T Nation

Chronic Tibial Tuberosity Pain (Still)


#61

I have this same thing right now (TT) that has been going on for three months. Starting PT this week and hoping I find something that works. I need to read through this thread again as it’s loaded with great info (thanks PB Andy). Unfortunately though, it doesn’t look like there’s any one-size-fits-all solution.


#62

Looks like I’ve got more to look forward to. On Jan 13 I had a patella nail hammered in and ever since mobilising a few weeks ago I get really bad pain as the nail presses into the patella tendon. If I just kneel on the floor for a few minutes me knee swells up like a baseball. I’ve got to get this thing removed ASAP. I’m sure the surgeon fucked it up. I can’t even walk properly right now.


#63

I was able to eliminate my pain by using a patella strap to prevent my knee pads from making contact with the painful bump. I practice Taekwondo and the sparring gear was irritating the bump on my knee. It became excruciating to the point i had to take time off of training. Doctors were no help. When i bought the strap I assumed that the point was to apply pressure or to stabilize the area but that was even more painful. Eventually I realized that if the strap is supporting the area around the bump without actually making contact there was some relief. After a few weeks of keeping the gear from making contact on that point, the pain went away completely. I’ve been without pain for over a year. Hope this helps.


#64

I’m glad I found this thread but it’s a little disheartening…

I’ve had the same pain for 8 months which was definitely bearable. I kept playing floor hockey a few times per week and also doing stop and goes outside but after last hockey game the pain was ten fold and I wasn’t able to walk straight for a few days. It seems better now but I am trying to find a way to cure it instead of living with it.

I spent a good 4 hours reading on the internet and I can’t find a single person who has this who got it cured. Not a good sign.

I went to the doc’s on Friday and all he did was check wikipedia and sent me for X-Rays. I still haven’t gone for X-rays but his diagnostics is definitely wrong after reading up on it, nice waste of money.


#65

ogomez, I will try what you suggested to see.


#66

Have you considered bursitis? It sounds be the deep infrapatellar bursa. There does not have to be a lot of swelling associated with it but it will be very point tender. Another possibility could be pateller tendonOSIS (not tendonITIS).

Have you ever looked into Graston treatments? Or some other form of myofascial scraping? It is very uncomfortable but very effective. If there is a chronic break down of the patellar tendon, fascial scraping will essentially “jump start” the healing process. It would need to be applied to the feet and deep posterior compartment of the lower leg also.


#67

PB Andy,

I’ll give you my input as a physical therapist: To me, the answer lies within you using the strap (or makeshift strap) which gave you a ton of relief. Patellar tendonitis at it’s finest. When you use one of those straps, it applies a force across the tendon and redistributes the force so that it is not pinpoint on the tendon insertion (aka the tibial tuberosity). I think all the recommendations you have been given aren’t bad but I’ll suggest a few modifications.

  1. Keep using that strap! If it works, use it.

  2. A modification that you can make to a quadriceps stretch is to have someone help you by lying on your stomach, having them lift your leg up off the table, and then flexing your knee. This hits the distal portion of the muscle toward the tendon a bit more from the hip being more extended in this position.

  3. Do resisted inversion at the ankle instead of eversion. People who are pronators are weak in their posterior tibialis which is the muscle/tendon which runs on the arch of the foot. Weakness is usually due to continuous collapsing putting a stretch on that muscle causing it to be longer/weaker over time. Strengthening this muscle will stiffen up your arch and make you less likely to pronate by stiffening the muscle/arch. Pronation of the ankle usually leads to increased adduction and internal rotation at the knee which is not good (increases pressure on the joint).

  4. Strengthening the adductors is not something I recommend to patients unless I feel they are not hitting stance phase of the gait cycle on that side on a consistent basis. Believe it or not, it is possible to physically be in stance on the leg but not be in the ideal hip position for stance. Obviously this isn’t something I can see through a computer, so I can’t tell you if he’s got you on the right track with this exercise.

  5. Give yourself a break from strengthening and high impact activity of the legs until the pain dissipates. I don’t enjoy giving you this tip, but if you constantly stress tendon without giving it the time to heal from rest, it can develop into tendonosis (this is actually the phase you are in now since it is chronic). This could take up to a month, but long term you will probably thank yourself.

Hopefully these are helpful tips for you. I don’t mean to sound like I’m underminding your chiropractor, more just giving you my 2 cents from your history/background. Good luck!

DPT


#68

I know this thread is very old, but I found something that seemed to work for me so thought I’d pass it along. For the first few weeks of PT, he had me doing a number of stretches that didn’t really seem to help (got a bit better but didn’t go away; hard to tell what improvement was from the exercises vs total rest).

