Quadriceps Tendonitis (Not Patellar)

[quote]BHOLL wrote:

[quote]nkklllll wrote:
BHOLL, have you had tendonosis? [/quote]

Does a bear dump in the woods?

Tendinopathy is associated with vascular hyperplasia, collagen misalignment, and infiltration of cytokines and substance P. Resting may have worked for you, but suggesting a blanket term resting will work for everyone is irresponsible considering the mounting evidence for eccentric based exercise as well as other techniques to promote blood flow. [/quote]

I don’t see how its irresponsible to have someone try a conservative approach which will cannot make things worse, and in all likelihood will make things better. There’s even an article on this site that talks about it. Something like “the truth about knee pain.”

I’m quite confident that resting WILL work for everyone given enough time. Like I said, I’ve tried all of the techniques there are. I’ll tell you that traditional PT got me back to walking up stairs and standing up out of a chair without pain. I’ll also tell you that I still could squat down without pain. Eccentric squats with an elevated heel got me to be pain free, except when I tried to continue the rehab after the pain was gone. Within 3 days I would be hard pressed to find a time when my knees wouldn’t hurt.

I bet you’d be hard pressed to find someone who took the time off, addressed any imbalances they had, and still felt the effects of the tendonopathy. However, it’s not hard to find someone who couldn’t reach 100% through any of the active methods. You’re talking to him after all.

Maybe I was remiss in saying that it is the ONLY thing that would work, because I know for some people some of the less conservative methods got them back to being awesome, but I’d be willing to bet that a greatly extended rest is the only one that would show improvement in ALL cases.

[quote]CharliePI wrote:
Hello Dezer,

Long time T Nation lurker here. Saw your post and had to create a new account to respond and share my story.

I have been powerlifting and training seriously for the past 5 years; however not squatting with the frequency you detail.

At a time I experienced pain in the same location, just above the knee cap. It was very painful to say the least; I could barely even bend down to tie my shoes.

Some things I tied:

  • Saw a physio;
  • Lots of foam rolling and stretching;
  • Icing;
  • Resting and avoiding all movements which caused discomfort;
  • Heel-elevated body weight negatives…
    … and so on.

Nothing worked the pain would not go away.

I did however pinpoint what may have been the cause of my tendinitis.

I had a change in occupation about 18 months ago, and this co-coincided with the pain starting. I started a new job as a police officer. On closer inspection of our issued boots i noticed that they did not provide proper support for my wide flat feet and my ankles would roll inwards excessively. I came to the realization that being on my feet most of the day and doing many kms walking was a potential cause of my problem. Also, i had never worked a job where i spent that much time on my feet walking around (new stimulus).

So… I bought new boots with proper support.

A few days passed and I had the shits from not squatting in forever so I hit the gym. Squatted through the pain and did obscene amounts of volume LOL (was probably not a good idea, but i could not handle not getting my rack time in :< ). Had the worst DOMS of my life, but funny enough could not feel the tendonitis pain with all the DOMS in my quads… when the DOMS faded the tenton pain was a little fainter… So i trained like an idiot again (2nd worst DOMS of my life :p)…

When that 2nd round of DOMS dissipated over-night so did the tendonitis!?! And about a year later it has not come back.

I cannot pinpoint exactly what i did right to fix my problem. But I have a few takeaways:

  • Assess what has/may have changed in your life that is causing the issue, have you introduced some sort of new stimulus in your day-to-day regime?
  • Check your posture/feet/ankes
  • Dont give up hope (I almost did) the pain will go away eventually (if it is any constellation I didnt lose any strength after my extended ‘rest’ period :))

Another important thing to mention (that may have caused my issue). Prior to my pain starting I did most of my squatting to parallel; shoulder width stance, kinda between high and low bar, and putting on the breaks to stop at parallel. When I started squatting again (when my pain went away) I changed to high bar and only squatting ass to grass. This may/may not have helped as i may/may not have read somewhere that putting the breaks on at parallel isnt great for the knees (I dont know, dont remember, dont quote me :p)…

