Patellar Tendonitis

Hey guys,

Patellar Tendonitis/Tendonosis, is causing me to go a little easier on doing sprints or squatting. I’m continuing my 5/3/1 program without the squatting, and mainly focusing on light/high rep squats with good form.

I’m nervous I’ve damaged my knees so severe over the years that I may need surgery; I pray that isn’t the case. I went to the doctor and physiotherapist, and they both told me I need to avoid the exercises that irritate it, ice, and stretch and foam roll much more (which I haven’t been doing, but have been doing a lot more recently). I may need to get an MRI or ultrasound, and see what is going on with my knees. I feel that when I deadlift heavier sets, they really don’t bother my knees; it’s only when I squat.

So my questions are, should I continue squatting focusing on form and light weight and high reps? Ice, stretch and foam roll as much as possible, and try other conditioning exercises other than sprints? Can I continue the program as I leave my squats alone? I just want some guidance on where to go from here. I’m too fucking stubborn to completely avoids legs or sprints. I know I can find other ways of doing conditioning, but avoiding any squats or leg work would drive me insane.

Any suggestions guys?

Thanks!

ditch the squatting for now. How long has this been an issue.

[quote]nkklllll wrote:
ditch the squatting for now. How long has this been an issue.[/quote]

This has been an issue off and on now for about 2.5-3 years. A physiotherapist told me that I’m hip dominant, and it’s causing inflammation down to my knees. I told my Doc about how long this has bothered me, but honestly I feel he has no idea what he is talking about at this point.

If it has been bothering me for this long…I feel it’s something more serious than just “stretching, foam rolling, and icing” this problem away. It has got to be the most frustrating injury in the world…for me anyways, haha.

Have you actually taken time off from the movements that cause you pain before? Or have you continued to try and work through it.

[quote]nkklllll wrote:
Have you actually taken time off from the movements that cause you pain before? Or have you continued to try and work through it.[/quote]

I have taken about 2-3 weeks off of squats, or either I did light box squats from what I remember. I never really gave them a break as much as I should have. Sometimes I get so pissed off and stubborn, I try to work through it. I train in MMA a few times a week as well. It’s hard to work around this…

This is a rare case where I like the leg extension machine. 2 up, one down (ie eccentric emphasis) leg extensions work amazingly well for patellar tendonitis. Each rep (the lowering part) should last about 30 seconds. Of course use a conservative load and use pain as your guide. You should feel very mild discomfort in the inflamed tendon. If it’s screaming at you, use less weight. I could write pages on the unsuccessful remedies I used prior to this working…

I got the idea from this article or one like it: Eccentric Exercise

1 Like

Here’s my advice - be disciplined to do what is necessary.

[quote]cubuff2028 wrote:
This is a rare case where I like the leg extension machine. 2 up, one down (ie eccentric emphasis) leg extensions work amazingly well for patellar tendonitis. Each rep (the lowering part) should last about 30 seconds. Of course use a conservative load and use pain as your guide. You should feel very mild discomfort in the inflamed tendon. If it’s screaming at you, use less weight. I could write pages on the unsuccessful remedies I used prior to this working…

I got the idea from this article or one like it: Eccentric Exercise [/quote]

Thanks bro! I will definitely give this a shot. How often would you do it throughout the week? I do Squats on Monday, and Deadlifts on Thursday. Would I do this as accessory work or maybe a warm up?

I’ve also heard others mention Decline Eccentric Squats?

[quote]Jim Wendler wrote:
Here’s my advice - be disciplined to do what is necessary. [/quote]

Thanks, Jim.

I want to avoid surgery at all costs. I honestly don’t believe it is so severe that I will need it. I pray to god I don’t. I couldn’t handle that big of a setback…

I guess an ultrasound or MRI (which I will have to wait for for about a year on a damn waiting list) will tell all.

[quote]Aches89 wrote:

[quote]Jim Wendler wrote:
Here’s my advice - be disciplined to do what is necessary. [/quote]

Thanks, Jim.

I want to avoid surgery at all costs. I honestly don’t believe it is so severe that I will need it. I pray to god I don’t. I couldn’t handle that big of a setback…

I guess an ultrasound or MRI (which I will have to wait for for about a year on a damn waiting list) will tell all.
[/quote]

Re-read your initial statement. You know the answer, you just won’t do it. I understand you want to feel “dedicated” but imagine if you would have done the right thing awhile ago - you’d be that much closer to being healthy and training properly.

[quote]Jim Wendler wrote:

[quote]Aches89 wrote:

[quote]Jim Wendler wrote:
Here’s my advice - be disciplined to do what is necessary. [/quote]

Thanks, Jim.

