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Author Topic: Patellar Tedinosis with Quad Atrophy  (Read 10219 times)

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Offline Sara10

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Patellar Tedinosis with Quad Atrophy
« on: January 07, 2013, 02:33:53 AM »
Hello,

2 months ago I injured my knee during a Barre Class, I felt a pop in front of my knee during leg work and I had to stop my workout.  It was toward the end of class so abs were next, and we did the bicycle and it was immediate that I couldn't lift my injured leg up to do the move.   I walked out of class fine, even down stairs fine, the pain went away.  It wasn't until a few days later the pain really sunk in, it was unbearable,  and I haven't been able to walk normal since (That's when I started RICE)

The MRI was negative says there was no tear but Tendinosis.   I've started physical therapy but it's difficult to do some of these easy moves ( assisted leg raise).  I can only walk (with a stiff leg) for about 1/2 block before my knee starts hurting and I have to get home.  So for these first 2 months.  I've really been at bedrest and doing upper body work.

Finally got to see my orthopedic surgeon and he said, I'm healing, but I really need to go to PT and to move more, try out a bike.  To get my quad to work again.  It literally feels like I can't tell my brain to engage my quad, there's a disconnect.

My questions are:

-If this really is a form of jumpers knee.  How come I've never had any pain in the patellar tendon before this injury?  It's only one knee... But I do feel like because my left one has been doing all the work for the past 2 months, it is also beginning to a hurt a little, no quad weakness though, I can extend all the way with no pain.

-I heard that the quad goes into atrophy as a way to protect the tendon (since it pulls on it).  But when will the pain go away?  I use RICE everyday.  Oh and sitting prolonged periods does not make me feel pain.  I only feel pain after I try and rehab my quad.

-How long has it taken anyone to get their quad back to half strength before the injury?

Also, the OS said I may have patellar chondromalacia in both knee, worse in my injured one.  This is a first I've ever noticed that grinding feeling when I touch it.  Is this what causes those painful pops in my knee since my injury?
 
Has this happened to anyone?  Please help, I really miss being able to lift my leg and walk normally.  It's affecting my well being.  A bit about my I've been practicing yoga for the last few years.  I walk and hike regularly because I have a desk job.  But I've never done sports

Thanks

-Sara
11/2012 R patellar tendon injury, immediate quad atrophy
12/2012 MRI- tendinosis
1/2013- OS- Patellar tendinitis and Chondromalacia
3/2013 L Patellar tendon pop, no quad atrophy
7/5/13   Normal MRI, right knee tendinosis cured!

Offline Sara10

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Re: Patellar Tedinosis with Quad Atrophy
« Reply #1 on: January 18, 2013, 05:39:55 AM »
To Follow up:

I've seem some improvement with pain since last my post.  But the pain waxes and wanes.  I do fairly well with electric stimulation of my quad and am able to life my heel off the table a few cm when it's stimulated.  Without it I still can't engage my quad

In the mornings the tendon feels really tight and I want to stretch it.  When I do it's like a tugging sensation, sort of painful so I don't do it for too long.

Please if any one has any insight of how much longer it'll take to heal.  Thanks
11/2012 R patellar tendon injury, immediate quad atrophy
12/2012 MRI- tendinosis
1/2013- OS- Patellar tendinitis and Chondromalacia
3/2013 L Patellar tendon pop, no quad atrophy
7/5/13   Normal MRI, right knee tendinosis cured!

Offline ALRunner

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Re: Patellar Tedinosis with Quad Atrophy
« Reply #2 on: March 27, 2013, 08:35:07 PM »
How are things going now?

Initially it's incumbent to rest an injured tendon. Ideally, for as long as it takes to recover it (can be months). However, if/once recovery stalls and it's no longer improving, then you will want to introduce activity, intelligently. That means nothing silly like jumping, and nothing that causes it huge stress. However, some low level of pain is something a lot of people advise; i.e. a little pain during activity may be ok, but it should go away after some hours.

