Lifting around/with Patellar Tendonitis

[booneman77]

A few weeks back I was having some slight pain in my left patellar tendon while doing heavy squats (3-4rm or so). It wasn't anyhting that stopped me, just more of an annoyance. I dialed back the weight a couple sessions and all seemed well... By early last week, the pain in my left knee was gone, however in my next session my right knee began to hurt, and far worse. I went easy, but even with that it has gotten worse, to the point where I can't squat even light weights without pain, leg presses are only ok in certain positions, and deadlifts (conventional) hurt as well.

My two main questions -
how can I still train lower body effectively without squats, deads, or really any heavy movements or moves taht cause my knee to bend more than 90degrees?

suggestions on rehab exercises or other help?

any help is appreciated.

 

[bradray5871]

Best thing to focus on is doing as much of a % of the rep as possible, yet comfortably. 1/2 or 3/4 reps can be just as effective as full range of motion. Lower weight and higher reps work well too, but i really would not push it too much just in case it is more than just a strain.

 

[booneman77]

Anyone else? Anyone even had this issue before?

 

[jswain34]

Personally...id start taking turmeric and a good joint supplement (i recently had a great 4 weeks with genoflex) and just hit glutes and hams hard until the pain went away. Rdls, sldls, gh raises, ham curls, etc. Nobody died from a strong PC. Gives it some time off and helps strengthen the knee flexors (and hip extensors) at the same time.

 

[Anabolikz]

Try BFR if you haven't. The protocol used in most studies is 2 rounds of 30, 15, 15, 15. 30 seconds of rest between each of these sets. Don't remove the wraps until you are done. Perform on leg ext and leg curl

 

[booneman77]

Try BFR if you haven't. The protocol used in most studies is 2 rounds of 30, 15, 15, 15. 30 seconds of rest between each of these sets. Don't remove the wraps until you are done. Perform on leg ext and leg curl

I actually don't need bfr to do extensions and curls. Those don't hurt. It's only the squatting/pressing motions that hurt

 

[mrgoomba]

I dislocated my knee cap, partially tearing my patella. This was 5 years ago, and i am just now starting to feel normal.

The best thing iv done was get 3 quality warm up sets in before I squat. avoid any extension exercise (1 day of this will cause pain for a week). My leg routine looks like:

Squat with quality warm up sets, foam rolling, and stretching, walking on treadmill, etc before I start.
Single leg, leg press really focusing on contracting the quads. When you push, activate the quad to start going up, not the patella. This will make the world of difference.
SLDL or Leg curls
Lunges (I step back, not forward). Steping back takes the stress off my patella.
Calves

This workout is pretty quad dominate, but my hamstrings overpower my quads to begin with.

 

[mrgoomba]

I actually don't need bfr to do extensions and curls. Those don't hurt. It's only the squatting/pressing motions that hurt

Interesting that extensions do not hurt.... its actually a miserable exercise for your tendons and joints.

 

[KevinConn]

Hmmm, not totally sure how to train around it - maybe Prowler if you have one and maybe just focus on posterior chain for a while while you let it heal.

But I have had patellar tendonitis before from too many ATG squats with a bounce and I'm still kind of dealing with it. Things that have helped:

-rest until initial pain is gone
-Voodoo flossing everyday during warmup and a couple times a day - fairly inexpensive tool and useful for any other joint as well, I recommend everyone has one
-Couch stretch everyday
-slow eccentric, quad dominant exercise - I recommend something like this - "China weightlifters method to help strengthen & protect knees" search that on youtube, I can't post links yet apparently because I don't have 20 posts
-don't stop squatting if you can, just use light enough weight that doesn't cause pain
-ice after a workout if it's quite painful
-knee circles and extra warmup sets with the bar and light weights - just gets the blood flowing to the area and the joint gliding nicely

That's all I can think of for now. Hope you can get it better, I know how annoying it is!

 

[booneman77]

Interesting that extensions do not hurt.... its actually a miserable exercise for your tendons and joints.

agree that its odd. its only the pressing motions where my knee can track out in front of my ankle/foot that bother it. that and extreme stretching of the quad. Even bodyweight squatting is legit painful and any weight is out of the question. Ia have been doing very small partials squats/leg presses by setting the LP at a very limited ROM (think calf press level) and squatting in the standing calf press machine set at the lowest level. These partials are working to activate the quad without getting the knee involved at all so far.

 

[booneman77]

Hmmm, not totally sure how to train around it - maybe Prowler if you have one and maybe just focus on posterior chain for a while while you let it heal.

