T Nation

Quadriceps Tendonitis (Not Patellar)


#1

Hello. This is my first post over these boards, I saw some good posts around and thought that maybe somebody could help.

I've been dealing with this for the last couple months. Basically I've switched to a powerbuilding program from october 2013 till now, nothing too fancy, squats 3 days a week, cycling the other lifts. A couple months ago I started feeling this dull pain (feels like doms mostly) above both my knee caps, I thought I was overreaching a bit because of the heavy squats 3 times a week, so I took a week off, just to realize that the "pain" wasn't gone at all. Researching online I found out that it's obviously tendonits, possibly even tendinosis already.

Since then I first took every quad exercise out of my training (still stretching, foam rolling etc doe), only resorting to deadlifts for legs. I spent 3 weeks like that, then when starting to ease into training quads again I tried some assisted bodyweight squats but even if during the session I was feeling good, the day after that I found out with much disappoint that the soreness was still there. Lastly I resolved myself to take a week completely off to see if something changed (I was starting to think that maybe my quads were still being stressed a bit on the deads).

After that week I was about to head to the gym to check the situation, but I got badly sick, so I had to take another whole week off. This monday I went to the gym again for the first time, warmed up very well, proceeded to bw squat, felt good again. However yesterday my aches were back again as usual. Here we go again I guess.

I just want to mention that since I started thinking that I had this condition I started foam rolling, stretching and icing like a mad man, but none of this helped apparently. I also did a 3 days cycle of ibuprofen, a few sessions of Tecar therapy (since a friend of mine is a physiotherapist and has that weird machine), and yet there was no actual progress to report. The ache just seems to go away after a few days without training quads by any mean, and comes back as soon as I hit them, no matter how gently I go.

I'm starting to feel desperate and depressed, I want to squat so bad, I've lost quite a bit of size already and I feel that all of my hard earned strength is quickly goin lost. Training around this stupid handicap feels retarded. I got into training with the sole purpose of getting stronger, and maybe one day competing in PL, I don't care about anything else, I don't care about aesthetics (to a great extent), I don't care about the size of my biceps and stuff like that, this is my dream and I see it fading away slowly, and this is tearing me apart. Next week I'll get an MRI and see how bad I'm messed up, but I'm so scared to know what's up that I don't even know if I wanna do it or not.

Has anyone been where I'm at now? How do you get out of this crap? Any kind of advice or support will be greatly appreciated.


#2

[quote]dezer7 wrote:
Hello. This is my first post over these boards, I saw some good posts around and thought that maybe somebody could help.

I’ve been dealing with this for the last couple months. Basically I’ve switched to a powerbuilding program from october 2013 till now, nothing too fancy, squats 3 days a week, cycling the other lifts. A couple months ago I started feeling this dull pain (feels like doms mostly) above both my knee caps, I thought I was overreaching a bit because of the heavy squats 3 times a week, so I took a week off, just to realize that the “pain” wasn’t gone at all. Researching online I found out that it’s obviously tendonits, possibly even tendinosis already.

Since then I first took every quad exercise out of my training (still stretching, foam rolling etc doe), only resorting to deadlifts for legs. I spent 3 weeks like that, then when starting to ease into training quads again I tried some assisted bodyweight squats but even if during the session I was feeling good, the day after that I found out with much disappoint that the soreness was still there. Lastly I resolved myself to take a week completely off to see if something changed (I was starting to think that maybe my quads were still being stressed a bit on the deads).

After that week I was about to head to the gym to check the situation, but I got badly sick, so I had to take another whole week off. This monday I went to the gym again for the first time, warmed up very well, proceeded to bw squat, felt good again. However yesterday my aches were back again as usual. Here we go again I guess.

I just want to mention that since I started thinking that I had this condition I started foam rolling, stretching and icing like a mad man, but none of this helped apparently. I also did a 3 days cycle of ibuprofen, a few sessions of Tecar therapy (since a friend of mine is a physiotherapist and has that weird machine), and yet there was no actual progress to report. The ache just seems to go away after a few days without training quads by any mean, and comes back as soon as I hit them, no matter how gently I go.

