Patellar tendonitis -- how long until it goes away?

7elizamae

Drat. I seem to have patellar tendonitis in my left knee. It isn't horrible -- I can walk and go up and down stairs. But I feel it when I do something 'explosive' like a squat, or going uphill on my bike, or doing a box jump at the gym.
I've been to PT twice, am doing my exercises faithfully, and am passing on workouts involving my knee. It's already been about 8 weeks, and no noticeable improvement.
If you've had it, how long did patellar tendonitis take to heal? I really miss my regular workouts!

Azdak

Patella tendinitis can be stubbornly difficult to heal. But If you have indeed been doing exercises properly for 8 weeks with no noticeable change, then you might need a different PT or a new exercise approach (or both).

One check: does your routine include a lot of glute work or does it focus mainly on the quads? The old approach focused on strengthening the VMO, but currently thinking is that weak glutes play a greater role. (Although I still find the quad work helpful).

The other thing is do your exercises involve progression? I have found that often therapists give out very basic routines that have a short shelf life. That is understandable since they see people in an acute state and cannot follow them long term.

A comprehensive approach will include foam rolling, stretching, strengthening exercises focusing on glutes (bridges, abduction, clamshells), and some eccentric loading. You also need to learn how to keep the knee tracking in place when doing movements.

Time to heal can vary. I’ve resolved some “tweaks” in a couple of weeks, one time it took ten months, and I had one client who refused to stop running, so it took almost two years.

I’ve never used one, but sometimes a strap or sleeve can help support the knee during exercise. It’s not a cure, but it can help reduce some of the irritation while you are doing your rehab (don’t wear it when doing rehab work).

7elizamae

The exercises include glutes, and hips (these were really hard at first!), but not much quads. I was bike commuting until this started, so my quads were/are relatively strong.

I'm tempted to just go back to biking and crossfit and see how it goes. I'm good at stopping if something causes pain, and the pain is occasional . Would that be a big mistake? My PT says I can do things that don't hurt. But that seems to be how I overused the knee in the first place -- it didn't hurt until it was too late.

aokoye

So I haven't had patellar tendonitis, but I have had my fair share of major knee issues and a boat load of physical therapy. Given it's been 8 weeks, I would go to an orthopedic surgeon and get a second opinion if you haven't already. That would likely involve diagnostic imaging if you haven't had any already. If they agree that it's patellar tendonitis, then I would get a new physical therapist if the one you're seeing now seems out of ideas.

7elizamae

aokoye wrote: »

So I haven't had patellar tendonitis, but I have had my fair share of major knee issues and a boat load of physical therapy. Given it's been 8 weeks, I would go to an orthopedic surgeon and get a second opinion if you haven't already. That would likely involve diagnostic imaging if you haven't had any already. If they agree that it's patellar tendonitis, then I would get a new physical therapist if the one you're seeing now seems out of ideas.

Did you get results from your PT?
I've never done PT before, so I don't know what to expect in terms of progress.

Azdak

7elizamae wrote: »

The exercises include glutes, and hips (these were really hard at first!), but not much quads. I was bike commuting until this started, so my quads were/are relatively strong.

I'm tempted to just go back to biking and crossfit and see how it goes. I'm good at stopping if something causes pain, and the pain is occasional . Would that be a big mistake? My PT says I can do things that don't hurt. But that seems to be how I overused the knee in the first place -- it didn't hurt until it was too late.

I am under the impression from your OP that you had a couple of sessions with the PT and you received exercises to do on your own. As I mentioned earlier, you can “outgrow” those beginning exercises (meaning you have progressed to where they are not as effective—that’s not a bad thing!). If you are still seeing a PT, then I guess he or she should be answering your questions.

So it may be that you are progressing as expected and you just need more time. As I said earlier PFS can linger.
If you want to try some other ideas, I found this site to be one of the more helpful ones.

https://runnersconnect.net/patellar-tendonitis-running/

You can try resuming your activities (cautiously). I would just be wary of “occasional” pain with this problem. A few random “twinges” are one thing, but if you experience any pain similar to your current symptoms, it is usually a sign that whatever biomechanical issues caused the pain are still there and you are running the risk of a setback. OTOH, if your muscle support/biomechanics HAVE improved, then you can also start “grooving” new movement patterns that will help in the long run. As long as you increase resistance and duration v-e-r-y gradually, then pain can be your guide. If you aren’t experiencing pain, then it is unlikely that you are reinjuring yourself.

