Chronic Tibial Tuberosity Pain (Still)

Training Injuries
1

I made a thread last year here about this problem, but I wanted to update.

I still have bad pain on my left tibial tuberosity. Pain first started in June of last year during a jerk (I used to compete in o-lifting). I’m almost 23 and done growing so it’s not Osgood’s. Pain is localized and does not radiate up or down.

Pain can get excruciating at times, especially during exercise. I have tried resting for 4+ weeks, icing, etc, and the pain would come back immediately when trying squats/etc. I have done seen a chiro and got ART on my tib anterior, seen a PT, and have seen four doctors total, so far.

The current orthopedic doctor I am seeing seems good. I got X-rays awhile ago, they were negative. I just got my MRI results (which my current doc wanted me to get), they didn’t show much except for some breaking down of cartilage. The doctor said my problem is bad patellar tendonitis, although I don’t get any pain in my patellar tendon, only on my tibial tuberosity.

As a side note I have broken three metatarsals in my left foot (I overpronate), and my pain is in the left shin bone. Whether or not these are connected, I don’t know. I suspect they are, because my right knee is fine.

I will be seeing my doctor again April 11 to see what he recommends from here on out. Until then I am doing complete rest, and taking lots of fish oil/curcumin.

I’ve also done some reviewing of past threads on T-Nation with those who had/have my problem. This is what I have come up with:

  1. Tight quads (I do quad/hip flexor stretches all the time)

  2. No bent-knee sitting (BBB recommended this, and truth be told I ALWAYS sit with my left knee bent under my butt. He could be on to something. I’m now putting my left leg straight whenever I sit)

  3. Contrast therapy/ice massage

  4. Foam roll quads/ITB (I do this all the time)

  5. Glute med work (I do these all the time)

  6. 12+ weeks healing time, complete rest. Apparently the patellar tendon, where it connects to the tibial tuberosity, is avascular so it takes a long time to heal?

Thanks for any input.

2

When you were younger were you told you had Osgood’s? You are right, it would not be classified as Osgood’s at your age, but rather “jumper’s knee”.

Take a look at this http://www.sportsinjuryclinic.net/sport-injuries/knee-pain/jumpers-knee
See if it sounds like what you experience.

And the patellar tendon is not avascular, thus not a factor for any healing

3

[quote]PB Andy wrote:
I made a thread last year here about this problem, but I wanted to update.

I still have bad pain on my left tibial tuberosity. Pain first started in June of last year during a jerk (I used to compete in o-lifting). I’m almost 23 and done growing so it’s not Osgood’s. Pain is localized and does not radiate up or down.

Pain can get excruciating at times, especially during exercise. I have tried resting for 4+ weeks, icing, etc, and the pain would come back immediately when trying squats/etc. I have done seen a chiro and got ART on my tib anterior, seen a PT, and have seen four doctors total, so far.

The current orthopedic doctor I am seeing seems good. I got X-rays awhile ago, they were negative. I just got my MRI results (which my current doc wanted me to get), they didn’t show much except for some breaking down of cartilage. The doctor said my problem is bad patellar tendonitis, although I don’t get any pain in my patellar tendon, only on my tibial tuberosity.

As a side note I have broken three metatarsals in my left foot (I overpronate), and my pain is in the left shin bone. Whether or not these are connected, I don’t know. I suspect they are, because my right knee is fine.

I will be seeing my doctor again April 11 to see what he recommends from here on out. Until then I am doing complete rest, and taking lots of fish oil/curcumin.

I’ve also done some reviewing of past threads on T-Nation with those who had/have my problem. This is what I have come up with:

  1. Tight quads (I do quad/hip flexor stretches all the time)

  2. No bent-knee sitting (BBB recommended this, and truth be told I ALWAYS sit with my left knee bent under my butt. He could be on to something. I’m now putting my left leg straight whenever I sit)

  3. Contrast therapy/ice massage

  4. Foam roll quads/ITB (I do this all the time)

  5. Glute med work (I do these all the time)

  6. 12+ weeks healing time, complete rest. Apparently the patellar tendon, where it connects to the tibial tuberosity, is avascular so it takes a long time to heal?

Thanks for any input.[/quote]

You didn´t say what kind of physical modalities were prescribe for the physical therapy. That´s important to know (superficial heat, ultrasound, diathermy, TENS, Interferencial currents, catertherapy, LASER, Shockwaves, etc) as well as what excercise were prescribed.