I’m starting to feel desperate and depressed, I want to squat so bad, I’ve lost quite a bit of size already and I feel that all of my hard earned strength is quickly goin lost. Training around this stupid handicap feels retarded. I got into training with the sole purpose of getting stronger, and maybe one day competing in PL, I don’t care about anything else, I don’t care about aesthetics (to a great extent), I don’t care about the size of my biceps and stuff like that, this is my dream and I see it fading away slowly, and this is tearing me apart. Next week I’ll get an MRI and see how bad I’m messed up, but I’m so scared to know what’s up that I don’t even know if I wanna do it or not.

Has anyone been where I’m at now? How do you get out of this crap? Any kind of advice or support will be greatly appreciated.[/quote]

MRI for patellar tendinopathy, welp minus 2 grand America.

Firstly, soreness in either the patella ligament or quad tendon is a relatively common response to heavy squatting. I don’t remember a day when my knees weren’t at least slightly sore the following day.
Second, 3X a week is way too much especially if you are not at an adequate fitness level. This is only something I would recommend to a high level athlete with adequate preparedness. Clearly the injury resulted from overuse.
Treatment wise, when you stretch are you stressing both the origin and distal attachments via hip extension as well as knee flexion.

Rework your squat form, anterior knee displacement on the eccentric portion places increased stress on the knees.

Learn to box squat for a while while you recover. By breaking up the eccentric/concentric portion you will decrease stress on the MT junction and still satisfy your urge to squat.


#3

[quote]BHOLL wrote:

[quote]dezer7 wrote:
Hello. This is my first post over these boards, I saw some good posts around and thought that maybe somebody could help.

I’ve been dealing with this for the last couple months. Basically I’ve switched to a powerbuilding program from october 2013 till now, nothing too fancy, squats 3 days a week, cycling the other lifts. A couple months ago I started feeling this dull pain (feels like doms mostly) above both my knee caps, I thought I was overreaching a bit because of the heavy squats 3 times a week, so I took a week off, just to realize that the “pain” wasn’t gone at all. Researching online I found out that it’s obviously tendonits, possibly even tendinosis already.

Since then I first took every quad exercise out of my training (still stretching, foam rolling etc doe), only resorting to deadlifts for legs. I spent 3 weeks like that, then when starting to ease into training quads again I tried some assisted bodyweight squats but even if during the session I was feeling good, the day after that I found out with much disappoint that the soreness was still there. Lastly I resolved myself to take a week completely off to see if something changed (I was starting to think that maybe my quads were still being stressed a bit on the deads).

After that week I was about to head to the gym to check the situation, but I got badly sick, so I had to take another whole week off. This monday I went to the gym again for the first time, warmed up very well, proceeded to bw squat, felt good again. However yesterday my aches were back again as usual. Here we go again I guess.

I just want to mention that since I started thinking that I had this condition I started foam rolling, stretching and icing like a mad man, but none of this helped apparently. I also did a 3 days cycle of ibuprofen, a few sessions of Tecar therapy (since a friend of mine is a physiotherapist and has that weird machine), and yet there was no actual progress to report. The ache just seems to go away after a few days without training quads by any mean, and comes back as soon as I hit them, no matter how gently I go.

I’m starting to feel desperate and depressed, I want to squat so bad, I’ve lost quite a bit of size already and I feel that all of my hard earned strength is quickly goin lost. Training around this stupid handicap feels retarded. I got into training with the sole purpose of getting stronger, and maybe one day competing in PL, I don’t care about anything else, I don’t care about aesthetics (to a great extent), I don’t care about the size of my biceps and stuff like that, this is my dream and I see it fading away slowly, and this is tearing me apart. Next week I’ll get an MRI and see how bad I’m messed up, but I’m so scared to know what’s up that I don’t even know if I wanna do it or not.

Has anyone been where I’m at now? How do you get out of this crap? Any kind of advice or support will be greatly appreciated.[/quote]

MRI for patellar tendinopathy, welp minus 2 grand America.

Firstly, soreness in either the patella ligament or quad tendon is a relatively common response to heavy squatting. I don’t remember a day when my knees weren’t at least slightly sore the following day.
Second, 3X a week is way too much especially if you are not at an adequate fitness level. This is only something I would recommend to a high level athlete with adequate preparedness. Clearly the injury resulted from overuse.
Treatment wise, when you stretch are you stressing both the origin and distal attachments via hip extension as well as knee flexion.