Anyway, he had me do a slant board squat. I used a half-round piece of foam and put my heel on that (about 3"), then do an eccentric squat with only the injured leg (about half way down or whatever’s tolerable), then up with both legs. I was doing this twice per day, two sets of 10 reps. After doing this for two weeks, the pain cleared up and I could resume squatting. It doesn’t feel good while doing it, or after, but it did work.

The reason I am back reporting this now (sorry I didn’t earlier) is because now I have the pain in my other knee (dammit). So I am resuming this exercise in the hopes it really was the reason for my recovery. Looking back through my logs, it seems the culprit here (for me) could be leg extensions. I started a leg specialization program four weeks ago that included leg ext after leg press; and this is the first time I’ve done them since last episode of knee pain. Doesn’t hurt while doing them for some reason, but it’s really the only exercise I’m doing now that I was doing then, so I’m done with those for good.


#69

[quote]Tyler23 wrote:
I know this thread is very old, but I found something that seemed to work for me so thought I’d pass it along. For the first few weeks of PT, he had me doing a number of stretches that didn’t really seem to help (got a bit better but didn’t go away; hard to tell what improvement was from the exercises vs total rest).

Anyway, he had me do a slant board squat. I used a half-round piece of foam and put my heel on that (about 3"), then do an eccentric squat with only the injured leg (about half way down or whatever’s tolerable), then up with both legs. I was doing this twice per day, two sets of 10 reps. After doing this for two weeks, the pain cleared up and I could resume squatting. It doesn’t feel good while doing it, or after, but it did work.

The reason I am back reporting this now (sorry I didn’t earlier) is because now I have the pain in my other knee (dammit). So I am resuming this exercise in the hopes it really was the reason for my recovery. Looking back through my logs, it seems the culprit here (for me) could be leg extensions. I started a leg specialization program four weeks ago that included leg ext after leg press; and this is the first time I’ve done them since last episode of knee pain. Doesn’t hurt while doing them for some reason, but it’s really the only exercise I’m doing now that I was doing then, so I’m done with those for good.[/quote]
I second you on the eccentric squats suggestion.

Another thing I have had done (maybe not a good idea in your case), is the eccentric part of the leg extension. LIght weight, lift up with 2 legs, and lower super slow with the injured leg.

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#70

Good suggestion. I’m taking a run at the slant board squats now. If things aren’t improving within a week, I’ll incorporate that. Thanks.


#71

Trying to revive this thread to see if anyone else has had luck addressing this. As I stated before, I am experiencing this pain in my left knee now. I have been doing the slant board squats and the negative leg extensions, but the pain is still there. I cannot do any quad movements (which basically limits all lower body work other than ham/glute isolation exercises) without pain.

Getting very frustrated here and looking for any other suggestions…


#72

I’ve experienced the same type of trouble for the past few months. I tried icing it, resting it, Read up about Osgood- Schlatter’s (I’m 28). I bought a knee brace to strap below the knee, thought it was also Jumper’s Knee. It was heavily inflamed over the summer so icing it cause the pain to slowly become locallized to the TT.

Quadricep stretches seemed to help greatly but the tenderness was always there.

I had an x-ray (nothing found) and an ultrasound on this area (no results yet)

Saw my Chiropractor today and he noticed a muscle behind the affected leg was extremely tender compared to the other one. I believe he said it was the Popliteus muslce. . He made an adjustment and the tenderness seemed to go away after he felt for it afterward. Feels the shin was twisted and causing muscles to spasm and pull away at the TT. Will update to see if I can do squats more comfortably, kneel without the pain in that area in a few days.


#73

Im 29 years old and been working as a physio for 5 years.
I myself developed tenderness on my right tibial tuberosity after playing alot of tennis
Usual treatment for this includes getting a knee strap, strengthening the glutues, core, vmo and ankle inversion muscles, getting a orthotic for your shoe and deep friction massage.
I have done all of the above and most effective treatment was deep transverse friction.
It is a very annoying condition and I advise rest from aggravating activities and see a physio …


#76

24yo F here, longtime athlete with the SAME problem. Both knees affected, significantly worse on my right. I can actually pinpoint when the pain started. I’d taken a week off from running and ultimate frisbee for vacation and when I came back poor warmup and 1 jump and I was out. I’ve been to PT, MD, OT, not to mention I’m a kinesiologist and med student myself. It’s such an irritating and chronically recurring problem. I am at my wits end!

