T Nation

Ruptured Patellar Tendon


#1


Hey all -

Long time lurker - love the diversity of perspectives and interesting training ideas I see here and apply to many different sports.

I completely ruptured my patellar tendon 11 days ago. Surgery 4 days ago. Pic attached. It was on a jump take-off. No preceding symptoms besides a pretty recurring pattern of mild patellar tendonitis for a year or so - that I just worked around with rest days, doing deadlift instead of squat, etc. Would love any personal or anecdotal rehab ideas (including pharma ideas), as well as thoughts on training set-ups for the 3-6 months before I can do dedicated leg-work again.

Goals: Competitive Weight Lifting and Track and Field (throws, sprints, jumps - at Master's level). Get back to and past below numbers in accelerated time frame (faster than 9 months).

Background: Master's level track and Field National champion several times; 5x Collegiate Track and Field All-American - got back to very competitive level decathlon marks at age 33.

A Few Recent Stats:

6'2" - 210 - 14% bf (lazy diet)
308 Power Clean (2 weeks ago)
205 Power Snatch (3 weeks ago)
365 A2G squat (2 weeks ago)
525 Dead (in December)
10'10" standing LJ (over summer)
11.59 100m (2013)
53.9 400m (August 2014)
2k row: 6:43

Training Set up: Do a variant of 5/3/1 - but a pretty extensive ramp up series of sets and my final ME set is ME for 1'

Day 1:
Speed (short sprints - 30m or less)
Snatch Technique to finish warm-up
Clean focused session
CrossFit Technique stuff for fun as I may try that
Back Squat
Vertical Upper Body Push-Pull

Day 2:

Recovery - Running or rowing intervals, and some sort of light circuit work (body weight or a basic crossfit session - only short metcons)

Day 3:

Plyometrics
Clean and Jerk Technique
Snatch Focused Session'
Overhead Squat
Horizontal Push-pull for upper body

Day 4 rest or back to day 1 - I have a lot of forced rest due to travel and family commitments.

Progress very gradually on weights - ironically focus has been on staying healthy. Jumping injury was randomly practicing a HJ take-off.

Any advice welcomed!!


#2

dual patellar tendon rupture a while back…was training for a strongman show and was doing a log press(was a weight I had hit for 5 a month earlier) at completion of first rep left tendon ruptured as well as quad muscle,tried to balance on one leg(STOOOOPID) and blew that one out …fell like a collapsed wall…long long rehab but back-will never compete again but had a front squat of 365x 3 @ bw of 235…just hit 295 x 5 last week ohh am 51 now was 44 when it happened…follow your doctors and rehab orders but be aggressive( i had one set back as I developed staph infection which screwed my rehab up a bit…keep positive,stretch and go slow…5/3/1 good start…invest in a pair of rehband knee sleeves…does wonders for warming up and peace of mind


#3

Good luck with your recovery. Very interested in any advice you get. I tore mine 18 months ago and still deal with a lot of pain.


#4

Thanks Dapper and HWPO - Yes, once back to training on it, something like 5/3/1 will likely be what I do - though concerned that early on - until I get my strength numbers climbing, that it may not be enough volume if I’m messing around with sets at 115# or something early on.

Slow and steady will also be key - I tend to push it a little too quickly on injuries - this one I’ll just tolerate.

Other thing I’m trying to figure out is the right maintenance plan these first 3-4 months to maintain muscle mass and maybe even develop some upper body strength while my legs are shot.


#5

[quote]bustedwheel wrote:
Thanks Dapper and HWPO - Yes, once back to training on it, something like 5/3/1 will likely be what I do - though concerned that early on - until I get my strength numbers climbing, that it may not be enough volume if I’m messing around with sets at 115# or something early on.

Slow and steady will also be key - I tend to push it a little too quickly on injuries - this one I’ll just tolerate.