Rework your squat form, anterior knee displacement on the eccentric portion places increased stress on the knees.

Learn to box squat for a while while you recover. By breaking up the eccentric/concentric portion you will decrease stress on the MT junction and still satisfy your urge to squat. [/quote]I’m afraid you’re right. Probably I faced this issue because My mechanics still weren’t spot on while I jumped in somenkind of advanced routine. I will try box squats. Where should I start from? I guess I’d be better off with something above parallel for now then add a little depth every two weeks or so? This way the tendons won’t risk getting teared up again right?


#4

[quote]BHOLL wrote:

[quote]dezer7 wrote:
Hello. This is my first post over these boards, I saw some good posts around and thought that maybe somebody could help.

I’ve been dealing with this for the last couple months. Basically I’ve switched to a powerbuilding program from october 2013 till now, nothing too fancy, squats 3 days a week, cycling the other lifts. A couple months ago I started feeling this dull pain (feels like doms mostly) above both my knee caps, I thought I was overreaching a bit because of the heavy squats 3 times a week, so I took a week off, just to realize that the “pain” wasn’t gone at all. Researching online I found out that it’s obviously tendonits, possibly even tendinosis already.

Since then I first took every quad exercise out of my training (still stretching, foam rolling etc doe), only resorting to deadlifts for legs. I spent 3 weeks like that, then when starting to ease into training quads again I tried some assisted bodyweight squats but even if during the session I was feeling good, the day after that I found out with much disappoint that the soreness was still there. Lastly I resolved myself to take a week completely off to see if something changed (I was starting to think that maybe my quads were still being stressed a bit on the deads).

After that week I was about to head to the gym to check the situation, but I got badly sick, so I had to take another whole week off. This monday I went to the gym again for the first time, warmed up very well, proceeded to bw squat, felt good again. However yesterday my aches were back again as usual. Here we go again I guess.

I just want to mention that since I started thinking that I had this condition I started foam rolling, stretching and icing like a mad man, but none of this helped apparently. I also did a 3 days cycle of ibuprofen, a few sessions of Tecar therapy (since a friend of mine is a physiotherapist and has that weird machine), and yet there was no actual progress to report. The ache just seems to go away after a few days without training quads by any mean, and comes back as soon as I hit them, no matter how gently I go.

I’m starting to feel desperate and depressed, I want to squat so bad, I’ve lost quite a bit of size already and I feel that all of my hard earned strength is quickly goin lost. Training around this stupid handicap feels retarded. I got into training with the sole purpose of getting stronger, and maybe one day competing in PL, I don’t care about anything else, I don’t care about aesthetics (to a great extent), I don’t care about the size of my biceps and stuff like that, this is my dream and I see it fading away slowly, and this is tearing me apart. Next week I’ll get an MRI and see how bad I’m messed up, but I’m so scared to know what’s up that I don’t even know if I wanna do it or not.

Has anyone been where I’m at now? How do you get out of this crap? Any kind of advice or support will be greatly appreciated.[/quote]

MRI for patellar tendinopathy, welp minus 2 grand America.

Firstly, soreness in either the patella ligament or quad tendon is a relatively common response to heavy squatting. I don’t remember a day when my knees weren’t at least slightly sore the following day.
Second, 3X a week is way too much especially if you are not at an adequate fitness level. This is only something I would recommend to a high level athlete with adequate preparedness. Clearly the injury resulted from overuse.
Treatment wise, when you stretch are you stressing both the origin and distal attachments via hip extension as well as knee flexion.

Rework your squat form, anterior knee displacement on the eccentric portion places increased stress on the knees.

Learn to box squat for a while while you recover. By breaking up the eccentric/concentric portion you will decrease stress on the MT junction and still satisfy your urge to squat. [/quote]Well, to be honest I may not have been advanced enough to be able to squat heavy 3 times a week, but well, what’s done cannot be undone…
How do you suggest I go about box squats? Should I start off with a high box + wide stance then slowly work my way down as the tissue strength builds up again? I was wondering whether reducing the height every 2 weeks or so could be optimal for allowng the tendons to recover. Thanks a lot for your help.