Thats all… good luck!
[/quote]
Thanks for your words and the very interesting read! I do have slightly flat feet, nothing major tough, but if I walk in shoes like Chucks for a few days in a row I sometimes get a pain between fourth and third finger, it’s like a neuroma but after some time walking in some shoes with a thicker sole it goes away. I’m used to squat in Chucks, low bar, slightly more than shoulder width stance. Before I got injured I ordered a pair of DoWins since Chucks started feeling a bit wobbly over 300 lbs, and the side on the canvas feels not hard enough when pushing outwards with the knees. Right now I’m puzzled tough, maybe this happened because I was becoming too quad dominant, and maybe the 3/4 Rougues will just exacerbate that, idk.
I should probably rework my form and try to have more vertical shins, probably the box squats I’ll do for rehab will help me with that. As to my job I mostly sit at a desk, sure it doesn’t help with hams felxibilty but I’m pretty mobile because I’m pretty religious about stretching. A bit skeptical about going ATG right now, sure DoWins may help but right now I’m very far from a full recovery so yeah, I’ll have plenty of time to decide how to go about it. Before getting injured I was just going an inch below parallel or so, no more than what it take to have a lift passed in a meet, so to speak, it always felt good so far so I don’t know…

[quote]nkklllll wrote:

[quote]BHOLL wrote:

[quote]nkklllll wrote:
BHOLL, have you had tendonosis? [/quote]

Does a bear dump in the woods?

Tendinopathy is associated with vascular hyperplasia, collagen misalignment, and infiltration of cytokines and substance P. Resting may have worked for you, but suggesting a blanket term resting will work for everyone is irresponsible considering the mounting evidence for eccentric based exercise as well as other techniques to promote blood flow. [/quote]

I don’t see how its irresponsible to have someone try a conservative approach which will cannot make things worse, and in all likelihood will make things better. There’s even an article on this site that talks about it. Something like “the truth about knee pain.”

I’m quite confident that resting WILL work for everyone given enough time. Like I said, I’ve tried all of the techniques there are. I’ll tell you that traditional PT got me back to walking up stairs and standing up out of a chair without pain. I’ll also tell you that I still could squat down without pain. Eccentric squats with an elevated heel got me to be pain free, except when I tried to continue the rehab after the pain was gone. Within 3 days I would be hard pressed to find a time when my knees wouldn’t hurt.

I bet you’d be hard pressed to find someone who took the time off, addressed any imbalances they had, and still felt the effects of the tendonopathy. However, it’s not hard to find someone who couldn’t reach 100% through any of the active methods. You’re talking to him after all.

Maybe I was remiss in saying that it is the ONLY thing that would work, because I know for some people some of the less conservative methods got them back to being awesome, but I’d be willing to bet that a greatly extended rest is the only one that would show improvement in ALL cases.[/quote]

"I bet you’d be hard pressed to find someone who took the time off, addressed any imbalances they had, and still felt the effects of the tendonopathy. "

You don’t have to rest if you simply find a manner to reduce stress on the quad tendon ie> box squat

Just a quick update. Yesterday I had my workout as scheduled, felt pretty good. I just did some bench work, rack pulls, glute ham and some arm stuff. In the evening I still had some annoyance on the stairs but nothing major. Woke up today after 10 hrs sleep feeling pretty good, stairs feel pretty smooth today, and I don’t even feel the urge to help myself with my arms when sitting up and down (I still do tough).

However I’m not gonna rush it just because I feel better: next week I’ll still skip full deads. I forgot to mention that yesterday was my last day on antibotics for the severe strep I had last week, I reaserched the substance before getting into training again and it appears that it shouldn’t affect tendon health, training or whatever, it’s just amoxicillin with clavulinic acid. I basically felt a little bit weaker the whole week but nothing major.

On another note I’ll keep foam rolling and stretching since it doesn’t bother me and apparently it helped with recovery in the last weeks before my legs started acting up again due to my bw squats at the beginning of this week, maybe just once instead of twice a day, so that the tissues don’t get too much stress.

One more thing. These days I also stumbled upon a supplement I never heard of, called cissus quandrangularis. It would appear from anecdotal evidence that it helps heaps with these kinds of issues. It’s realitively cheap so I decided to order a bottle of it just to try it out. Anyone had any experience with it? There isn’t any relevant study to back that up apparently but I’ve read a lot of interesting stories and feedback from prople who used it.

I took a full bottle of cissus quadrangularis while I had my two months off. I can’t tell if it was the time off or the supplement that helped. Probably both :slight_smile: Guess I have good experiences with it.

It’s interesting to hear from you, so keep us posted.

