Sunday, September 13, 2009

Will "Eccentric Exercise" Cure You?

Will "eccentric exercise" cure your chronic patellar tendinitis?

-- Even using the ideal protocol for eccentric exercise, one may not be completely cured. However, there are many success stories where people who have had years of patellar tendinitis (also spelled tendonitis or called tendinopathy) have outstanding success after a program of eccentric exercise. It is fast becoming the most accepted form of treatment for chronic patellar tendinitis.

-- These exercises put a lot of force on the patellar tendon, so they must be done very carefully over many months. If done improperly, they can lead to a worsening of symptoms. They should be used only for chronic cases, should not be used for inflammatory tendinitis, and should be done only under the recommendation of an appropriate physician.

-- Even if you are not completely cured, however, your pain might be reduced substantially and you may be much happier. Your pain may be reduced to such a low extent that it does not bother you much. And, there may be more times of the day when you have no pain, or much less pain. In my case, the exercises have helped me to reduce pain a substantial amount. Now, I rarely have pain. The times I do have some pain, it is substantially more tolerable -- and I am much, much happier.

-- The exercises may help you to have no pain or substantially less pain while you do certain activities, such as walking down stairs; driving a car; walking for long distances; bicycling, etc...

-- Even if you find you are not completely cured, eccentric exercise may still be a substantially better alternative than most other kinds of treatment, including surgery, other kinds of physical therapy, certain chiropractic techniques, extracorporeal shock wave therapy, prolotherapy, sclerosing treatments, etc...

-- In my opinion after reviewing the medical literature and trying a number of different kinds of treatments myself, I believe eccentric exercise is far better than other alternatives. The success rate is generally much better. Furthermore, other kinds of treatments, such as surgery, may lead to irreversible adverse effects.



49 comments:

Josh said...

Thanks for this blog, im a basketball player 20yo, I've had tendinitis on and off (months on months off) for about 2 years now.
I have it again and im getting sick of it as i can't train as much as i would like, i was given these exercises recently i will go at them properly now. I've been scepitcal of the physios as some just do ultrasound and send you on your way.

Again thanks for your blog, i booked an appointment with an institute of sport in my state i hope its not that bad

ario said...

I'm so glad to have found your blog! I will start your eccentric protocol immediately.

You may find my story and research I've compiled interesting...

http://interimlover.livejournal.com/527692.html

Up until 1 month ago, I was doing heavy weight deep squats with a knee that in hindsight, was at the tendonosis stage. I'm sure I made things worse, but hopefully, with your exercises, I can improve my situation.

Anonymous said...

Thanks for this blog. I'm a recreational runner and was doing about 4.5 miles. Then I started running on hills and my knees went downhill (pun intended) rapidly. I haven't run for about 5 weeks while researching the problem and narrowed it down to tendinitis in the knee. I'm in little to no pain now but was researching prevention techniques and stumbled across your site. This type of information is invaluable. Thanks for sharing.

Anonymous said...

Thanks so much for taking the time to document and post this information!

One question...during the first weeks/month, are you using a slant board, or is that something you add to the protocol after doing level-ground squats first?

Sigfus said...

In response to your question, I start with the slant board from the first day. (Other protocols I have read about typically begin with the slant board, as well.) However, if you want to ramp up more slowly, you can start with level-ground squats.

Anonymous said...

great site
can anyone tell me how long you need to do the eccentric exercises before u can go back to doing fully squats (eccentric +concentric)

NeezyDeezy said...

Hi,

Are you able bicycle now without pain? Do you think seat height or bike size contributed to your injury? How many miles / hours can you now cycle for without pain?

Thanks!!

Sigfús Víkþörðson said...

neezydeezy,

In response to your questions:

1) I can bicycle without pain. The original injury was 4 years ago. For longer distances, I occasionally have patellar tendon "sensations" that don't rise to the level of pain. Last month I rode 56 miles one day and had some tendon sensations at times, but no pain.