#5

How long have you had this issue?


#6

It looks like 5months. I’m at month 11. All that will fix this is time off. That’s it.


#7

@ nkk: Idk, reply button won’t work. Anyway, it’s barely 2 months since this started, and by started I mean I actaully started feeling discomfort while squatting, and in about 1-2 weeks that discomfort, that at first used to go away with proper warmup and sleeves, started to bother me throughout all of the working sets: infact during a normal workout (about a month ago) I got buried randomly at the 2 rep mark (saved by safety bands)through a set of 5,no warnings whatsoever, quads just gave in at the bottom, I was actually very surprised.

The day after that I was very sore above the knee caps, and sitting up and down became a pain, same goes for stairs and the like, to the point that for a good while I had to help myself with my arms in order to sit up or down. That’s pretty much exactly how this all started.


#8

Yep. You need to take out all quad work until there is no pain whatsoever. At all. For an extended period of time. That is the only thing that has worked for me. I’ve done ALL of the rehab stuff. Graston, traditional rehab, eccentric squats, foam rolling, lacrosse ball work, deep stretching. The only thing that has really helped has been taking crazy amounts of time off from any exercises that hurt.


#9

[quote]nkklllll wrote:
Yep. You need to take out all quad work until there is no pain whatsoever. At all. For an extended period of time. That is the only thing that has worked for me. I’ve done ALL of the rehab stuff. Graston, traditional rehab, eccentric squats, foam rolling, lacrosse ball work, deep stretching. The only thing that has really helped has been taking crazy amounts of time off from any exercises that hurt. [/quote]

Yeah, that’s what I’m gonna do now, all over again, just waiting longer this time, like way longer, and then I’ll start off with very high box squats and work my way down through the weeks/months. However, what I found out even before I got rid of the pain, is that conventional deads are ok, I mean I don’t get any kind of pain while doing them, nor the day after.

However as far as I know deads still activate quads to some extent, and this got me wondering wether it can or cannot be a good idea to keep doing them, even if they don’t bother me at all. At least I could be able to concentrate on bringing at least 2 of my big 3s up while I recover. Have you got any experience with that? Or will I just be better off sticking with SLDLs and isolation exercises as far as the posterior chain is concerned?


#10

I had exactly your problem last year. I started on a program (Madcow 5x5) with 3 squat workouts per week. My technique wasn’t optimal, I went ATG with my knees far forward. Very quad dominant squat. By march 2013 I started having problems squatting, I had a dull ache above my kneecaps. Like soreness, as you describe. I had a week off, but the pain was still there.

I started squatting again a bit, but very light and started playing around with different stances… It didn’t go away. In june 2013 I realized it wasn’t gonna go away until I let it heal completely, so I took 2 months off EVERYTHING. I had 2 months completely off, where I just did other things. Not even foamrolling, because it can irritate the tissue. I can definitely relate to the terms “desperate” and “depressed”, haha.

I then started again very light in august 2013 with Jim Wendlers 5/3/1 (one squat workout per week) and I have been going since. Today I’m stronger than I have ever been, so hang in there.

I advice you to drop everything that works your legs, yes, even deadlifts. You could of course work your upper body, but personally my motivation for being in the gym wasn’t there when I couldn’t squat.

Sorry for my bad english/grammar, bit late here in Norway :slight_smile:

Hope it works out for you!


#11

I’d stay away from deadlifts mostly. I know deadlifts make my ITBs get crazy tight, and that will add to a lot of the pain you’ll experience. In my log here you can see that I’ve done deadlifts only once since I started it, and only 3 times in the four months before that. However, I’ve pushed my RDL up and done a ton of posterior chain work (hyperextension, glute hams, etc) and my deadlift has gone up about 25lbs without pulling ehavy from the floor in that whole time.

If I could do it over again I would do this: rest, ice, whatever made me feel better, until I was completely pain free for a month. Then, I’d wait another month. That second month would/will be the hardest part because you’ll feel great, you’ll be able to squat a couple times without any pain, will be able to jump and run and all that jazz. But you’ll need to stay away from intense knee flexion. I’d say that once you’re pain free, and if you keep your mobility and recovery up, it would probably be safe to add deadlifts back in, but that’s up to you.

