Patellar tendonitis help?

Need some help here…I got an athlete who has had patellar tendonitis since ACL surgery about a year and a half ago. It gets better when she stays off the knee, but then obviously the leg goes to crap. I’ve been trying a lot of things…patellar squats(peterson squats), monitering knee angle during any leg movements, etc… The knee hurts more with patellar squats and she also gets pain as she increases the intensity of her squats. Same thing with running…as intensity increases, so will kne pain after a while. I know it could be any number of things causing the problem, but does anyone have any suggestions?

Finally I got rid of my problem with my patella tendon. I think basically it was a disbalance and as a result the way I applied force to the ground.

First my Quads were far too strong for my hamstrings. One thing that helped was I dropped Squats for a while and did Deadlifts and Cleans and Hang Snatches instead. Probably simply doing squats a way that includes the hamstrings more (lower) would be a nother approach.

Secondly a my right an d left leg ankle strenght was different - the weaker side patella tendon got the trouble…

Third I tried to improve my core strenght (with static exercises in extended position strengthening the whole line/axis lower back/glute/hamstring or abs/hip flexors/quads). Something like pushup position on your ellbows with only one foot an the ground, lift up the other one. And the same with heels and back to the ground.

Fourth I increased my flexibility - best was the exercise, no idea how to describe it - it’s shown in Charlies Speed Trap there is a picture of him helping Angella Issajenko doing it…

After trying a lot of various Physiotherapists (who could not help) an old Chinese Physician who did their kind of traditional massage, too (with all that meridiens and energy streams in your body stuff) helped most to find the cause.

But as you said - the problem could be caused by any number of things.

Aut_71 hit on some key points. Start with the basics, are the hamstrings at an optimal strength and are any other lower body muscle imbalances present? A great deal of research points to the need to strengthen the hamstrings after an ACL injury.

Tendinitis in general points to an overuse problem. Since the knee is already in a fragile state, focusing on exercises like peterson squats will only add additional stress to the tendon. The peterson squat is good for an injury free athlete who has moderate to major imbalances between the three muscle of the quadriceps. For the problem your athlete has, it’s not a good theraputic exercise.

I totally agree with the two gentlemen above. I started hearing a cracking noise about a few years back. This noise kept on getting worse and worse throughout the years, finally after losing a lot of weight and doing cardio twice a day, my knee was just to painful to do lunge. I went to many different physiotherapists and they all sucked until I met a woman who was the physiotherapist for the Canadian Olympic rugby team. She explained to me that the reason I was hearing that noise every time I would flex my knees past parallel was that my patella (knee) was grinding against my knee cap and wasn’t going in its proper alignment. She said that my legs were really tight on both sides and especially on my I-band (side of leg). She said that my inner muscle/s of my quad shut down to protect my legs from getting worse by the contracting of my outside quads. So when I contracted my knee my kneecap would veer off to the outside of my leg.

The recipe for recovery was to quit any lifting immediately and work on stretching for a couple of weeks. The stretches I did were the figure 4 stretch were your lying on your back and with one foot against the wall at a 90 degree angle and the other foot crossed below your knee towards your waist and the other stretch was the I-band stretch with you placing one foot in front of the other with both feet about shoulder width apart and most of the weight on the back leg with some on the front for balance and then you bend towards the back leg side. She would then have me come in throughout the week and do one legged squats with a biofeedback machine so that my brain could relearn how to use my muscle properly, afterwards she would have me sit on the doctors bed and partially contract my leg (each leg one at a time) to full extension while do electro stim. This is how my body learned how to restart the inside muscles of my quad.

Also do stretching for a couple of weeks, then continue stretching and start one-leg squatting to a comfortable degree, then couple of weeks later do full squats, then slowly add weight (i.e. if your max is 335lbs then start by doing the bar at 10-30 reps and then add 10 pounds every week till about 4 months, then you can do your regular lifting but start out on the safe side. Always do stretching throughout the rehab process. Stretch for 1 minute on and 1 minute of for a total of 3 times per day. Also use anti-flam cream on your knee after each weigthlifting session or whenever your knee gets irritated and if it does get irritated the stop doing the thing that irritated it.

These are just general guidelines, know the root cause of your injury first before rehabing it; otherwise you will be wasting your time!

I could not to do a lunge in January, now I’m squatting 335lbs, lunging 180lbs with dumbells, feel no pain while doing the exercises and rarely feel pain at any othertime.

Remember when you get the best, then you can become your best.

My patella tendon on the left leg has been clicking for a couple of years now but it hasn’t gotten to the point where it hurts. I really hope it doesn’t get to that point. But how can I make the clicking go away? Will it ever stop clicking?

It clicks at about the same rate and noise as it did a few years back. I’m thinking this clicking was caused from two reasons both related to hockey.

First off i couldn’t cross-over to the right continuously or even once very well until i was 17 and started playing junior a. Crossing over is basically like sprinting or running for a few strides on the ice but to the left or right. However i’d always been able to cross-over to the left continuously since i first started playing hockey at age 12. Playing junior a your skating pretty much everyday for 8 months so this finally got me used to crossing over to the right.

So i’m thinking my right leg was stronger than my left since i could turn and cross-over to the left. Once i was co-ordinated enough to cross-over in both directions equally is when the clicking started. I’m guessing cause the left leg was doing something new it hadn’t done ever, sustaining the strength, co-ordination and angles to cross-over to the right.

Also i sustained a several of knee on knee collisions with the left knee throughtout my 4 year junior career which resulted in sprained/bruised knee or bad charlie horse. The weaker left leg was always having to catch up to strength of right leg as a result of the left always being injured and having to recover because the right was always stronger and wasn’t injured much.

Should I strengthen the hamstrings to catch up to the quad strength or do lots of single leg stuff on each leg.

However Charlie said when u strengthen the weaker leg the other leg then becomes injured, which is I think, why he didn’t do single leg stuff. So what would you guys do? What would Charlie do? Don’t want the clicking to get louder and have patella tendon pop out of place.

I’m 22 now and hockey career ended at my 20 year old junior season.