I got my Super Cissus in the mail today and downed the first two caps. Let’s see if this thing helps. Today I had my training as scheduled, feeling good, bench went up finally so at least that’s something. I still don’t feel any kind of soreness so I think I’m healing just fine. I also started running some Animal Flex again, tought it could be good stacked with Cissus.
Tomorrow morning I’ll have another tecar therapy session, sure that won’t hurt as well. I’m feeling pretty positive today, feels like everything is slowly falling into place. I’ll keep you posted.

New update. Yesterday I worked out as usual, at the end I threw in some very mild quad work: bodyweight box squats to about 70°, then I was feeling pretty good so I did a few sets of one legged negatives on a board (also 70°). Felt easy and smooth. Looks like Cissus is finally doing something: also my usual pains and nicks from the past seems to be mostly gone, even the recurring annoyances with my elbows and shoulders.

I also did some light cardio on the bike yesterday evening, and yet this morning I woke up feeling very good, no pains nor soreness of any kind to report, knees feeling very smooth. This is pretty good I guess. TomorrowI 'll throw in the mix some other quad work, pretty much the same I did yesterday. If everything keeps feeling smooth maybe next week I’ll go a liiiitle bit harder, and maybe sneak in the full deads.

Currently dosing Cissus at 6 caps a day. Getting good pumps even being pretty low on carbs, and they last pretty much all day. This supp sounds like good stuff. I may try to up the dosage in the coming days if I feel like it. I’ll keep you updated.

Don’t be in a hurry now. I started out too quickly a couple of times too, before I realized I needed a long layoff. But things might be different with you, I don’t know.

[quote]dezer7 wrote:
New update. Yesterday I worked out as usual, at the end I threw in some very mild quad work: bodyweight box squats to about 70°, then I was feeling pretty good so I did a few sets of one legged negatives on a board (also 70°). Felt easy and smooth. Looks like Cissus is finally doing something: also my usual pains and nicks from the past seems to be mostly gone, even the recurring annoyances with my elbows and shoulders.

I also did some light cardio on the bike yesterday evening, and yet this morning I woke up feeling very good, no pains nor soreness of any kind to report, knees feeling very smooth. This is pretty good I guess. TomorrowI 'll throw in the mix some other quad work, pretty much the same I did yesterday. If everything keeps feeling smooth maybe next week I’ll go a liiiitle bit harder, and maybe sneak in the full deads.

Currently dosing Cissus at 6 caps a day. Getting good pumps even being pretty low on carbs, and they last pretty much all day. This supp sounds like good stuff. I may try to up the dosage in the coming days if I feel like it. I’ll keep you updated.
[/quote]

your welcome

[quote]ahnz wrote:
Don’t be in a hurry now. I started out too quickly a couple of times too, before I realized I needed a long layoff. But things might be different with you, I don’t know. [/quote]
Thanks, I appreaciate your concern. I do understand this actually, because I’ve done it before, apparently tho what really pissed off the tendons was me trying to do ATG squats too soon about 10 days ago. It appears that as long as I don’t go below parallel I’m pretty much fine right now, which is a step forward IMHO because when I first tried doing some partial presses after my first weeks off the pain would come back almost instantly. Sure I’m not gonna load the bar like crazy on the box right now because of this hunch I have, but it definitely gives me some input. Yesterday I did a few sets of box squats with the unloaded bar, which felt pretty good. Again, no soreness to report today whatsoever. Unexpectedly I felt a little bit scared under it (heck, under the empty bar!) which is something totally new to me, maybe that’s just because before this happened I always thought that my knees were made of steel: regardless of all of the stupid shit I did in the past I never got injured. Well, I guess it’s just my first reality check after all.

I’m thinking about reworking my form as soon as I get through this. I always squatted low bar with relatively wide stance, using Chucks, and I’m starting to wonder if this may have caused some imbalance, maybe my quads were too weak compared to glutes/hams, and that may have caused them to give in a little bit too much. Ideally switching to a narrower stance and a slightly higher bar would involve my quads more and in the long term strengthen them a bit so that I become less prone to injuries of this kind. I also have a pair of DoWins with a .75 heel which I haven’t really used so far if not for some overhead and bench work, and those may help me, even though the switch may be a little traumatic being used to Chucks. I’m kinda confused about all of this honestly. I plan on competing raw in the future, so I shouldn’t need to get used to a very wide stance in any case I suppose, yet I feel like I could move more weight with my current setup. Any suggestions? I have a couple old vids of me squatting, I may try to upload some in the coming days if I have the time.