I do have longstanding biomechanic issues: pronation and weak abductors are constant areas of focus for me. I did rest, ice, did US therapy, acupuncture, foam rolling. Currently I’m taping to help disperse the tension in the tendon (all the straps I found were too big). Absolutely no pain in tendon whatsoever, but taping does seem to take some of the strain off the enthesis. That’s really what mine is, enthesitis. It’s inflammation at the attachment point @ tibial tuberosity. It’s been so bad at times we’ve been concerned about an avulsion, but currently I’m babying it and complaining to practically anyone who will listen that might have valuable input.

Was hoping to run my first half marathon this year and I just can’t see it happening. So frustrated that I’ve always been pretty good to my body and now I’m sidelined. Being active is a huge part of who I am, I hate this!

Can someone explain the slant board squats for me again? I can’t quite picture it, and I’ll try anything at this point.


#77

PB Andy,
I’ve found this thread informative for my own injury. Much appreciation too all those who have contributed and responded with positive and informative feedback. For 6 months, I’ve had a swollen tibial tuberosity with dull aching pain on left knee due to trauma (hit patellar tendon/tibial tubercle on a rock from fall). X-rays negative and MRI only shows some swelling of the tendon with possible bursa swelling.

I enjoyed oly lifting and crossfit and strength training, but have continued pain even with simple movements like body weight squats and descending stairs. I’ve followed multiple programs of eccentric squats, mobility/foam rolling, stretching, icing with heat contrast - no noticeable success. A patellar strap didn’t seem to provide relief. I tried PRP (painful shot!) with little improvement after the 6 week follow up. Ortho does NOT suggest operating on knee - he’s unsure he could fix anything.

Im continuing adductor work, mobility, good nutrition (paleo), no weight training, and weekly dry-needling (4 weeks, 4 sessions) now.

The tibial tubercle and lower patellar tendon attachment point maintains a pronounced bump (much more than good knee) with dull aching pain at site and aggravated by increased activity or weights. Simply sitting for a period of time with leg bent causes pulsing pain at site.

I’d be very interested to hear what your status is after a couple years from your post. Injuries are truly frustrating. Thanks for considering! Thanks to anyone else with feedback.
Danny


#78

i have exact same pain as you for three weeks now, it wont go away, its always there when touching it…the worst part about this situation is that i feel hopeless, i did everything but there is no improvement…did it heal for you guys? any update?


#79

I was long time internet lurker, suffering from Patellar Tendonosis for over six years, constantly in search of the answer. I thought I’d share a success story since this sub is still relatively active.

My work is based in wildland Fire, so carrying lots of heavy gear all day, mixed with intensive exercising at the beginning of each day. I had a tracking issue with my left patella stemming from a dislocation as a child. As a constant runner, I developed major chondromalacia and rubbed away at the cartilage, causing severe limping while working, ultimately leading to more severe tracking issues, and ultimately patellar tendonitis (so bad I didn’t even like going for walks with my girlfriend anymore.) I opted for surgery, after suffering for almost five years, (to correct the tracking issue, which the doctor said would ultimately fix the tendonitis after Post-op PT and strengthening.) I had MPFL Reconstruction, meniscus repair, lateral release, and chondroplasty. The pain after that surgery was excruciating, for about 3 months. I could barely do a leg raise, with no ankle weights, while laying on my back. That’s how severely my quadricep had atrophied over the years of limping and from the surgery recovery period. Needless to say, that atrophy caused horrible pain in my patellar tendon. I even developed it in my good knee from relying on it so much.

Tendonitis is one of the most frustrating things I’ve ever dealt with. I’m currently post-op 19 months. It took PT, 4-5 days a week, for 17 months, before I could even jog for 3 minutes, at (5/10) pain level. Thousands and thousands of squats I’ve done, hamstring and hip stabilizer strengthening, you name it. The tendonitis hurt so bad for an accumulative 6 years that I thought it could NEVER go away. I spent endless hours on the internet searching forums and websites for any kind of help, and I like to think I tried almost everything.

Well I’m finally returning to who I used to be. I’m running extensively, doing box jumps, etc. To say I’m pain free would be a lie but it’s manageable with patience (and ICE!) and I finally expect a full recovery after years of doubt. Remind you I was in PT for 3 years before the surgery trying to correct all these problems, too. The best advice I can give is to find a VERY experienced PT, and be patient! If the therapist seems like they are going through the motions of their job and not really putting their time in to really help you, go elsewhere. I had to find a new PT and it made all the difference… I could tell he cared about the pain I was dealing with.

