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Patellar Tendon Pain

I figure if anyone knows how to solve tgis, it’s the powerlifters. I’ve been having significant pain in the patellar tendons for the last couple weeks and it’s making it very hard to squat, or do anything that involves a lot of knee bending. I bought sbd knee sleeves, and they help a bit, but it’s not getting better. I have begun working on stretching my quads more often to hopefully loosen them up, along with some one legged wall sits and foam rolling, but that has only been for a few days. I am pretty flexible already, but I think the pain could have something to do with tight quads. I hope it’s not tendonitis. I also have some arthritis and my meniscus is fairly beat up in both knees. I really don’t want to have to take time off from lifting. Any advice would be great. Thanks.

Massage around the tear-drop (VMO) area of your quad. Also your upper calves, just below your knees, around the back and sides, if that makes sense. And around to the front, to your tibialis (the muscle that gets shin splints) Feel around for muscle tightness or knotty areas that could be pulling on your tendons in an uncomfortable way. If you find anything, rub it out.

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Thank you! On it.

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Could also be the vastus lateralis (outer portion of the quad) close to the knee, sometimes mine get tight and make my knees feel weird.

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Is it below the patella or above? Patellar tracking may be off. Even though you powerlift you may have imbalance between the quad muscles. Typically In patients, even built ones, I’ve seen weakness in VMO, medial quad which tracks patella at terminal extension, which contributes to pain. I’ve had it myself. It may surprise you but some light weight terminal knee extension strengthening, while doing isometric adduction does the trick; or do quad extensions with a ball between your knees, squeeze at the end.

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Guys… patellar tendinopathy is not an issue with muscle length or strength, and often not even coordination/technique. Its an issue with tendon resiliency. Granted, you can check the above things, but only if addressing the tendon directly doesn’t work.

Tendon rehab involves three things:
1- Manage pain to continue training
2- Maintain if not increase heavy loading to increase collagen content of the tendon
3- Use some reactive/elastic exercises to stiffen the tendon

Managing pain to continue training

Isometric contractions of the quadricep desensitises the brain from the pain-sensitising input from the tendon. Basically, isometrics stop your knee from hurting. This effect lasts for around 45 minutes. It also helps contribute to collagen resynthesis in the tendon (part of reconditioning tendon).

These isometric contractions should be 30-60 seconds each, for 1-3 sets a time, 2-3 times per day. It is especially important to do this before lower body training so you can continue to squat heavy (a very important component of rehab).

Isometric exercises that work great are:

  • Split squat hold with a floating heel (meaning heel off the ground, weight through balls of the feet)
  • Single-leg squat with floating heel, support yourself with your hands for balance
  • Single-leg leg extension at 45-60° of bend
  • Sissy squat
  • Reverse Nordic

Maintain if not increase heavy loading to increase collagen content of the tendon

Heavy loading (and the isometrics) strain the tendons, increasing collagen synthesis in the tendon. Keep your knee-dominant lower body exercises in, and keep them relatively heavy and close to failure (like you usually would). Basically, to start with this, don’t change your training at all

Use some reactive/elastic exercises to stiffen the tendon

A tendon needs to be somewhat stiff and have a lot of collagen. Heavy loading will make sure it has lots of collagen, but will not stiffen it. Stiffening a tendon requires plyometric/elastic/reactive activities.

One of the best options is to do pogo hops/rope skipping for 5-10 minutes immediately after your isometrics. So, again, 2-3 times daily.

Recap

  1. Isometrics for analgesia and to strain the tendon
  2. Heavy loading to strain the tendon
  3. Reactive loading to stiffen the tendon

The tendon recovers in ~6 hours, so if possible, do your isometrics and plyos up to 3 times daily. Continue training your lower body as normal.

Give this 8-12 weeks (approximate time for significant tendkn adaptation) then re-evaluate if you need other therapeutic changes like specific soft tissue work, muscle strengthening or coordination training

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My VL’s get achy. Not sore like a normal soreness, a real dull, low ache that isn’t that bad at first, but when it doesn’t go away for weeks it threatens to suck the energy out of everything.

Above the knee. I read some about the patella tracking issue. It’s kinda hard to tell, but seems like it moves right to me. I know my vmo has grown considerably in the last 6 months, but that doesn’t mean it’s strong enough. Some light knee extensions are definitly worth a try!

Wow, thanks for the detailed response! I’m going to do what you are suggesting and see how it goes. You sound like you know what your talking about. Thanks again!

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Ahhh hold up, in which of the below three site(s) - red, green or blue - do you feel pain?

It’s okay if it’s in more than one

Is rapidly jumping/bouncing/hopping up and down painful?

Would you say you have high arches? Do you squat and walk with your feet very supinated i.e. lots of weight on the outside of your foot? How’s your hip internal rotation?

Patellar tracking disorders don’t exist, and if they did they likely are not contributing to pain. The VMO is not discernible from the rest of the VM, neurologically or anatomically. No one can reliably identify poor patellar tracking. The way that the patella moves on the leg bones is better represented by the orientation of the hip than the activation of the heads of quadriceps

Mostly red, thats where it started, has spread down some to the other sites, but still mostly red.

Bouncing feels alright, feet are flat as pancakes.

Internal rotation is limited, external rotation good. I squat with toes out for best hip mobility.

I was just looking at anatomy pictures. I think I miss stated the quad tendon as the patellar tendon. So, it’s the quad tendons that are giving me pain (above the knee cap).

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No biggie. Management between the two is almost entirely the same

These are probably linked. Try the second drill from this video.

That sounds like it could be the cause of your knee pain, or at least part of it. Try rolling it with a lacrosse ball (or other small hard ball) and focus on painful spots.

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I’ll try that first chance I get. I don’t have a slant board, but I can figure something out. Am I doing this as a test or as daily rehab?

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I like foam rollers, but I hate hard balls. They get into all the really knotted up parts of my muscles and it hurts. Probably means I need to do it.

It’s not going to feel good while you do it, that is for sure. But you can also do this with the ball against the wall rather than on the floor, it’s easier to control how much pressure you apply and less uncomfortable overall.

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The slant board isn’t totally essential, but what I’ve done is put the balls of my feet up on a few plates or the handle of a very light dumbbell

Use that however often you’d like, especially as a lower body warm up. When you do it, focus on keeping your weight on the inside of the heel of the back leg. You should feel adductors, hamstrings and a bit of glue medius on the back leg

Good luck mate

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