T Nation

Tendinitis, Pain Above Tibia & More

This is my first post… I’ve done searches and found some stuff that relates to my problem but nothing too specific… I just turned 25 years old… for the last 2-3 years the top of my tibia has been very sore… I don’ tknow if this is osgood schlatter’s or what… but in july i was at a basketball camp, running suicides every day… then friday morninig i wake up and i almost collapsed on my right knee… i felt as if my patellar tendon ruptured… i knew this couldn’t be or i wouldv’e seen specific signs or probably wouldn’t be able to walk at all… I couldn’t even lie w/ my legs straight and tighten my quad muscle of my right leg w/out pain…

after 1 week of icing… i was doing very light leg extensions and rehab stuff… similar to what you do for jumper’s knee… anyways after about 3-4 months of rehab i was able to jog w/ out pain, squat w/ out pain… matter of fact i was doing basketball drills today w/ out pain… bu that area is still tender… and i know w/ osgood schlatter’s sometimes the tendon pulls fragments of bone off the tibia… w

ell if i lie down w/ my right leg straightforward and relax it, then rub around where my pattelar tendon is i can feel as if there is something underneath, like loose cartilage or something… like it feels squishy… I used to do alot of plyometrics in the past, and was heavy into sprints and track work while trying out for a college basketball team… was hoping somebody could help me out… i seriously can’t believe my knee feels so much better from doing the rehab… i just want the tenderness to go away, im scared this shit could turn arthritic

I’m 27 and had 5 knee ops so although I have no medical traning I do know a bit about the subject…

First off NO leg ext, even light. It put tons pressure on the knee and that is the last thing you need. Do lots of BW squats, ass to grass and lunges 3x a week. Stay of the weight for about 3 months even if you are feeling better and then gradually start to squat but I would not go over 225lbs.

When playng basketball get one of those things (i’m not sure of the name but they are a thin wrap that goes right below the knee. It holds the patela in place and always helped me.

[quote]Illiptical360 wrote:
This is my first post… I’ve done searches and found some stuff that relates to my problem but nothing too specific… I just turned 25 years old… for the last 2-3 years the top of my tibia has been very sore… I don’ tknow if this is osgood schlatter’s or what… but in july i was at a basketball camp, running suicides every day… then friday morninig i wake up and i almost collapsed on my right knee… i felt as if my patellar tendon ruptured… i knew this couldn’t be or i wouldv’e seen specific signs or probably wouldn’t be able to walk at all… I couldn’t even lie w/ my legs straight and tighten my quad muscle of my right leg w/out pain…

after 1 week of icing… i was doing very light leg extensions and rehab stuff… similar to what you do for jumper’s knee… anyways after about 3-4 months of rehab i was able to jog w/ out pain, squat w/ out pain… matter of fact i was doing basketball drills today w/ out pain… bu that area is still tender… and i know w/ osgood schlatter’s sometimes the tendon pulls fragments of bone off the tibia… w

ell if i lie down w/ my right leg straightforward and relax it, then rub around where my pattelar tendon is i can feel as if there is something underneath, like loose cartilage or something… like it feels squishy… I used to do alot of plyometrics in the past, and was heavy into sprints and track work while trying out for a college basketball team… was hoping somebody could help me out… i seriously can’t believe my knee feels so much better from doing the rehab… i just want the tenderness to go away, im scared this shit could turn arthritic[/quote]

Here are a couple things to help you out:

  1. You have the residual affects of a jumper’s knee syndrome (or at least this limited diagnosis from the internet tells me so)

  2. Osgood-schlotter’s is a deformity of an enlarged tibial tuberosity that forces a greater angle of torque from the patella/quadriceps. This is only in people who have not finished growing. There is a possibility that you haven’t finished growing yet, but at 25 that is slim.

  3. You sound like you have tendonitis at the tibial tuberosity, or rather tendinosis at this stage. There is a small area in the tendon right now that probably appears like mucus wihin the tendon (if we were to open you up right now). This is avascular and takes a long period of time to heal. (Tendons themselves have limited vascularity, which complicates the matter further)

  4. Most importantly: what to do. NO plyometrics right now. This period of complete healing will take 12 weeks minimum (or more based on how much you use it during that period). The window of re-injury will be between the 3-6 weeks after the initial injury, so be careful if you find yourself able to move without much discomfort during that period; tendons are still very fragile then.

During a tendinosis type injury, the tendon will respond best OVER A 12 WEEK PERIOD to near maximal eccentrics. What I mean by this is similar to an old article on this site describing a solution to tendonitis. What I want you to do is get on a leg extension machine and for a typical bodybuilder workout sets (2-3 X 10 - 15) have a somewhat heavy weight concentrically lifted by both legs. Pause for a moment at the top to have a comfortable transition between a two leg lift and a one leg lift. Then, after you are stable holding the weight with one leg, lower the leg on a count of 4.

