UKC

Hi all,

Sorry to barge in out of the blue but I need some advice re: Hill Walking and a medical problem.

After a life time of hill walking I have, at the wrong side of seventy, suddenly been blighted with what a physiotherapist has confirmed as Patellar Tendonitis,

There is no pain when I put weight on the knee but the tendon is tender and sore and is painful when I bend the joint. I'm having occasional sessions with the physio and he's giving me tips and advise.

One of the best things I am finding to alleviate it is kinesiology tape aka sports tape. When I apply it to the knee there is an absence of pain and I have normal mobility.

I understand that tendons can take a while to heal but in the meantime it's kept me off the hills since mid January and I've really got itchy feet now. I'm really keen to get walking again before I'm really out of condition.

My question is has anyone else suffered from this problem; were you able to walk - with or without any form of support(tape OR elasticated support? Or if anyone else has any advice it would be gratefully received

Hi WindyBurper, sorry to hear this, it's rubbish being kept off the hill by this kind of injury. I can only talk about my experience of patellar tendonitis, but the best treatments I was advised were single leg squats (though I was in my 40s and have no idea if it'd be advisable for you - I'd suggest discussing with a physio) and orthotics for my feet as collapsed arches were part of the root of the problem.

Good luck.

Hi Kate,

Thaks for that. The physio did suggest some exercise including the single leg squat. It's actually the one I'm least able to do, probably due to age, lack of flexibility etc. I'm managing the others he suggested like knee flexion and lunging. I'm going to persevere with them.

The physio did say not to worry about keeping the tape on too long. Apparently it doesn't cause muscle atrophe like bandages do.

I'm going to try a bit more rest/exercise routine. I might then venture out on to a GENTLE hill walk - say one or two miles with minimal gradient - with the knee taped up.

I’ve had this from cycling and it was fixed with stretching, adjusting bike fit and some slightly tilted insoles to keep my leg and knee more aligned.  Not sure how this transfers to walking but it was also pushing too hard.  Perhaps some walking poles might help a bit?

good luck

Toby

Been using poles for about twenty years

I meant to add that I tend not to consult the GP about such matters. I've done so in the past only to be sent for an x-ray about three weeks later, by which time the problem has resolved. Also I sometimes wonder if the medics seem to think that paracetamol is a universal panacea when it really only treats the symptoms.

I go to a magic lady who is a McTimoney chiropractor. This is not a normal chiropractor, no bone cracking or rough treatment. She does very gentle soft tissue manipulation to deal with any skeletal imbalances. It really works. 

It might be that your issue stems from something out of alignment, these things quite often are. If you have someone nearby who does a similar treatment, it would be worth trying. 

Hi Windy

I had this when I was in my twenties and it’s a bugger to shift if you don’t treat it correctly.

You are correct by resting it from any causative activity and the taping is a good idea to offload the tendon.

Generally the eccentric treatment for this injury is a 3 phase one, and it may exacerbate your symptoms whilst doing it,  it it’s important to carry on unless it’s excruciating.

Single leg sets are phase 2, and too advanced for you yet by the sounds of it.

Phase 1 is double leg squats for up to twelve weeks or sooner if it resolves/ gets too easy.

Hold onto a firm surface with 2 hands, and slowly squat down, taking the weight through your bad leg. When you get to the point of painSTOP, and push up through the good leg. Aim to build up to 90 reps every day.

Stretches are important for all lower leg muscles.

1.Prone knee flexion which will also stretch your hip flex0rs

2. Calf stretches with straight leg and bent knee for Gastrocs and soleus

3. a decent hamstring stretch

3 x 1minute 3 times a day.

I would also add in some sets of ‘clams, bilaterally and bridging.

I would walk on the flat for some cardio and use poles as suggested if you must do inclines/ declines.

Also, friction massage the painful spot in a sideways direction.

Hooe that helps, but it won’t be quick.

Dave

I’ve had this…painful on occasions (I’ve struggled to walk upstairs with it).

The tape works because it pulls your kneecap into alignment when it moves. The issue being caused by an imbalance in the way your quads work pulling the kneecap off alignment.

Stretching/foam rolling/massage on the outside quad and then strengthening your inner quad is one option to try.