I didn’t have much time to post lately, however all I can say is that another week of training has gone by, and all is good so far. Today I did 3 sets of 10 squats to the box, a couple inches above parallel. I’m feeling really good, no soreness after the workouts, everything feels quite solid. Strangely enough I’m starting to feel kinda confident again.

Next week I may consider dropping to parallel, still to the box, starting again from bw, then slowly adding the the barbell and ramping up day after day. I firmly believe that if I don’t fuck up I’ll get almost back to where I was in just a few months. However this doesn’t mean I’ll start to throw on the plates on the bar like a mad man. As soon as I get back to a 1 plate squat with passable depth I’ll stick with it for a month or so, just to make sure everything is fine, then I’ll proceed from there. Or at least this is my plan.
I don’t really know is this Cissus+Animal Flex stack I’m taking is helping but it would seem it does: most of my recurring pains are gone after 2 weeks in, so I think it’s definitely doing something. I’m also kinda mega-dosing fish olis and sure that doesn’t hurt. Let’s see how this goes.

Struggling again…

I was so caught up with things in my life lately that I forgot I even made this thread, work, relationships, exams, moving and all that…
A few things happened since my last posts…For a few weeks I felt like the issue was totally gone, I even started a new 5-3-1 routine and I was feeling good. However after a month on the program I was getting a weird feeling. My left vastus lateralis was a little sorer than my right one for sometime after training.

At first I didn’t give it much importance, also because it felt kinda higher than the tendon insertion, that plus the fact that my tendon pain was located towards the end of my vastus medialis, so I thought it must have been something else. However after a couple weeks the pain became very similar to my good old tendon pain.

After a day biking it was hurting like a bitch while coming up and down the stairs, sitting up and down and all the usual bs, so I thought here we go again.

I took a 2 weeks break from squatting or similar movements, but once the light work I was doing got slightly heavier the pain was crawling in again. So I took another break. Yesterday I did some very light work, it felt good afterwards, but this morning the pain is definitely there again.

Needless to say since the first appearence of my issues on february I’ve never slacked on stretching, foam rolling, mobility works of all sorts, so to be honest I’m feeling quite desperate right now. It hurts more in the head than in the body, all my lifts were going up again, I hit a deadlift PR recently that made me feel proud and I was feeling that I was progressing again, thinking that maybe my first meet wouldn’t have been that far after all…but now I feel depressed again, I don’t know what to do with this issue. Probably surgery is the only option I’m left with right now.

I’d really love to hear from you guys, the last answers I got here gave me the hope and the motivation to try to push through, but I’m now starting to feel lost again.

[quote]dezer7 wrote:
Struggling again…

I was so caught up with things in my life lately that I forgot I even made this thread, work, relationships, exams, moving and all that…
A few things happened since my last posts…For a few weeks I felt like the issue was totally gone, I even started a new 5-3-1 routine and I was feeling good. However after a month on the program I was getting a weird feeling. My left vastus lateralis was a little sorer than my right one for sometime after training.

At first I didn’t give it much importance, also because it felt kinda higher than the tendon insertion, that plus the fact that my tendon pain was located towards the end of my vastus medialis, so I thought it must have been something else. However after a couple weeks the pain became very similar to my good old tendon pain.

After a day biking it was hurting like a bitch while coming up and down the stairs, sitting up and down and all the usual bs, so I thought here we go again.

I took a 2 weeks break from squatting or similar movements, but once the light work I was doing got slightly heavier the pain was crawling in again. So I took another break. Yesterday I did some very light work, it felt good afterwards, but this morning the pain is definitely there again.

Needless to say since the first appearence of my issues on february I’ve never slacked on stretching, foam rolling, mobility works of all sorts, so to be honest I’m feeling quite desperate right now. It hurts more in the head than in the body, all my lifts were going up again, I hit a deadlift PR recently that made me feel proud and I was feeling that I was progressing again, thinking that maybe my first meet wouldn’t have been that far after all…but now I feel depressed again, I don’t know what to do with this issue. Probably surgery is the only option I’m left with right now.

I’d really love to hear from you guys, the last answers I got here gave me the hope and the motivation to try to push through, but I’m now starting to feel lost again.[/quote]

Here’s what I would recommend, because it’s what worked for me. To keep myself sane I focused a ton on partial pulls so I could still get some lower body training in (lots of snatch and clean pulls off blocks, RDLs). I would do the same thing for you, let your tendons rest and hit your posterior chain hard.

I would stay away from surgery because it’s still gonna put you out of commission. Except you won’t be able to do anything.