Other thing I’m trying to figure out is the right maintenance plan these first 3-4 months to maintain muscle mass and maybe even develop some upper body strength while my legs are shot. [/quote]

After my hip surgery this was my upper body plan:

at first only 2 days a week until you adapt (12-16 weeks):

1st cycle 3-4 weeks, 10’s:
Day one: Bench: 3x10, increase weight each session by 5lbs each week unless you fail reps. If you make all reps on week 3, allow a fourth week of 10’s. Any time you fail a weight, repeat the weight.

Chin-Ups:
5x5, increase 5lbs each week

A barbell row variation

Curls: 10x10 increase weight each week

Any tricep exercise

Day 2:
Overhead Press: Same as bench

Chin-up:
5x5, same weight as day 1

Dumbbell row variation

Curls: 10x10, same weight as day one

Tricep exercise

Phase 2, 3-4 weeks, 3x8:

Phase 3, 3-4 weeks, 3x5:

Add in 3rd day of going for a heavy single, double, or triple in either the bench or press

Phase 4, 3-4 weeks, 3x3

Put on 10lbs over 3months and 35lbs on my bench press.


#6

nkkllll - thanks - I agree - something like that probably allows for more aggressive volume that I wouldn’t get otherwise. Good call - I like the 2 volume days and 1 heavy day. Then on in between days do abs/lower back/and might even be able to do some reverse hypers to get some work on the legs without stressing the knee.

I probably won’t start that up for a few weeks yet, and will do mostly KB Presses and the like for a while.

Yesterday:

Superset - 5x6+6
Single Arm KB Press
Single Arm Bent Row

Superset 3x10
Curl
Tricep Extension


#7

Anybody have any particular luck with any supplements - gear or other - to help accelerate recovery. Logically, I’d think GH would help, or TB500 (have heard positive things).


#8

The only lower body stuff I would do would be any prescribed rehab you’re getting. If you’re not getting any, you need to find a way to get some.


#9

[quote]nkklllll wrote:
The only lower body stuff I would do would be any prescribed rehab you’re getting. If you’re not getting any, you need to find a way to get some. [/quote]

Yeah - I’ve got a good PT prescribed - he is pretty aggressive and will follow directions and not do stuff before ready. The good thing is I’m already weight bearing a fair bit and that bodes well for continued recover.


#10

Update - starting PT tomorrow - 2 weeks post-operation.

Knee Brace unlocked to 10%
Quad Flexion and Knee extension strength beginning to improve
Able to bear minor loads
Once I am fully mobile and training again, I may post my recovery training in training journal section (probably this will be beginning in early March).


#11

Good to hear man. Keep us updated.


#12

This isn’t really the same thing, but I sliced through (not really ruptured, it was a clean cut) the extensor hallucis longus tendon in my right foot about 10 months ago. Right now I have about 80% of the function in that foot back. Looking to get closer to 99.9% over the next year or so. There might be some stuff in my story that could help you, so here goes.

  1. Connective tissue heals VERY slowly. My tendon was fully knitted after about ten weeks, but the one you’ve injured is thicker, so my guess is it will be longer. I don’t know about that though. Really the best thing you can do to help the process is take care of yourself - managing nutrition, sleep, stress levels etc. It pays to keep a closer eye on all those things than you might normally.

  2. One thing I did in the beginning that I think helped was doing as much moving and weight bearing around the injury as felt safe. I was in a cast for 2 weeks and then a moonboot for about 3 months. During the moonboot period I started gently moving the toe and standing on it a few minutes a day. Obviously you need to be careful and your situation may well warrant a longer period of complete immobility, but I was conscious that connective tissue strength is lost if you don’t stress it, and the longer I left the reintroduction of that stress, the harder it would be.

  3. If you can afford it/ your insurance will cover it, get yourself a decent physio and do what they tell you. I can’t tell you how much that helped me.

  4. Massage the injury and the surrounding area to break down some of the scar tissue. This is really good for improving range of motion. Just be careful in the early stages that you’re not causing more damage.