2) I don't believe seat height or bike size contributed to the injury. I bought the bike from a reputable shop after test riding a number of bikes that were the correct frame size. The seat height was fitted for me. Furthermore, after purchasing the bike, I rode the bike many, many times with varying distances per ride. I never had any problem. Instead, I am convinced the injury was related to the significant increase in the number of miles I rode over a period of two consecutive weekends. This was early in the season after not bicycling for 3-4 months. The injury was do to "overuse." (This occurred more than a year after purchasing and using the bike.)

Anonymous said...

Thanks very much for your blog. It is by far the best online resource for understanding eccentric exercises and patellar tendinitis.

I wonder if you could offer a brief description of the pain you suffered. Burning or aching? Pain across the front of the patella or localized in the tendon or at the insertion of the tendon? A sensation that the tendon was tearing or stretching? Did you have trouble sitting, climbing stairs, walking? Pain worse at rest or while active?

I've been diagnosed with quadriceps tendinopathy (too much biking, too soon), but sometimes have a hard time believing that so much pain can result from "just a tendon problem."

From the resources I've found, I understand that tendinopathy can be painful, but I've been unable to find many descriptions of the nature of the pain.

Again, thanks for the blog. It is a extremely valuable resource.

Sigfús Víkþörðson said...

Thank you for your comments. I reviewed my daily "knee diary" to answer your questions. Below describes the pain I had during the first 3 to 4 years since the problem began. Now, at the 4 1/2 year mark, I am happy to say I no longer have most of these symptoms. Today, I occasionally have low-grade "sensations" that don't rise to the level of pain.

Pain during the first 3 to 4 years:
-- Mostly horrible nagging achy tendon pain everyday. Also, gnawing, tearing, and pulling pain. All of these symptoms have either disappeared or become much minor versions what they had been.
-- Frequent unrelenting burning pain. This eventually went away completely. (I don't believe this neuropathic symptom is typical for most people with chronic tendinitis.)
-- Occasional feelings of knee stiffness. This eventually went away.
-- Rarely, I had some "bone-on-bone" type sensations. This went away.
-- Very rarely, some "pins & needle" sensations. This went away.
-- On very rare occasions, the feeling the knee was unstable and could twist or buckle off. This went away.
-- On rare occasions, the tendon felt tender when touched. This went away.

Pain was most pronounced:
-- During and after walking. (Today, I sometimes still have some sensations after walking longer distances.)
-- While standing in one place.
-- With prolonged sitting.
-- When driving, especially when pressing the accelerator. (I had the tendinitis in my right knee.) Today, I still have some sensations when driving.

In addition, my pain generally increased as the day went on. So, during the mornings I had less or little pain. In the late afternoon, I had much more pain.

I sometimes had pain walking downstairs. Less so, walking upstairs.

I typically had less or no pain when laying down completely flat.

Some days the pain was worse than others with no clear reason why.

The pain itself was throughout the length of the tendon, not just at the insertion points.

Anonymous said...

Your blog is great thanks! I live in Toronto, Canada and I'm having a hard time finding a slant board. Do you know of any web sites that might sell them?

Sigfús Víkþörðson said...

To purchase a slant board, a couple of websites you can try are:

allegromedical.com and

protherapysupplies.com

My preference is a metal slant board with a 22 degree angle.

You can search under "slant board" and may find other websites, too.

buckeye said...

Hi. I've had patella tendonitis now for about a year. it started when i was running a lot during lacrosse season and when i think it goes away, it ends up coming right back. i also play goalie in hockey and am going DI for that. One concern/queston...since the pain started and has been there for a year, i have a hard bump right over the spot that the pain occurs at the very tip of the botton of my knee cap). if i press the bump with my finger i can feel the bump move and almost "crunch". Did you ever have anything like this? The doc says it's scar tissue from possibly a minor tear...Are you know able to run regularly witout pain?

Sigfús Víkþörðson said...

buckeye,

I have not had a bump on my knee. However, I know someone who suffered with patellar tendinitis for many months and who did have a small bump. While she still has the bump, her patellar tendinitis symptoms went away. In answer to your second question, I can run without any pain.

acstewart25 said...