(note, if you are hurting in that knee doing this on the way up on your first couple of attempts, do not do this exercise for a little bit, while doing the other exercise I describe)

The other exercises: (no big deal here)

Leg presses in a bodybuilder’s set/rep scheme while keeping your tibia at a 90 degree angle to the platform.

Monster Walks: Take a thick band of tubing and tie it together in a circle whose diameter is no bigger than 12 inches. Put this around your the arches of your feet, and walk with straight legs and a wide stance forward, backward, and side-to-side with ten steps per foot.

Do this for a while to build up strength in your lower extremity. Remember that the tendon remodeling with eccentrics needs to be over a 12 week period. It will feel bad before it gets better, and you need to stick it through. Just ice the area after exercise and use this twim to not only allow your body to heal, but follow some upper body specialization scheme.

Sorry if I couldn’t give you more, but, this is not only online, but I should be studying right now, so my mind is elsewhere.

Best o’ luck!
the MaxX

  1. Osgood-schlotter’s is a deformity of an enlarged tibial tuberosity that forces a greater angle of torque from the patella/quadriceps. This is only in people who have not finished growing. There is a possibility that you haven’t finished growing yet, but at 25 that is slim.

  2. You sound like you have tendonitis at the tibial tuberosity, or rather tendinosis at this stage. There is a small area in the tendon right now that probably appears like mucus wihin the tendon (if we were to open you up right now). This is avascular and takes a long period of time to heal. (Tendons themselves have limited vascularity, which complicates the matter further)

thats definitely where the tender area is… there is also another name sanding larsen johanson syndrome its just like osgood… anyways thinks man i appreciate your effort… only this has been going on the last two years… and the extreme pain hit in july… two months of rest and light rehab… the leg extensions i was doing were very light 20lbs single legs and alot of hamstring work… im going to follow some of your recommendations… preferably using the bands… so you don’t think i should do squats w/ weight? i do 135lbs 15 reps, 3 sets once a week just to maintain strength… and been joggin once a week… no pain… but there is still tenderness… should i ice? i think i should use heat now

This is an update:

got an x-ray yesterday still waiting on the results… as far as i can see the bones look normal, but im not a radiologist so i guess i’ll wait and see…

ive been doing isometrics on a sled where i lower one leg for 10 sec’s… i also do leg extensions and terminal knee extensions w/ a band… three times a week… these really seem to be helping… i am also running twice a week, jogging and sprints one day… not sure why but yesterday i was shooting around, some light jumping, im a couple inches away from dunking… as i go back to my job my knee starts feeling tight, right where i described the pain… i felt weakness when going up and down stairs and even getting up from a chair… i did leg extensions w/ some minor pain… right after i did tke’s w/ a band… the strange thing is my pain subsided and i was even able to bend my knee and put pressure on it w/ out pain this is along w/ walkin down stairs? does anybody know why this is? does it sound like arthritis, tendonitis? what doctor can answer these questions?

[quote]the MaxX wrote:
During a tendinosis type injury, the tendon will respond best OVER A 12 WEEK PERIOD to near maximal eccentrics. What I mean by this is similar to an old article on this site describing a solution to tendonitis. What I want you to do is get on a leg extension machine and for a typical bodybuilder workout sets (2-3 X 10 - 15) have a somewhat heavy weight concentrically lifted by both legs. Pause for a moment at the top to have a comfortable transition between a two leg lift and a one leg lift. Then, after you are stable holding the weight with one leg, lower the leg on a count of 4.
[/quote]

Decent advice, but leg extensions aren’t a great idea. The research has actually shown decline squats to be a superior exercise for these purposes.

The most important message from all of this is that you have tendinosis, and NOT tendinitis. The former is degenerative, and the latter is inflammatory. As such, anti-inflammatory medications are not indicated - and can actually be counterproductive to the healing process.

www.ericcressey.com

took an XRAY of my knee 5/2, results came back negative… took an mri exam friday, the nurse called me to tell me that i have a partial thickness tear of the patellar tendon right below the kneecap and that there was bone marrow edema… now im going to collect the sheet tomorrow so i can post the results word for word… but what exactly should i be doing about this meanwhile?

Also, could someone please explain to me bone marrow edema? I’ve read that this could progress to osteoarthritis. The nurse also asked me if i had a preexisting injury if i had ever got hit there and i said no, but i said i just played alot of basketball. She responded with “you probably had an injury during basketball”