Now, my solution was to strengthen everything in my leg again due to atrophy. Your answer could be stretching, ultrasound therapy, who knows. You need a PT to make a strength assessment and check for other issues that may be causing your pain. No matter what your solution may be, remember to be PATIENT. Listen to your PT and become very friendly with ice. STRETCH EVERYDAY. My daily regiment is an intense hamstring stretch, intense calf stretch, and 4 minutes of rolling the IT Band. This is after 5-10 minute warm up (very important.). I can wake up sore as hell, hobbling around the house, and go the gym to warm up and stretch - and bam, run 4 miles no problem, no pain. I’ll ice afterward and do single leg squats the next day. But I can only do this because I spent hundreds of hours restrengthenig, retraining, and listening to my PT to make sure I didn’t push too hard.

Beating tendonitis/tendonosis is exhausting… But possible. Have faith. Make PT a lifestyle and it will help you. Keep your legs strong and stretch, and they will take care of you. Ice.

I’m currently going through the motions to become a rookie Smokejumper this April. The rookie training is seriously intensive and I feel confident in myself physically. I never thought I’d see the day that I was running 5:15 minute miles again, even at 32 years old.

Seek the help you need and be disciplined about your recovery. There is honestly no quick fix. Those knee straps can help one day and be useless the next. (If it helps, sure, use it, but be determined to address the underlying problem instead.). Don’t buy into that expensive Tommy Copper crap either.

Good luck to all of you, I feel your pain and wish you all the best. Keep up!


#80

PB Andy,

Suffering from the same condition and just curious if your condition improved over the years with time and if so, what ultimately helped.

Thanks,
John


#81

I have the same type of pain and have been battling this for nearly 5 years.

I’ve tried all sorts of things - the first bout went away with a programme of drop squats and plyometrics. Jumping up and down, backwards and forwards of a little step. This helped and it went away.

It came back again about 6mos later and then I was prescribed with decline exercises, dry needling and rest. This didn’t work and I switched physios. My next physio got me a scan asap and revealed a 4cm tear. I was then referred to a Sports Doctor who prescribed 2x autologous blood injections. Essentially they remove blood for your body and inject it into the tendon with some anesthetic. This causes inflammation in the tendon and promotes healing. I probably had 6 weeks in between each shot. After my 2nd shot I began rehab and a lot of strengthening exercises.

This lasted around 9mos and the results were awesome. The pain pretty much vanished. However during the 9 mos, I wasn’t active as much - i.e. I’d play basketball inconsistently and sometimes I’d load my knee 3x a week, then take a week off and do the same thing. This is most likely why it’s come back.

I’m hoping to revisit my Sports Doctor to get another scan - I’m hoping there isn’t another tear.

My right hip is also very tight and have tried some exercises to loosen this up. To add to the drama i’m also experience some tendonitis in my right achillies. I believe there is some sort of muscular imbalance on my troubled right leg… it’s so frustrating. I’m basically stretching and strengthening everything - calves, glutes, hams and quads - hoping everything else will even out…

Glad I found this forum because this pain is a PAIN IN THE ASS.


#82

This is an old thread. But I figured I’d share what has been helping me. First check your shoes, make sure they support the arches in your feet. Next you need a rumble roller. Not a normal foam roller because it uses to large of a surface to put pressure on the muscle. 3rd, if your like me you have weak or inactive glutes which is screwing with your posture. Or maybe only one weak/ inactive glute and then your body is gonna compensate for that by over working the muscles around them/it. First things first, take a hot shower to get the blood flowing through your legs. 2nd use the rumble roller and roll out every muscle in your lower body. Feet-muscles on the sides of your shins, calves, adductors all the way to the base of the groin, quads all the way to the waist, hamstrings, hip flexors, glutes.

This is extremely painful if you’ve never used a rumble roller before but it works like magic and eventually it won’t hurt but don’t be afraid to apply pressure when you do it but be sure to breathe and stay relaxed. Next, develop a stretch routine that targets these same muscles 2 sets for 30 seconds at a time on each muscle. It’s important that you don’t do this before you foam roll because you want the tension to be equal throughout the muscle. Finally you’re not gonna perform any movement that causes pain or inflammation to your upper shin. But you gotta get all those muscles working together to prevent one from being overloaded. What I do for my legs are just simple isolation movements such as calve raises, quad extensions, hamstring curls, adductions and abductions, single leg deadlifts with a light kettlebell gradually progressing in weight. The next thing I do is on a treadmill that is capable of inclining. Set it to full incline and walk on it from 15-30 minutes. Your glutes and calves will most likely be sore if they weren’t functioning properly in the first place.

This isn’t a magical fix, you still have to let your body heal but this will speed up the process because the amount pressure on your shin is what’s preventing it in the first place. Do this every other day. Hope I could help at least one person.