doctor to get a second opinion and gauge of where I’m at. He takes x-rays and MRI’s of both of my knees.
I was shocked when his response was that “there is nothing wrong with my knees and I can take part in any activity”. He said there was only a little inflammation behind my knee caps that I could take aleve for.
Clearly there must be somethin wrong with my knees when standing for prolonged times hurts, any activity hurts and my knees have tons of clicking, popping for the last 3 years. The doctor is convinced it’s not a knee issue and that I see a neurologist.
I’m no doctor but has anyone had a doctor say nothing is wrong with all their knee pain?
Hi Ian, Glad things are getting better. Sorry to hear about your idiot physician. Sounds to me like since he cannot find, in imaging, indication of your pain that it doesn’t exist. This is incredibly stupid and naive of him. As worthless an opinion as going to a psychiatrist and he telling you your depression isn’t real because it doesn’t come up in a scan.
If I sound annoyed it’s because I am. I saw several physicians about my patellar tendinosis and all were extremely dismissive about it because my knee checked out fine during clinical examination, x-ray was good, even a couple of MRIs came back clear.
However, in my head, the pain I had was real, it wasn’t neurological, and due to their lack of interest/competency despite textbook presentation of symptoms not a single one diagnosed me as having tendinosis. Instead, I, a lay person, was forced to research this and diagnose it myself.
Last year I had the best doctor in the city see me, confirm my diagnosis, and finally it actually came up on an MRI (mild patellar tendinosis).
The moral is: Doctors are smart, but they are not omniscient. I was also told I could more or less get back to activity, despite that activity being the cause of my discomfort. A silly recommendation.
Hey, i came across your post while researching knee braces…i’m an avid and competitive basketball player who had patella surgery 18 months ago for a completely torn patella. I do wall sits, which have worked great, eccentric also, but i’m intrigued by your experience.
However i’m curious about the exercise because your knee is noticeably in front of your toes, which according to every PT I’ve spoke to and read, that positioning exacerbates the strain on the patella tendon. Knee should always be behind the toes. Have you discussed this aspect of the exercise? Thanks!
I was suffering for a year with the same problem! Even touching it was excruciating. I got the plasma injection into the knee. It was very painful for the few seconds but a week later it was perfect and haven’t had trouble since! That was 5 years ago! My right knee has developed the same problem now and I’m getting the same injection next month! Unreal results!
Jom7
I’m very curious about your experience with PRP. I’ve tried several different methods in my quest for painless knees and PRP injections are next on my list. I plan on leaving no stone unturned and hopefully my results will be as positive as yours. Please tell me more.
I have a consult with an exceptional sports doc in my city for next month to talk about PRP. Unfortunately insurance doesn’t cover it–and unfortunately that tells you something, specifically that it’s not a uniformly scientifically proven approach. However, it is covered in some medical techniques, even if not direct tendon injection.
Moreover, there are enough anecdotal indications about it that I think it is probably worth the $600-800 to try, at least if the doctor agrees. Risks are low, but I have seen some occasional references by people of scar tissue build up. However, my sense is that if you’re considering surgery it is probably worth PRP.
I am considering it partially because I’m considering surgery but partially because I’m not; sometimes I can go a couple of days straight with no tendon pain. Even though I’ve had it for many years now, I feel it’s probably not severe enough that surgery is truly indicated, so maybe PRP would be worth it.
I’ve read enough success stories regarding PRP to roll the dice and see if I can become one of them. Fortunately I have the funds, I’ll just have to get oreo cookies for my wedding rather than a wedding cake. Risk seems minimal and when it comes to my health I’ll try ANYTHING! I had arthroscopic surgery on my right knee that definitely wasn’t necessary, I recommend putting of surgery at all costs.
I stained my acl very badly wh job they honk has cause my patellar tendonitis! I can’t hardly run a short lap without pain! I use the strap but doesn’t really do much for me! If I sit still for to long it stiffens up a lot! Crossfit squat holds help it a lot however the pain always returns! Think this slant board could help! I am a very very active person and rarely slow down!
Hi Matt,
I’m thinking, because you’re on a 25 degree angle, some amount of you is going to have to be in front of your toes, so you don’t fall back.
The technically correct normal squat, on flat ground, the knees are supposed to stay behind the toes. It’s a balance exercise, as much as it is a strength exercise. Right? So, I would think to attempt the same type of balance, as far back, and technically correct as possible. But since you’re on an angle pushing you forward, you will have to comensate. That’s just my guess.
I’m not a medical, physical, legal, or much other of an expert. Just like the helpful young man who started this is.
Interesting that people keep asking him for medical advice, when he has clearly stated, at least severl, if not many times, he is not a medical expert.
I would like to thank him for this blog tho. Seems an awful lot like an advertisement, but also seems like a lot of good discussion and information has come of it.
Ciao!
Troy
Great article. Anyone have a success story to share, I could really use some motivation. How are you doing Brian?
I have quadricep tendonosis in both knees that started with a hiking injury four months go. I have no history of knee problems and am 30 years old. After being misdiagnosed with “runners knee” I spent 2 months in physical therapy, daily icing, NSAIDs. None of this helped. Even resting for a month. It wasn’t until I demanded an MRI that I found out it was chronic tendonitis.
I immediately started the eccentric squats. Unfortunately, I jumped into it way too fast, adding weight and one legged squats from day one. Big mistake. Now I’m resting for a week or so and will get back to the eccentric work very SLOWLY.
Anyway, the moral of this story is FIRST get a proper diagnosis and SECOND start eccentric work SLOWLY.
I would appreciate any encouraging success stories with healing this annoying problem. I’m very depressed and having trouble coping. Please email me at joelatham2001@yahoo.com
Thanks :)
Hey guyz, I have been dealing with patella tendonitis for almost a year now and I got it through basketball. My doctor said no matter how hard you try to make it get better, your tendon will never be 100 percent again , I cant go hard as I used to . Is this true people
Also, has anyone here experienced “buckling” of the knee or feeling like its “giving out” with their tendonitis?
It seems to happen if I overstrech my hamstring once and a while…..any comment is much appreciated :)
Joelatham2001@yahoo.com
I have had patellar tendinitis for about 7 months now. Almost all my swelling gone. I have a lump on my patellar tendon. My PT told me it was scar tissue. Does anyone else have scar tissue or know if it can be broken up? Also is it permanent? Thanks for all your advice
Anthony,
After trying everything to heal my Patellar Tendonitis for over a year I found a Doctor who has done the F.A.S.T procedure over 40 times. I had this procedure done about 5 weeks ago and as far as I can tell it has given me no relief :( I had really hoped that this would finally be the solution but for me at least it was a waste of time.
Hi,
My mom has chronic arthritis in her knee and after an arthroscopic surgery, the pain has worsen. Both her knee and ankle have weaken tremendously. She also experiences petallar tendonitis and tends to limp, because she can’t exert any weight or pressure on that leg. Would you still recommend the board for her? Thanks for any feedback!
Hi Amanda, I’d check and see if the doctor will prescribe physical therapy. And, if so, consult with the PT on if the board and or eccentric exercises would help. If they feel it is safe, it could definitely be worth a try.
I’ve found that doctor’s don’t know much about physical therapy and the route to recovery, so talking with a PT who does it day in, and day out would be best. They know the different modalities, when to push and when to hold off, etc.
Best of luck, I hope it works out for your mother!
Do you have any info on healing from patellar tendinosis? It is a graduated form of tendonitis that causes tendon degeneration.
Hey Longshot22, when I talked to my Orthopedist about Tendinosis vs Tendonitis, he said it is just parsing words and there isn’t a difference.
I don’t know much more than that, although I do remember thinking, after researching, that I had tendinosis based on what I read.
The end result was I just pressed ahead, reading as much as I could on both, as it seems there are far more similarities than differences.
Mine felt like that, and when the weather is really cold, I put on a brace because I know that it feels weaker when it is cold and tight.
When it is cold, my knee is also more likely to hyperextend (or feel that way) by going inwards, so a simple neoprene brace keeps it nice and warm without restricting mobility.
I got mine through basketball as well. For me, I’m not 100%, but the pain/injury is managed and I can play basketball if I want.
For what it’s worth, my patellar tendinopathy can be traced to Ultimate frisbee as well.
Brian,
Hi Brian,
Great post.
I’m assuming that this is one of the studies you read:
http://www.umphysicians.org/prod/groups/ump/@pub/@ump/documents/content/ump_content_421644.pdf
But can you share the references you found for this comment:
“I didn’t realize that I should be feeling pain there, so I thought I was doing something wrong. Well, after even more digging, I found that I was definitely supposed to be feeling it because it is literally isolating my knee/tendon on the board so that it has to do all of the work – the slant board basically takes away the hamstring and quad’s ability to help lower me down.”
Thanks!
Hi Brian
I am happy that you got overload of your pain. Tendinitis means swelling. Tendinosis means tendon degeneration. This means there is a lot of scar tissue built up on you tendon. You have to break it down and remodel it. It’s painful.
Brian, how long did it take u to recover to where your at now with this injury? Thank you very much
I have been reading this thread periodically over the last year when I had patellar tendonosis on the lower part of my left knee. I decided to get the PRP injection which ACTUALLY WORKED. The best advice I can give to anyone who gets this injection is to be sure you give it time to work. Despite my ortho telling me it would take 6-8 weeks, it ended up taking about 3-4 months before the tendon was healed. This is injection is not meant to be an instant fix, it basically kick starts the healing process (which is why this injury is such a bitch, your body doesn’t do anything to heal it). Unfortunately right when I got back into exercising normally, I seemed to have gotten the injury again at the top of my other knee. I’m currently having insurance issues so I can’t get it diagnosed by MRI, but I may just go for the PRP again considering my previous success.
Taylor
I’m so happy that you got over this injury. I’m looking into prp injections at the moment. I hear that not many insurance companys cover it. I hope mine does.
Currently I am stretching my hip flexors, quads, hamstrings and doing ankle dorsiflexion for ankle mobilization. I also do buttocks , hip flexors exercises and eccentric squats on a slant board. Furthermore I am doing cross friction massage on my tendon. I do cross friction massage and the stretching daily. I do the exercises every other day. I have had patellar tendinosis for 7 months now and I am finally seeing some progress. Taylor. How many shots did you receive of prp injections? Please respond as soon as you can :)
Hi Taylor, thanks for sharing about your experience – that is awesome that PRP worked for you.
I also think hamstring and quad strength has a lot to do with this injury, as I’ve noticed that as I’ve been doing more weighted front and back squats, my knee has become more spry.
Since you’ve had it in both knees, it could indeed be a form or strength issue. Maybe not… but just a thought.
Hey Longshot, I’d suggest adding in front and back squats, eventually weighted (if you haven’t already).