PFS can be frustrating, but I also think it can be actively managed. The good thing is that all the work you are doing will give you a much stronger base going forward.

Azdak

aokoye wrote: »

So I haven't had patellar tendonitis, but I have had my fair share of major knee issues and a boat load of physical therapy. Given it's been 8 weeks, I would go to an orthopedic surgeon and get a second opinion if you haven't already. That would likely involve diagnostic imaging if you haven't had any already. If they agree that it's patellar tendonitis, then I would get a new physical therapist if the one you're seeing now seems out of ideas.

I would disagree. Unless there is an acute rupture, I am not aware of any diagnostic imaging that would provide any greater insight.

And for patellofemoral syndrome, an orthopedic surgeon would be almost totally useless at this stage. Which is not a criticism—it’s just not their field of expertise. There is a surgical procedure—a lateral release—that has been used in the past, but that would be only for the most intractable of cases. In fact, I can’t recall the last time I ever heard of someone having one or seeing it mentioned in the literature. I would say that in 95+% of cases, physical therapy will eventually work for this issue.

7elizamae

Azdak wrote: »

7elizamae wrote: »

The exercises include glutes, and hips (these were really hard at first!), but not much quads. I was bike commuting until this started, so my quads were/are relatively strong.

I'm tempted to just go back to biking and crossfit and see how it goes. I'm good at stopping if something causes pain, and the pain is occasional . Would that be a big mistake? My PT says I can do things that don't hurt. But that seems to be how I overused the knee in the first place -- it didn't hurt until it was too late.

I am under the impression from your OP that you had a couple of sessions with the PT and you received exercises to do on your own. As I mentioned earlier, you can “outgrow” those beginning exercises (meaning you have progressed to where they are not as effective—that’s not a bad thing!). If you are still seeing a PT, then I guess he or she should be answering your questions.

So it may be that you are progressing as expected and you just need more time. As I said earlier PFS can linger.
If you want to try some other ideas, I found this site to be one of the more helpful ones.

https://runnersconnect.net/patellar-tendonitis-running/

You can try resuming your activities (cautiously). I would just be wary of “occasional” pain with this problem. A few random “twinges” are one thing, but if you experience any pain similar to your current symptoms, it is usually a sign that whatever biomechanical issues caused the pain are still there and you are running the risk of a setback. OTOH, if your muscle support/biomechanics HAVE improved, then you can also start “grooving” new movement patterns that will help in the long run. As long as you increase resistance and duration v-e-r-y gradually, then pain can be your guide. If you aren’t experiencing pain, then it is unlikely that you are reinjuring yourself.

PFS can be frustrating, but I also think it can be actively managed. The good thing is that all the work you are doing will give you a much stronger base going forward.

Thank you. This is encouraging.
I'll be going back to my PT in about a week, and I imagine he'll change up the exercises again. I have gotten much better at them -- and they were hard at first!
I probably just need to be patient about returning to the gym. I'm really missing it, though. It had become an important part of my days and I feel a bit gloomy not being able to work out with that kind of intensity. I have been doing upper body workouts that are certainly challenging, but I really miss my crossfit workouts.

aokoye

Azdak wrote: »

aokoye wrote: »

So I haven't had patellar tendonitis, but I have had my fair share of major knee issues and a boat load of physical therapy. Given it's been 8 weeks, I would go to an orthopedic surgeon and get a second opinion if you haven't already. That would likely involve diagnostic imaging if you haven't had any already. If they agree that it's patellar tendonitis, then I would get a new physical therapist if the one you're seeing now seems out of ideas.

I would disagree. Unless there is an acute rupture, I am not aware of any diagnostic imaging that would provide any greater insight.

And for patellofemoral syndrome, an orthopedic surgeon would be almost totally useless at this stage. Which is not a criticism—it’s just not their field of expertise. There is a surgical procedure—a lateral release—that has been used in the past, but that would be only for the most intractable of cases. In fact, I can’t recall the last time I ever heard of someone having one or seeing it mentioned in the literature. I would say that in 95+% of cases, physical therapy will eventually work for this issue.

I knew I should have mentioned this - orthopedic surgeons do a lot more than surgery. From the American Academy of Orthopaedic Surgeons:

Orthopaedic surgeons explore nonsurgical options first, such as pain medication or rehabilitation. They also have the expertise to perform surgery to repair an injury or correct a condition, if necessary.