Hi Sigfus, was reffered to this site via an Australian injury discussion forumn. I have had the same symptons as you for years now. Been to physio, surgeon (no surgery) and now physical medicine doctor. Also an MRI which diagnosed patellar and quadricep tendonopathy. A lot of money spent on this highly frustrating injury.

At what stage did you begin to carry out your exercises? I.e were you still experiencing pain when you started? I am worried that if i do this I will cause further damage, including starting with no additional weight.

Any response much appreciated.

Cheers
acstewart25

Sigfús Víkþörðson said...

In response to your questions:

I began doing eccentric exercise 2 years and 2 months after developing patellar tendinitis.

I still had significant pain everyday when I decided to start the exercise program.

During the several minutes each day when I performed the exercise, I did not have any increase in pain. (I do not recommend doing the exercise if it increases one's pain.)

It is important to start such a program very, very gradually with no weights at first and only a very few number of repetitions when you start.

Cactus Kid said...

Just wanted to thank you for this excellent resource! I picked up mine training too hard for a marathon 3 months ago. I think the mistake I've been making is not being constant in my approach.I never rest long enough and then start in on a protocol too hard and then stop because it flares up. I'm determined now to really rest it to get max benenfit from that before starting eccentric decline squats. Many thanks for your detailed notes. I too am keeping a blog at:

http://mysorerightknee.blogspot.com/

to help record the symptoms I get and the pain I feel - might be useful for other folks as well

NC said...

Hi Sigfus, thanks for the great blog. I was diagnosed with quadriceps and patellar tendinopathy in February 2009 and have been struggling with recovery since. I started eccentric loading using a leg press (two legs up, one leg down) in July 2009, then moved on to a decline board (single leg) in August. After a few weeks of the decline board, the pain became almost unbearable (hobbling), so I've been resting since. I likely moved too quickly from the leg press to the single leg board. It's been a month without leg exercising (just walking), but the pain has only decreased marginally--it is worse than when I first injured it!

When do you recommend returning to the eccentric exercises? It is incredibly frustrating the rate of progress. Would you recommend resting altogether (immobilization brace of legs) for a week or few? Seeing it's been so many months since my injury, perhaps my doctor would support this as well. Thank you!

Sigfús Víkþörðson said...

NC --

A few comments:

1) Periodic flare-ups of symptoms with patellar tendinopathy isn't uncommon.

2) It is important to learn what led to each flare-up and document it, so you will try to avoid doing whatever led to the flare-up to reoccur. In your case, moving too quickly to the decline board may be the likely explanation.

3) Remember when starting on the decline board, you need to progress VERY SLOWLY. Please re-read my protocol. Did you start on the decline board with two legs for a couple of weeks before going to one leg? Did you start off with few repetitions? If the answers are "Yes", then when you return to the decline board, you will need to progress at an even slower pace. For example, you may want to use both legs together for a month, starting with only 2 or 3 repetitions once every other day. From there, when you go to the single leg, again start off with only 2 or 3 repetitions perhaps every other day. Keep a diary of the number of repetitions you do. ADVANCE SLOWLY OVER TIME!

4) Confer with you doctor on your progress. Perhaps, this protocol may not be appropriate for you. Or, you may need to modify it. Or, perhaps you may need to put it off for a couple of months before restarting it. Personally, I had a number of flare-ups of symptoms when I was starting off doing eccentric exercise. My lesson was that I needed to progress very slowly. If I had a flare-up I'd take one or two weeks off before re-starting the eccentrics.

5) You say you are walking. Very short distance walking is probably o.k., but extensive walking can definitely lead to flare ups.

6) Immobilization is usually not recommended at all because it leads to a weakening of muscles around the knee. But, I would take it easy for some time, avoiding much walking and stairs.

7) When you and your doctor feel you are ready, you can re-start the eccentric protocol, but at a much slower ramp up than you did previously. If you feel terrible pain, I would hold off, consult with your doctor, and perhaps focus for some time on light stretching.

Best of luck! Please let us know of your progress and any modifications you make to the protocol.

NC said...

Thank you for the helpful response, Sigfus.

