Knee tendinitis advice?

Fugazi

Professional
I have pain right under my right kneecap. It's not THAT painful, but it keeps me from moving properly in tennis and especially in squash. Not sure how it happened, but it seems like I overdid a few stationary bike sessions (sprints with a lot of tension). I'm led to believe that it's a tendinitis, and it's been going on for about two months. I feel pain when I walk down the stairs, or whenever I have to bend and push. Some tell me to ice it, take ibuprofen, and rest (it doesn't seem to work that well...), while others tell me that rest is not necessarily the best option, that active rehab would be better. I'll probably go see a physio or something eventually, but I'd like to know if anyone here has tips for speeding the recovery (I'd appreciate if you could tell me if you've had the same problem, or if you have some kind of expertise on the subject). Thanks!
 
I had similar pain that was most noticeable going down stairs and when I saw a specialist it turned out I had a torn meniscus but that's not what was causing the pain. He said it was a "bone bruise" due to hyperextending my knee and that they can sometimes take months to fully heal. Thankfully the pain was only enough that I was aware of it during tennis and I didn't have to take a break. I don't know if it really helped or if it was just in my head but those knee straps like Nadal used in the past really helped me with the pain so that I felt nothing until after tennis when I took it off. It wasn't recommended by my doctor or anyone else and I thought I would give it a shot and in my mind at least it helped.

I would recommend seeing a doctor as soon as you could. If not possibly causing more harm to your injured knee I found I started favoring my knee (out of doubt) and that was putting stress on my other leg and started hurting my hip. Seeing the doctor gave me piece of mind even though no surgery was required. Just some PT to strengthen the other muscles around the knee.

Good luck.
 

Sintherius

Rookie
Yesterday this pain suddenly came to me after being UP 5-0 in the first set. Caused me to lose the match in 3 sets. It's rough, idk if it's tendinitis or not (I'll be pissed if I have tendinitis at age 17) but it certainly stops you from playing at your highest level, or even at a high level. Completely screws you on getting in position. Icing and hot bath and icing and ibuprofen DOES help, to an extent. I bought a knee brace last night after my match and will be wearing it today.

DEFINITELY see a doctor. I will be very shortly.
 

Vik

Rookie
I've been battling the same pain. I figured it was patella tendinitis until I went to the Dr. He poked around and said it probably wasn't because where he pressed I had no pain. Said mine was most likely scar tissue from an old surgery.

He said to stay off of it 2 weeks (no explosive movement) then slowly work back up to full speed the next few weeks. If it was tendinitis, that should heal it. Mine still hurts so most likely its scar tissue for me.

For tendinitis, he said exercises won't really help the tendinitis. Tendons are poor at healing. I too wear the knee strap. Have worn it for many years. I think the scar tissue has slowly built up over the years.

Oh and he did give me a NSAID that helped almost immediately.
 
I have pain right under my right kneecap. It's not THAT painful, but it keeps me from moving properly in tennis and especially in squash. Not sure how it happened, but it seems like I overdid a few stationary bike sessions (sprints with a lot of tension). I'm led to believe that it's a tendinitis, and it's been going on for about two months. I feel pain when I walk down the stairs, or whenever I have to bend and push. Some tell me to ice it, take ibuprofen, and rest (it doesn't seem to work that well...), while others tell me that rest is not necessarily the best option, that active rehab would be better. I'll probably go see a physio or something eventually, but I'd like to know if anyone here has tips for speeding the recovery (I'd appreciate if you could tell me if you've had the same problem, or if you have some kind of expertise on the subject). Thanks!
Seeing the physio or orthopod is definitely the way to go so at least you will know what you have for sure, and get specific recommendations from a local expert.

But from your biking history, it does sound like you have "patellofemoral pain syndrome".



The kneecap slides over the underlying bone (head of the femur) whenever you walk, run or pedal a bike.

Biking at high tension likely caused abnormal tracking of the patella within the groove of the femur, resulting in inflammation.

(Another common way of getting this problem is from those who mistakenly use the lower leg raise machine to try and build up their quads.)

You raise a frequently asked question of whether rehab now will lead to a quicker recovery.

The answer is that REST is the most important element in letting the inflammation subside. (Ibuprofen and ice might help to decrease the inflammation, but realistically no one ices more than a small fraction of the day, and ibuprofen is not that great an anti-inflamatory. Cortisone, a really good anti-inflammatory, unfortunately has potenial problems with tissue degeneration and healing. Every drug and device manufacturer is trying to come up with the trillion dollar way of safely reducing inflammation, but despite all the research, there is no good, workable solution.)