Personally, I have tendinosis in my right knee and I've experimented a lot over the years with it. The worst it's been in years was last spring. It hurt nearly constantly, and going down the stairs in the morning was painful. This was after almost no activity, so obviously I wasn't stressing it. I decided to get back to eccentric squats, as I'd done in the past. For the first several days these hurt a lot, but I pushed through the pain and within a few months I had my first day of zero pain. None in morning, or during the squats. I stopped them eventually because I was getting a weird IT band issue, so now I'm doing light cycling each morning, but joints do need some degree of movement to stay happy or else they just seem to get lazy and crappy :)

Offline Sara10

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Re: Patellar Tedinosis with Quad Atrophy
« Reply #3 on: March 29, 2013, 01:10:09 AM »
Thank you for responding!! I don't feel so alone now.  I posted one update: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=61716.msg595492#msg595492

But after that it's been a slow recovery.   Extremely frustrating. 

Right knee is now pain free a couple months.  Still have weakness, but I'm now able to walk up stairs.  Walking downstairs is still very week and I use the rail to hold my weight.  I can lift a straight leg with my heel maybe 3 inches off the ground.  Which is so nice to be able to do! I feel like my leg has life again, it's been so long!

My left knee is still bothering me from the pop, but, because it took 3 months for the pain in my right knee to go away I'm going to guess this will go away in another 2 months.

Did your knee "pop" out of no where?  That's the thing.  I've never had an pain or knee problem and out of no where during exercising my R knee pops and my quad immediately went into atrophy.   Then 3 months later when walking my Left knee now popped but no quad atrophy. 

I've started some eccentric training with my quads, but it's just difficult.  It's not that it's painful to squat, it's just that my right quad doesn't have strength so I can't go down very far.

Any thoughts on that?  Thanks again for your response
11/2012 R patellar tendon injury, immediate quad atrophy
12/2012 MRI- tendinosis
1/2013- OS- Patellar tendinitis and Chondromalacia
3/2013 L Patellar tendon pop, no quad atrophy
7/5/13   Normal MRI, right knee tendinosis cured!

Offline ALRunner

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Re: Patellar Tedinosis with Quad Atrophy
« Reply #4 on: March 29, 2013, 01:18:23 PM »
Just to be clear: I have zero medical training. All I know about this stuff is what I've read and experimented with. That said, after being given the wrong diagnosis (despite textbook tendinosis, I'd later learn myself) by a couple of doctors, and PTs who seemingly had no idea what tendindosis was, I eventually diagnosed myself. And lest one thing I'm a total quack, this diagnosis was eventually confirmed when I saw the best sports doc in my city, including on MRI. I'm relaying this because doctors often get it wrong. It's also absolutely just amazing how ignorant the medical community seems to be of tendinosis. A few web page readings told me what I had, and yet when I had presented these symptoms prior, nobody ever so much as used the word tendinosis or indicated its generally recommended treatment.

In your case, your physician doesn't seem to know what your issue is, so I'd try and find another one.

My understanding is that tendinosis is generally slow to onset. Even if we're talking days or something; it's not a pop. A pop is indicative of a tear--if it happened in a tendon. And absolutely not all tears are complete tears.

My right knee, the one suffering from long-term tendinosis, had the problem come on over months of running. Eventually there was the introduction of a clicking/catching, which I think is due to a thickening in the tendon and it catching the fat pad in the knee. Never any popping at time of onset, however.

On the other hand, my left knee last year I was doing some weird activity and despite nothing strange happening, a few hours later I had some increasing pain, and the joint was "shifty"/clunky. Within a couple of days it hurt a lot, even to stand for long. As it started to heal itself up it felt a lot like tendinosis of the right, but I have left it alone for the most part and 10 months later it's nearly perfect. I did see a doc at the time and xray was fine (not surprisingly), but he thought maybe some cartilage was loose in the knee (though I doubted this). I was told if it didn't get better to get an MRI but it's nearly fine now. My guess is I mildly tore the tendon, but I may never know as most days I feel nothing.

In terms of activity, I think that you should do as much as possible that doesn't hurt, whatever it may be, and it sure seems important to really work diligently on strengthening your quads if you're having weakness/atrophy, as long as it doesn't hurt the leg too much.