I know deadlifts have felt great for me the last 2 times I’ve done em. Absolutely no pain the during, immediately after, or in the days afterwards.


#12

OH! One thing that always gave me a ton of relief during inflammation flare up (like if I had to walk for a long time for some reason) was putting my shower on cold, and pointing the nozzle straight at my knees for like 4-5 minutes.


#13

[quote]dezer7 wrote:

[quote]BHOLL wrote:

[quote]dezer7 wrote:
Hello. This is my first post over these boards, I saw some good posts around and thought that maybe somebody could help.

I’ve been dealing with this for the last couple months. Basically I’ve switched to a powerbuilding program from october 2013 till now, nothing too fancy, squats 3 days a week, cycling the other lifts. A couple months ago I started feeling this dull pain (feels like doms mostly) above both my knee caps, I thought I was overreaching a bit because of the heavy squats 3 times a week, so I took a week off, just to realize that the “pain” wasn’t gone at all. Researching online I found out that it’s obviously tendonits, possibly even tendinosis already.

Since then I first took every quad exercise out of my training (still stretching, foam rolling etc doe), only resorting to deadlifts for legs. I spent 3 weeks like that, then when starting to ease into training quads again I tried some assisted bodyweight squats but even if during the session I was feeling good, the day after that I found out with much disappoint that the soreness was still there. Lastly I resolved myself to take a week completely off to see if something changed (I was starting to think that maybe my quads were still being stressed a bit on the deads).

After that week I was about to head to the gym to check the situation, but I got badly sick, so I had to take another whole week off. This monday I went to the gym again for the first time, warmed up very well, proceeded to bw squat, felt good again. However yesterday my aches were back again as usual. Here we go again I guess.

I just want to mention that since I started thinking that I had this condition I started foam rolling, stretching and icing like a mad man, but none of this helped apparently. I also did a 3 days cycle of ibuprofen, a few sessions of Tecar therapy (since a friend of mine is a physiotherapist and has that weird machine), and yet there was no actual progress to report. The ache just seems to go away after a few days without training quads by any mean, and comes back as soon as I hit them, no matter how gently I go.

I’m starting to feel desperate and depressed, I want to squat so bad, I’ve lost quite a bit of size already and I feel that all of my hard earned strength is quickly goin lost. Training around this stupid handicap feels retarded. I got into training with the sole purpose of getting stronger, and maybe one day competing in PL, I don’t care about anything else, I don’t care about aesthetics (to a great extent), I don’t care about the size of my biceps and stuff like that, this is my dream and I see it fading away slowly, and this is tearing me apart. Next week I’ll get an MRI and see how bad I’m messed up, but I’m so scared to know what’s up that I don’t even know if I wanna do it or not.

Has anyone been where I’m at now? How do you get out of this crap? Any kind of advice or support will be greatly appreciated.[/quote]

MRI for patellar tendinopathy, welp minus 2 grand America.

Firstly, soreness in either the patella ligament or quad tendon is a relatively common response to heavy squatting. I don’t remember a day when my knees weren’t at least slightly sore the following day.
Second, 3X a week is way too much especially if you are not at an adequate fitness level. This is only something I would recommend to a high level athlete with adequate preparedness. Clearly the injury resulted from overuse.
Treatment wise, when you stretch are you stressing both the origin and distal attachments via hip extension as well as knee flexion.

Rework your squat form, anterior knee displacement on the eccentric portion places increased stress on the knees.

Learn to box squat for a while while you recover. By breaking up the eccentric/concentric portion you will decrease stress on the MT junction and still satisfy your urge to squat. [/quote]Well, to be honest I may not have been advanced enough to be able to squat heavy 3 times a week, but well, what’s done cannot be undone…
How do you suggest I go about box squats? Should I start off with a high box + wide stance then slowly work my way down as the tissue strength builds up again? I was wondering whether reducing the height every 2 weeks or so could be optimal for allowng the tendons to recover. Thanks a lot for your help.[/quote]

I would spread it out longer then 2 weeks, decrease frequency to 1-2x per week. Yes parallel or above.