I want to avoid surgery at all costs. I honestly don’t believe it is so severe that I will need it. I pray to god I don’t. I couldn’t handle that big of a setback…

I guess an ultrasound or MRI (which I will have to wait for for about a year on a damn waiting list) will tell all.
[/quote]

Re-read your initial statement. You know the answer, you just won’t do it. I understand you want to feel “dedicated” but imagine if you would have done the right thing awhile ago - you’d be that much closer to being healthy and training properly.

[/quote]

I wish I had trained a little smarter and took care of myself when I was younger. Pretty depressing when you think about it, haha. Oh well, I got myself into this problem and now I need to get out of it. But does this mean I need to completely stop squats for now, in your opinion? Even if I’m going light?

If you’re contemplating surgery then you should probably stop until you figure out what you’re doing. Sounds to me like you need to put this in the hands of a medical professional that you trust.

[quote]Aches89 wrote:

[quote]Jim Wendler wrote:

[quote]Aches89 wrote:

[quote]Jim Wendler wrote:
Here’s my advice - be disciplined to do what is necessary. [/quote]

Thanks, Jim.

I want to avoid surgery at all costs. I honestly don’t believe it is so severe that I will need it. I pray to god I don’t. I couldn’t handle that big of a setback…

I guess an ultrasound or MRI (which I will have to wait for for about a year on a damn waiting list) will tell all.
[/quote]

Re-read your initial statement. You know the answer, you just won’t do it. I understand you want to feel “dedicated” but imagine if you would have done the right thing awhile ago - you’d be that much closer to being healthy and training properly.

[/quote]

I wish I had trained a little smarter and took care of myself when I was younger. Pretty depressing when you think about it, haha. Oh well, I got myself into this problem and now I need to get out of it. But does this mean I need to completely stop squats for now, in your opinion? Even if I’m going light?[/quote]

Did you re-read what you wrote? Your answer is clearly there.

But you do whatever you want; if you think “light” squats are worth shitty knees, be my guest.

[quote]Aches89 wrote:

[quote]cubuff2028 wrote:
This is a rare case where I like the leg extension machine. 2 up, one down (ie eccentric emphasis) leg extensions work amazingly well for patellar tendonitis. Each rep (the lowering part) should last about 30 seconds. Of course use a conservative load and use pain as your guide. You should feel very mild discomfort in the inflamed tendon. If it’s screaming at you, use less weight. I could write pages on the unsuccessful remedies I used prior to this working…

I got the idea from this article or one like it: Eccentric Exercise [/quote]

Thanks bro! I will definitely give this a shot. How often would you do it throughout the week? I do Squats on Monday, and Deadlifts on Thursday. Would I do this as accessory work or maybe a warm up?

I’ve also heard others mention Decline Eccentric Squats?[/quote]

I would drop the squats for now. You will be trying to decide, “is this working?” and even light squats will add a variable that will muck up your “data” (ha). How often? I did the protocol I mentioned earlier 5-6x/week prior to each workout. I made sure to do it first because it’s really boring and I’d have a tendency to skip it if I put it off. I felt a noticeable decrease in the pain on day 2! Within a week I could watch a movie in the theater or drive a long distance without agony. I don’t know how fast you will respond, but you should notice some improvement in short time. When should you start squatting again? This is guesswork in person, let alone over the internet. The best I can say is use pain as your guide.

-Russell Peele

P.S. to make sure i’m not completely talking out of my ass, I just texted an orthopedic surgeon (currently team doc for the Orioles) friend asking, “When does patellar tendonitis require surgery?”
His response, “failed conservative management.” He’s in clinic right now so he can’t elaborate, but you very well may already past this point. Either way, good luck!

It is probably too late for this but have you ever tried box squatting instead. They seem to be a whole lot less stress on the knees. Although you might be past the point where that would make much difference.

You should definitely take some time off as Jim is stating, or maybe re-stating what you said.

If you’re hip dominant you need to figure out why. Are your Psoas taking over for weak hamstrings or weak quads? Poor mobility? Go to a sports med doc if you can and / or a physical therapist and figure that out; it may not require surgery at all. You may just need to take a break and work on that issue, but then maybe the doc will find you do need surgery, who knows; get that MRI. It’s not just going away. You can make that situation worse and possibly even cause additionally injuries. The last thing you want is to tear a ligament or also damage your hip flexors.

[quote]cubuff2028 wrote:

[quote]Aches89 wrote:

[quote]cubuff2028 wrote:
This is a rare case where I like the leg extension machine. 2 up, one down (ie eccentric emphasis) leg extensions work amazingly well for patellar tendonitis. Each rep (the lowering part) should last about 30 seconds. Of course use a conservative load and use pain as your guide. You should feel very mild discomfort in the inflamed tendon. If it’s screaming at you, use less weight. I could write pages on the unsuccessful remedies I used prior to this working…

I got the idea from this article or one like it: Eccentric Exercise [/quote]

Thanks bro! I will definitely give this a shot. How often would you do it throughout the week? I do Squats on Monday, and Deadlifts on Thursday. Would I do this as accessory work or maybe a warm up?

