Knee tendinitis/tendinosis! help!

[april]

Hi i'm wondering if anyone has any suggestions on how to help heal tendinitis aka tendinosis of the knee. I feel a sharp, shooting pain whenever i put weight on it when it is bent, though there isn't any obvious swelling or outward structural problems with the knee. It is aggravated by running and squatting, sometimes even everyday walking is painful, and i feel something is wrong even when sitting. It's a frustrating problem i've had for almost a year now, and topical NSAIDs and physiotherapy where they recommended strengthening of the quad muscles (e.g. repetitions of sitting up and down from chairs and resistance training with a leg extension machine), have not helped.

I'm not sure whether i should be doing activity when i feel pain. Should i be doing no activity, only activities if they don't cause pain, or, how much pain is ok? What other courses of treatment help? I've seen some sites recommend "friction massage", can anyone help explain? I don't know if it's getting to the point where surgery is necessary. Also, I would like some clarification on the tendinitis/tendinosis terminology. From what I've seen on the web, some places say that the modern way of describing this condition is tendinosis, since it is not technically an inflammation, but the doctors i've seen still use the term tendinitis, though i've asked them about the tendinosis description. If it is in fact a "collagen degeneration" as described by the tendinosis definition, how do you treat it? In that case, anti-inflammatories wouldn't help anyway since it's not addressing the cause of the problem!

It is also frustrating for me to deal with peers who say that I should be doing MORE exercise to strengthen the knee, and should "work through the pain" while my gut says that once the pain starts, it's only going to get worse.

Would appreciate it if anyone with first-hand experience with this problem, either treating it, or experiencing it, could tell me what has actually worked.

[jathib]

I've struggled with tendinitis in my shoulders for years from swimming. My doctor keeps telling me, "If it hurts, you're hurting it". The only way to get rid of it is to rest, rest and when you think you're fine, rest some more. It can take months or years and even when it's gone it can come right back when you start your routine again. In other words, if what you're doing is causing pain then you need to stop.

[plantgeek58]

Hi April,
I'm struggling with the same condition. What I've been told is that you shouldn't do anything that causes more pain. The conservative treatment is rest, ice, NSAIDs and stretching of the quads, calves and hamstrings, not strengthening. I seem to remember reading something about cycling irritating it too, but I'm not sure about that. Stretching is supposed to take the pressure off the tendon. Friction massage is where you take your index and middle finger and rub them horizontally across the tendon. It's supposed to realign the tendon fibers. My PT recommended it. We also tried ultrasound treatments, which helped, but only for a day or so. I've been doing all of this for more than a year, with little relief. My latest MRI showed some degeneration, which is usually when they start considering surgery, but my OS didn't think my condition was bad enough to warrant that, because I didn't flinch when he pressed on the tendon. Like you, however, it hurts when I walk and I work on my feet. I've put in a call to him asking if he'd reconsider. I have a scope coming up in two weeks for a torn meniscus and would like him also to address the tendon problem. Haven't heard back from him yet, but I'll let you know when I do. This is such a frustrating problem, because it can keep returning over and over again.
Terre

[april]

Thanks for the replies. I too spend pretty much all day on my feet at my job, which is aggravating. I have an appointment with a sports medicine physician in a couple of weeks. I hope that I can get some scans done (haven't had a proper X-ray or MRI yet) and that they can figure out what's going on.

I have been through more cycles than i can count where I avoid exercise for a couple of weeks, feel no pain, get back into gradually doing it... then bam! it's back. At that time i was only seeing GP's and had a referral to a physiotherapist. I am afraid that this condition was underestimated: i was not under the impression that this was something that needs up to years of recovery, and more rest than what was prescribed.

The following may seem rediculous, and perhaps it's my frustration talking, but: what i am afraid of when I go to my appointment, is that they DON'T find anything wrong with my knee upon examination, which would make it trickier to decide on a course of treatment. A major thing I find frustrating about this condition is that there is no obvious sign of injury and people can't see it, which may lead them to wonder if the pain is in a large part "in my head". But, I definitely experience pain, and I can tell the difference between muscle soreness and the pain which signals that something is functionally wrong with my knee.  And it hurts to not be able to do the sports i enjoy, and face the prospect that this could go on for another year or more, and maybe will never perform with the same level of vigour. Sometimes I wish instead of having this, that I could have something which is obvious and easily treatable, though it may be more acute... I've seen people around me recover within a couple of months from broken bones. Perhaps if i were to continue, it should go in the "spritual help" forum?