I was certainly too aggressive with the decline board in going directly to single leg from the leg press. You mention resting for 1-2 weeks after flare-ups. Is this irregardless of the exacerbation/increase of pain you felt during flare-ups? For example, were some flare-ups worse than others, requiring longer time?

In regards to atrophy, this makes a lot of sense, but I would imagine minimization of walking would almost be comparable to immobilization? In reading the literature, 2 weeks of immobilization may result in up to 15% atrophy (as measured by amount of nutrients metabolized), but returned to original levels after 2-3 weeks of exercise.

After this many months of slow, and sometimes, backwards progress, I'm almost afraid of walking. Psychologically, this is a quite deflating. I can't imagine the 4+ years you've dealt with it! When I read about athletes ending their careers because of this, I'm even more wary of what's ahead. At the same time, when I read about Rafael Nadal returning to tennis after only 3 months of therapy, I dearly want to know what he did to recover from quadriceps tendinopathy so quickly and visit his doctors/therapists immediately!

Sigfús Víkþörðson said...

NC --

Some additional comments:

1) Some flare-ups may require more time before you restart the eccentrics. It involves trial-and-error. I could see sitting out for a month until things start to quiet down. Restart when you and your doctor think it's appropriate.

2) Reducing walking is not the same as immobilization. With immobilization, there is no movement at all.

Separately, there are straight-leg lift exercises often recommended by physical therapists where you are on the ground on your back lifting your leg while holding it straight. This way you are getting exercise without flexing and aggravating the patellar tendon. A physical therapist could show you how to properly do this.

Keep up your hope. For some time, I thought I would never be cured. However, two weeks ago I did a one-day 100+ mile cycling event and had no patellar tendon pain during, immediately after, or since the ride.

JohnDoe said...

I am currently suffering severely from quad tendonosis. I am a professional athlete (basketball) and I have been all over the country seeing different doctors and after 3 platelet rich plasma injections, several different PT's with several different protocals I am just fed up. I have finally come to the conclusion that I will miss this entire season bc I have no improvement. Being a free agent that means no income for the year. Terrible. This actually makes me feel like I am going to have my career stopped prematurely ( i am only 24) I don't even remember the last time I my leg felt no pain. I can't even go down the stairs without extreme pain much less play defense on somebody or explode to the basket. My question is do you think this will work for quad tendonosis? I have done eccentrics several times but usually on a leg press and extension w/o a 100% dedication to it most of the time. The one time I was dedicated to it I was doing other exercises as well which I think may have overdone it. Any information would be helpful. I have the top docs in the country and they are thinking surgery is the next step!! Already had an ACL (hamstring graft) and a scope on this leg!! HELP!

Sigfús Víkþörðson said...

Very sorry to hear about your situation, I have a number of thoughts:

-- While most studies on eccentric exercise for the knee specifically refer to chronic patellar tendinitis, rather than quadriceps tendinitis, eccentric exercise appears to benefit quadriceps tendinopathy, as well. In fact eccentric exercise has been found to benefit tendinopathies in other orthopedic ailments, as well, such as in the Achilles and the elbow (although the method of performing the eccentric exercise is clearly different than for the knee.)

-- In my own situation, I had symptoms of both chronic patellar and quadriceps tendinitis, although the quadriceps symptoms were less frequent. Now, I rarely have symptoms of patellar tendinopathy and never any symptoms of quadriceps tendinopathy.

-- The eccentric exercise protocol requires a high-level of dedication. Even still, there could be some temporary flare-ups of symptoms in the weeks and months after you begin the exercises. There is also no guarantee it will work in all cases. For me, it was the only thing that worked.

-- During the first 2-3 years after I developed the patellar tendinopathy, before embarking on the eccentric exericses, I had terrible pain most everyday and it seemed it would never go away.

-- Since you have been doing a number of other physical therapy protocols and getting injections, you may need to take a rest for few weeks before starting the eccentrics. Perhaps, you have already done this.

-- To reduce pain walking downstairs and as you go about your daily activities, you may consider a "Cho-Pat Dual Action" knee strap or something similar. This may help reduce your pain temporarily. Just don't wear this while doing the eccentrics. Also, don't get too dependent on it.

