Treatments I tried for Patellar Tendinopathy

Physical Therapy -- Over three years I went to three different physical therapists. Altogether, I was in physical therapy for 2+ years. None of the therapists knew about the medical research on using eccentric exercise for patellar tendinopathy. The key benefit from physical therapy was learning the stretching exercises from the third physical therapist. I am convinced that the first physical therapist that I went to made my problem worse by having me ramp up way too quickly with certain (non-eccentric related) strengthening exercises. The second physical therapist I went to did not include any stretching into the program. Furthermore, that therapist had me do exercises that I believe should be contraindicated for early stages of patellar tendinitis -- jumping with heavy weights. Some of the modalities used in physical therapy for patellar tendinopathy such as ultrasound and electrical stimulation probably don't provide any real long-term benefits.  Unfortunately, many physical therapists are simply bad at what they do, and there are many stories of therapists injuring their clients.

Orthopedic surgeons -- Over the course of three years I consulted with three orthopedic surgeons, two of whom have been the chief physicians for college and professional sports teams. While they each gave me the same diagnosis, none could offer any solutions apart from physical therapy. I am grateful, however, that they refused to recommend cortisone or other steroid injections. This is because research has shown that such injections can weaken or rupture tendons. Furthermore, such injections may not provide any long-term benefit. I am also grateful that these surgeons did not recommend surgery. This is because surgical outcomes for patellar tendinopathy are often not that good. Surgery also requires recuperation time and physical therapy afterwards. Surgery can lead to complications. It is also irreversible. Unfortunately, none of these fine doctors mentioned eccentric exercise as a possible treatment.

Chiropractic techniques -- I went to two chiropractors for a period of time. The approach used by each was very different. I sometimes found short-term benefit (an hour or more of pain relief), but unfortunately no longer-term benefit. The approach of one was to use a butter-knife type instrument and apply a scraping-like motion across the tendon. The same chiropractor put me on a table and actively stretched my legs. I generally felt much better coming out of these sessions than when I went in. Unfortunately, the next day I was back to the same without any lasting improvement. I found less success with the second chiropractor I went to. This chiropractor's technique was to put intense finger-point pressure on muscles around the lower body and maintain that pressure for a period of time.

Massage of the tendon and surrounding muscles -- While this did not cure my patellar tendinosis, I believe that regular treatments may reduce the likelihood of problems in the first place and reduce the risk of re-injury.

Orthotics and shoes -- I have found some benefit to orthotics and certain shoes. However, I found this to be a bit of trial-and error in finding what was helpful. Furthermore, I found no benefit to customized orthotics versus standard orthotics that I bought in a store. In fact, I much preferred the feel of some off-the-shelf orthotics. Customized orthotics can cost substantially more than off-the-shelf orthotics (In 2008 a pair of custom-made orthotics cost around $400 versus off-the-shelf orthotics that cost as low as $18.) Orthotics may wear out and need to be replaced every year. I generally find sneakers to be much more comfortable (and less pain-provoking) than work shoes. Some types of sneakers are better than others. Some kinds of work shoes are much better than others, as well.

Patellar straps -- For me, these were an excellent way to deal with short-term pain. But, they only relieved short-term pain and did not provide a long-term solution. Unfortunately, I found that using these straps for many weeks on end led to other problems -- such as pain on the sides and back of the knee. While I recommend the straps when pain is bad, I would try not to use them everyday for weeks on end.  I ordered off the internet many variations of patellar straps and perhaps tried 5 to 10 different kinds. I found a few that I liked. Sometimes I preferred ones that applied more pressure to the tendon. These generally had a thick piece of rubber that curved around the tendon. Other times I preferred softer patellar straps without the rubber. I also found helpful "dual action" straps, which have one strap above the knee and one below.

I discovered a particularly serious risk, although probably rare, that may occur with the frequent wearing of patellar straps.  As the strap goes around the leg, it may compress the peroneal nerve, which comes close to the surface of the leg near the knee.  (This occurs near the head of the fibula on the lateral aspect of the knee.) This could lead to nerve injury.  Symptoms to watch out for include pain, weakness, decreased sensation, numbness or "pins & needles" sensations in the foot or leg, "foot drop," where the foot slaps the ground when walking, the inability to walk on one's heals, and reduced dorsiflexion, i.e. the ability to backward bend the foot towards the leg.  The symptoms can be temporary or permanent depending on the severity of the nerve injury and may require medical treatment.  If you notice any of these symptoms, stop wearing the strap and see a medical doctor.

Rest -- My view is that rest is good in the very early days and first few weeks of developing patellar tendinitis when there is inflammation. However, at some point, strengthening exercises, such as straight-leg leg lifts, should be added, to reduce the likelihood of muscle atrophy. I also believe that walking should be kept to a minimum in the early days of tendinitis. However, once tendinitis morphs into tendinosis after many months, rest won't serve any useful purpose and certainly won't cure longstanding tendinopathy.

Acupuncture -- I had too few sessions to likely make an informed opinion. However, I can say that a few sessions certainly did not work for me. Furthermore, while it may be possible for acupuncture to relieve some pain, it does not get at the root cause of the problem. It certainly won't cure the underlying pathology.

Ibuprofen and other anti-inflammation drugs -- Perhaps I had some very short term minor pain relief, but no long-term benefit. Taking too much of these or taking them for too many days can lead to significant negative medical complications, as well.

Ice -- During the early phases of acute tendinitis, ice can help reduce inflammation and pain. But, once the inflammation is gone and one is left with tendinosis, ice probably won't help except for providing a very short term benefit of pain relief. There likely won't be any long-term benefit. I believe that too much prolonged icing can lead to other problems, such as changes in skin and possible nerve damage. I used to ice religiously, but now I don't ice after doing my eccentric exercises. After experimenting with and without ice, I find no need for it.

Knee taping -- This provided some short-term pain benefit, but it certainly wasn't a long-term solution. Having to reapply tape every few days and ripping the tape off was not a real long-term solution. Furthermore, walking up and down stairs wasn't very possible at times because of the position of the tape.

Topical knee creams -- I tried a variety of balms, creams and lotions. While those with camphor and menthol provided very short-term pain relief, others with aspirin derivatives provided no short-term help. However, none of these potions provided any long-term benefits. Plus, some of them have strong odors that can permeate an office environment. Also, avoid compounds with capsaicin (sometimes used for arthritis and other ailments), which will temporarily worsen your pain by making your knee feel like it is on fire.

Glucosamine & chondroitin pills -- I took these for three months and saw no change in my pain level.

Eccentric exercise -- This is the only thing that has worked to substantially reduce my knee pain on a longer-term basis. But, such exercise must be done properly with the right protocols, otherwise it can lead to a relapse of symptoms. Eccentric exercise is one of the few treatments that I know about that might actually help reverse or improve the underlying tendon pathology.