T Nation

Knee Pain - Osgood Schlatter vs Tedonitis?

Before anyone storms on me for posting an injury thread, know this - I have scheduled an appointment with a doctor, but the only time he is available is around 2 weeks from now. Can’t go to any other doctors in the area, since my international insurance only works with this guy’s group.

Okay,

So I haven’t squatted in 3 weeks, holiday and business travels and all, and started squatting again yesterday. I also got my first pair of WL shoes, Wei Ruis, and started using them for my squats.

Before the holidays, my squat max (high bar) was 225, not much i know. For Yesterday, I decided that i want finish that day light, with 3x5 165lbs.

On my last rep of the last set, I felt a sharp pain on, what I just learned to be, my tibial tuberosity, the bony upper part of my shin bone that attaches to the patellar tendon.

Finished that rep, but the pain lingered for a couple of seconds and then dissappeared. It still hurts everytime I push my knees beyond my toes, and if I directly put pressure (touching, kneeling) my tibial tuberosity area.

There was no swelling whatsoever, no pain/discomfort when walking normally, only when i touch it, or have weight on the leg while the knnes are forward to my toes.


Took NSAIDs, didn’t really relieve anything, since there was not that much pain to begin with.

Ordered a patellar strap online, should be arriving 2 days from now, see how that works.


Did a little online research on this kinda pain, the two biggest probabilities are

  1. Pattellar Tendonitis

or

  1. Osgood Schlatter (OSD)

The symptoms seem to really be close to OSD, however, I’m currently 22 and have stopped growing a while ago, nor do I have any history of OSD from my pre-adolescent years (did mostly swimming and boxing, no high impact to the knees)

I’ve also read that Pattelar Tendonitis pain can be anywhere from the soft, mushy, part of the tendon (smack in the middle of the tuberosity and the patella knee cap), to the kneecap itself, or directly on the tuberosity attachment (which my pain is).

So I’m assuming this IS Tendonitis, with the strain mostly on the lower attachements, over the tibial tuberosity.

I’ve been RICE-ing since yesterday, mild alleviation, looking to see how it feels a week from now.

I will probably refrain from ANY leg exercise for a week (which sucks because i just got my WL shoes, and I have a bball tournament i registered for)

After this week, if the pain alleviates, what exercises am I allowed to do?

  1. Bench? Pretty safe I guess.
  2. OHP? Standing OHP? I’m pretty sure push presses can be detrimental
  3. Chin-Ups? Don’t see why not, i never kip
  4. RDLs? I tried unlocking my knees enough to get enough hip ROM for RDLs, there was no pain since the knees were still behind my toes.

What y’all think?

Thanks!

Just posting to say that I’m interested in this thread. I’ve had chronic left tibial tuberosity problems for 1.5 years, and did not have OSD as a child. Seen two orthopedists and three physical therapists, so I’ll be interested to know what comes up in this thread.

At this point i’m think surgery for myself but I have no idea what a surgery for my injury actually entails (tibial tuberosity transfer? I don’t know).

JJ- You already pointed out that you are too old for OSD and I agree. At tendonitis is an overuse injury fixed by rest. If you only have pain when the knee is in full flexion all the workouts you asked about should be okay. If the pain occurs at full extension, then do seated presses.

PB- if 2MD’s and 3PT’s can’t figure out your case I doubt this thread will. Give us the gist of your rehab in order to educate us.

I’ve included two general information links that I think will be helpful to you JJ. No matter what give the knee a rest and do some single leg exercises.

General info- http://orthodoc.aaos.org/drkehoe/Patellar%20Tendonitis%20(Jumper’s%20Knee).pdf
Tx- http://www.mayoclinic.com/health/patellar-tendinitis/DS00625/DSECTION=treatments-and-drugs

rlBanda, thanks for the response.

Although at this point I’m pretty sure it is Patellar Tendonitis, it’s still weird that the pain is only in the top part of the shinbone (tibia tub), and i have no pain/discomfort whatsoever in fully extended my knee, event violently jumping. The only pain is when my knees flex beyond my toes, and when I directly put pressure on the tibia tub.

Is this normal for Patellar Tendonitis? Or could this just be mild tendon strain, as I did, regretfully, tried too much weight after a long lay-off?

Could be the lay off but I was so caught up in the medical side I looked over the most obvious cause of your pain… Oly shoes. It’s not uncommon to experience pain when you make a transition in footwear for any athlete but more so for weight training. I would say go ahead and keep up with the pain management (especially those included in the articles) and perform whatever activity you want as long as its pain free. I would give it a good 10 days of treatment and try to squat in your normal shoes and finish with a light set in your Oly shoes.

A few months back I had anterior knee pain after I switched to a pair of Inov8 Bare-XF 210 (very minimalist shoe) for all of my workouts. The only treatment I did for the pain was switch back to my old shoes (Nke Free 3.0) and the pain was gone in a little over a week. Side note: I now train in a pair of high top chucks and I love them. Hope this helps with your pain, go ahead and update us in a few days.

[quote] rlBanda wrote:
JJ- You already pointed out that you are too old for OSD and I agree. At tendonitis is an overuse injury fixed by rest. If you only have pain when the knee is in full flexion all the workouts you asked about should be okay. If the pain occurs at full extension, then do seated presses.

PB- if 2MD’s and 3PT’s can’t figure out your case I doubt this thread will. Give us the gist of your rehab in order to educate us.

I’ve included two general information links that I think will be helpful to you JJ. No matter what give the knee a rest and do some single leg exercises.

General info- http://orthodoc.aaos.org/drkehoe/Patellar%20Tendonitis%20(Jumper’s%20Knee).pdf
Tx- http://www.mayoclinic.com/health/patellar-tendinitis/DS00625/DSECTION=treatments-and-drugs [/quote]

Well, it’s not that they can’t figure it out… all but one PT said it was patellar tendinitis, the other PT (my latest who seems to be the best out of all of them) said patellar tendinosis instead of an ‘itis’. Unfortunately all the modalities I’ve been through haven’t worked… Graston, single-leg eccentric decline squats, this and that… hell even resting for a total of three months did nothing, the pain came back! The MRI was clear as well (no avulsion fracture or anything like that).

What’s perplexing is that I was doing pretty well before the holidays… lifting consistently throughout the week with no pain, and I credited that to my latest PT who proscribed the single-leg eccentric squats. I then did a road trip for the holidays, did a bunch of sitting and was generally inactive for a week or so, and then drove back home, and my pain came back when exercising… like it was a tightness issue in my hip or quad from all the sitting (if that WAS the case then it wouldn’t be a patellar tendinosis issue, at least in my eyes).

If the break was long enough for you to lose strength and you return to training with high intensity the pain would return. Go back to the rehab you were doing if you haven’t already and keep in mind you will have set backs especially with chronic conditions.

Is there any history of corticosteroid or AAS use?

[quote]rlBanda wrote:
If the break was long enough for you to lose strength and you return to training with high intensity the pain would return. Go back to the rehab you were doing if you haven’t already and keep in mind you will have set backs especially with chronic conditions.

Is there any history of corticosteroid or AAS use?[/quote]
No to corticosteroid injections/AAS.

Regardless, I have messaged my PT and ortho so basically, we’ll see… Ortho mentioned a repeat MRI if I want which I think would be pointless, and told me to come in to discuss possible surgical options. He’s the ortho for the Chicago Bears, if that counts.

I’m sure you are frustrated by now and because your doc is highly respected I would go with whatever he says.