-- Before even considering surgery, you want to make sure you've tried other more conservative approaches. Surgery may not work at all for you; it is irreversible; it could lead to other problems; it may entail a long recovery time.

I wish you the best of success. Unfortunately, there are no quick or easy cures for this.

Please let us know of your progress.

JohnDoe said...

Thank you for the quick response. I really appreciate your insight. It's funny because after all the things I have done for this, the eccentric protocal seems so simple. Maybe that's what i need though. I agree with you about the surgery bc like i said before that would be my third surgery on this knee and I don't think that I will be able to return to my sport as strong as I could If I am able to control this without the surgery. I am dedicating myself to this bc I have been in total depression over this. (obviously bc my athletic career is my life). I will give updates on how it is doing and hopefully it will help give more information on what this can do for the quad tendonosis. I am 2 days in and I am recording symptoms and pain levels. Thanks again, and if anyone else has any advice or anything I would love to hear it.!! Thanks!

NeezyDeezy said...

John just remember to take it very slow. You might want to reconcile yourself to the idea that you might not be able to play basketball for a while if you really want to give your leg a chance to fully heal. I did the protocol for patellar t. and it's helped somewhat, but only once I took a very conservative, long-term approach and reduced the frequency and reps I did.

JohnDoe said...

Yeah your right neezy. The problem for me is I can't play bball even if i wanted to. Trust me I have tried. lol. Thats how bad my conditions is. It has been this severe since April, so I am very pesamistic about how this is going to turn out. I really do like to hear that you have found some success with this, that gives me a little hope. I appreciate your comments and concern, and welcome any other replies. thanks again

Jehaan said...

Hi. First, I would like to thank you for this extremely informative blog.
I've been suffering from patellar tendinosis (or jumpers knee, whatever you want to call it) for 2,5 years now. Traditional physiotherapy (mainly concentric exercises and friction massage) only helped for a while.
I'm going to to try eccentrics after I get the go from my sports physician.

Before that however, I have a few questions.
First, if I get to the point where I can squat with, say, between 10-20 pounds WITHOUT a slant board, you think I can start again with a slant board of 25°, or should I build it up (10°, 15°...).
Second, about the stretches. Did you do all of them each day? How long and how many sets? Did you do them even when you had a relapse in pain?

With regards
Jehaan

Sigfús Víkþörðson said...

Jehann,

In answer to your questions:

1) You can start with a 25-degree slant board. However, I would start with fewer repetitions and gradually add repetitions every few days.

2) I did the stretches each day, generally once in the morning and once in the evening. For each type of stretch, I did 3 or 4 repetitions and held each for around 30 seconds. I continued to do the stretches during the relapses as long as the stretches themselves did not cause or intensify any pain.

Good luck. Let us know of your progress.

Salman said...

Hi Sigfus,

Your protocol worked great for me. I owe you many many thanks. I returned back to playing basketball at almost 100% and have had no recurring problems over the last 7 months.

A few days ago I started doing lunges and had a flare up. I have heard Peterson step up's and single leg squats are helpful for tendonitis. What kind of leg strengthening work is good once symptoms have gone?

Sigfús Víkþörðson said...

Salman,

I'm happy the protocol worked for you.

Flare-ups can occur. Take a break from exercise for at least a few days to a week. Avoid lunges when you resume exercise.

My favorite exercise for leg strengthening: Straight-leg lifts with ankle weights.
I like it because you don't bend your leg and thus, don't aggravate the patellar tendon. I'd start off with few repetitions and increase reps slowly over time. I'd add small increments of weight to the ankle weights over time, as well. You should consult with a physical therapist for proper technique.

Good luck!

Mariano said...

Hi Sigfus,

thank you for sharing this information. Like you and many others I have tried pretty much all other methods of cure and exercises and after 1 1/2 yrs. I am still dealing with Patella Tendonosis. I am starting your protocol and I am hoping that it will work for me as well. I have several questions:
1) how long did you do these exercises before there was no pain?
2) Have you heard of any success stories for volleyball players? Unlike many other sports volleyball requires running towards the ball, stopping the forward momentum (so not to run into the net) and then jumping. I believe that this is what caused my problem much more than just jumping.
3) When you had flared ups and you mentioned stopping and starting over, did you mean starting all over with no weights or did you mean stopping for a few days and then starting from where you left off?