The idea of "early" rehab is just to maintain range of motion so that scar tissue does not build up, and you end up with a "frozen joint". But this is just not going to happen if you are doing even a bit of walking in your every day activities. (These range of motion "exercises" are not really exercises per se, more movements of the joint through the full range of motion so scar tissue doesn't start to build up.)

After your pain has gone away, then you can start to increase your activities, to build up the lower extremity muscles that may have weakened somewhat during your "rest" to let the inflammation subside.

But as a tennis player, there is no need to curtail doing your thrower's ten: http://www.asmi.org/SportsMed/throwing/thrower10.html
or core exercises so you are ready to go as soon as possible. (Unfortunately it is not that uncommon to suffer another injury coming back to an "unrelated" area because of decreased overall body conditioning.)

Good luck!
 

Fugazi

Professional
Seeing the physio or orthopod is definitely the way to go so at least you will know what you have for sure, and get specific recommendations from a local expert.

But from your biking history, it does sound like you have "patellofemoral pain syndrome".



The kneecap slides over the underlying bone (head of the femur) whenever you walk, run or pedal a bike.

Biking at high tension likely caused abnormal tracking of the patella within the groove of the femur, resulting in inflammation.

(Another common way of getting this problem is from those who mistakenly use the lower leg raise machine to try and build up their quads.)

You raise a frequently asked question of whether rehab now will lead to a quicker recovery.

The answer is that REST is the most important element in letting the inflammation subside. (Ibuprofen and ice might help to decrease the inflammation, but realistically no one ices more than a small fraction of the day, and ibuprofen is not that great an anti-inflamatory. Cortisone, a really good anti-inflammatory, unfortunately has potenial problems with tissue degeneration and healing. Every drug and device manufacturer is trying to come up with the trillion dollar way of safely reducing inflammation, but despite all the research, there is no good, workable solution.)

The idea of "early" rehab is just to maintain range of motion so that scar tissue does not build up, and you end up with a "frozen joint". But this is just not going to happen if you are doing even a bit of walking in your every day activities. (These range of motion "exercises" are not really exercises per se, more movements of the joint through the full range of motion so scar tissue doesn't start to build up.)

After your pain has gone away, then you can start to increase your activities, to build up the lower extremity muscles that may have weakened somewhat during your "rest" to let the inflammation subside.

But as a tennis player, there is no need to curtail doing your thrower's ten: http://www.asmi.org/SportsMed/throwing/thrower10.html
or core exercises so you are ready to go as soon as possible. (Unfortunately it is not that uncommon to suffer another injury coming back to an "unrelated" area because of decreased overall body conditioning.)

Good luck!
Thanks for that. When I said "under", I meant below (not inside), so from your picture I believe the inflammation is in the patellar tendon. In any case, I will probably go and see someone, and your advice seems to apply anyway.
 

jk816

Rookie
You definitely want to get to a sports doc/ ortho as soon as you can. Tendinitis is easy to blame, but there are a myriad of knee issues that can present with thse symptoms. PFPS was mentioned, which is a broad answer for many knee problems. Charlie's thought that the problem could lie with a maltracking patella is a common diagnosis for patellar pain, as a laterally or medially subluxating patella when compressed (bending the knee under load)will focus the pressure from the underside of the patella to an area of the trochlea (the groove in your femur where the patella glides) not meant to bear that much pressure and while the cartilage has no nerve endings and can't feel pain, the underlying bone as well as synovial lining surely will feel it.

Patellar subluxation is generally attributed to muscular imbalances in the leg. A weak VMO (part of your quad) is commonly blamed, but I've found that overtightness/ build up of my hamstrings and calves will worsen my sublaxations. And all the stop /start/pushing off in tennis tends to overwork the hams and calves WRT the quads.

Tendinitis in many ways would be a welcome diagnosis, as it is typically ucralbe and preventable. For most knee issues the conservative (non-surgical) treatment will be rest (w/ ice and possibly various forms of stimulation) until moderate PT can be done without pain, followed by stetching and strengthening of the legs & hips (they play a part in leg function too) to alleviate imbalances and mitigate shock/ stresses on the joints.

