Knee pain on and off - quadriceps tendonitis?

[azrael201]

I have been playing tennis casually for probably 10 years and just this past year decided to ramp up my game this year. When I use to play in college with friends I was probably a 2.5-3.0 and ran around a lot and never felt any pain in my knees.

Now fast forward to now I have bulked up 10lbs of muscle (yes I workout my legs) and playing at a 3.5-4.0 level. The pain is left knee lateral superior patellar pain. Feels like it is at the insertion of one of the quadriceps tendon. I think it also radiates down to lateral patella. Initially I thought it was Iliotibial band syndrome which I got when I first started training for 5k races. That pain was also lateral and went away with a knee brace and gradual jogging to running.

I have been wearing a knee brace hoping i'll strengthen the knee through playing but i've been hoping to wean off the brace but the pain came back. I also started to feel it on the right knee too. I am 5'11" 175lbs in my late 20s.

Is this quadriceps tendonitis, ITB, or PFS?
I assume it is from all the side to side motion?
Is there conditioning I can do to prevent this?

I guess I want reassurance this won't continue to plague me especially since I want to be more competitive.

 

[Chas Tennis]

That is very complicated and needs a firm diagnosis. For example, patellar-femoral joint pain can be caused by imbalances among quad strengths or the timing of how they fire, etc. You need a specialist to evaluate your knees.

The quads might not function as they should and cause injury to the patellar-femoral joint (under the knee cap). http://www.aafp.org/afp/2007/0115/p194.html
See Table 3 for a list of knee injuries.

For example only - I believe that this particular rectus femorus issue applies to me and causes pain under the patellas near the femurs -

The knee has two joints - the one between the femur and tibia with the meniscus, etc., and the one under the knee cap, the patellar-femoral joint.

In my opinion, pain under the knee cap is often caused by posture issues, quad strength & tightness, as discussed in the above replies.

When I had an MRI for a torn meniscus, the MRI report included serious damage to the patellar-femoral joint. (Get the written MRI report from the imaging specialist, read it and research all issues even those not being treated or showing symptoms.)

One particular issue, that of a short/tight rectus femorus, is described in this link

http://www.mrtherapy.com/articles/article3.html

BE AWARE THAT STRETCHING THE RECTUS FEMORUS MIGHT PUT STRESS ON THE LOWER BACK.

The rectus femorus is special because it is the only quad that attaches above the hip joint, the other three quads attach to the femor.

I believe that this is a good description, believe that I have a short rectus femorus, and that the stretch is very effective in correcting it. It may be my over-simplified picture, but I believe that a tight rectus femorus simply causes the patella to ride too high in the joint. This damages the cartilage separating the patella from the femur. Some of the other better known patella tracking problems involve lateral tracking issues, the patella being pulled to the side or 'tilted' relative to the joint track.

Search: rectus femorus quadriceps anterior pelvic tilt

 

[azrael201]

i like that diagram. maybe my pain is still ITB.

still not sure from what part of tennis. initially i thought it was my serve but i changed the way i bend my knees and it has felt better. i think it really is the cutting.

also maybe i have a slight length difference in my legs of a 1cm.

 

[Chas Tennis]

Hopefully your injury does not involve tendinosis. Understand the difference between tendinitis(with inflamation) and tendinosis (with defective healing).

Read the one page report in Reply #1 and the longer paper in Reply #15.
http://tt.tennis-warehouse.com/showthread.php?t=442912&highlight=tendon+injury+nuthouse

There are many threads with links to information on knee injuries including those discussing posture issues.

A Dr could rule out many of the possibilities in a short time.

 

[azrael201]

Thanks for your help. I have seen a sports medicine doctor before when I first felt the pain but all he could tell me was that it wasn't likely meniscal injury.

 

[RogueFLIP]

Suggest you ask for a referral to a physical therapist.

They'll be able to palpate, evaulate, prescribe any exercise, stretches etc...

You'll be able to ask any questions and probably get more satisfactory answers than on this board about your current situation.

Good luck.