4

[quote]jav88 wrote:

[quote]PB Andy wrote:
I made a thread last year here about this problem, but I wanted to update.

I still have bad pain on my left tibial tuberosity. Pain first started in June of last year during a jerk (I used to compete in o-lifting). I’m almost 23 and done growing so it’s not Osgood’s. Pain is localized and does not radiate up or down.

Pain can get excruciating at times, especially during exercise. I have tried resting for 4+ weeks, icing, etc, and the pain would come back immediately when trying squats/etc. I have done seen a chiro and got ART on my tib anterior, seen a PT, and have seen four doctors total, so far.

The current orthopedic doctor I am seeing seems good. I got X-rays awhile ago, they were negative. I just got my MRI results (which my current doc wanted me to get), they didn’t show much except for some breaking down of cartilage. The doctor said my problem is bad patellar tendonitis, although I don’t get any pain in my patellar tendon, only on my tibial tuberosity.

As a side note I have broken three metatarsals in my left foot (I overpronate), and my pain is in the left shin bone. Whether or not these are connected, I don’t know. I suspect they are, because my right knee is fine.

I will be seeing my doctor again April 11 to see what he recommends from here on out. Until then I am doing complete rest, and taking lots of fish oil/curcumin.

I’ve also done some reviewing of past threads on T-Nation with those who had/have my problem. This is what I have come up with:

  1. Tight quads (I do quad/hip flexor stretches all the time)

  2. No bent-knee sitting (BBB recommended this, and truth be told I ALWAYS sit with my left knee bent under my butt. He could be on to something. I’m now putting my left leg straight whenever I sit)

  3. Contrast therapy/ice massage

  4. Foam roll quads/ITB (I do this all the time)

  5. Glute med work (I do these all the time)

  6. 12+ weeks healing time, complete rest. Apparently the patellar tendon, where it connects to the tibial tuberosity, is avascular so it takes a long time to heal?

Thanks for any input.[/quote]

You didn�´t say what kind of physical modalities were prescribe for the physical therapy. That�´s important to know (superficial heat, ultrasound, diathermy, TENS, Interferencial currents, catertherapy, LASER, Shockwaves, etc) as well as what excercise were prescribed.[/quote]
I’ve had ART a few times in the Tib Anterior. I’ve had ultrasound and some kind of laser/infrared thing, didn’t really help much. The PT found some strength/flexibility deficits in my lower body which I’ve been keeping up with…

5

[quote]jimmyiosis wrote:
When you were younger were you told you had Osgood’s? You are right, it would not be classified as Osgood’s at your age, but rather “jumper’s knee”.

Take a look at this http://www.sportsinjuryclinic.net/sport-injuries/knee-pain/jumpers-knee
See if it sounds like what you experience.

And the patellar tendon is not avascular, thus not a factor for any healing[/quote]
Yeah I’ve looked into jumper’s knee. I have pain on only the tibial tuberosity, no pain on knee cap or tendon. It is also painful when I press on the area, like a bruise, and it definitely gets a bigger bump then the right tibial tuberosity.

No aching/stiffness, just sharp pain. No pain when contracting quads. No calf weakness.

I’m about at a Grade 4 at this point.

6

just a bump for any suggestions :slight_smile:

7

OK guys just a little update:

So I ordered a patellar tendon strap online, it’s not here yet though. So what I did, just to fool around, is take a neck tie (lol) and put it right under my kneecap, and tightened it real hard. I then tried some bodyweight squats and stuff and I had close to no pain… which is ridiculous to me. If I take it off I get crazy pain on my tibial tuberosity.

This is good news, regardless. I’ll let my ortho doc know about it of course, and keep doing whatever rehab stuff I have to in the mean time. But maybe I can actually squat pain-free with this strap thing.

So my question is, does this indicate that my problem is an inflammation thing or degenerative thing?

8

just a bump if anyone has more input. That jumper’s knee strap seemed to help at first but now I have pain regardless if I use it. So there’s that.