[jathib]

Overuse injuries can be a bugger but it's best to wait until you've gotten a proper diagnosis before you start to worry that they won't find anything. Since you haven't even seen an ortho doctor yet it's too early to guess at the problem. You could have bursitis or a torn meniscus or any number of things that are treatable. At any rate, you'll probably end up with a cortisone injection and/or physical therapy.

Don't worry about what people think. Only someone with an injury can really understand what it's like. I have so many injuries from my shoulders to my ankle that I'm always in pain. I don't bother to even mention it, I just carry on with my life as usual. Only one close friend even knows that I see a pain management doctor. And only one coworker knows the extent of what I deal with on a daily basis.

[plantgeek58]

April,
What you're feeling is definitely not ridiculous. I felt the same worry before my first visit to my OS. I was afraid he'd blow me off and tell me there was nothing seriously wrong with my knee and I'd have to simply live with the on-again, off-again pain that seemed to be increasing. He didn't, though and neither will your doctor. He probably will do both x-rays and an MRI, as well as manipulate your knee in various ways to see exactly what generates the pain. The more accurately you can describe it to him, the more helpful it will be.
I finally heard back from my OS, and he agreed to do the surgery on the tendon when I go in. I also posted a question about the surgery and heard from someone who has gone through it. Apparently, full recovery can take 9-12 months, and it will be difficult to stand for long periods for a few months, but it relieves the pain for about 85% of people who undergo it. Maybe you can discuss this option with your doctor.
Good luck with your appointment and let us know what happens. I will probably start another post-op diary, so if you want to know how my surgery goes, you can look for it.
Terre

[Ian C]

Hi April,

Reading your post prompted me into giving you some of the treatments I have endured over the last 18months.
Firstly you are right to think in terms of Collagen defect but will only be confirmed by an MRI.
Any decent Sports Physician will suggest a course of non surgical techniques before opting for the latter. This would take the course of a thirteen week eccentric exercise programme.(You are encouraged to work through the pain as did the originator of the technique a Swedish OS).
If that fails (it works for a lot) then options can include injecting your own blood into the injured tendon, and , or Extra Corporeal Shock Wave Therapy (ECSWT). ECSWT is a high voltage current direct into the tendon aimed at generating a healing response. After that then surgery is the last option,there are a number of different techniques used - Removal of the bad scare tissue in the hope that good and organised scar tissue takes it place - The killing of the nerve/ pain receptors into the tendon so you don,t get the pain signals sent to your brain!
Two weeks ago I had surgery (removal of scar tissue) now on crutches for the next six weeks followed by lengthy rehab.
Good luck and best wishes.

[ALRunner]

I know this thread is almost 5 years old, but as my tendinosis is now older than that, I feel I'm ok to bump, and others may come upon this in time. OP said that

The following may seem rediculous, and perhaps it's my frustration talking, but: what i am afraid of when I go to my appointment, is that they DON'T find anything wrong with my knee upon examination, which would make it trickier to decide on a course of treatment. A major thing I find frustrating about this condition is that there is no obvious sign of injury and people can't see it, which may lead them to wonder if the pain is in a large part "in my head".

And in fact this is exactly my experience. I have seen now three sports physicians and had two MRIs. When I am in their office I present with few symptoms and the MRIs look "mostly" clean (last one years back showed a possible partial tear in patellar tendon, however!), but in all cases the docs are like "Wow, this doesn't seem so bad--prescribing you some PT you'll be good to go". Except, now many years later, I'm not. I have an appointment with the best sports doc in the city next month and will try again, this time assertively stating that yes although the pain on my knee isn't more than a 2-3, and I can weight-train it, the fact is despite being in my 30's I cannot run, I cannot even walk very far without pain, and though I can generally do something like heavy leg press, at times when I wake in the morning I cannot go down stairs without pain.

This is definitely an absolutely dastardly problem, and when I "ran" into it (it was caused by running) years back I never dreamed I'd still be dealing with it for so long. I don't run anymore. I've taken months off with no activity, I've spent months again strengthening, etc. I have found that the best thing for pain is total rest, but even that doesn't resolve it entirely, so I generally do strengthen it. Eccentric is ok, but not a panacea for me.

Unfortunately, surgery is no panacea for this, either, with an uninspiring success rate.

Further, there is little scientific evidence showing that things like extracorporeal shockwave therapy work well for it.