I have suffered various knee and ankle problems over the years as I get older, and resting up a while usually does the trick, maddening as it is. Best to listen to your body and not rush things. Good luck.

PS - I have found that a neoprene support helps on both knees and ankles.

https://www.ukclimbing.com/forums/running/patellar_tendonitis_-_suggestions...

I have found the blog links in this post (Mr Fuller) very helpful, as it not only details the exercises he used to recover, but also makes some insightful observations about knee physiology.

Thanks to all for comments and advice. Seems there might be some progress. I've been doing the exercises and I kept the tape on until Monday morning and haven generally been resting the knee. I went out for a shortish walk on Monday and, so far, I've not had any pain or discomfort. Weather permitting I'll be out for another easy walk tomorrow or Friday. Fingers crossed.

Yes.. but you are neglecting to tell OP how to strengthen the inner quad (vastus medialis), which is absolutely  THE answer if someone knee cap tracks incorrectly and "catches" at the top outside corner. I've had it myself. https://en.m.wikipedia.org/wiki/Quadriceps

The quads are inervated (controlled by nerve) by a single nerve, you can't clench one of the 4 in preference to another it's all 4 or nothing. Anyone who says otherwise is talking nonsense (as there's only a single nerve). Like my first physio when I had this.

However... the 4 muscles in the quadriceps are on slightly different positions and insert to the knee the prett much same ---> but attach in slightly different places at the top! Any exercise and you will exercise all 4, but some parts of the movement range *slightly* shift more load on one of the 4 than another due to the different attachments and leverages 

When the knee and hip are hardly bent, like going jogging, running, hillwalking there is slightly more load on the outer muscle and over time if that's your only/main exercise you can develop an imbalance that pulls the kneecap out of track slightly grating on the top outside corner with sudden pain and weakness out of proportion to the injury. Sometimes called runners' knee.

When the knee and hip is very bent, like sitting on your heels the load is shifted slightly to the inner quad. If you can exercise the quad with the knee and hip bent at 90 or deeper -- that's the correction.

After 10 years of barbell squats going to parallel-squat or better, I can report a good vastus medialis bulge on the bottom of the inner quad and never had runners knee in last 10 years.

You don't need to squat, but you do need any quad strength building in that bent position you can do. Do NOT do just the top half of the squat movement, that makes it worse. Starting really gently and small quantities and slowly and gradually building up the resistance. 

Try sitting on a park bench and have feet on a low box or block or something so they are bent >90 degrees. Stand up slightly to raise your bum 1 Inch off the bench, hold and as slowly slowly load back onto bum over 10 seconds. That's a good starting point! Increase the box increase the time, progress to one leg, there's many ways to increase the difficulty progressively l. But do stuff to strengthen the inner quad in preference to the outer quad to correct the imbalance 

See a medical specialist. Many physios are just interested in keeping you visiting and paying. Few are truly qualified medical professionals, many have no real training at all. Just see a doctor, or self-refer to a specialist!

tendons need blood supply to heal, and they only get "blood / nutrients" when they are under mechanical tension. Most physio works if you do it, so finding the most convenient way is best. IMO the best approach to physio is a snacking one, one which you can do several times a day without too much thought or effort, having a band or weight ready to go in the kitchen.  The intensity of the exercise should be easy,  where you can feel the blood going to the needed area but can keep going for 20 reps. You want to feel effort in the needed area but don't want to overload it to failure. Pain during or after physio is ok but it shouldn't be getting worse. This will all take some creative experimentation both with the intensity and whatever exercise you find works best. 

"'Physiotherapist' and 'physical therapist' is a legally protected title in the UK which means you can only use this title to describe yourself or your profession if you are registered as a physiotherapist with the HCPC"

All physios should be fully qualified.

You may be confusing with sports massage therapists, which is less controlled. Of course many SMTs are excellent despite not having a physiotherapy degree.

It can be a bit galling to keep going back to the physio and shelling out, but having undergone a programme of physio, the way it builds, introduces new things, once you are past the visits and back functioning you can see why. I can definitely tell the difference between a good sports physio and a generic one, and that difference is worth paying for IMO.