Patellar Tendonitis Research: Good News and Bad News

The Queen in her carEarlier this year in London, I saw the Queen, Prince Charles, and Dr. Peter Malliaras.

Only one of them came prepared with new insights about tendonitis.

Dr. Malliaras, PhD, is one of the world’s leading tendinopathy clinicians and if you get the chance to take one of his courses, I highly recommend you do so.

The two biggest aha-moments I had in his seminar fit the old “good news, bad news”-cliché.

Let’s start with the bad news.

Here’s the Bad News

As part of his work, Dr. Malliaras regularly performs ultrasound imaging. For him, it’s an important tool to reassure patients by saying “look, you’ve got 80% normal tendon” and to aid in differential diagnosis.

Clinicians can see tendon pathology on ultrasound, but much like a shoulder with a torn rotator cuff can be pain-free, a pathological tendon is not necessarily painful. This confirms my patellar tendonitis treatment advice: “Just because you’re pain-free, doesn’t mean your tendon is healthy”, but here’s the bad news.

Once a tendon has become pathological (i.e., the collagen alignment inside the tendon has degraded and other negative changes occurred), the pathological changes will not go away again.

You read that right.

Once a tendon has become degenerated, it will stay degenerated, as shown by ultrasounds of recovered tendinopathy patients. These folks are pain-free and able to enjoy their sports without a problem, but the inside of the tendon has not returned to the pre-injury state.

Here are my key takeaways from this.

1) Ignoring the pain is officially the worst way to deal with tendonitis, because of the high risk of doing irreversible damage to the tendon.

2) To prevent pain from coming back once you’ve recovered, keep doing strengthening exercises for your tendon. That brings us to the good news.

You CAN Get Rid of Pain (In Many Different Ways)

The most popular exercise for patellar tendonitis is eccentric squats on a slanted board. It’s been around for decades and looks like this.

eccentric squats on a slanted board for patellar tendonitis

A newer treatment approach relies on heavy slow resistance training (HSR), which you can do on the leg press machine, the leg extension machine, the smith machine, hack squats, and even with barbell back squats.

HSR exercises for patellar tendonitis, pictures B through D - Source: Koonsgard 2009

HSR exercises, pictures B through D – Source: Koonsgard 2009

Of course your next question is, “which one is better?”

It depends.

If you look at the landmark study by Koonsgard from 2009, you’ll find that while HSR has a slightly better outcome in terms of pain scores at the 6-month follow-up compared to eccentric training, the difference is not statistically significant.

In this study, some people did better on HSR exercises and others on eccentric training.

The key insights in terms of outcome difference were that both, eccentric training and HSR, are superior to corticosteroid injections over the long-term, and that patient satisfaction was higher in the HSR group, because of the lower training frequency.

At the seminar, Dr. Malliaras said, “It doesn’t matter what exercise you do, people will get better.” That is, as long as you’re using an exercise that can be progressed and are not progressing too fast.

Here’s my take on the advantages of heavy slow resistance training compared to eccentric squats.

Pros and Cons of HSR for Tendonitis

+ Lower training frequency (in the first months only – I advise against daily training with eccentrics as soon as you do single-leg variations)

+ Potentially better than eccentrics if exercise irritates your tendon easily (HSR allows for adding resistance in small increments, so you’re progressing more gently)

+ Allows for isolating the quadriceps muscle group (in the squat, quad weakness may be masked by more engagement of other muscles)

– Requires gym membership (and you will need to drive there)

– Requires technique instruction (for smith machine squat, back squat, and leg press) to reduce risk of back injury

If you already have a gym membership and are experienced with the required exercises, HSR is a good option. If you’d rather train at home, eccentric exercises are the more attractive option.

Regardless of which exercise you pick, be sure to move slowly and without momentum. You need to avoid flare-ups.

How to Make Your Knees Strong Again

The research is clear on one thing. Your knees won’t get better with resting. You need progressive loading.