Hi all,
It’s been about a month and a half since my PRR injection and the verdict is still out. One thing I can say is that both of m knees have been feeling better with significant rest. I was definitely OVERDOING it in the gym and on the slant board. Right now I’m only doing leg lifts, hip abductors and light squats and everyday walking around feels great. Still, that’s a far cry from the athlete that I am hoping to return to. When I return to the slant board I am going to make a point to take it veeeeeeeeery slowly. I’ll share PRP updates as I feel them.
Longshot
I only received one injection in my knee. It is true that insurance companies won’t cover this yet, however my ortho only charged $300 for the shot (well worth it). From what I’ve heard, the average price for this may be around $1000 which is a bit ridiculous considering they are just injecting your own platelets back into you. I would suggest calling a few orthos in your area and see who is offering the best price. Again I want to stress that this injection starts the healing process of the tendon. If you have been suffering with this injury for 7 months, realize it may take 5 months before it is fully healed. As for what Brian said about quad and hamstring strength, I agree 100 percent that this can help prevent the injury. However, in my case I squat and deadlift often and heavy (have been doing so for a while). My issue likely is due to overuse, as I am also into Crossfit. I, like most others, have a terrible habit of jumping back into my usual routine too quickly after recovering from an injury. Needless to say, from now on I’ll be adamant about easing back in to my workouts, under-doing it is always better than over-doing it.
Brian. I will eventually ad back squats once I get over some of the discomfort/pain. I also noticed that when do the exercises; the next day my knees feel great, but later during the day they start to get stiff again. I have to constantly keep stretching to release the tightness.
Taylor
I hope I can find an ortho that can charge me that low of a price. I will pay him immediately. I also have read that once you have this for more than 6 months it takes 3 – 6 to heal and up to a year for you to be 100% completely over it. Seems like I got a long recovery ahead of me since I have only been at this fir 2 months.
Hey Longshot, do a search for Prolotherapy in your area – this is essentially the same treatment as PRP, but they inject saline into the injury area. I’ve found that many of these practitioners are now performing PRP, so you might find someone offering PRP at the price you are looking for.
Brian
Yes. U am currently doing that but I must wait till after New Years since every office that I have called recently is closed. :)
Love this blog, thanks. I have learnt so much.
I bought a slant board from Physiofoam.co.uk because it seemed much cheaper and lighter than the wooden ones, and so far it’s been great. I think that 90% of my knee pain is gone.
Is this as good as it’s going to get for me? I’m mulling over the injection but I can run again now and don’t want to risk that. My injection would be through the NHS and therefore free.
Love this blog, thanks. I have learnt so much.
I bought a slant board from Physiofoam.co.uk because it seemed much cheaper and lighter than the wooden ones, and so far it’s been great. I think that 90% of my knee pain is gone.
Is this as good as it’s going to get for me? I’m mulling over the injection but I can run again now and don’t want to risk that. My injection would be through the NHS and therefore free. Any thoughts?
Hi all,
A couple of things to respond to:
Longshot:
You had mentioned scar tissue and I wonder if I am experiencing something similar POST PRP. There is a lump where the doctor did the final injection. There is still pain in the area which is apparently unusual. I’m still hoping PRP worked for me but wonder if I now have scar tissue in that area due to it.
Helena:
That’s great that you are now able to run. I wouldn’t consider PRP. Being able to run is a HUGE accomplishment. I’m curious:
1. How long have you dealt with Tendonosis?
2. How long have you been using the slant board?
Thanks
Ian J gibbons.
The scar tissue form because I kept re-injuring the tendon. I have almost gotten rid of most if it but it is still there none the less. I noticed once all the swelling had subsided there was a bump only tendon. I can see it slowly go away as I continue to do cross friction massage daily but the progress is gradual.
Hey Brian,
I started with tendonitis from eliptical over use above my kneecap ( quad tendonitis) and about 6 months later it spread to my patella below. I had MRis PT doctors etc and theres no tearing just swelling. Above my knee and below ( below the the kneecap the patella tendon itself is swollen and above the VMO muscle is swollen along with soreness in both tendons north and south of the kneecap.) I noticed after I do your excercises the swelling is worse…have you ever heard of this, or this type of injury? I know your not a doctor but thought it cant hurt to ask.
Thanks
Hi Peter,
I am very familiar with what you are describing as I have experienced it as well. I have taken a break from the slant board and the soreness north the kneecap was gone in 2 weeks. I had realized a couple of things:
1. I was doing too much too soon, in addition to gym exercises
2. I was doing the exercise in the morning and then walking all day. It began getting better when I did the slant board at night and had 6 hours of sleep for the muscles to rest.
3. Be very mindful of not letting your knee pass your toes.
Those things helped but rest really knocked it out.
Good luck.
If I can chime in on this………I think the eccentric exercises need to be started after the tendons have healed to a certain point. Where that point is is different for every person. I say this because after developing PT in Feb. of 13′ I continue to play bball through it (like an idiot) for months and months. I would rest for a week here or there or two weeks here or there. It got so bad to the point where I knew I had to rest period. I started eccentric exercises (with the flex-n-go board) but it wasn’t helping…..only continued to irritate my tendons. Now I’ve rested for 100 days and my tendons feel 85 percent better. I’m going to wait until they are between 90 to 100 percent healed and then start the exercises again. Btw, the way I define how they are healed is the level of irritation there is when I massage the tendon area. Initially that irritation was really high but has gone down considerably in the last 100 days. All I can say is this……the healing process is very slow when it comes to the tendons and resting is unavoidable. Any other insights are appreciated:)
Hey man I’ve also been reading this page for the last year on and off to get feedback from different people. Don’t want to sound pessimistic but there is a chance that the PRP still didn’t work……the tendons (depending on how badly they are irritated and injured) can take 3-4 months (or longer) to heal. I’m thinking it will take about 6 months for me to be close to 100%. My ortho also said wait 5-8 weeks which is bogus because A LOT of what I read says you have to rest for 100 plus days. The tendons heal wicked slow which is why its so frustrating to deal with. Best of luck to you.
Hi again, just touching base to give an update on progress and some additional advice. Things definitely moving in the right direction since first post 3 months 2 weeks ago. Poison significantly less and even a few pain free days here and there. Not quite back to running but within a month I reckon.
I have also found that in addition to the eccentric exercises, if you jump on an orbital trainer and cycle backward, yes backwards, it is doing wonders for strengthening my vmo. It is also another option for cardio much less painful than running or other impact exercises.
Again thanks for making this site. Keep the results coming in.
Has anyone bought this e-book?
http://anthonymychal.com/kneepain/?hop=jamtack
Fucking Fucking patella tendonitis! Am I right?
I also tried everything:
Rest for 2 months – worst decision
Gym exercises – bad decision
Knee socks – useless
Osteopathy – who knows
Cycling backwards – a little helpful
PRP injection – 2 months later 30% pain is reduced
Pilates – helps track the knee. This combined with eccentric cycling and PRP seems to be helping a little although I am still a long way from running.
I am 21 and have had severe PT for a full year now. Hopefully one of these techniques will clear me completely although I’m not too confident :/
Quick question:
Who knows about/has had the Grastin technique? Is it advisable to try and what sort of doctors do it? it looks damn painful
Hey benson. U need to wait for most of the inflammation to subside before u start doing any kind of exercise. What u can do in the mean time is stretch. I have had this for 8 months and I m finally looking at some great progress. I can see my tendon begin to take shape. I will say my tendon is almost back to normal and my pain level dropped over 60%.
What my remedy is stretch my quads hamstring hip-flexors and calves. Then I follow these exercises
http://www.fix-knee-pain.com/jumpers-knee-treatment-triangle/
I have been faithful for two whole months and it has really helped me. I also due cross friction massage after I complete this process. U should also try to avoid pain when doing daily activities. Like when climbing stairs and getting into a car or even getting up from using the toilet. I have modified every aspect of my life and I happy to that it has helped a lot.
About the graston technique. I did it on myself and it did help. The night after my leg felt loose and I had no pain, but eventually the pain came back as it always does with patellar tendinitis. I don’t think I will be trying the graston technique at all anymore. It is very painful and your leg gets bruised very badly. It basically speeds up the recovery time by breaking down scar tissue. None the less it yields results.
Hi Again.
I want to update you all about my patella tendinopathy situation. Obviously my knee got so bad this summer that I had to walk with crutches. After trying to protect the knee by compensating a lot, my other patellar tendon got tender as did one of my achilles tendons. That meant that I couldn’t walk anymore and got in a wheelchair for 2 month patially due to that and since I got severe tendinopathy in both shoulders (supraspinatus tendons) since I had to use my shoulders to to a lot of the work the legs usually did. I was also hospitalized for 2 weeks because a couple of doctors and myself started to believe that the main cause could be rheumatoid arthritis, which often starts out with tendon pain in ankles, knees and shoulders.
After having rules any arthritic condition out, the doctors best guess was that I have natually weak tendons judges on my history of tendon injuries the past 5 years (about 15 different tendon injuries) and the fact that several on my moms side of the family have had severe tendon issues.
After that I was at a rehab center for a month before I was able to move into my own apartment again and walk properly.
Then after new year, I started up at a new rehab facility where the intensity of the rehab exercises went up. It wasn’t very hard to do, but after the first, 2nd and 3dr time especially, the knee felt wrong. The physical therapist didn’t understand why cause a previous ultrasound scan back in late october revieled nothing abnormal in the tendon. I tried to warn her since an ultrasound scan doesn’t tell everything about a tendon condition. I had really severe swelling and tenderness prior to it and had not done much rehab since then, only rest. Rest alone is a must to start of with and may last for weeks depending on the severety of the injury.
As I mentioned in my previous post, as I studied to become a physical therapist myself and did my bachelor project last spring on patellar tendinopathy, I found a great deal of evidence, that decreased ankle dorsi flexion and increased ankle pronation (related to knee valgus) does increase the force on the tendon during sports activities. That being said, those factors are msotly important to be aware of is you are and athlete where you jump and LAND a lot.
But back to my situation. Through my journey through the Danish health care system I’ve met a lot of people from doctors, to physical therapists and occupational therapists and very very few of them have had any real insight of how serious my injury(s) was/still is and how to deal with them. I had a ton of arguements with them because they wanted to take over my rehab and make me to things, they thought would help me. They failed to realize that my long immobilization period wasn’t a choise of mine, but a nessasary thing for me since I had to stop compensating during my daily activities.
On top of that, the occupational therapists and a nurse wanted me to do as many daily activities as possible by myself and stop thinking about protecting myself since they thought that the cause of my problems was in between my ears. I decided to do some of the activities they wanted me to do and still regret it here 3 months after cause it made my shoulder problems increase so much since my shoulders were aldready fatigued at that time. First after their tactic failed they started to listen to me a bit and let me decide the rehab approach.
I based to rehab on a combination of knowledge on tendon healing and knowledge of my own body’s response mechanism. Both thise things are absolutely crucial. The therapiststs didn’t know nothing about that and had 0 experience with tendon rehab. Yet they were wouldn’t believe that they were wrong about a lot of things.