Thank you in advanced for any additional information that you may be able to provide.

Sigfús Víkþörðson said...

Mariano,

Answers to your questions --

1) The first time I tried eccentric exercise was in late 2005. I experienced reduced pain within the first 3 weeks. However, the pain continued and I had occasional pain flare-ups. After some time, I stopped the eccentrics. I tried the eccentrics again in mid-2006 making refinements to my protocol. By early 2007, my pain was noticeably reduced. By mid-2008, I was essentially cured.

2) I know of two studies of eccentric exercise involving volleyball players. (Both studies were published in 2005 and abstracts of each can be found in the Pubmed.gov website by using volleyball, eccentric, and tendinitis as search terms.) One study showed significant reduction in pain along with improved volleyball performance. Another study showed no improvement. However, that study was done while the subjects were continuing to play volleyball and the authors wonder whether the players would have seen improvement if the study was done in the off-season instead. Also, I would like to know if the protocol used was a good one!

3) When I had flare-ups, I would typically take a break for at least several days, and then resume again with somewhat fewer repetitions and less weight. If in doubt, sharply reduce the weight and add more days to your break.

Good Luck!

Clay said...

Hi Sigfus, and thanks for all the information. I've been suffering from tendinitis in the left knee, along with a tight IT band, for about 18 months due to overuse (running/hiking/biking). I won't belabor you with details b/c they're similar to those of other cases posted on this site.

What I'm most curious about, is how did you cope with the frustration? I noticed you mentioned the importance of watching your eating habits, but this knee is driving me crazy and it makes we want to eat and drink my troubles away. I have classes and soon hopefully will have a job, so I do have distractions, but still it's hard to get through the day without wanting to tear my hair out. Any suggestions for coping with this anger/frustration?

Also, I wasn't entirely clear on your present activity level. Are you able to run significantly now? It sounds like your biking is good, but I'm curious if you've gotten back (more or less, at least) to your pre-injury activity level in all activities. Do you have to avoid certain exercises? Can you do the "athlete's standard" of 4-5 days of exercise a week? Also, what about weight lifting? And when you transitioned back into doing aerobic exercise after several months of eccentric drills, how long did it take you to reach your current aerobic activity level? It sounds like you really turned things around for yourself... I guess I'm fishing for some inspiration.

Oh, and I'm going to look at your Iceland photos next. :)

Sigfús Víkþörðson said...

Clay,

Dealing with the pain and frustration of chronic patellar tendinitis is challenging. A key way to deal with this is believing that one day you will be cured even though it may now seem to you that this will never happen. It often seemed to me that my pain would last forever and things would never improve. But, things eventually improved and I am now back to normal. I can do all the things I did before. In fact, I believe I am now in better shape after still continuing to do daily stretching, which I started to do as part of my treatment plan. Other things to do to reduce frustration: learn what aggravates your pain and try to minimize those activities; wear a patellar tendon strap if you need to if it reduces pain, but remember it isn't a cure;
pick up additional hobbies that won't aggravate your knee; read all you can about chronic patellar tendinitis to see if there are additional non-surgical things you can do to reduce pain, even if they just temporarily reduce pain; go to the movies to take your mind off your knee. These are some things that I did and would recommend.

Good Luck!

Anonymous said...

I struggled with this for over a year and had to give up basketball. Sitting in any position with a bent knee was agony - even driving! After I started the slant board regimen I noticed improvement in about 2 months and in about 6 months I was basically pain free. I'm back to basketball now with no pain whatsover. A big thanks to those who discovered this!

Clay said...

I'm curious, did these exercises cause you discomfort over the course of your improvement? For me, the patellar pain never entirely subsides, even if I rest for months (although I'm certain the inflammation is long gone). I was started on an eccentric regimen by a physical therapist, but he pushed too hard and it made things worse. I guess I'm wondering - since my knee always hurts anyway, how am I supposed to gauge what is an effective eccentric regimen, and when I'm doing too much?