Most importantly, though, I believe you want an accurate diagnosis. Doctors love to throw around chondromalacia patellae <sp> as a diagnosis even when it doesn't match at all. That was the first diagnosis I ever got. *groan* and heck it was even the same one I got last year on my left knee that is now nearly healed up. I was also told a year and a half back after presenting a textbook case of Achilles tendinosis to a podiatrist to "take a month of anti-inflammatories to really knock out the inflammation". That's absolutely the wrong course of treatment for long term tendinosis and absolutely no journal article on this condition will say it's correct.


Offline Sara10

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Re: Patellar Tedinosis with Quad Atrophy
« Reply #5 on: March 29, 2013, 10:59:09 PM »
Thank you for getting back to me!  It's always good to hear someone else's input

Yes I'd like to get a second opinion.  With my HMO insurance, it might be difficult I'm not sure I'll check with my doctor whenever I go in next.  But after all the research I've been doing on my own, I definitely feel I've become my own doctor.  My OS is probably great at actually doing the surgeries but if there is nothing to repair, he's not all that interested.

When you said when your left hurt and you left it alone, do you mean you just stopped running?  Did you try to do eccentric training on your left?  Has Friction massage helped?  Glad to hear it doesn't give you problems anymore

I hope there's hope for me out of this, and I don't develop any real tendinitis and this is just a one time injury. 
11/2012 R patellar tendon injury, immediate quad atrophy
12/2012 MRI- tendinosis
1/2013- OS- Patellar tendinitis and Chondromalacia
3/2013 L Patellar tendon pop, no quad atrophy
7/5/13   Normal MRI, right knee tendinosis cured!

Offline ALRunner

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Re: Patellar Tedinosis with Quad Atrophy
« Reply #6 on: April 01, 2013, 05:22:11 PM »
Quote
When you said when your left hurt and you left it alone, do you mean you just stopped running?  Did you try to do eccentric training on your left?  Has Friction massage helped?  Glad to hear it doesn't give you problems anymore
My name is a misnomer now. I stopped running for good 18 months ago, but it was a struggle for the few years prior.

Leaving it alone I just did normal stuff (admittedly not working out much over the last year, either, of any kind!). I tried some eccentric but not much, because it was getting better. It still gives some problems and if it doesn't continue to heal to a point of painlessness I will introduce eccentric to see if that helps out...

Offline Hawko73

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Re: Patellar Tedinosis with Quad Atrophy
« Reply #7 on: June 17, 2013, 12:11:25 PM »
I am just going to resay what my friend said to me, which was
- Heavy eccentric training 2-3 times per week
- Stretching two times per day

Within three weeks improvement should be noticed. Within 12 full return to activity should be possible

I currently am battling as well but this person has had it but he still does tonnes of Plyo and jumping so he obviously got over it. He is super fit.

I hope this works for you, and for me I suppose :)
Tendinopathy since August 2012.

Not yet cured :(

ACL and Meniscus repair July 2013
Seems to be healing well

Offline Sara10

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Re: Patellar Tedinosis with Quad Atrophy
« Reply #8 on: June 22, 2013, 04:54:20 AM »
Hi Hawko

How did your tendinosis develop?  It's maddening to me that it develops so quickly, and then takes forever to heal.  Can you walk now without pain? or does walking aggravate it?

I know I should be more adamant about doing eccentric squats, but it's hard to do something  that causes pain. 
I am happy to report it's been a full month I haven't had a flare up from walking.  So happy to walk again ( little things like running errands with no pain)  My R quad has gotten strength back, and R knee haven't had pain in 5 months.
My left knee I wrote about how it starts to feel like it was going to act up, and it did! Left popped as well and took a while for that to heal.  It's that knee that is pain free 1 month.

So I'm at a good point I think, with that said I still have not gone back to my routine.  I don't know when that'll be.  Actually getting a second MRI with contrast in 10 days!!!!  I found a new doctor and he wants to rule out any tears or fat pad issues.  Excited to know.  Sometimes I feel like my knees are going to break on me if I don't sit down.