The biggest mistake they made were:
. Not listening to the patient
. Not paying attention to me injury history
. Not learning about the healing time and mechanics of tendons
. Attacked my rehab like they normally did with their patients (mostly older people) with the ,ain focus on activities of daily living.
Finally I want to bring up a few key things I’ve learned through studying and experiencing the injury myself:
. Respect the tendon’s healing time!! Go through the different stages and phases one by one and MONITOR the injury.
. Don’t push through the way. Avoid it completely eventhough some therapists and even programs say that pain is okay. Yes, if you have a chronic injury, the tendon will be wery sensitive to stimuli and will send pain signals to the brain even when to damage has happend to the tendon – related to allodynia. Despite that, it’s a risk to go into the pain and as I’ve learned the hard way, the more your tendon is injured (weakened), the less pain your must feel when you rehab! I’ve made my injury much worse without feeling anything before the next day.
It’s all about beeing in control of your injury, which I will define as experiencing progressive improvement through your rehab and notice increased force tolerance. That may take 3-4 weeks to notice that.
This is very important! If you suffer at setback, be careful: Don’t try to keep doing your rehab at the same intensity. Your tendon has weakend and it needs A: rest B: less intensive rehab.
The restperiod is not described in detail anywhere it seems, but I believe that the more serious your injury is, the longer your rest period needs to be. Remember, this is not a muscle injury. It won’t heal up in just a few weeks.
If it’s a very severe tendinopathy, you may have to treat the injury like a post surgery rehab. That will include RICE for 2-6 days, (mostly) rest for 3 weeks followed by stretching (very light). Stretching is important to avoid that scar tissue to become unorganized and stiff cause that will make you prone to reinjure it. A lot of scar tissue may require shock wave therapy and/or Graston Technique to break up adhesions. I will also give PRP a try as well as laser.
Strength training may have to wait till after 6 weeks where the primary healing has taken place, but the tendon can remain vulnable till 100 + days.
Hope some of this was usable to some of you.
hi brian,
I want to thank you for sharing the slant board miracle! The more I perform eccentric exercises, the more my knees become stronger and the pain was gone. It helped me a lot. This stuff really works!!!!
Just to add to what I wrote just above:
Some of you have described pain despite having been “cleared” by doctors who say that your tendon is fine. Like I wrote above, if their statement only is judged on palpation test and/or ultrasound, there can EASILY still be tendon weakness. There was in my case. MRI may give you more information than just an ultrasound and it could revial other problems than just the patellar tendon. Now, why should there be other issues than just tendon injury? Because if you’ve had long lasting tendinopathy/tendinosus, the tracking of your patella (knecap) is likely not proper because intraarticular knee pain and swelling will severely decrease the activation of the VMO (vastus medialis obliquus) on the medial side of your knee. The vastus medialis is vital for the patella tracking so that the kneecap can run smoothely in the femoral groove. If it’s not working properly, the kneecap will track laterally and possible tilt as well and compres the structures on the lateral side of the knee including the lateral plica and wear down the retropatellar cartilage. I had
On top of that, your lateral retinaculum will get tight and make your kneecap even less mobile.
If your patellar tendon have gotten injured and reunjured several times, chances are that a lot of scar has build up shortening the tendon which can lead to patella baja (where the kneecap is aligned too low and often inferiorly tilted too. That will likely put excessive pressure on the fat pad (located just underneath it) which is a very sensitive area.
I personally experienced all the secondary problems above with my other knee (yes I also had patellar tendinopathy there several years back), and even after the tendon had healed, the pain and discomfort comtinued. Several doctors told me my knee was fine due to non positive tests and even and MRI scan. After 3 years of pain I got rid of the pain within one month of treatment once I realized what the root cause of my pain was – maltracking of my kneecap. So I specifically worked on the VMO, strecthed out the lateral structures (vastus lateralis, lateral retinatulum and IT band), did cross friction massage on the lateral plica (to break up scar tissue) and recieved 6 PRP injections. After that absolutely no pain, so it worked out great for me. That being said, I can not say it will for you guys too, but I want you to pay attention to those other areas inside your knee as well. You can ask your PT, orthopedic surgion or doctor about it, but if your problem is really an issue for you, it would be smart to ask more than just one “expert” about it.
With my other knee I got the wrong diagnosis by a PT who claimed that I had a partial tear of my ACL and told me to never play sports ever again. 3 experts and an MRI scan later I leaned that nothing was wrong with the ACL.
As far as those other trouble causing areas inside the knee is concerned, it can be difficult to feel if your pain is located to the tendon or those other structures I just mentioned, but in general, if you feel discomfort from just sitting with your kneejoint in the same position (also not flexed), it can be due to chondromalacia patella. Pain when hyperextending the knee can come from the fat pad.
The PRP may work for some but not for other for the simple fact that not allc clinics uses a machine that spins the blood properly to extract the platelets from the rest of the blood. The PRP should have up to 8 times the amount of platelets compared to the normal blood, which they say often is not the case.
So is patellar tendinitis something that would show up on an MRI? I’ve been having sore knees after squatting for a few years now and it can just get sore while sitting down. Finally I got an MRI and all it showed was a thickening of the fat pad? Doctor says its just a strain injury but it seems to hurt even if I haven’t squatted in a few weeks. Anyone had any similar experiences? Is the eccentric movement likely to help me?
Slight tendinitis may not show up (but will on an ultrasound with doppler effect showing the inflammation as red colours), but chronic tendinopahty of the tendon will (thickening of the tendon) will be visuable. You can get more information from an MRI than you can get from an ultrasound and see other problems like the fat pad in your case.
Here is a bit from a study about MRI’s on patellar tendinopathy: “The radiological and MRI appearances of 24 knees with
patellar tendonitis resistant to conservative therapy
were analysed to identify the characteristic MRI
appearance and to determine if the patellar morphology
was abnormal. A significant thickening of the tendon
was found in all cases; this was a more reliable
diagnostic feature than a high signal within the superior
posterior and central aspect of the tendon at its proximal
attachment
The site of the lesion shown by MRI is more
compatible with impingement of the inferior pole of the
patella against the patellar tendon than a stress overload
of the tendon. There were no significant differences in
the length of the patella, inferior pole or length of the
articular surface when the patellar morphology was
compared with that of a matched control group.”
I’d also like to comment on a few things that are rarely toughed on related to the healing process of an injured tendon.
First of all, an injured tendon, like I mentioned and as you might have found out, has a very long healing time due to poor blood supply.
From point of injury, the healing process will take place and consist of several overlapping phases:
. Bleeding followed by and inflammation stage (normally within the first 72 hours)
. Proliferation stage with (from day 2 till about 6 weeks)
. Remodelling stage (from about week 6 till 6 + months)
Recently it has been accepted in the medical world that chronic tendon problems is NOT an inflammatory condition as most of the inflammation has cleared the tissue with the first 3 days on injury. That being said, you can still have injury recurrence which will be inflammatory.
Inflammation is said to be bad for the healing process, but it’s actually vital in the first part of the healing in order to clean up the area.
Now, in the chronic tendinopathy, there is often adhesions with scar tissue laid down in a very unorganized way, unlike healthy tissue. That weakens the tendons significantly by reducing it’s stress tolerance and can be a major problem for good rehab results. That is why aggressive methods like shockwave is often introduced for the chronic problem in order to break up the adhesions and restart the healing process. In that instance, inflammation is wanted and needed. That being said, you still don’t too much inflammation after every rehab session you’ve done because that delays the healing process, which is why you don’t start rehabbing just after you’ve had shockwave treatment.
So for the most part, I encurage you to eat healthy and get enough calories in so that you DON’T LOOSE any weight during the healing phases of the tendon. Reason being is that tendons only grow stronger like muscles when you take in more calories that you burn! Huge but yet overlooked factor!
I will recomment eating a healthy diet with a lot of vegetables and less meat, SUGAR and grain. If you can. stay away form alcohol, tobacco and even caffeine which will higher your stress level by switching on your symphathetic nervous system.
Stress can delay tissue healing by a great deal by increasing inflammatory activity, decreasing blood blow to the injured target tissue.
If you look at the elite olympic athletes, the best of those recover the fastest and they have a great ability to calm their selves down and relax when needed. Many of then practice relaxation in some form for example by breathing exercises, yoga, meditation, and more. If those athletes became stressed, overuse injuries like tendinopathy would possibly occur because of a lack of postworkout recovery.
If you have a chronic injury, your are very likely to have a higher daily stress level and if your CNS is in that mode, your body’s own ability to heal itself will be affected. You tolerance to external stress will be low, meaning both the tissue itself and your nervous system.
That’s why a good rehab for the chronic patient should focus on the mental part of the rehab as well and why you should too.
Like the great Tony Robbins have said. The most important thing for us humans to feel better when sad is personal growth. So while being injured, take the time to grow. Don’t waste the time but use it wisely to get stronger both physically and mentally every day. Think: Today I am going to get stronger than I was yesterday. Be patient with it and slowly but surely the result will show and that will get you emotionally high. It doesn’t matter that much that your not 100% yet. But just improving day by day feels great and if you place smaller goals along the way, improvements are easier to spot when you reach those goals.
Look at this as a test and an opportunity to grow. You have the opportunity to learn something about yourself and become a better and more humble human beeing from this experience.
As they say, tough times don’t last but tough people do! Stay strong!
hey.. thanks for this article on ur site.. I am suffering from tendonitis since past more than 2 year.. I have tried everything EVERTHINHG.. my ortho gave me a steroid injection as well..
I am sick and tired of thing injury now.. pls pls help me.. I was a regular runner (doing high intensity interval training) i had to stop it cause of this injury and my weight have increased in past 2 years..
please please help me.. i want to do high intensity interval training as soon as possible..
thanks very much.. really appreciate your article but will this slant board thing help me ??
kindly reply and guide me..
I’ve suffered tendonitis in my right knee for about 2years now.
I have had cortisone injections and countless physio appointments. Costly process but only temporarily stopped the pain, i play soccer all year around so no time to rest.
The season before last I took 2 months off but it never got better on its own, so a few pain killers ( inflammations ) before the game and I’m good to go. After once i’ve cooled down the my knee is very painfull to touch very imflammed. I find it hard to sit down sometimes my knee needs to be straight and moved around a bit to stop the discomfort. Only being 24 fit and healthy this is a problem I am willing to fix once and for all.
I am willing to try anything and I hope I can try this treatment method within my normal soccer scheduled and hopefully see results. I don’t want to sit around with this problem anymore, no one can seem to help me its not normal. Long car rides and plane rides are a nightmare, aching knee just from being bent is a nightmare.
will stay posted
The slant board really helped me and the pain in my knee is almost gone. The more you perform eccentric exercises using the board, the lesser the pain in the affected area. You will suddenly feel that your affected knee is getting stronger.
I am also using the LP open patella knee support 788 when playing basketball and I can say that I am slowly but surely recovering from Patellar tendonitis. The slant board is indeed a miracle!