  5. Walking and standing oddly for weeks and months together wreaks havoc on your biomechanics. Seven months after dispensing with the moonboot I’m still having problems with my hips and my back slipping out of alignment because I held them consistently at weird angles for so long. They’re much better now than they were at the start, but pretty much all the improvements I’ve seen have been over the last couple of months. Before that I just felt like I was spinning my wheels. My ways of addressing the problem are basically a heap of foam rolling and stretching, along with my physio’s making adjustments every ten days or so. And I try not to sit for long periods, because that seems to be the real killer.

Some of this stuff is really just common sense, so I apologise if I’m just repeating what you already knew. Also, I’m not a medical professional of any sort and none of the above should be taken as gospel. I’m just sharing what’s worked for me. Standard disclaimers apply.

Anyway, sorry for the length, but I hope some of it helps. Feel free to ask any questions you have. Good luck dude.


#13

Thanks TheWolfMan. Good advice there. Starting to mess with the scar tissue, which will obviously be a work in progress.

Have a great physio - guy works with a bunch of top athletes in NYC area and is very solid.

I continue to lose weight - and not just fat, but muscle mass as well - but such is life.

In PT today, I executed my first successful straight leg leg lift, which is a lot better than 3 days ago when I couldn’t even begin to move it.


#14

[quote]bustedwheel wrote:
Thanks TheWolfMan. Good advice there. Starting to mess with the scar tissue, which will obviously be a work in progress.

Have a great physio - guy works with a bunch of top athletes in NYC area and is very solid.

I continue to lose weight - and not just fat, but muscle mass as well - but such is life.

In PT today, I executed my first successful straight leg leg lift, which is a lot better than 3 days ago when I couldn’t even begin to move it. [/quote]

Yeah, busted wheel, I entered the OR at about 198lbs. 6 weeks later, the first time I had a chance to stand on a scale, I was down to just over 184. I was able to put on about 20lbs over the course of the next 3-3.5 months, lost some of it, and am now back up to about 207-210 on a consistent basis.


#15

Yeah - I figure I’ll have something like that re: weight loss and regaining health. Continuing to do basic upper body stuff (pull-ups, push-ups, single arm OHP and Rows) and just adding a little volume every day - until I can get back in gym and do a real workout - likely 3 weeks, and then obviously will continue to do just upper body, but add more volume and accessories. As long as my body comp doesn’t get really screwed up over next 4-6 weeks, and I just drop 5-10 lbs each of fat and muscle, I can eat my way back pretty quickly.


#16

Update: 3 weeks + 1 day post op - went to surgeon yesterday - he was very impressed with progress. Knee flexion to 70 degrees. Able to do 5 straight legged leg lifts. Doing a few hundred quad flexes, knee extensions per day. Weight loss stopped - had gotten as low as 200, now back to 201 - though it’s not like I leaned out, just lost 10 lbs of muscle, and maybe gained a little fat.

PT hurts like hell - real tightness throughout calf, IT bands, psoas that we’re working on - also doing e-stim on the quad. Quad atrophy has stopped - total loss of size 1 week ago was 3", this week still 3". But difference on uninjured leg is only 2" difference.

Did a little mini workout today: 5 rounds of 12 with a few minutes rest per round

  1. Hand Release Push-ups
  2. L-Position Pull-ups - last couple rounds, couldn’t quite get 12 unbroken.
  3. KB Swings - being pretty controlled on lowering it and minimizing knee flexion - didn’t bother knee at all, but will be cautious on this

Going to do 2 more weeks of this sort of thing - just adlib - and then begining 3/2, will go back into gym and going to do a 2 day set-up where I go

Day 1 - heavy work on upper body press and pull and body weight work doing a little higher volume than I’d usually do and some sort of finisher that will be metabolic conditioning and maybe minorly involve lower body - nothing like squats yet, but maybe light RDLs, Reverse Hypers, wheel barrow pushes, etc
Day 2 - Accessory work plus core, and some additional body weight work and skill type stuff, and some sort of cardio - but different than day before.