Sigfús Víkþörðson said...

Clay,

If you push too hard, you will have pain. I've found that physical therapists often give their patients too many sets or repetitions of a particular exercise without properly ramping them up at a slower progression. It does not surprise me at all that your physical therapist pushed you too hard. When I developed my protocol I did so after trial and error, including trials when I ramped up too fast and had flare ups in pain. I learned to ramp up SLOWLY. Please read the protocol again. There are suggestions on how to ramp up slowly and what to do if you have flare ups in pain. It's better to err on the side of caution so you are less likely to over do it. If it has been at least a few weeks since you stopped the eccentrics in physical therapy and your pain level is back to where it was before you began physical therapy, you could restart, but ramp up very slowly.

Keep us informed of your progress. Good Luck!

Tommy said...

Hi Sigfús,

Your blog is fantastic: clear detailed description of the protocol, good overview of stretching, sharing your experience, ... This has given me new hope!

I'm a volleyball player ("outside hitter") and have been suffering with patellar tendinopathy/jumper's knee for nearly 2 years now. I think it was initially caused by the following:
- Playing too intensively & frequently.
- Wearing the same volleyball shoes for many years (so no more proper cushioning!).
- Overpronation of feet.
- Slight overweight: 100 kg (220 pounds) for height of 1.89 m (6 feet 2 inches) -> BMI = 28.

Anyway, I've had similar frustrating experiences with anti-inflammatory drugs, physicians, orthopedic surgeon (luckily I didn't have surgery or shockwave), orthotics, chiropractor, ...
I'm definitely going to try your protocol & stretching! If I can resume volleyball after some months (even as "just" a setter, to minimize the jumping), I won't buy you a cup of coffee... but then I'd buy you a case of Duvel! This is the best beer of Belgium, and probably of the world! :-)

A question: should I try to lose some weight (e.g. 10 kg) as well? If yes, should I do it before, during or after the protocol? (I guess it won't be easy, if I can't do other kinds of exercise)

Cheers,
Tommy

Sigfús Víkþörðson said...

Tommy,

Your question about whether you should lose weight is very easy to answer. YES !!! If you go by the Body Mass Index, based on your height you should be less than 195 pounds if your extra weight is all fat and not muscle. In any case at 220 pounds you should start now. If It were me I would eat 2 nonfat yogurts for dinner, light breakfasts and lunches every day until you lose weight. Record your weight daily and make sure you make daily progress. Each extra pound of weight puts a lot of stress on your knees. You can lose weight by eating better even if you don't exercise.

Good Luck!

tom said...

Hi Sigfus,

i was reffered to your blog by a physio that i saw in London to show how to do eccentric exercises. it was great to read as it has given myself hope that i can get past this problem, i am a hockey player and have had to stop because of my knees. i have had the pain in my left one for a lng time now but my right one is also sore, probably from over compensating for the left. i have two questions that i would be greatful if you could answer.

1) the video my physio sent me is one where you sit down at the end of the squat and sit up on two feet, whereas yours is just constantly doing it one one leg, can i do both or jus one and which one would you suggest?

2) should the exercises hurt while doing them, as it does for me but it is manageable, doing the exercises without weights on a slight slant.

many thanks

Sigfús Víkþörðson said...

Tom,

In answer to your questions:

1) Doing the exercises where you sit down at the end of a one-legged squat and then stand up with both feet would be appropriate, AS LONG AS THE CHAIR HEIGHT IS NOT TOO LOW. If the seat is too low, you will end up squating too low, putting way too much pressure on your bad knee.

If done appropriately, your version has the leg in question correctly focus much of its energies on the eccentric phase of the exercise, which is ultimately what we want, as opposed to the concentric phase.

2)Ideally, you should feel no pain while doing the exercise. Or, perhaps I should say no more pain than you might have on a typical day. Some protocols do allow for some increase in pain while doing the exercises, but then you get into questions of how to define what is an acceptable level of pain. If you have some manageable level of pain doing the exercises, and your physical therapist tells you to continue with the exercises, then my advice would be to ramp up exceedingly slowly over weeks, to make sure you aren't worsening things. So, early going you may want to do fewer reps and sets than your therapist indicates. Trial-and-error may be used, but cautiously so.

