I explained in the last post that a new MRI clearly showed patellar tendinopathy (degenerative process in the patellar tendon). This post will explain what we plan to do about it (I mean “we” as in “my healthcare team and I,” not in a royal sense).
I have a lot of pain right straight through the front of my knee during a specific ROM (have since about four months after the big surgery), and I thought perhaps that was the scarred fat pad because it feels like there is something physically in there that my knee has to work around (I’ve described it like someone jammed their finger into my knee right below the patella and now the knee has to bend around it; it’s weird). Doc said he doesn’t think it’s the fat pad; he thinks that the tendon is so thickened, it’s catching/rubbing during ROM.
I was inadvertently making the problem worse over the last couple of months. I knew the pain had increased, but I didn’t yet know for sure that the pain was coming from the patellar tendon. I was doing leg extensions with increasing weight/pain, and some nights, it was all I could do to get through the leg extensions. I had to turn my headphones all the way up to help take my mind off the actual exercise, and I’d occasionally sit in the gym literally talking myself into doing the sets. I might go deaf because of a knee issue, but, by gum, I’m going to do the exercises I’m told to do. I’m sure I looked and sounded like a crazy person talking to myself and singing along to my tunes.
I knew I had a problem when the knee started hurting in the pool, but I didn’t stop because the PT had told me that I should push through the pain. I’d worked the knee into such a tizzy that, by the time I had the MRI, I was having all kinds of trouble going up/down stairs again. The pain was so bad, I would throw my leg out from the hip to get it bend enough to go down the stairs. Not good.
I was not a fan of the new PT for a number of reasons. I think a lot of the issues stemmed from his inexperience. He had a specific protocol for a specific diagnosis, and he couldn’t tailor it to a specific patient’s needs. I had to make a quick decision when the doc said to continue with PT for the patellar tendon issue, so I decided to go back to my previous PT (the awesome one who has helped immensely over the past year). It’s a bit odd since she’s in a different clinic, but I trust her and value her guidance.
I met with my previous PT last week, and she showed me a few things to do to see if the tendon will respond favorably. She also did ultrasound while in the office (we’re not sure it will work, but it shouldn’t hurt). I’m supposed to do some at-home work to see if I can reconfigure the scar tissue in my knee and to see if I can stretch the quad to allow my kneecap to drop down into a more normal position (we know from the exam and a previous MRI that I have patella alta). In addition to these things, I will do eccentric exercises to load the tendon in a protected manner. We didn’t specifically talk about squats on a decline board, but quite a bit of the research I’ve read in the last couple of weeks shows decline squats are something that works for patellar tendon issues. Like with everything else, there are also detractors who don’t think decline squats are the way to go (so confusing!), so I’m unsure whether or not I will do those. I will, however, go back to the leg extension machine and use it in a slightly different way. I’m only using 30 lbs (so lower weight), and I use two legs to push it up and then lower it with just one very slowly. I still freaking hate this machine.
We’ll see if all of this helps a tendon that first showed signs of a problem on the MRI in May 2013. That’s 19 months that have gone by without directly addressing this issue, though we did work around it because I’ve always been sore there. In some ways, like the single-leg extensions I’ve been doing, we’ve probably made the issue worse. Seems like it’s going to be a lot of slow work, but I am glad there is something specific to address.
The good news is that, through all of this, the lateral portion of my knee that had caused such pain in the past has not been affected. At some point during the summer/fall, that particular pain largely dissipated (I’m willfully ignoring that there might be a connection to the fact that I was swimming so much, I stopped biking very much at all), and it hasn’t returned. Let me be clear. There is “pain” there, but it’s minimal and totally manageable. That really just leaves the big pain through the front of my knee. I feel like there’s nothing I won’t be able to do, if we can improve that pain. Well, nothing other than running and other high-impact activities. But the doc indicated he sees no reason I can’t ride, as long as I can manage the pain. Exciting!