9

hey there mate ive actually got something really similar to this atm also!! im 23 soon and the pain is only over the tibial tuberosity hurts to touch especially if i hit it!!! got an xray back from doctor they called it mild osgood schlatters, slight ossification of the tibial tuberosity where the tendon connects. it started after i did alot of running, not warming up properly running when really sore and then playing sport all in the one week. stopped me from squatting etc. a guy i saw unknotted alot of muscles in the leg and that made it go away, just recently i had a week off, so no strecthing for over a week, had a max rep day at crossfit and didnt warm up aswell as i should have, days later it was playing up again thats when i decided to get xray. now i know what the problem is ive just gotta figure out how to fix it!! im gonna try acupuncture this week get some blood into the tendon n hopefully try stop the tightness in my hips quads hammies etc

10

I’m glad you bumped this thread because I’m still have problems… I really don’t know what to do to fix it. I’ve tried resting for 4+ weeks while doing tons of re-hab (strengthening of VMO/adductor/hamstring/sartorius, while stretching the quad and foam rolling the lateral quad/IT Band), tried acupuncture, etc. Might just have to schedule another appt with my ortho. How long have you had this problem, and what areas did your guy loosen up? I haven’t been able to squat/deadlift/etc without pain for over a year now.

11

its freaking crap hey!!! umm it started towards the end of last year had it once saw a physio lady and she fixed it cant remember what she did exactly. feb this year i cut my foot bad and was limping for a week or two, walking really poorly, when that came good went to do squats bam pain was there. i saw the first lady she didnt fix it, saw another lady, she didnt fix it saw this other guy he got it first go unknotting from hip, behind knee and ligments in the foot. unfortunately this time he hasnt been as successful in stopping the pain and releasing the problem. it seems the common trend here was being out of action for too a period of time and getting into excercise with tight muscles, although u said u have stayed stretched etc and had no success its all very disheartening really. i put a link below i found this guy seems to have had exact problem i think

ive started taking magnesium, calcium and silica also these are meant to be help problems like ours but yeah i just want it to go!!!

http://www.coolrunning.com.au/forums/index.php?showtopic=15994

12

[quote]cameron123qwe wrote:
its freaking crap hey!!! umm it started towards the end of last year had it once saw a physio lady and she fixed it cant remember what she did exactly. feb this year i cut my foot bad and was limping for a week or two, walking really poorly, when that came good went to do squats bam pain was there. i saw the first lady she didnt fix it, saw another lady, she didnt fix it saw this other guy he got it first go unknotting from hip, behind knee and ligments in the foot. unfortunately this time he hasnt been as successful in stopping the pain and releasing the problem. it seems the common trend here was being out of action for too a period of time and getting into excercise with tight muscles, although u said u have stayed stretched etc and had no success its all very disheartening really. i put a link below i found this guy seems to have had exact problem i think

ive started taking magnesium, calcium and silica also these are meant to be help problems like ours but yeah i just want it to go!!!

http://www.coolrunning.com.au/forums/index.php?showtopic=15994[/quote]
Yeah I’ve actually been to that link. You wouldn’t believed how many different combinations of words I’ve searched in google or how many different/random forums I’ve been to. The thing is, a lot of people have my problem and I have a pretty good idea of what caused it in the first place, but whatever I do re-hab wise doesn’t really do much for that constant tenderness on the bone itself (that’s where the pain is, not on the tendon). So either it will take a huge amount of rest 12+ weeks of literally nothing for that area to clear up, or something as drastic as bone scraping surgery… who knows.

13

You live in Illinois, right?

Look into prolotherapy. Worth a shot.

14

[quote]Ray567 wrote:
You live in Illinois, right?

Look into prolotherapy. Worth a shot.[/quote]

Yeah, Chicago. What kind of doctors generally do prolotherapy? Sports med docs? I have an ortho who mentioned the possibility of using an injection, but I think he was talking about a platelet-rich plasma shot.

15

I am 36 y/o and I have the exact same problem. Sharp pain isolated to the tibial tuberosity. It feels like I recently slammed it in to something and it is severely bruised (I wish that was the case). It is tender to the touch and hurts pretty bad when I squat, especially when I exceed about 45 degrees of flexion. I never had Osgood’s as kid and the pain just started about 6-8 months ago.

I am Army Infantry and have been in for about 15 years so the body has taken a beating. I just started serious lifting about 2 years ago on a linear progression and switched to more of a wave periodization about 6 months ago. I used to have very weak lower body strength and puny legs, but have made some decent progress over the last couple years. My lifting mechanics and form are pretty good and I have a pretty balanced program, so I really don’t think it is a result of muscle imbalances, but I guess it could be possible.