Something I used that worked out was a product called Voltaren Emulgel by a company called Novartis. I am not sure if it is available in the USA though. In Canada you can buy it at most pharmacies. Using that plus heels on an old catalog and squatting but now I will buy Kelly’s board to use instead of the catalog.
hey.. thanks for this article on ur site.. I am suffering from tendonitis since past more than 2 year.. I have tried everything EVERTHINHG.. my ortho gave me a steroid injection as well..
I am sick and tired of thing injury now.. pls pls help me.. I was a regular runner (doing high intensity interval training) i had to stop it cause of this injury and my weight have increased in past 2 years..
please please help me.. i want to do high intensity interval training as soon as possible..
thanks very much.. really appreciate your article but will this slant board thing help me ??
kindly reply and guide me..
http://healthtipsspace.blogspot.com/2014/01/how-to-get-rid-of-knee-pain-fast.html
hi bryan,
I’ve been using the slant board for 3 weeks and the results are amazing. Now I can play basketball and the pain in my knee is slowly vanishing. I think it will be more effective if you try to focus on the eccentric exercises using the slant board and isolate yourself from other harsh activities that causes knee pain. I perform these exercises 3x a day. Again, the slant board is a miracle to me. I hope you will also experience the same thing. Good luck!
Hei Brian
I have the same problem as you had. I have pattela tendonitis on right knee. I have just one question.
My healty left knee is some degres more flexibility than injury knee. I feel kind of limited when trying to stretch both legs equally. Have you the same problem?
I am from Slovenia so sorry on my english.
Bye
I want to make one thing clear to those of you who are suffering a lot from the chronic problems with the patellar tendon problem is no longer inflammation (unless you’ve reinjured it just recently). Your problem is degeneration of the tendon tissue with thickening of the tendon and scar tissue formation. The scar tissue forms primarily in the first 6 weeks of the healing after injury or reinjury. If you’ve had decreased range of motion in the knee for a while it is most likely because the scar tissue has formed but in a very unorganized manner. Therefore you will also be far more likely to reinjury your tendon, so therefore you have to regain full range of motion in your knee as one of the first things.
Your knee may not tolerate the standing eccentric exercises because it’s too weak, so you must focus on the elasticity of the tendon first and maybe just do Terminal Knee Extensions early on.
In a very extreme case like my own, the rehab should be treated like a postsurgery rehab with very limited activities for those first 6 weeks until the remodelling phase is reached.
After 3 weeks of relative rest, you can begin to stretch the tendon. The most safe way is dynamic stretching where you bend the knee for about one second and extend it again. Do only bend the knee very slightly past the first stop of resistance and do it 10-15 times every 2-3 hours every other day. Make sure that the knee has been warmed up a lot before you do it. This may cause slight discomfort after you’ve done it, but if it goes away after less than 10 minutes, you should be okay. If you experience a set back (increased pain and/or swelling), you may not know it before the day after as inflammation has entered the area then. That’s the tricky part of the rehab knowing how much/little the tendon can tolerate. In terms of a setback, you might have to take a brake for anywhere from 4 days to 3 weeks depending on the severity. Waiting more than 3 weeks won’t do you any good and only allow the tendon to stiffen up more. There are the somewhat official recommendations from manual therapists in my country of Denmark.
Hi! I’ve been in pain in my right knee for almost a year now. I’ve done the lot, just like everyone else. PT has not helped at all, and my doctor is out of ideas. I’m very willing to try this, but I can’t get hold of one of the boards any time soon. Is there a way to do eccentric exercises for my knee without the board?
Thanks!
Also, did anyone have success with immobilizing the knee for a period of time?
Knee immobilization is a bad idea. Some movement is necessary. As far as the board I just use a concrete stepping stone propped up with a few bricks. If you can’t get an official slant board just get creative.
patellar tendonitis-cured 100%
thank you very much slant board!
thank you for this wonderful article brian..
The answer is neurosoma! Neurosoma! Neurosoma!
Hopefully you guys remember my post regarding my moms patellar tendonitis and pain she experienced with similar symptoms to jumpers knee. She had tried surgery, physical therapy (3 different places), even the slant board (which eased the pain at the moment only to return the following day), acupuncture, and Bikram yoga (which also eased the pain but short term )
We were about to resort to PRP but….
Longest story short
Neurosoma therapy!
She found a chiropractor who does neurosoma therapy, he eases the muscle spasms with a pulstating machine and manually.. my mom who was limping yesterday is walking straight today! She had her chronic arthritis and tendinitis pain for 2 years so it’s taking her 5-6 treatments, but she felt the difference the first day.
If you reside in California I can refer her doctor, he lives in the Central Valley.. Worth the drive. From neck pain to weak ankles they work on everything
This guy had a back injury where he lost sensation in his foot, neurosurgeons recommended surgery, but 3 treatments and he was able to walk so and he is now studying to do therapy on others.
It’s amazing & wish you all quick recoveries
Had patellar tendinosis for over 3 years now. I’m 25 and love sports and being active, so I’ve been very limited and its so annoying. I’ve done all the basic stuff, but nothing seems to have worked so far. I did prp last summer, that didn’t work, I’ve tried physical therapy twice, other techniques, etc. I just did the Tenex FAST procedure three weeks ago. I haven’t noticed any changes yet, but hopefully it at least does something. Whether it helps or not I’m for sure gonna go back to the slant board eccentric strengthening. I did them for a little bit but didn’t notice a difference so I stopped. Maybe I just didn’t give it enough time or didn’t do them right or something. One of these days I’m gonna get rid of this thing. I don’t wish this upon anybody!
Hey Brian, I’m right around your age and I’ve had patellar tendinitis now since December 2012. Just wondering how long you had the injury before it started getting better? Is it still doing well? I have consistently been seeing physical therapy over the past year with really no real improvement. Any suggestions other than the slant board? I guess my main question is: with having patellar tendinitis for over 15 months now, is there still a way to get improvement where the pain in the tendon area could be reduced 75-85%? Thanks!
what if you have patellar tendonitis in both knees? i’ve been dealing with this for about 3 months now.
GB
Please post your an update and let us know if tennex fast helped u. I am considering having it done. Thank u.
Mark Hanberg
I have patellar tendonisis for about 1 year. 4 of those Months I have been doing some stretching, eccentric strengthening and cross friction massage. I have seen a lot of improvement. I can feel the pain get lesser and lesser every day as I do my routine. Unfortunately I have reached a platoe on my recovery. I have about 40% of scar remaining on my tendon. This scar tissue is a lot thicker than the previous one I worked on. It goes away very very slowly.I am considering having the tennex fast procedure if it won’t go away in 2 to 4 months. Any suggestion? Thank u
Valentina,
U need to do eccentric squats on a slant board. I suggest u wait until done of the inflammation goes down. Wait about 4 to 6 weeks if I haven’t done so already. Do the squat using both legs and use a stick or a or a balcony to pick yourself self up with out putting stress on your knees. This will help u a lot. Also try to avoid anything that causes pain to your knees and keep them flexible. I do the routine on http://www.fix-knee-pain.com/jumpers-knee-treatment-triangle/. I wish u luck on your recovery.
Hi Brian,
I also have been fighting patella tendonitis for about a year and a half. Unfortunately I have also developed it in both knees. I have gone to Therapy for a year, I also had the F.A.S.T procedure done 4 months ago(no relief at all). I had a PRP injection a month ago also no deference. I also tried nitro glycerin patches. I went to my follow up today and the Dr recommended surgery but I am not going to deal with that for both knees. I purchased a slant board a while back and used it for a few weeks consistently. How long did you use it before noticing some relief? This is so frustrating, I just want to put this behind me :(. Thanks
Paul,
Sorry to hear about your knees. I also have this problem in both knees so maybe I can help. I’ve had to completely modify my activities and it’s now tolerable on a day to day basis but mind you I can’t do anything close to aggressive.
I do the slant board at night so they get rest while I sleep and alternate legs. In the gym I don’t go anywhere near lunges but I do smith machine squats, abductors and hamstrings.
Pain is present but if I want to live it up for a day of hiking I find that they don’t hurt AS much afterwards.
I’ve tried PRP as well and somehow my knee is worse. Still looking for answers but day to day is relatively ok.
Hi Mary,
Thank you for posting this information. Thank you also to Brian for posting the original article. Mary – I would love to hear how you are going now. It sounds like your A.R.T practitioner is the kind of person most of us on this site would like to have helping us.
I should share my story. I have had tendonitis for 5 months. On advice, I iced my knee every night for 3 weeks and rested for a total of 6 weeks followed by 3 weeks of intense mobility exercises to loosen everything from my butt (piriformis) to my ankle including one of the weirdest Ilio-Tibial band stretches I have ever encountered. I also did foam rolling including something called active tack and stretch which involves the using the foam roller on the quad muscle until you find a really tight spot and then flossing back and forth by bending and straightening your lower leg while keeping your thigh on that tight spot – painful but effective.
After the stretching phase, I did weighted squats with my heels elevated (as Brian did but with weights). My physical therapist suggested 2 seconds down, 2 seconds up and as heavy as I can bear – 25 reps, 3 sets with 30 seconds rest in between – I also concentrated more on keeping my shins vertical since one of the causes of ‘jumper’s knee’ is taking off or landing with the knee past the end of the toes.
My pain became less but then came back any time I did any explosive movement like jumping or running. Apart from the fact that I did these ‘open kinetic chain’ exercises too early in my treatment, I know now that part of the problem was that I abandoned the stretches for a while. After Mary’s explanations above, I’ll be taking these up again. Especially since I visited an orthopedic surgeon who just shrugged and said “you’ll just have to manage with the pain”
Well “booo” to you Mr Orthopedic Surgeon. I’m not giving up being active, including my favorite sport – snowboarding – if there is a solution.
So I’m going to persist. I figure that if I keep trying things in an educated way, eventually something has to work. My plan now is to go back to stretching and rolling upstream and downstream of my injury to feed some slack to the patellar tendon, continue with weighted slow squats and building in some one-legged door frame squats (as suggested above) and wait another 6 weeks before I try anything involving faster movement.
If that doesn’t work, I’ll try something else.
Best of luck to you all.
Please can you advise what training you did to keep your strength and fitness whilst doing these exercises as my training programme is mostly concentric but don’t want to affect my progress if doing these exercises!
Thanks
Hi Brian, would you recommend still using the one-leg technique if you have it in both knees? I have patellar tendonitis in my right knee but my left knee gets a little sore at times. I was wondering if I would just do 10 reps on each side?
Hi Brandon, hmmm…. tough question. The reason I use one leg is to isolate the bad knee on the eccentric (down) motion, and then I bring in the other leg so that my bad knee doesn’t have to do all the work on the way up.
I think that, depending on severity, I would do both or one at a time if I were in your position. If I could do singles, I’d probably do that. But if I couldn’t yet, I’d do both legs at the same time until I could work up to singles.
Again, I’d talk to a Doctor or PT first, as I’m not an expert.
I kept things pretty light. Lots of slow movement (walking), stretching, occasional sports game.