Good Luck! Let us know how you progress.

gazza1286 said...

Hi Sigfus

I've suffered with quadriceps tendinosis since October 2010 and the pain has been debilitating at times. Your advice and regime have helped immensely. I was beginning to forget what life was like without this pain.
It is only over recent weeks that the discomfort has begun to ease. I am keen to return to my bike and over the last few weeks have been on a few short rides up to 8km. The last two rides were totally pain free - not even a twinge! Always on relatively flat roads and at a high cadence of around 80. Very mild discomfort followed several hours later and only then for a coupe of hours or so. Far too early to suggest that I'm cured!
What advice can you give regarding my return to fitness. For the last 18 months I have been sitting down a lot. No exercise to speak of and very little walking so I know the recovery will take some time. Before the problem struck I was able to do a 50km ride twice a week with no problems whatsoever.
Do I need gym work - swimming - riding (build up the KMs slowly on flat roads) What do you advise?

Many thanks

Gary

Sigfús Víkþörðson said...

Gary,

I am glad you had two pain-free rides. Congratulations!

OK -- my key advice is DON'T OVER DO IT! Continue to ramp up your cycling slowly over weeks and months. Same with walking. Same with swimming. Do only a very, very small amount of walking and swimming at first. Take a break for a day or two, then add a little more the following day, and follow the same pattern. If this doesn't work, and your pain increases, you should consult a doctor. A good physical therapist may be of help at this stage. You must keep a diary of exactly what exercise you do and how much you do each day, if any.

Good Luck!

Cohen Ilan said...

Awesome!

Sara Becks said...

Hello,

Thank you for this blog, it has been extremely helpful. I've been dealing with tendinosis for 10 months now (first in my right knee then in my left). I would say my right knee hasn't had any flare ups in 6 months. And most recent MRI came back normal. My left knee is still improving.

My question is, is that my flare ups result after small pops in the tendon. I'll be walking up a ramp or stepping up onto something and feel a quick "pop pop pop" in the tendon. This will go away, but two days later the tendon will flare up. I have believed this to be the misaligned fibers breaking, and it feels like that's what it is too. And wonder if this is a good sign. Have you come across this in your knee journey? My doctor and physical therapist don't know what to make out of it, since most people's flare ups don't start from pops. Nothing is torn when this happen (MRI- just tendinosis- otherwise normal knee)

I've been taking my rehab very very slow. I am now able to bike on flat surface, and walk a mile or two at a time. I have not run jumped or skipped in 10 months though.

Wondering what your thoughts are

Thanks for your help. It's must appreciated. It's hard to find good help, unless your had tendinosis no one really understands what you are going though.

Thanks- Sara

Sigfús Víkþörðson said...

Sara,
I'm glad you like this website. I have not heard of the "pops" you mention. I have not come across this in my readings or from others on this site. Perhaps, you can continue to explore what they are with other orthopedic doctors or physical therapists. Good luck!

FLEX-N-GO said...

Hello Sigfus, I am so thrilled to hear from you personally. I can not tell you how many times I have sent the link to your video as a follow up to Brian. I add you in as a "continue to build the strength video". Having a good source is such a blessing. Yes I will in the very near future add a patellar tendinopathy tab to my site.

Have you seen this as well

http://www.amazon.com/Beating-Patellar-Tendonitis-Treatment-Pain-free/dp/1491049731

also

http://www.fix-knee-pain.com/the-jumpers-knee-treatment-triangle-3-secrets-to-stopping-patellar-tendonitis/

This gentleman is Martin Koban. His information is outstanding. His free news letter is also top notch.

I look forward to corresponding with you in the future. Best Wishes!! Kelly Reeme

Cohen Ilan said...

Now this is really interesting!

Victoria said...

Thanks very much for your blog. It is by far the best online resource for understanding eccentric exercises and patellar tendinitis.