Hi !
I have read most articles about patellar and quad tendinopathy (yours, Stronger by Science, Squat University, Overcoming Tendonitis, etc.), yet I’m still having some questions regarding this condition. I have asked my doctor to get an MRI to at least see if there is some degeneration going on. I know imaging isn’t always reliable but it’s better than not having it, I guess.
Basically I did a lot of jumping and heavy lifting a few years back (pliometric based sports, powerlifting style training.) When I eased up on this, the pain eventually subsided, and even disappeared. I switched to other sports which were still pretty load related (skateboarding) but maybe less so than my previous sport (Parkour), and for a couple of years, things were pretty great. Great enough that I didn’t even think about it anymore.
Now a few week backs, after a 3h skate sesh, the irritation I felt back then came back. Pain right in the center of the top of the patella, right where the quad tendon attaches. Obviously my first thought was that it is tendinopathy. I don’t see lots of articles on top of knee cap pain, so it is my current assumption. I visited a physio which noted a slight lack of tibial rotation, external hip rotation, and slightly weaker glute medius. Now I have my doubts about any of this being related to the pain. It does not appear to be related to quad or hip tightness, as those assessment were in normal range.
I have avoided any irritating exercice since it started back. Pain in daily activities ranges from 0 to 2 out of 10. Where I am getting mixed signals is in the apparition of symptoms. I made several self test; a jog or moderate accelaration does not aggravate it. I can do multiple vertical jump, single leg hops, without feelin any pain. I can run up stairs no problem.This does not seem to be in line with what I understand of tendinopathies. That being said, these tests do not use much knee flexion, so it is possible that the tendon is not stressed enough in those position ? As a counter exemple, a single leg eccentric squat will ellicit more pain when reaching a certain angle. Standing immobile at my job (no movement for consecutive minutes) seems to aggravate it further than a jump, too, which isn’t really load related either. I also can do deep knee flexion with no pain, but a knee flexion with simultaneous hip extension (such as couch stretch, reverse nordic) is extremly irritable on the tendon.
So I guess it all comes down to these question; loading is usually the problem in tendinopathy, but is it dependant on the angle/compression force ? Like a single leg consecutive hop places a lot of stress on tendons but in a very small range, so could it be why it does not seem to aggravte it/ellicit pain ? Is there any other “common” problem that ellicit pain a the top of the knee cap ? There’s lots of info on patellar tendon problems, but quad tendons in comparaison seems much less documented (since it is rarer due to it being thicker, If I remember correctly).
Guess I am rambling for now, thank you for reading, ahah.