I am 27 years old and currently 8+ months removed from ACL reconstruction in my right knee using a hamstring graft. I have developed a lump at the base of my patellar tendon that is painful when pressed upon. I saw my physical therapist about it, and she was concerned, but not to the point where she referred me to my surgeon. She performed Graston and said that if the lump gets any bigger or any more painful to schedule an appointment with my doc. It is currently about the size of a nickel and stands about a quarter inch off my knee.
I never had any sort of knee pain as a kid/teenager in either of my knees, never had any lump, etc., so I never even had a reason to be diagnosed with OS. This particular lump only popped up within the last 2-3 weeks. I should note that I did have some ongoing tendinitis at that EXACT spot that the lump has formed. Before my knee injury, however, I never had any problems with that knee.
Looking at symptoms for OS, what I’m experiencing fits that exactly, even down to the exact spot where this lump has formed. I know by definition that OS only occurs in kids/adolescents who are still growing, and it has something to do with growth plates. If this isn’t OS, is there some type of adult equivalent that I could be experiencing?
I should note that for about three months as part of my rehab, I have been performing plyometrics such as box jumps, depth jumps and broad jump variations (single and double leg). I have increased the height/distance of the jumps gradually.
I have seen OS type symptoms come up in ACL-R people before. You basically are causing excess irritation at the tibial tuberosity, most likely from increased work-load on your knee and especially increase plyo work. It isn’t OS in it’s truest definition, but basically the adult equivalent. The extra tension being placed on the tibial tuberosity at the patellar tendon attachment can cause some swelling/inflammation as well as calcification at the tibial tuberosity, which is why you are likely seeing the bump.
I would continue with the soft tissue work to the hip flexors, quad, and quad tendon. Light work on/around the tibial tuberosity would be okay, but I wouldn’t go too aggressively over it too soon as the area is already quite inflamed. You can also try some ibuprofen gel/voltaren gel over the area or take a holistic approach and try some Arnica cream. Also, keep your fish oils intake up, as adding other natural anti-inflammatories such as circumin, ginger, etc will be helpful as well.
Also, trying wearing a knee sleeve to bed as well to provide some warm to the area. I know BBB has recommended it for elbows, which has helped me and others that I have worked with, and I have tried it with knees as well and seems to have some positive effects.
Thanks for that…should I alter my training at all? I have not done any plyos over the past two weeks because of a deload phase, but I would work them back in this week on my normal schedule.
I would avoid too much training that produces excessive anterior force on the knee. If you do start plyos again, progress slowly and I would avoid them if they are causing pain or worsening symptoms.
Might be jumper’s knee along with the tendonitis. Check this out and see if it applies: http://www.sportsinjuryclinic.net/cybertherapist/front/knee/indexjumpersknee.html
It’s an inflammation - ice after workout, compression during. I would lay off heavy plyometrics for a while. Regular lifting should be fine.
Whatever you do, DON’T keep irritating it - it will only get much much worse. 3-4 weeks off now is better than 3 months off later. Speaking from experience.
Thanks for the advice. Just out of curiosity, what is a good protocol for plyometrics? What are the proper amount of sets/reps, when should you add weight, what does a typical plyo session look like, etc.? I may have been doing way too much volume with these, as I was using a 3x8 set/rep scheme for each exercise.
I will list below what I have been doing for the past 3 months. This is all once per week on the following schedule:
Monday - Upper body, weight day (bench, pull-ups, rows, shoulder shocker, core work)
Tuesday - Lower body, weight day (back squat, RDL, Bulgarian SS, GHR, core work)
Wednesday - Plyos/sprints/basketball
Thursday - Upper body, weight day (same as above)
Friday - Lower body, weight day (same as above)
Plyos/Sprints/Basketball
*My goal recovering from surgery is to get back to playing recreational basketball, so after I stretch, I will shoot, dribble, cut, penetrate, etc. on the basketball court for about 20-30 minutes
Box jumps or depth jumps (alternate each week) - 3x8
*Also a landing phase after each jump from about 2-2.5 feet from the ground
Triple broad jump, over boxes of varying heights - 3x8
Single leg box jump, front-to-back and laterally both ways - 3x8 (both legs)
Single leg triple hop - 5 times each leg
That is a pretty intensive plyo session, especially if you are also performing other strengthening exercises. Is there any reason you are dedicating a separate day to plyos?
I would drop down the total volume personally and also keep the reps per set to about 6 at most. Also, I’d recommend just integrating some plyo drills into your regular weight training routine and sperad out the plyo drill throughout the week to keep the overall volume of plyo drills per day fairly low.
Level hit it on the nose on this. Take 1 or 2 plyo exercises and incorporate them into your lifting days. Do them first (after warmup of course) - great activation exercises too. 3x8 is fine, depending on exercise. If you get fatigued from it, it’s too much. If you feel your performance drop, quit the set immediately. Every jump should feel as easy as the one before, or easier.
This way you’ll have the strain spaced out evenly through the week, so your knee doesn’t get overloaded on 1 day.
Also, I’d toss in some plyos for the core and arms. A bouncy medball ~ 10-15lbs is best for these. Overhead throws, chest passes, lateral passes, trunk twists, supermans with throwing the ball…there’s a ton of good ones.
So, maybe leg days start off with a couple leg plyos and a core plyo. Then workout as normal. Arm days, start with arm plyos and a core plyo, workout as normal.
Thanks again. I wrapped up that 8-week session recently and started a push/pull this week. I’ve worked in one plyo per session and I feel better already.
I haven’t tried this yet, but would sprints be considered something that puts excessive anterior force on the knee? I recently borrowed a knee strap from an athletic trainer I know, and that’s seemed to alleviate some pain too.
I would consider sprinting a form of plyo exercise and calculate it into the overall volume of plyo work being done in the week and volume of total work being done all together. Remember, it gets to a point to when you add to something, you have to give up a little of something else sometimes.
Ease into the sprinting and see how it feels on your knee. I wouldn’t be too concerned with the anterior force on the knee as long as it is progressed smartly.
I had these symptoms really bad when I was around 23-24…39 now. I wore a ace bandage to compress the knot and then bought a holeless neoprene sleeve that I wore off and on for several years. I would wear it to bed. On a rare occasion it still flares up and I resume wearing the neoprene sleeve for a while until the symptoms disappear.
Sometimes it feels like my knee would hyper extend if I let it relax or flex my quad. So, I was always aware not to let it completely extend when sitting with my legs straight out or lying on my stomach. I
I don’t notice it much except when the barbell hits during deadlifts.
The local gym guru said that I was possibly separating the tibia and fibula when I rebounded at the top of the squat. The end of the barbell would bounce up and down. He said the force come down was causing those two bones to bow out and stretch the patellar tendon. I believed him with a grain of salt.
how did u go with this injury did it recover? i am 23 and having the exact same problem its so depressing!!!