#14

[quote]nkklllll wrote:
It looks like 5months. I’m at month 11. All that will fix this is time off. That’s it. [/quote]

No offence, but what worked for you does not work for everyone. Making blanket statements like this is irresponsible. I agree that he needs to decrease the mechanical stress but whole heartedly disagee with “all that will fix this is xyz”


#15

BHOLL, have you had tendonosis?


#16

Hello Dezer,

Long time T Nation lurker here. Saw your post and had to create a new account to respond and share my story.

I have been powerlifting and training seriously for the past 5 years; however not squatting with the frequency you detail.

At a time I experienced pain in the same location, just above the knee cap. It was very painful to say the least; I could barely even bend down to tie my shoes.

Some things I tied:

  • Saw a physio;
  • Lots of foam rolling and stretching;
  • Icing;
  • Resting and avoiding all movements which caused discomfort;
  • Heel-elevated body weight negatives…
    … and so on.

Nothing worked the pain would not go away.

I did however pinpoint what may have been the cause of my tendinitis.

I had a change in occupation about 18 months ago, and this co-coincided with the pain starting. I started a new job as a police officer. On closer inspection of our issued boots i noticed that they did not provide proper support for my wide flat feet and my ankles would roll inwards excessively. I came to the realization that being on my feet most of the day and doing many kms walking was a potential cause of my problem. Also, i had never worked a job where i spent that much time on my feet walking around (new stimulus).

So… I bought new boots with proper support.

A few days passed and I had the shits from not squatting in forever so I hit the gym. Squatted through the pain and did obscene amounts of volume LOL (was probably not a good idea, but i could not handle not getting my rack time in :< ). Had the worst DOMS of my life, but funny enough could not feel the tendonitis pain with all the DOMS in my quads… when the DOMS faded the tenton pain was a little fainter… So i trained like an idiot again (2nd worst DOMS of my life :p)…

When that 2nd round of DOMS dissipated over-night so did the tendonitis!?! And about a year later it has not come back.

I cannot pinpoint exactly what i did right to fix my problem. But I have a few takeaways:

  • Assess what has/may have changed in your life that is causing the issue, have you introduced some sort of new stimulus in your day-to-day regime?
  • Check your posture/feet/ankes
  • Dont give up hope (I almost did) the pain will go away eventually (if it is any constellation I didnt lose any strength after my extended ‘rest’ period :))

Another important thing to mention (that may have caused my issue). Prior to my pain starting I did most of my squatting to parallel; shoulder width stance, kinda between high and low bar, and putting on the breaks to stop at parallel. When I started squatting again (when my pain went away) I changed to high bar and only squatting ass to grass. This may/may not have helped as i may/may not have read somewhere that putting the breaks on at parallel isnt great for the knees (I dont know, dont remember, dont quote me :p)…

Thats all… good luck!


#17

I’m with nkklllll on this one. Had this myself.


#18

Thanks to all of you guys for the advice and the kind words, it feels bad when you have some condition that sets you back for a while, and knowing that I’m not alone makes me feel a lot better. I’m now resolute to do what it takes to get better, whatever it takes. My dream is to compete, and and I won’t let this stop me.

Heading to the gym right now, and since my knees still feel quite wobbling I’ll just leave out Deads for today, I think I’ll just base my training around rack pulls, romenian deads and glute ham raises (plus obviously bench work) for a week or two, then I’ll go back to conventional deadlift training, just avoiding deficit ones. I hope it’s a good idea. Remaining untrained for the coming months is out of question, I would just freak out. I still have a lot of things to work on besides my squat, time to kick myself in the butt and get going. I will keep you posted.


#19

Sounds like a solid plan. Get after it bro.


#20

[quote]nkklllll wrote:
BHOLL, have you had tendonosis? [/quote]

Does a bear dump in the woods?

Tendinopathy is associated with vascular hyperplasia, collagen misalignment, and infiltration of cytokines and substance P. Resting may have worked for you, but suggesting a blanket term resting will work for everyone is irresponsible considering the mounting evidence for eccentric based exercise as well as other techniques to promote blood flow.