[quote]nkklllll wrote:

[quote]dezer7 wrote:
Struggling again…

I was so caught up with things in my life lately that I forgot I even made this thread, work, relationships, exams, moving and all that…
A few things happened since my last posts…For a few weeks I felt like the issue was totally gone, I even started a new 5-3-1 routine and I was feeling good. However after a month on the program I was getting a weird feeling. My left vastus lateralis was a little sorer than my right one for sometime after training.

At first I didn’t give it much importance, also because it felt kinda higher than the tendon insertion, that plus the fact that my tendon pain was located towards the end of my vastus medialis, so I thought it must have been something else. However after a couple weeks the pain became very similar to my good old tendon pain.

After a day biking it was hurting like a bitch while coming up and down the stairs, sitting up and down and all the usual bs, so I thought here we go again.

I took a 2 weeks break from squatting or similar movements, but once the light work I was doing got slightly heavier the pain was crawling in again. So I took another break. Yesterday I did some very light work, it felt good afterwards, but this morning the pain is definitely there again.

Needless to say since the first appearence of my issues on february I’ve never slacked on stretching, foam rolling, mobility works of all sorts, so to be honest I’m feeling quite desperate right now. It hurts more in the head than in the body, all my lifts were going up again, I hit a deadlift PR recently that made me feel proud and I was feeling that I was progressing again, thinking that maybe my first meet wouldn’t have been that far after all…but now I feel depressed again, I don’t know what to do with this issue. Probably surgery is the only option I’m left with right now.

I’d really love to hear from you guys, the last answers I got here gave me the hope and the motivation to try to push through, but I’m now starting to feel lost again.[/quote]

Here’s what I would recommend, because it’s what worked for me. To keep myself sane I focused a ton on partial pulls so I could still get some lower body training in (lots of snatch and clean pulls off blocks, RDLs). I would do the same thing for you, let your tendons rest and hit your posterior chain hard.[/quote] Thanks for the advice. Honestly I was thinking about picking up some kettelbell swings or similar work to somewhat still train my legs, I may look into cleans and snatches also but I’m not experienced with those lifts so maybe kettlebell training could be an easier option, since it appears to have a smoother learning curve. As to the other pulling movents I do them already so I guess I’ll just bang on…
I tried some leg extensions too but they don’t seem to be worth it…apparently the tendon itself doesn’t get much stressed if I go light, but my knees never really liked that exercise and after a couple weeks they start hurting.

[quote]nkklllll wrote:
I would stay away from surgery because it’s still gonna put you out of commission. Except you won’t be able to do anything.[/quote]

I know, but since this stuff seems to have become cronical I was starting to think that maybe there’re some scar tissue messing up which has to be removed, just a thought. After this summer if it doesn’t clear out I’ll just go ahead and get it checked seriously because I’m starting to feel tired to spin my wheels over this.

[quote]dezer7 wrote:

[quote]nkklllll wrote:
I would stay away from surgery because it’s still gonna put you out of commission. Except you won’t be able to do anything.[/quote]

I know, but since this stuff seems to have become cronical I was starting to think that maybe there’re some scar tissue messing up which has to be removed, just a thought. After this summer if it doesn’t clear out I’ll just go ahead and get it checked seriously because I’m starting to feel tired to spin my wheels over this.
[/quote]

Mine was chronic as well. Also, cleans and snatches aren’t really gonna be good for your knees. You should minimize quad involvement. Look into ART and maybe gua sha therapy.

If you want to do cleans and snatches, I would do power cleans/snatches from blocks. Or just clean/snatch pulls.

I echo the non-surgical approach. Unless there is significant tendon tearing or degrading, I think surgical intervention for a tendinopathy would not be worth it. There are likely underlying issues (poor gluteal activation, poor tissue quality, poor hip mobility, etc) causing the increased tension and load on the tendon. Unless you address those issues, it will likely just return.

Juat a quick update and some thoughts…
This week I managed not to hit legs, if not incidentally by doing deads (deload week anyways so nothing heavy).
I haven’t felt any discomfort since Tuesday, so I guess so far so good.
Starting monday I was thinking about introducing some bodyweight squats to the box with a pretty high one, like not bending past 75�°, then again slowly progressing from there. Last time it helped I think so why not try it again.

I’m just debating between starting back in chucks or do-wins, because when the tendonitis reflared in the new spot for the first time I was giving those a try. Obviously I don’t mean to use them for the box work, my knees don’t like when I sit back on those.