Now that I’m all good, I go pretty hard at Crossfit and am looking to play soccer and basketball more when the weather turns.
Hi Paul, it sounds like you are on a similar journey to me in terms of treatment. I would give the slant board a few months, really closely counting your reps and measuring pain level, to see if it gives you any measurable improvement.
I haven’t heard great things about surgery on the patellar tendon, particularly because there is no surefire guarantee of success. I’d hate to go that route before exhausting every other possible option.
Good luck. It didn’t work for me the first time around, but I think it is just because I didn’t give it long enough.
Circle back and let us know either way if it works out for you.
Great idea!
Amazing!! So glad my article/video helped you.
Hi Jernej, no, I didn’t have that problem. If I did, I would probably work on mobility and flexibility in my soar knee/inflexible leg.
Come to think of it, the lack of flexibility might have an impact on your patellar tendon, as perhaps the tendon is having to compensate when you are doing complex movements.
I’m no expert, but just a thought.
The slant board definitely helps me. I do HIIT training now (CrossFit) without issue, although I do wear a sleeve on my knee, just to keep it warm.
Glad I found your website.
I’ve had knee issues for 3 years now, including an 8 month stint with PT, which was mismanaged by my first physical therapist, had the FAST procedure done–maybe did more harm than good–and then had open surgery (debridement) when I couldn’t walk the dog around the block when it became so painful. That surgery is a big deal. I’m almost 6 months out of surgery and after working my tail off in pt and at gym, PT is back. I also have OA, I’m told by present surgeon, and patellofemoral pain syndrome–lots going on, but the PT is the star of the show. I can tell that my current surgeon feels he’s done what he can do and is giving up. He’s my fourth knee doc! I’ve had neighbors get and recover from knee replacements and I’m not closer to solving this PT situation. I’m going to check with current physical therapist about the eccentric ramp to see if it would be OK for me–I’ve been told no squats by surgeon and therapist, but maybe what you illustrate is a different mechanical thing than ordinary squats.
*Thank you for this website and this topic thread*
Hi all I just want to start of by saying what an amazing forum you have set up Brian.
my story is I have had pain in both of my knees for 2 years now. I am addicted to sports and have played many high impact sports for years, football, basketball, cricket, squash, tennis and golf. I have been using a physiotherapist for at least 6 months. He diagnosed me with pattela tendonigtous in both legs and I have been having brutal treatment during this time. I get to a stage where he is happy for me to go for a light cycle or run and without fail the burning pain returns. It’s so frustrating ahhhhhhh… I have tried magnetic pattela straps. Continuous stretches, ultrasonic treatment and ice.
I decided to go to doctors which resulted in an X-ray followed by a MRI all my doctor told me from results is that inflamed around bottom of knee and offered me an expensive chiropractor. Cheers then hahaha. I am going to try this board as due to my job and lifestyle I rarely time to have major resting periods. I asked my physio why I have it and he believes it’s due to my youthful stretching techniques which I bloody regret now? He also explained that the tendon is like a piece of leather which makes it difficult to free up the scar tissue to allow blood to flow through easily.
I will update people when I have gave the board a try. Cheers
Hello Brian
Thank you for sharing your experience with Patellar Tendonitis. I have been dealing with the same injury for two years. Would say that your pain is completely gone? Have you been able to return to normal physical activity? specifically basketball
Thank you
Hi folks,
It’s been awhile so I figured I’d share some thoughts.
First off, either PRP sucks or the doctor that administered it sucks. I have considerably MORE pain in the knee that had the PRP injections and it’s been 5 months. MRI confirmed that the tendon is worse. His last injection hurt so much and it’s still swollen and painful in that very spot. Another hurdle but life is full of them.
Now….I’ve been 2 months steady with the slant board and while I feel FAR from good, my knees seem to have more longevity before they feel awful. A week and a half ago I completed a steep 7 mile hike through an unexpected 2ft of snow, probably the most grueling I’ve done in years. My knees hurt a lot but don’t stop me in my tracks as they did 6 months ago from less strenuous activities. I do see signs of progress.
I would like to share a band aid for if you just need some relief or need to use your knees. My doctor gave me Voltaten Gel, which is an anti-inflammatory. Aside from sounding like it’s from another planet…..it provides some solid relief. Since I’m looking for a SOLUTION and not a band aid I don’t rely on it…but it’s nice for the occasional gift to myself. I recommend.
Keep on keepin on people.
I’d like to make a few things clear here.
A lot of you are mentioning that you have used the slant board. What the slant board does it that it increases the load on the patellar tendon itself since the quad muscle have to work harder. As I may have mentioned earlier in a previous post, if you haven’t had any succes with that type of rehab, you might want to stop doing it. The could be several reasons why your rehab hasen’t payed off:
. Overloading of the tendon either from not being warm enough before exercising or making the exercise too hard either loading wise or too many sets or reps.
. Doing it too often – In contrast to what some say, this is really not something you should do every single day. Like muscles tendon need time to regenerate and that rest period must be at least two days, maybe several more depending on how hard it was and how fast you recover.
. Slow healing – you may be a slow healer if you are up in age, are stressed, smoke, drink alcohol, eat inflammatory foods with sugar, gluten and even a lot of meat. Genetic factors can also play a role here.
. You tendon fiber may consist of a lot of adhesions, which restrics the normal elasticity of the tendon and makes it stiff.
. Calcification – some parts of the scar tissue may be dead and could make you a candidate for surgery in case calcification is very visible on an MRI.
. Taking too many anti inflammatory drugs. Yes if you’ve had tendon problems for a long time you don’t have any inflammation left in the tendon anymore. At this stage, you tendon is thickened and degenerated and likely very stiff which is the main problem. The inflammation btw. is vital for the tendons healing and is the first of 3 phases in the process. In the case of a chronic tendon problem, inflammation might be a necessary thing because it can help break down some of those adhesions and restart the healing process concisting of several healing factors floating into the injured tendon. That is why shockwave therapy is used for chronic tendon problems. After a shockwave treatment you are not allowed to use antiinflammatory medication for this exact reason just as with PRP.
I have been at the slant board for about 5 months. I have had slight improvement but can’t get over the hump. My tendon has always been extremly sensitive (painful) to the touch since I got tendonosis. Did this pain go away for you?
This caused pain to flare up for me. Is it normal? The one thing I am not getting here is should it hurt? Shoudl it flare up the next day? Should I wait a day for this to suside?
No Jeremy S, if you’ve experienced pain the next next, you have pushed the tendon too hard! As I’ve mentioned earlier, in some cases the tendon will not reinjure despite of some leight pain when exercising, but if it feel any worse the next day (and even the hours after exercise) you’ve done too much. You should wait until the pain isn’t constant anymore and the warm sensation (inflammatory stage) is gone. That can take up to 6 days, but even after that, the tendon will be even weaker than it was before and you’ll need to do less than before and be really really patient with intensifying the exercise. Remember to WARM UP a lot before you do any exercise at all.
I have had this for 2 years and only now decided doctors cant help. Trigger point seemed to help a lot so I though I could start to strengthen by doing this. What if I cannot seem to get to a point where it doesn’t hurt to do this?
When is the right time to start the eccentric exercise? I got a chronic patellar tendinosis… I learn that after a month before you start eccentric because it is in the remodeling phase.
I am not quite sure what kind of tripper point treatment you are referring to. Usually we refer to trigger points in the muscles, where there is excessive tighness very locally, but tendons can get very tight too in the areas of adhesions where the scar tissue from the injury has become regid. This can be treated in several ways, like cross friction massage or dynamic stretching with knee flexion. This should not be done until at least 3 weeks after a flareup since the tendon needs some time to heal.
In the case chronic injury though, you might have to brake some of the adhesions down by literally creating a new injury in order to get better elasticity to it. This can also be done with SHOCKWAVE treatments. For me it is hard to determine, which way is more helpful for you. I still remain possitive, that every patient should try the PRP treatment due to it’s good evidence. I will be recieving that in a few months myself.
James, I really think it depends on the induvidual case in terms when the time is right for eccentric exercises. The severety of the injury will dictate when the time is, but it is also important to remember how slow tendons heal. According to physiology, injured tendons normally need 3 weeks (post injury) to gain enough tensile strength to sustain just dynamic stretching. At 6 weeks the real remodelling phase begins and can last up to over a year. That’s when I normally would be doing eccentrics for the chronic tendinosis. In very extreme cases like my own, the eccentric exercises will have to be with only your own bodyweight to start of with and maybe only starting with 15 degrees of knee flexion and working it down to around 90. A period of just concentric exercises and/or eccentrics with ultra light resistance may begin after about 3 weeks of relative rest, but since tendons take extremely long to adjust to new loads, you are going to have to take really small steps in terms of exercise progression, definately less than 10 % intensity increase per week. Personally it took me over 4 months to get my knee ready to just doing 3 sets of 20 reps of TKE’s after being in a wheelchair for 3 months due to jumper’s knee and many other tendon injuries at the same time. So be really really careful and monitor your knee looking for any signs of overuse (increased discomfort and/or swelling).
Jumping knee can not stretch like a healthy knee. There is a considerable difference. When I try to fully compensate the injured knee pain and appears as a kind of blockage in the knee. Is this a result of this injury which has lasted for more than a year, but before I did not know what the problem is.
Well Jernej, that depends on what you mean by blockage, but in general, the diseased tendon has lost some of it’s elasticity. Therefore it may limit knee range of motion and can’t store potential energy like and tendon normally would during running of jumping. That makes it more vulnable. In my opinion dynamic stretching and cross friction massage should be a regular part of the rehab for the knee to realign those tendon fibers and regain some of the lost elasticity within the tendon.
Mark please help me sir :(
I have had tendinosis for about 11 months and 5 months I have been in rehabilitating on my own. I got to a point where I would hardly feel any knee pain for about a week. I got excited and I did some gymnastic training and nowy legs hurt again. I notice I feel pain on both legs but there is hardly any scar tissue my right leg and no scar tissue on my left. Why do they still hurt? I don’t have swelling either. I really want to get rid of this. The mental anguish is unbearable. I feel like crying right now… As I do most of the time when I am rehabbing my legs.
Hey longshot,
Patellar Tendonosis is no fun and I can relate to you. I’ve been battling this for 4 years now and in the last 2 months I have seen marked improvement. I know in the past, when things improved I got a little too excited and did too much too soon, only to experience pain and let down. Now I take things veeeeeery slowly. I have been pain free for 2 weeks and plan on going slow for at least another 2-3 months. I do the slant board and every month I go up only 2 pounds. I think I’m far from healed but I did do a viscous 7 mile hike 2 months and oand only had 4 days of flare up. 2 weeks ago I danced hard for 5 hours in dress shoes and no flare up at all. Maybe taking it slow will help you to?
EVIDENCE–SUPPORTED REHABILITATION OF PATELLAR TENDINOPATHY
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971642/
Well said Ian J. Gibbons.