An orthopedic surgeon consult is not automatically a surgery consult, at least not in my experience with at least three orthos (one of who works at a teaching hospital). I was not saying or implying that surgery would be a logical option, so much as a second opinion and confirmation of the diagnosis would be a good plan. For instance, when I broke my shoulder in spring of 2018, I went to an orthopedic surgeon but not with the idea that I'd need surgery (and in fact, I didn't need surgery nor expensive imaging).

Good to know that diagnostic imaging wouldn't necessarily be useful for this specific diagnosis though. That said, I think it's important for the OP to have the correct diagnosis. They also probably need more than two PT sessions.

aokoye

7elizamae wrote: »

aokoye wrote: »

So I haven't had patellar tendonitis, but I have had my fair share of major knee issues and a boat load of physical therapy. Given it's been 8 weeks, I would go to an orthopedic surgeon and get a second opinion if you haven't already. That would likely involve diagnostic imaging if you haven't had any already. If they agree that it's patellar tendonitis, then I would get a new physical therapist if the one you're seeing now seems out of ideas.

Did you get results from your PT?
I've never done PT before, so I don't know what to expect in terms of progress.

I did, yes, but I was also dealing with very different injuries/situations that you are. I also suspect you'll need more than two visits to a physical therapist if only to get more structure than you currently have with regards to your home PT exercises. I guess the other question is has it been 8 weeks since you first noticed pain or 8 week since you last went to PT?

The_Enginerd

I was diagnosed with patellar tendonitis by my knee doctor after I went to him when having pretty acute knee pain from running. I was also doing the Strong Lifts program at the time, lifting 3X a week. For me, backing off on running too far, too fast in training, icing, and time took care of the issue. It took months to get better, but I was able to continue easy slow running during that time. I was doing just two days a week, a 5k run and a 10k run each week, at that time. Since then I became a long distance runner and have not had that issue come back. I also don't race every run like I did back then. In my case, PT was not prescribed.

7elizamae

The_Enginerd wrote: »

I was diagnosed with patellar tendonitis by my knee doctor after I went to him when having pretty acute knee pain from running. I was also doing the Strong Lifts program at the time, lifting 3X a week. For me, backing off on running too far, too fast in training, icing, and time took care of the issue. It took months to get better, but I was able to continue easy slow running during that time. I was doing just two days a week, a 5k run and a 10k run each week, at that time. Since then I became a long distance runner and have not had that issue come back. I also don't race every run like I did back then. In my case, PT was not prescribed.

Did you keep lifting?

The_Enginerd

7elizamae wrote: »

The_Enginerd wrote: »

I was diagnosed with patellar tendonitis by my knee doctor after I went to him when having pretty acute knee pain from running. I was also doing the Strong Lifts program at the time, lifting 3X a week. For me, backing off on running too far, too fast in training, icing, and time took care of the issue. It took months to get better, but I was able to continue easy slow running during that time. I was doing just two days a week, a 5k run and a 10k run each week, at that time. Since then I became a long distance runner and have not had that issue come back. I also don't race every run like I did back then. In my case, PT was not prescribed.

Did you keep lifting?

Yes I did. In my case, it did not aggravate the problem and I had been lifting for over a year before adding some running to my fitness routine. It sounds like there are a variety of causes so your treatment and limitations while healing may differ. Working with your PT and trial and error on what you can do without causing an increase in symptoms is a good path forward.

I can understand your frustration. I've had my fair share of injuries and issues and have had to adapt over time or take breaks. But long term, your body will thank you if you let things heal properly and address the causes.

7elizamae

I had been biking daily (12 miles roundtrip) and going to crossfit 4x week. Apparently, that was too much, which is so disappointing because I loved my routine and was gaining so much strength and stamina. You're right about working with my PT and being patient for the long term benefit. I guess I was just hoping for some kind of magic cure!

aokoye

7elizamae wrote: »

I had been biking daily (12 miles roundtrip) and going to crossfit 4x week. Apparently, that was too much, which is so disappointing because I loved my routine and was gaining so much strength and stamina. You're right about working with my PT and being patient for the long term benefit. I guess I was just hoping for some kind of magic cure!

Patience really is the key here. I know far too many people who have tried to push through, even when their doctor/PT told them otherwise, and it didn't end well. Which is to say, they reinjured themselves leading to a longer recovery, not progressing in the sport they were doing as quickly as they could have, likely getting more frustrated than had they just been patient, etc.

Hannahwalksfar

Have you had an mri done?

LAT1963

Don't mess with tendons. They take much longer to heal than bones do and its easy to do permanent damage if you don't allow them to heal.