I definitely don’t put as much emphasis on mobility and SMR as I probably should, so I will try to do that. But it is really annoying and has gotten to the point where it is adversely effecting my training. I can’t squat very deep at all without significant pain.

1 Like
16

I’ll keep you updated bhugh. I am currently seeing the chiropractor for the Chicago Bears/Cubs and after one session it is doing a lot better.

17

[quote]bhugh002 wrote:
I am 36 y/o and I have the exact same problem. Sharp pain isolated to the tibial tuberosity. It feels like I recently slammed it in to something and it is severely bruised (I wish that was the case). It is tender to the touch and hurts pretty bad when I squat, especially when I exceed about 45 degrees of flexion. I never had Osgood’s as kid and the pain just started about 6-8 months ago.

I am Army Infantry and have been in for about 15 years so the body has taken a beating. I just started serious lifting about 2 years ago on a linear progression and switched to more of a wave periodization about 6 months ago. I used to have very weak lower body strength and puny legs, but have made some decent progress over the last couple years. My lifting mechanics and form are pretty good and I have a pretty balanced program, so I really don’t think it is a result of muscle imbalances, but I guess it could be possible.

I definitely don’t put as much emphasis on mobility and SMR as I probably should, so I will try to do that. But it is really annoying and has gotten to the point where it is adversely effecting my training. I can’t squat very deep at all without significant pain. [/quote]
hey so this is the gist of what my chiropractor is doing. Basically what he said is I do have a bit of tendinosis, but the main reason for my recurring pain on my tibial tuberosity is because of the constant pull/excessive tension on the patellar tendon, due to my rectus femoris and vastus lateralis taking over all of the movement, and it’s actually being pulled on at an angle because of this (lateral side). Whereas, he said my VMO is completely inhibited and my adductors are really weak as well.

Right now this is basically what we are doing:

He does ART on: piriformis, TFL, lateral calf, vastus lateralis, the area where the vastus lateralis/IT band kind of merge just above the knee (lateral suprapatellar pouch, I believe), groin/adductor area (very tender spot for me), and also in this area on the medial side of the VMO where it is almost the adductor but not quite, and he does ART on this area while I try to get full terminal knee extension on the knee… it’s quite hard to do so. He also does a lot of weird stuff with my foot/ankle (on the foot that I broke), like calcaneus adjustments, putting my ankle through some extreme ROM, and even doing ART on the plantar fascia of my foot.

He just started me on some basic rehab movements while he clears up all the balled up areas. Right now it is:

  1. Peterson step-ups 4 x 15
  2. Side-lying adduction w/ band 3 x 15
  3. Post glute med (side-lying clams) 3 x 25 (huge burn here)
  4. Ankle eversion w/ band 4 x 20
18

btw this is the chiropractor for the Chicago Bears and Cubs. He actually travels w/ the Bears in-season for all the away games. The guy is actually quite young but he’s working all the way up and down the chain, from big toe to my sacrum.

also to bhugh002, I am not doing any running or lifting with my legs right now as the chiro suggested, he just wants me to do the rehab movements for now. He gave me a time-frame of 8-12 weeks of being 100%.

19

Is he doing anything for your pronation? Pronation causes internal rotation of the hip, which can change the angle of quad pull–your vastus lateralis would contract more with knee extension. If you didn’t have the knee pain before your foot problems, I think it would actually be a result of your foot problems. Is he doing foot exercises to increase your arch strength? It is good you are already doing hip external rotation exercises–this can help counter the internal rotation caused by pronation.

20

[quote]smallmike wrote:
Is he doing anything for your pronation? Pronation causes internal rotation of the hip, which can change the angle of quad pull–your vastus lateralis would contract more with knee extension. If you didn’t have the knee pain before your foot problems, I think it would actually be a result of your foot problems. Is he doing foot exercises to increase your arch strength? It is good you are already doing hip external rotation exercises–this can help counter the internal rotation caused by pronation.[/quote]

On my first visit he said he was surprised that previous practitioners didn’t do anything with my feet, and said it wasn’t a coincidence that I started to get the TT pain down the road after the left foot surgery. He does ART on my foot and he mentioned something to the other chiropractor today, something about ‘focus on the big metatarsal’, or ‘medial something’… lmao I have no idea, I’ll have to ask him on Tuesday. For now besides ART he is having my do ankle eversion w/ band resistance.