Knee Tendinopathy Frustration

Medical Q&A [Moderated]
1

Good evening Doc. I know you’ve had questions on this endlessly. I’ve read all of your articles and scoured the podcasts for answers. Many of the situations seem to have a more acute onset than mine. I’ve been dealing with bilateral anterior knee pain for over 4 years now. I was a competitive lifter and I’m now 45. I stopped squatting for years because of it while continuing to train the other lifts. I’ve recently put myself on the NLP to dial in form and give myself a bit of a reset.

Im excited about squatting again and I’ve worked back up to 3x5 @ 275 with plenty of room to spare. I’m able to stretch out and squat relatively pain free with shoes and sleeves. It’s the other 23.5 hours of the day that I’m miserable. The pain is no worse with or without training, so I’m staying with it. I do understand the neurobiological aspect of pain perception and I’ve started mindfulness meditation for pain management (Jon Kabat-Zinn) in the hopes of addressing that aspect of it.

Ive heard you mention isometric work for tendinopathy. I’ve started getting into the bottom position of the squat throughout the day (pushing knees out with elbows) in the hopes of retraining my brain that it is a safe position. I just seem to be getting nowhere. I take 2 alleve when the ache starts shooting up to my hip and down my shins to calm it down and it does seem to help a bit. But I only take it when it’s really bad and I have to work. I’m a Captain in a busy Fire Drpartment and I have to be able to function. Climbing in and out of the wagon 40 times a shift and up these damn spiral stairs 20 times doesn’t help.

Just looking for for any input you may have or additional information about potential success of specific isometric work that you’ve mentioned.

Thanks for your time and for all the info you put out for us.

2

Are we sure this is actually tendinopathy?

3

I had X-rays with a sports medicine orthopedic Doc which ruled out any arthritis. My knee caps do sit up like a pull tab on a soda can, tilted out laterally. Was diagnosed with patellofemoral syndrome and patellar tracking issues. Went through all the PT, dry needling, mobility, movement screenings, foam rolling which changed nothing. Never had an MRI since the pain doesn’t worsen with training.

There is is pain upon palpating the anterior patella. I’ve always felt like it was generated from extremely tight hips. When my warm ups are particularly painful, I do that bottom position squat stretch whike pushing knees out and I get some relief so I can train.

What else should I consider besides just a chronic tendinitis?

4

Based on your description, this does sound much more like patellofemoral pain syndrome than it does a quadriceps or patellar tendinopathy.

One of the most detailed discussions I’ve found on the topic outside the scientific literature is at painscience.com , so I’d start there.

5

Ok. I’ve heard so much about that diagnosis being BS that I figured it didn’t really exist. I guess I am a special snowflake.

I’ll take a look over there. Thanks for the link.

6

It absolutely exists, though we don’t really have a good understanding of how it works.