I’ve also heard others mention Decline Eccentric Squats?[/quote]

I would drop the squats for now. You will be trying to decide, “is this working?” and even light squats will add a variable that will muck up your “data” (ha). How often? I did the protocol I mentioned earlier 5-6x/week prior to each workout. I made sure to do it first because it’s really boring and I’d have a tendency to skip it if I put it off. I felt a noticeable decrease in the pain on day 2! Within a week I could watch a movie in the theater or drive a long distance without agony. I don’t know how fast you will respond, but you should notice some improvement in short time. When should you start squatting again? This is guesswork in person, let alone over the internet. The best I can say is use pain as your guide.

-Russell Peele

P.S. to make sure i’m not completely talking out of my ass, I just texted an orthopedic surgeon (currently team doc for the Orioles) friend asking, “When does patellar tendonitis require surgery?”
His response, “failed conservative management.” He’s in clinic right now so he can’t elaborate, but you very well may already past this point. Either way, good luck!
[/quote]

Thanks again man. I honestly believe if I drop squats and use exercises that don’t aggravate my knees, and maybe find other ways of doing conditioning rather than sprinting 2-3 times a week,
And also use that eccentric exercise…I think this will really help.

Regardless, an MRI is a must.

[quote]Aches89 wrote:

[quote]cubuff2028 wrote:

[quote]Aches89 wrote:

[quote]cubuff2028 wrote:
This is a rare case where I like the leg extension machine. 2 up, one down (ie eccentric emphasis) leg extensions work amazingly well for patellar tendonitis. Each rep (the lowering part) should last about 30 seconds. Of course use a conservative load and use pain as your guide. You should feel very mild discomfort in the inflamed tendon. If it’s screaming at you, use less weight. I could write pages on the unsuccessful remedies I used prior to this working…

I got the idea from this article or one like it: Eccentric Exercise [/quote]

Thanks bro! I will definitely give this a shot. How often would you do it throughout the week? I do Squats on Monday, and Deadlifts on Thursday. Would I do this as accessory work or maybe a warm up?

I’ve also heard others mention Decline Eccentric Squats?[/quote]

I would drop the squats for now. You will be trying to decide, “is this working?” and even light squats will add a variable that will muck up your “data” (ha). How often? I did the protocol I mentioned earlier 5-6x/week prior to each workout. I made sure to do it first because it’s really boring and I’d have a tendency to skip it if I put it off. I felt a noticeable decrease in the pain on day 2! Within a week I could watch a movie in the theater or drive a long distance without agony. I don’t know how fast you will respond, but you should notice some improvement in short time. When should you start squatting again? This is guesswork in person, let alone over the internet. The best I can say is use pain as your guide.

-Russell Peele

P.S. to make sure i’m not completely talking out of my ass, I just texted an orthopedic surgeon (currently team doc for the Orioles) friend asking, “When does patellar tendonitis require surgery?”
His response, “failed conservative management.” He’s in clinic right now so he can’t elaborate, but you very well may already past this point. Either way, good luck!
[/quote]

Thanks again man. I honestly believe if I drop squats and use exercises that don’t aggravate my knees, and maybe find other ways of doing conditioning rather than sprinting 2-3 times a week,
And also use that eccentric exercise…I think this will really help.

Regardless, an MRI is a must.[/quote]

You’re crazy if you keep doing any lower body exercise at this point. If that one doctor is right and you’re “too hip dominant” here are some additional issues you can face if you end-up causing problems with your hip flexors from overuse. I’m not making this up either; it’s straight from a Structural Kiniesiology class I’m in.

  • Tight psoas inhibits gluteus maximum; increases compressive forces in the lumbar spine
  • Tight psoas inhibits lumbo-pelvic-hip complex intrinsic stablization which increases translational and rotational stress in the lumbar spine during dynamic movement.
  • The Sartorious (supports hip function): Problems can cause compensation at the hip and KNEE external rotation.

You’re risking too much by continuing to do lower body exercise without medical guidance.

I have had the same issues in the past. I went to wide stance box squats and was still able to train squat. I’m a raw lifter so it didn’t make much sense so I stopped squatting for about 3 months. Just started back 4 weeks ago and am right back to where I was when I left off and 18lbs lighter body weight.

Take the time to heal. It is worth it if you wanna keep lifting in the future. Strength comes back pretty quick. It also made me realize just how vital recovery and rest are.

You should find out what your doc meant by ‘hip-dominant’. Usually a dominant posterior chain will help protect the knees. Sure he didn’t say quad dominant??

Maybe he means that you have the classic lower cross syndrome where you lower back is locked into extension. That could certainly lead its way to knee issues. Either way…these things don’t get solved with random mobility work. You have to know what you’re attacking.