Longshot22, I can understand your frustrations with this when experiencing a setback like that. I’ve been though it too many times myself. I can not give you a definitive answer just based on the info that you are giving me though. I’m in a bit of a disadvantage since I can’t test your knee manually. I you want to seek help from any sort of health care provider, it has to be a specialist in knee and/or sports injuries. If you can do that, clearly that should benefit you the most. If not the person most likely wont know how to give you the best advice fro your problems.
Here are my thoughts: There could potentially be some different tissues around the tendon that causes you issues as well, but if there is pain or even the mildest discomfort when (or just after) you palpate and push directly on the tendon, chances are high that it is a patella tendon problem.
And I would not be surpriced if your injury has reoccured since the tendon still may be weak even though there isn’t any visible adhesions left on ultrasound or MRI’s. I’ve experienced setbacks myself with my knee just by doing bodyweight squats several months after an MRI revied “nothing wrong”. So this injury takes a very long time to recover from in most cases and a lot longer than most people think, including many therapists and doctors. Personally I had a tendon injury in my elbow once that didn’t hurt for 4 months, so I thought it had healed, but when I started doing curls with very light weight after those 4 months, I reinjured it immitiately. That is the tricky part about tendon injuries, they can fool you and be very serious even though you don’t feel that much pain or swelling.
The key is to progress so slowly that you never take more than a half a step at a time up that “rehab latter” at a time since the tendon needs so much time to adapt.
There is not any rules for when to rehab after the injury has reoccured at what intenisty to start from, but I like to recommend a slightly longer rest period than most before starting on rehbabing, just to be sure that things don’t get out of control and the inflammation continues beyond normal time. If it’s just a very small flairup, a week of rest could be enough, just to get the inflammation away and get the tendon to calm down first. In a moderate to severe case though, the tendon tissue needs 3+ weeks before it can handle any real stretching. I would start doing cross friction massage after 3 weeks of relative rest. You can look the technique up on the net, but just start with 1 minute with light pressure and try to pay attention to how it feels. The discomfort should not increase after that. If it does, you may have overdone it and you need to stop and ice it. Then you may want to wait a few days before you try again. If it feels okay tough, you can do the cross friction every day, but remember to warm up the tendon first! Warming up is extremely important when you rehab from this! Here after 3 weeks, most people will get benefit of doing light exercises for the legs like squats. Like I’ve mentioned before in here, eccentric squats with added weight and on a decline board might be too much of a load to put on the tendon at first. Some people think this type of rehab is the definate magic cure to all tendon problems. That being said, big loads like that should be included in the rehab at some point and for at least two months before doing any jumping, but done too early, it can do a lot more harm than good. In contrast to what some people claim, I would absolutely not accept any pain when doing the leg exercises. Only a real mild discomfort at the last few reps is okay and that sensation most not get worse after the rehab is done. I would just start of with one set of 15 reps and
After 6 weeks, the most important part of the healing has taken place, and a more intence stretching regime can begin, where I would combine the cross friction massage with dynamic knee flexion. That should be done (again after proper warmup) sitting or laying down where you grab your leg and bend your knee slowly until you feel a firm stop. That should be done for 10-15 reps and every other day.
So after 6 weeks (post injury/reinjury) you should be able to do both crossfriction massage, knee bending and squats with at least your own bodyweight and bending down at least 30 degrees. Only in very rare and extreme cases like my own, that squats would be too much at that point.
Based on scientific evidence, I still think that PRP (platelet rich plasma) treatment is worth trying. I will be getting that myself within the next couple of months. That should accelerate the healing quite a bit.
One last thing: This comes from my own experience of not being able to walk at all for 4 months due to this injury – feeling sorry for yourself wont help at all here. It tels me that you need to work on your approach to this and that you need to start finding some positive things to focus on. You can not let this destroy you! There is a way out of this and you will find it! Remember that tough times don’t last but tough people do, so keep your head up and take it one day at a time.
Awesome last post from Mark.
I posted to this earlier, have skipped most of the replies since, as it’s getting too much activity to stay abreast from.
Quick status update from me: 2005 started with my patellar pain, saw doctors, PT, etc. had some results with decline board. Saw this city’s best doctor yet again in Dec/2013 and had a 3T (that’s a new, nice one!) MRI that, at the very most picked up “mild tendinosis”. In fact, the MRI didn’t mention it, but 18 months earlier the same machine scanned me, and doc said it looked the same even though radiologist 18 months prior called it mild tendinosis.
Anyway, for most of 2014 I’ve had basically no pain. It aches at times, but I’ve gone days without pain, including a short vacation last week with a lot of walking. That’s after damn near a decade of dealing with this in a number of ways: rest, working out, negatives, etc.
I was going to get PRP–and I do think it is worth doing for patellar tendinosis (and the research to date supports that), but the doctor said my tendon didn’t even look diseased enough for that, let alone surgery.
Although I’m only 36 I am positive ALL impact sports are gone from my life forever, and I’m okay with that. I won’t even jog after the kids. I’m being very careful with working out now, just 10-15 minutes biking or elliptical at a time, and I can generally feel a bit of discomfort over those. As far as strengthening my most recent kick has been ultra light squats, so 50-100 reps in a set on a hack squat machine, for example. I want to bring my muscle to failure without it being a lot of weight on the tendon.
I also got achilees tendinopathy 2.5 years ago and it’s slowly recovering. I tried some PT stuff (eccentrics), but basically I’ve just been leaving it. For some of us these injuries will take years to heal and we need to be honest about that.
The bright light at least in my case is that in 2012 I couldn’t even descend stairs in the morning without pain and now I can. Honestly, I haven’t even thought about it that much these past five months. My knee hasn’t been this good since 2005 before I got into running. It is absolutely compromised, and I’ll never run again, nor can I even expect to do weighted squats or anything like that, but just having most of the past several months being pain free is enough for me.
You never know. 20 years from now they might be injecting all kinds of stem celly magic into our joints and they’ll be like when I was 18 :)
That was interesting to hear Tendonman!
Eventhough your tendinopathy has been there for several years, you still seem to have found many ways to enjoy life. Great to hear.
Obviously having dealt with it for 9 years on and off is a very long time and makes your tendon condition sound very permanent. Theoretically speaking, a cronic tendinopathy should be able to heal if A LOT of right things are done and even more wrongs things are avioded. That can be extremely tough to accomplish and it makes the rehab one of the most difficult of all injuries. Complete tears of tendons and ligaments tend to heal 100 percent or very close, but the chronic tendinopathy can be an even more serious injury over time.
What would be ideal in order to get to 100 percent would be:
To get rid of excessive scar tissue, remodel/realign the scar fibers and strengthen the tendon.
As you probably know, there are a number of ways to accomplish those things:
. Surgery (not the first option though): get remove scar tissue and eventually the apex of the patella (bottom part of the kneecap) since that tends to pinch the tendon
. You can also use Shockwave treatment to brake up the adhesions and restart the healing process.
. PRP: Get more blood into the area and accelerate the healing
. Remodel the fibers my stretching and strengthening
. Work on global muscle balance with a lot of focus on ankle and hip joint alignment.
. The “little” things: ake sure to be healthy in other areas: Get enough sleep, east right, avoid stress, to much alcohol and tobacco.
. And: Avoid flairups and progressing too quickly
If we can continue to do the good things and avoid the no so good things, the tendon should keep getting more and more healthy as long as there is no arthritic condition pressent.
Those are the main things your should do – in my opinion at least. However I would like to know much you’ve done of what I just mentioned. What has worked out the best and what hasn’t? Would be interesting to hear from your experience.
Hi Mark, over the years I’ve spent dozens of hours reading about this, I’ve had four MRIs (!), seen a number of sports docs, three different PTs. I could write an essay on it, but as brief as I possibly can be:
Male now in 30’s.
2005 started running too much. Had anterior knee pain. Inside of 6 months noticed a clicking in joint upon extension
2006 first MRI, joint looked perfect other than a mild meniscus tear. Sports doc & PTpist put me on a strengthening regimen because my hips were (and are to this day) weak/imbalanced. Cut back on running but still did it. Knee got a bit worse.
2007 another MRI, less indication of meniscus tear (not sure if even used the word possible tear that time), also possible minor tear in patellar tendon. I only asked for this MRI because doc was about to go into joint, thinking my issue was a meniscus (damn glad I asked for that MRI). Did a lot of PT that year, still doing some running and a ton of cycling. Joint was better from the strengthening for sure, but still hurt.
Last 2007: I first read the term tendinosis (nobody had aforementioned it). And started eccentrics. These helped a good bit, getting heavy on a decline 1-2 times/day.
2007-2011: Running on and off, including exploring different ways to run. Still some eccentric work. Sometimes I’d take months off and joint would get a bit better, but back to pain when resume activity. Finally gave up running in 2011 after getting tendinosis in left achilles (due almost certainly to aforementioned hip imbalance).
2012: got 3T MRI. Other than a couple of cysts doc said are no concern, it had “mild tendinosis”. This doctor–a well reputed one who has co-authored a paper on PRP and is widely considered the best in the city–was surprised nobody else prior had mentioned tendinosis. Was nice to finally have somebody who had heard about it in the medical profession!
Also early 2012 I noticed a prominent scrunching in my knee when extending it. This was prior to MRI–clearly cartilage wear, but nothing enough for MRI to care about. No indication of meniscus tear.
I got back into eccentric work again and after a few weeks it helped massively. However, then I started getting a clicking in what I think is IT band upon descent, and it began to hurt, so I stopped.
End of 2012 MRI again. Unlike 2012, no indication of patellar wear, but doc said it looked the same (i.e. very minor). No meniscus tear, but this time some pattern change on a small bit of articular cartilage (surely related to my scrunching). I think it’s totally unrelated to my knee pain, though, and doc played it down as totally irrelevant.
The biggest frustration over a number of years was being forced to research this myself. When i finally read about tendinosis online I couldn’t believe nobody had mentioned it before, because it was so obvious that I had it–and quite common. I know earlier PTs struggled to take me seriously, too, because here’s a fairly young person complaining of chronic knee pain and yet nothing/virtually nothing on the MRI.
My pain has never been “omg I can’t walk”. Never, ever. Most it’s ever been was maybe a 5-6/10 after I ran a marathon in 2005 (oops), otherwise it hovers from 0-4/10. This generally mild, nagging pain has been an annoyance and it’s not entirely surprising some health care professionals haven’t taken it seriously, because they are used to people with torn ACLs.
Also interestingly I can generally do weights, even heavy ones, without pain. But small impact stuff, even like a stair climber I’ll feel it.
My knee scrunches a good bit now, but the MRI shows my cartilage as pretty good overall, so I continue to believe the pain is all tendon related. Pressing on it rarely hurts, and rarely ever has.
Shockwave therapy never did much/anything for me.
It’s possible my hips still are a pretty strong cause of this, as they are weak, and this impacts my functionally short right leg. I am cognizant of that.
Hi agian Tendonman.