Will follow a very simple linear progression on both where I alternate adding load or volume each session. Don’t expect to do anything dynamic lower body, or heavy, or heavily loaded squat movements for 2-3 more months at a minimum - but will do met-cons such as loaded carries, sled drags or pushes, etc - and really work my stability so that by summer when training fully again I will have a bunch of my weaknesses ironed out.


#17

One way of keeping the strength up in your good leg might be to do one leg cycling, which is not quite as awkward as it sounds. Cardio machines usually annoy the hell out of me, but when I couldn’t put any stress at all on my right foot I had to look at other options. I basically just did all my upper body stuff, then set the resistance on the bike to the highest level and did a few sets of around 40 seconds. I didn’t lose any strength at all in my left leg over that period - which is not bad when you consider that all I was doing apart from that biking was stabilizing myself on crutches.


#18

[quote]TheWolfMan wrote:
One way of keeping the strength up in your good leg might be to do one leg cycling, which is not quite as awkward as it sounds. Cardio machines usually annoy the hell out of me, but when I couldn’t put any stress at all on my right foot I had to look at other options. I basically just did all my upper body stuff, then set the resistance on the bike to the highest level and did a few sets of around 40 seconds. I didn’t lose any strength at all in my left leg over that period - which is not bad when you consider that all I was doing apart from that biking was stabilizing myself on crutches.[/quote]

Good call. Would also give some cardio. I could also do aerodyne with seat really high and minimal knee bend - or rowing with my brace on and limit ROM.

Today: 5x13

Hand Release Push-ups
L-Pull-ups
KB Swings


#19

Little update:

7 weeks post operation and making some phenomenal progress. Leg is still very atrophied, but not getting any smaller. My ROM is up to about 130 degrees, which is apparently very good at this stage. Pain is minimal although swelling is still present, and quads have all but disappeared. Walking with only a moderate hitch.

I’ve been doing following 2 day routine just alternating back and forth. For 2 weeks or so. Adding weight every day on Day 1, and a little volume every day on day 2.

Day 1
Warm-up - Very easy 2-5 minute row (at around 2:00 per 500m pace)

  1. Push Warm-up: 5x5 sets of Working Exercise (either Pause Bench or Overhead Press) with band pull-aparts and paused pull-ups in between.
  2. Push - 5x5 - ramping up weight each week. Did 5x5 at 175 pause bench and 5x5 at 135 strict OHP this week.
  3. Pull - 5x5 weighted pull-ups - did +35# yesterday - alternating that with sets of strict Chest to Bar Pull-ups which is much tougher than I expected.
  4. Complex - 3 rounds
    a. Reverse hypers x 10
    b. Shrugs x 10
    c. 30m loaded carries at bodyweight

Day 2

  1. Warm-up - Easy row - just adding a little volume each day - doing this in my knee brace unlocked to 110 degrees.
  2. Shoulder and hip mobility work
  3. Complex:
    a. Curls
    b. Tricep Extensions
    c. Lateral Raises from various positions
    d. Hollow-Holds
    e. Supermans
    f. Calf Raises

#20

2 years post - a little update: might start a training log

Range of motion pretty much all the way back- but still prefer stopping at parallel on squats.

First year was mostly just rehab and recovering range of motion. The last year has been a steady progress of 531 (doing it with power clean and power snatch as well - where AMRAP set is how many good singles I can do in 1’) and Crossfit. Today will be my first day back at the track in over 2 years and will start slow.

Have put on quite a bit of weight in the last year, currently 225 or so. Lifts at:

200x2 OHP
185x3 power snatch
395 back squat
285 power clean

1k row at 3:07

Would like to drop about 5-7% body fat and maintain or improve strength.