But I have had patellar tendonitis before from too many ATG squats with a bounce and I'm still kind of dealing with it. Things that have helped:

-rest until initial pain is gone
-Voodoo flossing everyday during warmup and a couple times a day - fairly inexpensive tool and useful for any other joint as well, I recommend everyone has one
-Couch stretch everyday
-slow eccentric, quad dominant exercise - I recommend something like this - "China weightlifters method to help strengthen & protect knees" search that on youtube, I can't post links yet apparently because I don't have 20 posts
-don't stop squatting if you can, just use light enough weight that doesn't cause pain
-ice after a workout if it's quite painful
-knee circles and extra warmup sets with the bar and light weights - just gets the blood flowing to the area and the joint gliding nicely

That's all I can think of for now. Hope you can get it better, I know how annoying it is!

much appreciated for the tips... unfortunately all weight of squatting and leg pressing with full ROM is out of the question. Even bodyweight is painful. I have been trying to do some warming of the area by holding on to a bar or wall and doing an almost strictly hamstring focused squat, but even that can cause pretty nasty pain.

Even deadlifts hurt as its anything that bends the knee and then requires a press. replaced deds with rack pulls tho so thats working for now to maintain back strength and the SLDL/RDL work I can still do without issue.

 

[Rodja]

What kind of shoes do you wear?

There really shouldn't be any knee flexion on a deadlift. That makes it to where you're squatting up the weight with the quads and lower back.

 

[booneman77]

What kind of shoes do you wear?

There really shouldn't be any knee flexion on a deadlift. That makes it to where you're squatting up the weight with the quads and lower back.

Very worn down minimalist running shoes. Basically all but barefoot.

The simple act of squatting down enough to to get to the bar is what hurts. Straight leg is fine but the slightest bit forward from strictly heels causes pain

 

[KevinConn]

much appreciated for the tips... unfortunately all weight of squatting and leg pressing with full ROM is out of the question. Even bodyweight is painful. I have been trying to do some warming of the area by holding on to a bar or wall and doing an almost strictly hamstring focused squat, but even that can cause pretty nasty pain.

Even deadlifts hurt as its anything that bends the knee and then requires a press. replaced deds with rack pulls tho so thats working for now to maintain back strength and the SLDL/RDL work I can still do without issue.

Damn, that sounds pretty rough - must be pretty intense damage/inflammation at the tendon. Have you gone to see a PT?

And have you been icing at all? Ice and NSAIDs might be what you need right now for the pain to subside a little. After that I think you're going to need to find a non-painful way to load the tendon no matter how light and work from there. It's the only way for tendon injuries to get better. Rest may work at first but it doesn't solve the problem - you need to strengthen it, especially eccentrically.

And since you said full ROM is out of the question, does that mean partial ROM is ok? If so, you'll need to start there.

 

[booneman77]

Damn, that sounds pretty rough - must be pretty intense damage/inflammation at the tendon. Have you gone to see a PT?

And have you been icing at all? Ice and NSAIDs might be what you need right now for the pain to subside a little. After that I think you're going to need to find a non-painful way to load the tendon no matter how light and work from there. It's the only way for tendon injuries to get better. Rest may work at first but it doesn't solve the problem - you need to strengthen it, especially eccentrically.

And since you said full ROM is out of the question, does that mean partial ROM is ok? If so, you'll need to start there.

I travel for a living so seeing a pt isn't even an option. Plus it only hurts during the activity. No pain or swelling/inflammation otherwise.

If you read through I've been doing some partial leg presses and squats using the calf press machine. Still doing as much as I can and working to stretch it and such.

I'm honestly just unsure how it got injured because the motions that hurt it are very oddly specific and it doesn't hurt outside of during the motion. Strange injury for me

 

[KevinConn]

Yeah mine came on very suddenly too - one day it was fine then the next time I squatted hurt like hell just to go up stairs after my workout.

But yeah, yours sounds like it's pretty serious - it's too bad you can't see a PT. I would say you need more rest but it sounds like its already been a month or so, so I'm not sure what to tell ya. I'm going to graduate school for PT in the fall so I'm not too helpful yet unfortunately! Hope it gets better man!

 

[Rodja]

Very worn down minimalist running shoes. Basically all but barefoot.

The simple act of squatting down enough to to get to the bar is what hurts. Straight leg is fine but the slightest bit forward from strictly heels causes pain

There's your problem. Minimalist shoes often lead to weak/unstable ankles and/or calves. Worn down ones are going to be even worse as the friction will be compromised.

Shins should be near vertical while setting up on a deadlift and that requires weight on the heels.

 

[booneman77]

There's your problem. Minimalist shoes often lead to weak/unstable ankles and/or calves. Worn down ones are going to be even worse as the friction will be compromised.

Shins should be near vertical while setting up on a deadlift and that requires weight on the heels.

Huh? I think you're confused about minimalist shoes... That means almost zero sole to them... Meaning they're about as close to barefoot as possible while still having rubber underfoot. Shins are 100% vertical due to no heel lift?

Also as far as stability, by having almost zero shoe/sole/support that should improve natural calf/ankle use and strength?