I can tell you’ve also been through a lot with your knee. Struggles like that alone will give a kneepatient a lot of experience that can be vital for the diagnosis and rehab, especially when no health care provider seems to understand the real issue nor it’s seriousness. Most of the doctors and therapists, I’ve been in contact with over this last year of my knee struggles, have had very poor understanding of how serious a patellar tendinopathy can be. If it wasn’t for my physical therapist education and the fact that I wrote my bachelor project about this exact injury, I would have been in even bigger trouble than I am today. I was wrongly “diagnosed” with a meniscal tear after a fall in the woods almost 2 years ago, but first found out that it was the patellar tendon, AFTER I started my project about it in april last year! By then the injury had gotten so bad and out of control, that traditional rehab made it even worse and I had to use crutches for 2 months and a wheelchair for 2 months since I also got an achilles tendon injury and 2 rotatorcuff injuries by simply very bad luck I believe… even though an arthritic condition still isn’t ruled out. Genetic factors have possibly also had an impact. Many in my family have had tendon injuries.
Under the circumstances we’ve both been through, the injury story can provide very usefull information to the “expert” that is dealing with it – also since scans won’t reveal the injury every time. To a certain extend, the patient is the expert in his/her own injury since the patient is the one who’ve experienced how it feels, what makes it better and what makes it worse. A doctor who’ve never had a patient with a serious tendon injury or having had it him/herself is probably not qualified to rely on. My own doctor never believed that my injury was serious at all and thought that my main problem was placed between my ears. It never occured to her that the experience and background I had made my words worth listening to. That’s why you have to seek a real expert when dealing with this type of injury. Good for you that you did!
Based on your decriptions, I don’t doubt that you’ve been dealing with your patellar tendon a lot. When some abnormal tissue is visible on MRI’s, then it’s pretty safe to believe it. Obviously you have also battled some other knee injuries and it can be very hard to determine, what your current pain comes from.
In terms of injury rehab and preventing recurrence, we always like to find the root cause of the patient’s pain. Even though I can’t prove it, my best guess would be that the scrunching you’ve experienced is a result of tracking issue of your kneecap. During any type of intraarticular knee damage, the vastus medialis (especially the oblique part) will atrophy and loose some of it’s tone causing an imbalance between the pull of the musclefibers and other tissue on the lateral side and the pull of the vastus medialis. So the kneecap will run more lateral in the femoral groove and tilt a bit too. That will cause the scrunching and over time that will wear down soem of the cartilage underneath the kneecap, causing discomport after sitting down for longer stretches (“theater sign”). If you are lacking cartilage in that particular place, chances are high that you have/have had a maltracking issue of your kneecap. Maybe a slight displacement of your kneecap is also visible. If the cartilage wear is between the femur and the tibia, it’s more likely a secondary problem to the meniscus injury.
Personally I’ve had some problems with my cartilage (in my now healed knee) too due to the issues mentioned above. After 6 PRP injections the daily retropatellar pain, that had been there daily for over 2 years completely dissapeared and has never returned since. In that knee I also had impingement of the lateral synovial plica due to the lateral tilt of the kneecap. That also went away after the PRP and some aggressive cross friction massage.
Another secondary problem occuring from patellar tendinopathy can be irritation to the fat pat (infrapatellar corpus adiposum). If the kneecap is tilted too inferiorly, it can pinge the fat pad. That could happen is the quad muscle or tendon is very tight after a tendinopathy. A relief when pushing the superior border of the kneecap posteriorly (like a see-saw) will be present if the fat pad is irritated. In opposite, wearing a patellar tendon band will relieve pain in the tendon, but irritate the fat pat. Excessive hyperextention of the knee and anterior pelvic tilt will dispose people more to this problem. This can explain why a fat pad issue can literally be hidden behind a tendinopathy.
It is also a possibility that your meniscal injury disposed you more to injuring your tendon since the knee tends to lack a few degress of extension after meniscal tears. That will put more pressure on the tendon during weight bearing activities, based on some studies.
If all this information confused you, then you are welcome to ask me questions about it. But since your symptoms haven’t pointed directly at the same issue, it can be a good thing to rule certain things out.
You sure are a well of information regarding the knees. Maybe you should go to medical school, specialize in treating Patellar Tendonisis and rescue us all!
Mr. Mark handberg.
First of all I want to thank you for encouraging me to stay positive and be optimistic a bout dealing with such a delicate injury. I have made promise to myself to not do anything relating to fitness until 2015. It’s the only way to beat this injury. It has been almost a week since I re-injured my patellar tendons and I can feel my legs getting better as time moves forward. Today I felt some discomfort but I wasn’t bad at all.my tendo still has a bit of scar tissue and it feels thicker thang left one. It doesn’t hurt at all when put pressure on them at all. It actually feels good. I do series of stretching daily which included my hamstrings,quads,calves,adductors and hip flexors. I then do the fix jumpers knee strengthening protocol that is available at http://www.fix-knee-pain.com/jumpers-knee-treatment-triangle/
It seems to help a lot. I end my entire routine with some cross friction massage. That has gotten rid of a ton of scar tissue that I has accumulated only tendon. Once I get back where I was prior to reinjuring myself; I will do some quad exercises like leg extensions and leg raises which were recommended by my dr. Furthermore. I have had an MRI recently. My dr said that my tendon was fine. He suggested just to stay off it and to strengthen the tendon. He said if were obedient that it would go away. Overall my progress with this injury has been substantial. I made a promise to not do anything relating to fitness until next year. I positive that if I continue to stay off it and strengthen the tendon very slowly; I will get rid of this once and for all.
Thank you for all your advice mark and Ian. God bless u
Good to hear that Longshot22. Remain very patient, listen to your body and don’t take any chances in the process. Be careful with the legs extension exercise though. This exercise gave me my biggest setback a year ago, where lifting just 30 kgs backfired big time. That was after months of being able to do eccentric single legs squats without problems, so save that exercise to the very last stage of your rehab.
Btw. Great article about battling jumper’s knee! I totally agree with just about everything in it. But again, the eccentric squats on the slant board may have to wait much longer than a months in very severe cases like mine. Just don’t accept any discomfort while doing the exercise. You body will tell you when you are ready to do it.
Hey Longshot,
We are all helping each other here so I can thank you as well. Like Mark, I also had issues with traditional leg extension so I actually cut them out of my workouts FOR LIFE. If anything I would consider eccentric leg extensions but only if/when this whole patellar thing is behind me.
Have you ever used ace knee braces for some relief? How I emotionally handle my patellar issues these days is once a month, I treat myself to something that I would normally do like dancing, hiking etc with the knee braces on. Yes my knees often hurt afterwards but in time the pain goes down so long as I behave again. Life is short and it lets me feel like my old strong athletic self for the day. My knees also seem to bounce back quicker so I can now do this.
Maybe the same would work for you?
I swear by the Donjoy neoprene patellar strap. They gave me one when I was going to therapy a few years ago and it works wonders for me. If i’m on my feet I have it on and feel almost no pain. I usually wear out 2 a year. I don’t know where I’d be without it.
hey guys. I’m a college athlete that found this looking for some answers. Went to an orthopedist about my patellar tenondonitis, which i already knew i had, and all he did was give me some anti- inflammatory pills and schedule physical therapy. what i wanted was an ultrasound to make sure that there were no micro tears in the tendon because i had a feeling that it is whats causing the pain. i have known about my tendonitis for months now but it never really affected my play before until recently. i came home for the summer after not playing soccer for two weeks because of finals, and i played a few games and about an hour in i could even run anymore. when i got home i couldn’t walk up the stairs, and it took me a week of laying off physical activity in general to recover. now i just want the pain to go away because i haven’t been at 100% in almost a year and its killing me. please help.
Hi Nick,
I would like to clarify a few things for you and offer you some advice. Granted that you’ve had issues with your patellar tendon for months, this injury is no longer referred to tendinitis, but tendinosis or tendinopathy. The reason why I am bringing that up is that “tendinITIS” means inflammation of the tendon. However inflammation normally only lasts for less than a week (unless you keep reinjure the tissue all the time). In the chronic stage, this means that inflammation is no longer present in the tendon. The inflammation right after the injury has occured (or recurred) and is part of the body’s natural healing process. It gives you pain, discomfort, a warm sensation and maybe slight redness in the area. In the chronic stage of a patellar tendon injury (after a few months) inflammation is not your concern anymore, in fact taking anti-inflammatory medication is not a good thing because it will calm down the reactive cell response which you actually need at this stage. That’s why I would NOT recommend you taking this right now. Just like when you recieve PRP (platelet rich plasma) or Shockwave treatment for a chronic tendon injury, you are not allowed to take any anti-inflammatory medication afterwards for that excact reason. It doesn’t surprice me that the orthopedist wasn’t aware of this since, this is fairly new stuff.
I would recommend taking fish oil, b and c-vitamins instead, eating greens (like salat) and stay away from tobacco, alcohol, stress, junk food and sugar (for the most part).
Make sure to get enough sleep too as your tendons collagen synthesis needs proper rest periods.
Now the most important thing: Since your injury has progressed so much already, you immediately have to stop all physical activity that gives you pain, discomport and/or swelling afterwards! I can not stress the importance of that enough. This is a VERY serious injury that may recuire surgery (like in my own case) cause when you’ve reinjured it so many times, you’ve not only created micro tears in the tendon, but also changes the fiber alignment making the fibers look unorganized. That severely decreases the tendons elasticity and tensile strength.
To tell you like it is, you will very likely need to go through many months of pretty intence rehab consisting of a structured stretching and strength training program. Doing this with help from a skilled physical therapist is a must and should be tried for a few months with very very slow progressions. Hopefully that will result in improvements, but if not, surgery might be necessary.
I am telling you all this based on my personal experience with this injury and my knowleadge as a physical therapist.
I will also recommend getting the book “Beating patellar tendinitis” by Martin Koban, which can be really helpful to let you know what you are up against.
Hope this was helpful. Good luck.
I have patellar tendonitis in both of my knees how should I go about using the slant board seeing as u would raise yourself up with the good leg I have pain in both
Alan,
I also have it in both knees. I use a long stick or a railing to help me back up. I started squating down with both legs and using the stick to assist me up. After I progressed, I added weights in a backpack, then I went to single leg squats still using the stick.
Hi all,
How many of you do cross friction massage and how has it benefited you? I just started it and initially I have to say that it feels pretty darn good. Has anyone has this help “cure” tendonitis/tendonosis or is it just a relief?
Thank!
Hey Ian, my PT did it. It felt great (hurt so good), but I’m not sure if it did any good (or bad).
Thanks Brian,
How are your knees feeling these days and how do you maintain?
This will be the 300th comment on this page – wow!
I’m doing great. I’ve done a lot of Crossfit over the last year, and I really feel that the increased quad strength takes a lot of the load of my knee for explosive movements. I think this definitely helps.
I break out the slant board every few days and still get my reps in. For me, it is still the silver bullet for keeping everything all good in the left knee. It isn’t perfect, but I operate at 100% most days, and it only flares up after extended workouts with a lot of running.