My ortho indicated to me a quick check for patellar tendinitis was placing light pressure on the tendons above or below the patella; tendinitis will typically be painful to pressure. Another good reason to get checked out is possibly to catch other problems as early as you can. Sadly for me my MRI turned up Grade 4 chondromalacia of the trochlea, which is currently asymptomatic, but continued wear will eventually produce arthritis. A good strengthening program may prevent or alleviate that. Running and tennis are tough on knees.

Good luck!

Jim
 

Player#1

Rookie
Eccentric exercises for the quad muscles or Prolotherapy. Once it has become chronic, those are the only two things likely to help. I had problems with this for years. Eccentric exercises were the only thing that helped.
 

Fugazi

Professional
Eccentric exercises for the quad muscles or Prolotherapy. Once it has become chronic, those are the only two things likely to help. I had problems with this for years. Eccentric exercises were the only thing that helped.
Eccentric? Can you please elaborate? BTW, I'm seeing a physio now, and I have exercises, but not sure if it's eccentric exercises...
 

Player#1

Rookie
The quad muscle and the patellar tendon will be lengthening as they are contracting. (the other type would be concentric... muscle is shortening as it is contracting)

In other words, your knee will be bending and resisting a force during contraction. ( as opposed to the leg straightening as your quadriceps muscle contracts) Let me know if that explanation isn't clear.

And just in case... Do not let them give you a cortisone shot (some of the older, less specialized or less experienced doctors will sometimes mistakenly recommend this) The shot makes the tendon weaker and more likely to rupture within the next year.

Surgery is also something you will want to avoid. It only is successful about 80% of the time.

Prolotherapy is relatively new and has shown good results, but it's often not covered by insurance yet.
 

Fugazi

Professional
The quad muscle and the patellar tendon will be lengthening as they are contracting. (the other type would be concentric... muscle is shortening as it is contracting)

In other words, your knee will be bending and resisting a force during contraction. ( as opposed to the leg straightening as your quadriceps muscle contracts) Let me know if that explanation isn't clear.

And just in case... Do not let them give you a cortisone shot (some of the older, less specialized or less experienced doctors will sometimes mistakenly recommend this) The shot makes the tendon weaker and more likely to rupture within the next year.

Surgery is also something you will want to avoid. It only is successful about 80% of the time.

Prolotherapy is relatively new and has shown good results, but it's often not covered by insurance yet.
Yeah ok, I have an exercise where I have to slowly bend my leg, so that seems to be eccentric (as opposed to an exercise that would straighten up my leg like a quad push or something). I'll check what prolotherapy is...
 
E

eliza

Guest
Mamma mia! Reading all these posts on meniscus, plantar fascitiis, torn Ligaments, knee cups, jolted ankle, wrist, rotator cuff....you wander: was not sport supposed to make you fit?
Seriously: I cannot believe medicine is so poorly equipped to help us tennis players.......
 
E

eliza

Guest
Eccentric exercises for the quad muscles or Prolotherapy. Once it has become chronic, those are the only two things likely to help. I had problems with this for years. Eccentric exercises were the only thing that helped.
Stop there, my dear!!! I was talking to my doctor in Italy, and he mentioned they do this "prolotherapy"....but the doc here does not know what it is....
Are you in a big city?
 

RedWeb

Semi-Pro
Mamma mia! Reading all these posts on meniscus, plantar fascitiis, torn Ligaments, knee cups, jolted ankle, wrist, rotator cuff....you wander: was not sport supposed to make you fit? Seriously: I cannot believe medicine is so poorly equipped to help us tennis players.......
I've come to believe that tennis, played seriously, is one of the hardest things you can impose on your legs/body. I've played competitive football (HS), competitive soccer (including refereeing high-level games until I was 50), long distance running and competitive basketball (HS, college, well into my 40s) and nothing has broken my body down as much as tennis (which I started when I was 50). Of course, some of that is due to age but hardcourt concrete tennis is not for sissies. That is why I'm starting to think I need to revamp my approach to the game. I'm simply asking too much of my body.
 
Last edited:
E

eliza

Guest
RedWeb, I am like you. And the idea of "slowing down"does not sit well with me. Anyhow, looks like UK and Italy have advanced clinical trials for a new staminal cells teraphy, and they are having wonderful results on knees, achilles, shoulders and spine.....No surgery required.
I am keeping my fingers crossed!
Take good care, E
 
Top