UKC

After experiences if I may...

I'm booked in for a cortisone injection, guided by ultrasound to treat a tendinopathy in my patella tendon.

Does anyone have any personal experience of this treatment. Or does anyone have a medical opinion?

Many thanks
Irk

In reply to XXXX:

thats a fairly standard treatment for non resolving inflammation, has minor risks but as a one off should be useful. Whats the cause of the tendonitis?

In reply to XXXX: It's hard to have an opinion as you don't give much information. I assume that you've had this repeatedly for some time.

I had minor outburst of this when I ran a lot. Cures were to back off running a bit, ice it after long runs, stretching, change shoes to something with more cushioning, more running off road and so on. So it all depends on how advanced your situation is.

In reply to XXXX:

I just bought myself one of these to give it a go before going down the injection route (different injury, but tendonitis in a couple of places that physio has not cured) . It's a punt but if it turns out well, I will re post to let everyone know.

https://www.amazon.co.uk/Therapeutic-Ultrasound-comprehensive-Application-s...

In reply to XXXX:

Sorry yes, context...

Keen runner and running has done it. Not sure if it was building up too quick or general accumulation of miles.

Self treated for 8 weeks, physio for 5 months, has got better but restricting running to 10-15 mins. Longer than that causes pain and puts me right back.

Not sure an injection is the way forward as inflammation will surely be long gone.

In reply to XXXX: What did the physio say, do?

You've tried stuff like different shoes,running off road? What do you normally wear, do? What were you doing before the 8 months, and for how long? What do you want to do?

In reply to wbo:
I've run every distance from 5k to 100 miles and trained from 0 to 120 miles per week, at different times in my life.

I'd like to run ultras again, challenge 10k pbs and basically run again in the hills.

I've run about 7500 miles without this problem so I'm sure it's not about my shoes (no recent change) or surface (I run on and off road but mostly off).

Physio did some strength and loading exercises and then moved on to some biomechancial things.

In reply to XXXX: So you've thought about the stuff that's obvious.
But no distinct cause? What was the result of the biomechanics?

I guess the ultrasound is to break up scar tissue (?) - the cortisone I don't know - I always avoided it.

In reply to wbo:

Some weirdness, but I think it's my natural gait. The ultrasound is just so they know where to stick the needle.

Why have you always avoided it?

In reply to XXXX: Well ignoring the fact I'm not keen on needles I preferred to just rest and ice to remove swelling, and then try to fix the cause. Maybe I was lucky and nobody ever suggested it to me for any of my injuries

In reply to XXXX:

What the research says about patella tendinopathy;

- Steroid injections can be helpful (especially if guided).However they are often a short term fix. Avoid repeated injections.
- Dont bother with therapeutic ultrasound. It doesnt work.
- Tendon pain is often caused by overload/ too much too soon.Temporarily reducing the load on the tendon usually helps ie reduce running intensity.
- Progressive strengthening helps. It increases load tolerance.
- Tendinopathy often takes longer to settle down than people want.

Hope that helps.

In reply to Static:

Thanks, think I'll refuse the injection and ask to go back to the beginning with another physio.

Slowly slowly catchy monkey and all that

In reply to XXXX:

I am finding that decent orthotics help a lot.
It's early days but after months of pain the new insoles in my work boots are helping a lot.

In reply to XXXX:

I've had patella tendonitis for 4 years now, got it by upping mileage too quickly. I can't comment on the cortisone, but I can say to be very very careful, I wasn't which is why I still have it 4 years later. One thing that can help quite a bit is taping quite tightly around the tendon to achieve the same sort of effect as using a brace, works a lot better with tape though (can also recommending shaving the knee area if you try that!). If it persists/keeps on coming back after you think it's gone away you might want to try and get an MRI, I had one and found that I had a pointy bit of bone on my patella which was damaging the tendon, so I had an operation to get that removed and now things are slowly beginning to get a bit better. Good luck.

In reply to Fellover:

What do you mean be careful? Obviously, be careful not to get it... but that's too late now!

In reply to XXXX:

I ignored patella tendonitis in both knees for 18mths whilst I played football. Masked it with ibuprofen before and after games and basically put up with the pain.

Its a pretty sure sign that something either isn't aligned correctly (Muscle or bone structure) or that the tendon isn't healthy in some way.

Trust me, the effects of snapping it effect every single day of your life (Mine ruptured in half, not at the bone and its a guessing game getting your knee cap back in the same place). Given the chance again I would do whatever it took to get to the bottom of the issue before continuing sport.

In reply to XXXX:

Hey sorry, didn't notice the reply. By be careful I basically mean really try and sort it out properly before returning to any kind of vaguely intense activity. Definition of vaguely intense being specific to how much yours hurts.


Agree with this completely, I kept on playing badminton, football, lacrosse etc. after I injured mine, just a kind of 'man up and deal with the pain' attitude, which was a terrible decision. Just made it worse and the recovery period way longer. If you let it get that bad it really will affect every day for a very long time, eg. it's hard to bend down and get stuff from the bottom shelf at the supermarket, can't cycle to and from work, walking in the cold is painful, stuff like that. If i could go back to when it happened and give up sport for a year to let it recover I absolutely would.

In reply to XXXX:

Quick google reveals this: https://runnersconnect.net/running-injury-prevention/patellar-tendonitis-ru...

Potential for confusion with patellofemoral pain? I've greatly lessened my patellofemoral issues with sorting out a whole load of muscle imbalances (under use of glutes amongst others) and changes in running gait. I also ran for many years over a variety of distances and terrains with no issue(orienteering, fell running, road 10k's), but triggered my pain by quickly going back to high loads after a long period of less running activity. Also had a sport scientist friend extol the benefits of sports massage (or diy foam rolling), followed by stretching phase followed by antagonistic exercises, and finally re-incorporating "normal levels" of training.

Wonder if any of my experiences might translate to your situation? Think the time frames for resolving any tendon related issues are fairly long term so 8 and 5 weeks you mention don't sound particularly long and improvements you describe may attest to that?

Happy to be shot down by anyone more expert than I!

In reply to all:

Thanks everyone. Just to clarify, the timescales are now a year of this with little exercise.

Had ultrasound last week but refused the injection as I couldn't find any evidence it was going to help long term.

Scan shows chronic patella tendinopathy with bursitis. Not too bad as they go, but definitely in need of rehab. Likely to be a cumulative mileage issue rather than biomechanical as the other knee looks like it could go too.

Will be starting a 6 month tendon loading and strength programme and seeing how it goes. If I can't commit to a decent level of rehab without pain I'll go back and get the steroids.

Any advice on good loading exercises appreciated. Or indeed reccomendations for physios with this as a specialism in the south east.

Wish me luck...