 

[Rodja]

Huh? I think you're confused about minimalist shoes... That means almost zero sole to them... Meaning they're about as close to barefoot as possible while still having rubber underfoot. Shins are 100% vertical due to no heel lift?

Also as far as stability, by having almost zero shoe/sole/support that should improve natural calf/ankle use and strength?

A worn down shoe is a worn down shoe. Minimalist or contoured to your foot is irrelevant when the sole is gone as you still need friction.

Strengthening assumes your gait pattern is correct while wearing them. Ever notice how that minimalist craze died down? It's because most of the claims were complete BS. That's partially why Vibram got hit with a large lawsuit.

While true you should the least amount of space between you and the ground while lifting (hence, why I wear wrestling shoes), if you're not able to spread the floor and engage the hips, you need better footwear.

 

[booneman77]

A worn down shoe is a worn down shoe. Minimalist or contoured to your foot is irrelevant when the sole is gone as you still need friction.

Strengthening assumes your gait pattern is correct while wearing them. Ever notice how that minimalist craze died down? It's because most of the claims were complete BS. That's partially why Vibram got hit with a large lawsuit.

While true you should the least amount of space between you and the ground while lifting (hence, why I wear wrestling shoes), if you're not able to spread the floor and engage the hips, you need better footwear.

These are actual running shoes not vibrams or the like. They're essentially the same setup as chucks (which are widely considered one of the better dead shoes) with very thin sides and soles.

I'm still not seeing how the shoes would be the cause of knee pain though

 

[Rodja]

These are actual running shoes not vibrams or the like. They're essentially the same setup as chucks (which are widely considered one of the better dead shoes) with very thin sides and soles.

I'm still not seeing how the shoes would be the cause of knee pain though

I didn't say they were Vibram's. Shoes are your base and you have a bad base. Due to that, you're not able to set/engage your hips properly. Even on a conventional deadlift, the knees out cue applies. However, you need friction for this and a worn out shoe doesn't provide this.

 

[booneman77]

I didn't say they were Vibram's. Shoes are your base and you have a bad base. Due to that, you're not able to set/engage your hips properly. Even on a conventional deadlift, the knees out cue applies. However, you need friction for this and a worn out shoe doesn't provide this.

I totally understand the engagement portion but what I'm trying to get across is that there's no issue with grip of the floor... They're just beat down and thin to begin with. Not slipping. My issue is in the squatting down to grab the bar and then squatting back up to start the motion before I begin straightening up

The heel drive is what hurts as its that pressing motion both deadlifting and squatting that is painful

 

[Rodja]

I totally understand the engagement portion but what I'm trying to get across is that there's no issue with grip of the floor... They're just beat down and thin to begin with. Not slipping. My issue is in the squatting down to grab the bar and then squatting back up to start the motion before I begin straightening up

How can you have a worn down shoe yet still have friction? That's a complete contradiction. You shouldn't be squatting to the bar on the deadlift. That's not how you setup.

 

[booneman77]

How can you have a worn down shoe yet still have friction? That's a complete contradiction. You shouldn't be squatting to the bar on the deadlift. That's not how you setup.

Well I can't very well reach the bar without bending my knees ha.

These shoes are one solid sole. No rubber over foam or anything. The sole is broken up into pieces so they're exactly the same as they were day 1, just thinner.

 

[booneman77]

Rodja And I'm not trying to say you're wrong, just trying to understand how/if that really could be the main issue.

 

[Rodja]

Well I can't very well reach the bar without bending my knees ha.

These shoes are one solid sole. No rubber over foam or anything. The sole is broken up into pieces so they're exactly the same as they were day 1, just thinner.

It's hip flexion, not knee flexion on a deadlift.

Post a pic of the bottom, please.

 

[booneman77]

It's hip flexion, not knee flexion on a deadlift.

Post a pic of the bottom, please.

These are about the best I can do by myself and in my basement (not great but I live 700miles from friends/family ha). Let me know if there's maybe a better angle

 

[Rodja]

There's definitely a raised heel on those, which is causing the weight to shift to the toes.

That last pic also shows ankle supination.

 

[booneman77]

There's definitely a raised heel on those, which is causing the weight to shift to the toes.

That last pic also shows ankle supination.

Due to the wear though the inside is quite sunken in which reduces the heel (it's much less than it looks from the outside. Maybe 1/8" thick at most). In the last pic though you can also see that the toes don't even really touch the floor. The weight on the heels practically lifts the toes up. Would that be incorrect?

I see what you're saying about the supination though. I've actually noticed that just in how the shoes are worn that there is more wear to the outside than the inside but I thought that would be indicative of the "spreading the floor" that I'm focusing on when squatting or deadlifting?

 

[Rodja]

Your ankles should stay neutral even in the process of spreading the floor. Otherwise, it causes an imbalance in the stabilizers within the calves.