What has really helped me is I starting to avoid stairs/hills.  If I had to take the stairs I side step down.  Doesn't aggravate them.  I also did a complete rest 2 week veg mode.  It was brutul not to walk much but I think really helped speed up healing.  I've also stopped icing (does 3x a day for 7 months really still do anything?).  I do friction massages every night.  That helps.

Once I feel life my quad is up to par.  I'll religiously do the eccentric squats.  I'm just so so scared.  After so long you really don't want to go backwards you know?

Thanks for your reply I might be in touch with questions for you!
11/2012 R patellar tendon injury, immediate quad atrophy
12/2012 MRI- tendinosis
1/2013- OS- Patellar tendinitis and Chondromalacia
3/2013 L Patellar tendon pop, no quad atrophy
7/5/13   Normal MRI, right knee tendinosis cured!

Offline Hawko73

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Re: Patellar Tedinosis with Quad Atrophy
« Reply #9 on: September 16, 2013, 09:55:19 AM »
Haha, sorry for the VERY late reply, I actually did my right ACL playing Australian Football about 2 months ago, and I completely forgot all about my this haha. I had surgery nearly 4 weeks ago and am recovering well, can do partial squats and would be further along if I hadn't torn my Lateral meniscus, which has stopped me doing rehab until Thursday.

I got teninosis on my left knee last year, also playing Australian football. This is because I was in the ruck, and I strained my knee, didn't rest it, and now I have got this strand of bulging scar tissue in my left patella tendon. My role in football involved a lot of jumping, like basketball, at least 20 times per day, and I strained it again in my for last game that season, the grandfinal, which we lost.

I took the off season off, and didn't realise I had set myself up for failure by not doing anything, and when I went to do pre-season it flared up again and I had to do six weeks of hard-core rehab to be able to even run again. I was having Physio once per week and I managed to get into the football side, and a few bye's early meant it had time to adapt and I didn't end up missing a game until I did my ACL in the ninth game, in which we won the premiership, and I was on the ground clutching my knee as the siren went. It was truly bitter/sweet .
I would not have made it through the season if I hadn't done my knee exercises. I was going to take them further but because I have been on crutches I haven't been able to.

Interestingly being on crutches has strengthened my knee, and i feel virtually no pain from it, though I can stiff feel the scarred tissue in the tendon

How is your knee going now?
Tendinopathy since August 2012.

Not yet cured :(

ACL and Meniscus repair July 2013
Seems to be healing well

Offline Sara10

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Re: Patellar Tedinosis with Quad Atrophy
« Reply #10 on: October 05, 2013, 05:06:46 AM »
Thanks for the reply!  Sorry about your ACL :(   You choose a cadaver tendon, part of your patella tendon or hamstring?

It's still a battle.   I was on a boat for work for the last 2 months and it woke up my right quad like no other.  Feels so good to have strength in it again.   My left knee acts up off and on.  It's funny that you said being on crutches strengthens it.  I can agree that the second you stop doing things that hurt it its like it gets 100% for a second.   

For the most part walking no longer causes flare ups.  And I get around like a normal person for once.  Still have no run jumped or skipped in almost a year now :'(

 I still avoid stairs or take them side stepping down.  And I've officially started eccentric squats, decline, both legs no weight.  I'm on day 12 and it's the first day I decided to skip.  I think the squats are helping over all.  But I just gotta be careful.

I don't know.  I keep thinking I understand this condition, and then something happens where I realize I don't understand it at all.  Both my knees are hurting a bit right now.  And I can't quite figure why yet.  They had done SO well this last week of squats.

When they did the scope on your ACL did they look at the tendon at all?   It's disappointing that tendinopathies are kinda overlooked.  My last MRI on my right knee came out normal no tendinosis.   So I guess it shows that MRI's can't find everything

Ttys :)
11/2012 R patellar tendon injury, immediate quad atrophy
12/2012 MRI- tendinosis
1/2013- OS- Patellar tendinitis and Chondromalacia
3/2013 L Patellar tendon pop, no quad atrophy
7/5/13   Normal MRI, right knee tendinosis cured!















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