Hi Brian,
This is a fantastic article and the advise inspired me to buy a declined board and work the same exercises as yourself.
I have been plagued with patellar tendonitis for 7 months now but since starting to use the board I have really progressed, I hope to be pain free in the next month.
My question to you is: When I become very comfortable and controlled with the eccentric movement, should I start to use my bad leg in the upward movement as well…provided it doesn’t induce any pain.
Also my quad has become quite depleted over time. do you have any exercises that work the quad well without aggravating your tendonitis.
Thanks in advance,
Phil
Hi Philip, I still don’t use the bad leg in the upward movement. For the slant board, for me, I just focus on the eccentric movement.
In regards to strengthening your quad while still working through the tendonitis – good question. I waited until my knee was feeling a lot better, and then started incorporating squats to strengthen the quads. I’m sure there are other things that perhaps a PT could suggest.
Best of luck, and keep us posted on how it goes!
Thats great Brian, I appreciate the reply.
All the best!
Hi all,
A couple of questions:
1. Has anyone found orthotics insoles helpful at all?
2. I’m doing one leg eccentric squats with 5lbs and everyday seemed a little taxing on the quads. Anyone having better luck with only a couple of times/week?
Oh and Philip, I’ve found that squats on a Smith machine with your legs out in front of me has allowed strength without any noticeable issues with the knee. I just NEVER let the knee go anywhere near past the toes.
Hi Ian
To answer your first question: Possibly – if you tend to either pronate or supinate a lot when to play sports, run, walk or lift weight. Eccessive pronation or supination in these situation will definately increase the wear and tear on the patellar tendon. WHen you are doing one legged squats, you must make sure that your weight is balanced correct on your foot. If not, you could move into either pronation or supination, which will affect your knee and hip joint position. So yes orthotics can help, but they are a quick fix and even Podiatrists tend to recommend corretive exercises over orthotics for the best results in the long run. The exercises that should be done, will depend on what your malalignment of your foot is like – overpronation or supination (?)
Your answer your 2nd question: I will not recommend doing eccentrics ever day because just like in strenth training of muscles, you are trying to stimulate tendon growth. When you try to build up muscles you don’t traing the same muscles every day because they need time to recover. The same thing goes for tendons and the rest period might have to be slightly longer since the collagen synthesis takes longer than the protein synthesis process. The so called experts who recommend eccentrics every day have not taken these above fact into context. If you just lift every day, you might end up braking down the tendon instead of strengthening it!
So I will only recommend doing it every other day at your level and if/when you start lifting heavy (like under 10 RM) do it only every 3rd day.
Just an update. Before I could begin to attempt this exercise I found that using a foam roller 1-2 times daily (pain!) on my quads allowed my knee to relax. It has begun to heal and I am able to perform at least 10 reps safely now. Slowly getting there! FOAM ROLLER
Hey Brian,
Your article gave me hope for the first time in quite awhile. I have a bad case of pt in my left knee as well and haven’t played any sports or even jogged for 6 months now and yet i haven’t felt much improvement if any after quitting these recreational activities. I’m planning on trying your recipe for success but i have a question. How deep should I go on my ‘squats’? Should I be feeling a significant amount of pain, or do I only lower myself till I begin feeling pain?
Hey Brian,
Your article gave me hope for the first time in quite awhile. I have a bad case of pt in my left knee as well and haven’t played any sports or even jogged for 6 months now and yet i haven’t felt much improvement if any after quitting these recreational activities. I’m planning on trying your recipe for success but i have a question. How deep should I go on my ‘squats’? Should I be feeling a significant amount of pain, or do I only lower myself till I begin feeling pain?
Any input on the whole pain factor would be appreciated. Thanks
Hey Brian
I am currently suffering from patella tendonitis. I am considering doing this. Just curious as to knowing if you think it will still work if I am still involved in physical activities such as basketball. I am also currently doing a jumping program.
Guys, I’ve been trying decline squats on the Flex-N-Go for about a month and a half now to treat my severe PT and have seen minimal results. In some cases it hurts worse the next day. Can anyone comment on whether its worked for them, and if so, how long you stuck it out….. this is the the worst affliction!
Brian,
Thanks for the info. Everything you mentioned sounds exactly like what I’ve been going through. I’ve got over 25 years of basketball on my knees and my left knee is feeling the affects. I’ve had the patellar tendinitis pain for nearly two years and it’s progressively gotten worse. I’ve tried just about everything. The best treatment I’ve experienced is an anti-inflammatory my doctor prescribed called Medrol (comes in a 6-day dosepak). Took the pain away almost immediately and lasted several weeks, but the pain eventually returned.
I would really feel the pain when I would jump pretty hard off my left leg playing basketball. Upon landing, I would immediately feel searing pain like I had been hit with a bat. It severely weakened my knee. It also really hinders my leg workouts, particularly with leg presses, squats, and lunges. I recently aggravated it again playing basketball and it’s worse than it has ever been. I can’t even walk up or down the steps without fully supporting myself. It’s been 3 days and the pain and weakness in my knee has not subsided at all. Went to see an orthopedist and he confirmed it was Patellar tendinitis and suggested a topical AI and physical therapy. I’ve tried a topical (Voltaren) before which did nothing, and PT is expensive and a waste of time. I was seriously considering surgery since it has not improved in almost two years. I will give this method a shot and see how it goes. I just have to be patient, but it will be extremely difficult with as much as I workout and play basketball.
So, I have tendinitis in both knees. How should I start?
Hey Danny,
I would have to agree, this IS the worst affliction. In my experience I have found the slant board to be a lesson in trial and error. For numerous periods of time I’ve had to lighten the amount of weights in my backpack or lessen the amount of times/week I do the slant board, to not over do it. Things have gotten better………..slowly but not without setbacks. For example lately I have only been doing the slant board once a week because my knees and quads hurt from overuse. Take it slow and mind your activities because when I push too hard the Patellar tendonitis/nosis whatever pushes me right back.
Guys,
I have been having this problem on my left knee for 6 months now (due to long time ~10 years involvement with shuttle badminton) and had to stop most physical activity during this time. I am working on physical therapy and recently started with the eccentric exercises using a slant board. It definitely seems to help! One question I have is about swimming. Have anyone tried swimming with this problem? I am looking to take swimming classes (need to do some physical activity) and am wondering if this would worsen or make better the patellar tendon problem. Any suggestion/tip would be greatly appreciated! Thanks.
Hi everyone,
I discovered I had tendonitis in my left knee in August 2012 after a weekend of Ultimate. I didn’t believe it was tendonitis for ages because I hadn’t had gradual increase of pain, it went from 0 to 8/10 in one long car journey. The ache was incredible.
After seeing a friend who was a physio he suggested I did some squats. I half heartedly did them and then sought out the advice of a doctor on the UK NHS which was a big mistake. It meant that I didn’t actually start seeing a decent Physio until January / February. By now my knee was aching a good 7/10 all of the time it was unbearable.
I then in April 2013 started seeing a Sports Rehabilitation guy who to be fair was pretty good. He tried to get me fixed quick (which didn’t work obviously) and then put me on a stretch / loading regime / ankle mobilisation. I didn’t do any strength work which was a mistake I believe. Amazingly by August 2013 I felt pretty good, and went to compete at the European Championships with my team. I was dreading the bus ride because I knew my knee would ache the whole way, but with the help of some tape (from my original Physio friend) we managed to get the knee to sit in a position where it didn’t ache. I think that because the location of my tendonitis is so specific (right on the bottom of the knee cap) shifting the patella slightly gave it some relief.
I went and had a great time, only playing maybe 10 / 15 points over 4 days. I then came back all excited about the idea of playing another season of Ultimate. The next week I played again (without the tape) and I was back to square 1. Nightmare. I was so devastated that I just gave up for another 6 months because I was heartbroken.
I decided to give it one last shot so in January 2014 I managed to get an MRI just to confirm that I hadn’t damaged the patella itself, because the pain was so concentrated on the bottom (tip) of the patella itself it really feels like the bone is bruised. Alas the results came back and said “Mild thickening of the tendon, inflamation of the hoffa fat pad and a mild marrow oedma at the inferior pole of the patella) which basically confirmed everything. I have a damaged tendon and the patella has a mild oedema (bone bruise) at the bottom of it. Apparently these oedema’s are part and parcel of the tendonitis. I found a new (more qualified) physio to work with who’s main focus now was to sort out the huge difference in size of my quads. My damaged knee has caused me to over compensate on my other leg for so long that I have some serious wastage in my left quad. They are almost 2 inches different in size.
I didn’t really feel like with the new physio’s regime that I was making much progress. Zero change after 14 weeks of single leg raises (apparently as good as eccentric squats) and knee stabilisation exercises I decided that I wanted another change. I remembered reading this blog ages ago and thought I would try the slant board again (I did try it for a few months in Dec 2013 to Jan 2014 with not change).
I also decided to add in some extra exercises that I had read / watched online.
So now my regime comprises of eccentric squats on my slant board, 2 x 20 once a day going down with both legs but 90% of the pressure through the damaged knee. I also do some quad activation exercises which I think really help. I sit with my legs straight out infront and really focus on tightening the quad but making sure the muscle activates at the top of the leg (I try and do this everyday). I also so side leg raises to get the glutes firing, 3 x 10 maybe 3 times a week (although it’s got mega tight recently so going to get it massaged out next week). I have also started doing front squats at the gym (low weights focusing on form) and added in some Bulgarian split squats to try and strengthen up the weak leg.
I feel like my condition is getting a tiny bit better every day with this new regime. The knee still aches a lot but it’s a low dull pain and I can do the slant board with minimal sharp pain and I am pretty amazed that the front squats don’t aggravate it as much as I would of thought.
This whole scenario has been one of the hardest things I have ever been through in my life. I know people have awful diseases and I should consider myself lucky, but I wouldn’t wish this upon anyone. It has taken away everything I love in life and I am so determined to beat it now and get my normal life back. I am 28 years old and am really hoping to be back playing Ultimate by Decemeber.
I wish I had known what I know now back in August 2012 when the issue first started. I have been offered a PRP injection by the hospital to help try and speed up the process but I am very scared to do it because if the pain got any worse I would be completely devastated.
My advice to anyone who has mild tendonitis do something about it straight away. Find a good physio / pt / friend who can help you through the process of sorting yourself out. There is quite a bit of good advice on here about how to make sure your leg is balance, ankle, knee, quads, hamstring, hips. http://www.fix-knee-pain.com/patellar-tendonitis-knee-tendonitis/ and do not under estimate how bad it can get! I wish I had caught it quick and had been given a total understanding of the problem / healing times at the very beginning. Also keep a note of all the exercises you do (I still don’t do this which is a huge mistake)
To everyone which chronic tendonitis, be strong and believe that it can get better! I’m just gunna keep at it, making sure I take it easy and listen to my body. I’m gunna work hard to make sure my ankle, knee, muscles and strength are all balanced before going back to Ultimate.