 

[booneman77]

Your ankles should stay neutral even in the process of spreading the floor. Otherwise, it causes an imbalance in the stabilizers within the calves.

And that could lead to the knee issues?

 

[ryox82]

Due to the wear though the inside is quite sunken in which reduces the heel (it's much less than it looks from the outside. Maybe 1/8" thick at most). In the last pic though you can also see that the toes don't even really touch the floor. The weight on the heels practically lifts the toes up. Would that be incorrect?

I see what you're saying about the supination though. I've actually noticed that just in how the shoes are worn that there is more wear to the outside than the inside but I thought that would be indicative of the "spreading the floor" that I'm focusing on when squatting or deadlifting?

I had shoes like this that i lifted in and during squats my heals would sink, same with deads. Better off with a new pair of chucks or bare foot.

 

[Rodja]

And that could lead to the knee issues?

Yes. Did you really think that if your calves and ankles weren't healthy that there wouldn't be ramifications?

 

[booneman77]

Yes. Did you really think that if your calves and ankles weren't healthy that there wouldn't be ramifications?

Well no, I just have never had any pain or issues with them so I never would have pinpointed them as the underlying cause.

The simple solution here being barefoot squats/deads?

 

[Rodja]

Well no, I just have never had any pain or issues with them so I never would have pinpointed them as the underlying cause.

The simple solution here being barefoot squats/deads?

No, you need new shoes. Barefoot only works if you have healthy, stable ankles, but I never recommend it due to the aforementioned friction issue.

 

[sparks2012]

I actually don't need bfr to do extensions and curls. Those don't hurt. It's only the squatting/pressing motions that hurt

I didn't think of this until I saw it, but theoretically, BFR could force more nutrient rich blood into the lower extremities and possibly speed up the recovery process. Logically, it makes sense. In practice it could be a different story depending on what the injury actually is. I've got a friend who has a pretty bad case of Osgood-Schlatter's in one of his knees and sleeves help tremendously. It's not a cure-all, and certainly not something I'd want to be dependent on, but it might help.

 

[booneman77]

No, you need new shoes. Barefoot only works if you have healthy, stable ankles, but I never recommend it due to the aforementioned friction issue.

cool. I've actually got new shoes sitting around, just havent broken them out yet.

as far as rehab/strengthening the ankles/etc... any suggestions?

 

[Rodja]

cool. I've actually got new shoes sitting around, just havent broken them out yet.

as far as rehab/strengthening the ankles/etc... any suggestions?

You're going to laugh, but yoga. Seriously.

 

[booneman77]

You're going to laugh, but yoga. Seriously.

crap... i did yoga once a few months back and hated it ha... guess i'll be giving it another try. could be worse views

 

[booneman77]

So after a few days of really looking and feeling I can truly see how rolled out and angled my shoes are. Def gonna swap them out finally when i get home this weekend.

 

[Rodja]

So after a few days of really looking and feeling I can truly see how rolled out and angled my shoes are. Def gonna swap them out finally when i get home this weekend.

Glad you took the time to observe this. Our feet are the foundation, but they get horribly neglected in training.

 

[booneman77]

Glad you took the time to observe this. Our feet are the foundation, but they get horribly neglected in training.

Yes sir. Thank you for all your help and patience with my questioning!

I was actually able to complete a modified leg day today pain free for the first time... subbed a few exercises in and some partial ROM but nothing hurt finally at any point

 

[Rodja]

Yes sir. Thank you for all your help and patience with my questioning!

I was actually able to complete a modified leg day today pain free for the first time... subbed a few exercises in and some partial ROM but nothing hurt finally at any point

No problem. Just trying to help and spread my knowledge.

 

[herderdude]

cool. I've actually got new shoes sitting around, just havent broken them out yet.

as far as rehab/strengthening the ankles/etc... any suggestions?

The voodoo floss band recommended in an earlier post is the best. Stretch in eversion and dorsiflexion like you're trying to break your foot off while wrapped. The ankle is a tough and sticky joint. You won't screw it up. Strengthen with a band wrapped around your foot, going for inversion/eversion mostly and a big dorsiflexion stretch.

To help with the supination, think about grabbing the floor with your feet, then cranking the knees out.

I was once told by a knowledgeable person that the knee is only transmitting what it's given, like a speaker. It can only do what it's told by the hips and ankles. Knees, without direct trauma, do not cause problems by themselves. They are almost always the result of poor interaction between hip and ankle.

 

[booneman77]

Very happy to report that I was able to squat pain-free yesterday (only went up to 225 for a single). huge progress in the last week or so. Cant thank you enough Rodja et al for the help. Since your advice I've brought out the new shoes (which seem to help a ton just in daily walking/activity) as well as began working in some barefoot and rehab exercises.