Let me show you a simple way to get rid of pain and make your knees strong again.

Click here to get free instant access.

Patellar Tendonitis & Jumper’s Knee:
How to Get Rid of It

Patellar Tendonitis & Jumper's Knee: How to Get Rid of ItLearn how to get rid of your Patellar Tendonitis in this ultimate guide to curing Jumper’s Knee.

My name is Martin Koban and I suffered from patellar tendonitis (aka “jumper’s knee”) myself. I know how frustrating it can be and since you’re reading this, I don’t have to tell you about it.

To cut a long story short, I almost quit sports altogether before I finally discovered a number of techniques that helped me heal my knees and get back to being active.

I collected this knowledge through years of research and self-experimentation. The techniques you will learn on this page have already worked for thousands of people and professional athletes are using them as well.

If you want to get rid of your patellar tendonitis, this is your holy grail.

[Read more…]

Jumper’s Knee: It’s Okay to Train through Pain If… [Checklist]

If you had jumper’s knee for a while, you know that ignoring pain doesn’t work, so what should you do if you feel pain during your training or even during rehab?

Let’s talk about how you can recover faster by knowing when it’s okay to push through pain.


Do you want get rid of your tendonitis ASAP? Join my advanced course today.

Video Transcript

So you’re trying to get rid of patellar tendonitis, but because some pain is always there, you’re not sure how hard to push yourself during rehab or training. You don’t want to cause a setback. [Read more…]

Knee Pain: How to Stay Sane When You Can’t Do What You Love

I’d been lying on my bed, staring at the ceiling, for hours.

The knee pain wasn’t even that bad, but this one thought had kept me awake past 2 AM.

How would my life change, if I could never again run or jump as I used to?

In retrospect, it’s a stupid question to ask. Here’s why.

The mind will give you answers to every question you ask, so if you try to picture a bad future, your brain will come up with tons of depressing imagery within seconds.

Brain: “So you want to feel bad? Okay, here goes…”

Before you know it, you’ll be sucked into a negative spiral of self-pity and apathy. I’ve been there.

Today I want to talk about how to stay sane when you can’t do the sport you love.

The Biochemically Most Important Step

If you’re used to doing sports several times a week, your body biochemically depends on your activity to maintain a positive mood.

Without sports, you’ll start to feel bad. The longer you stay inactive, the shittier you’ll feel, but there’s an easy solution…

Keep active in any way you can!

Your body relies on muscular activity to feel good and any type of training will work. Here’s what worked best for me.

Two effective exercises you can do almost anywhere are chin-ups and push-ups. They’re super-safe for your knees and a great way to use a big part of your upper body musculature.

Rubber boot chin-ups are the best chin-ups.

Even if you don’t like these drills, you’ll find that you’ll feel great after doing 30 to 50 total repetitions spread out over as few sets as necessary. Three sessions per week will suffice. That’s less than 30 minutes of training to feel good for a whole week!

I dare you to do the push-ups right now. Safe the chin-ups for when you have access to a bar.

These two drills kept me sane and gave my training purpose when I couldn’t do anything else.

If they’re too tough for you, you can also do dumbbell presses and rows or push-ups with your hands on a table. JUST STAY ACTIVE (I can’t emphasize this enough).

Step 2: Distract Yourself

I used to play basketball in the afternoon on the weekends and Tuesday evening. When I couldn’t play, I filled those time-slots with other activities to keep my mind distracted from what I was missing.

My go-to activities to distract myself were photography, reading books, and watching TV shows. Check out this page to find great TV shows (my favorite: The Wire).

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Of course, you can also use this time to catch up on other hobbies that you wanted to spend more time on.

Maybe you have guitar that’s collecting dust in the corner or maybe you’re into painting or poetry. Whatever it is now is the time to get better at it.

We begin to love a sport because being good at it gives us satisfaction.

I sucked when I started playing basketball, but after 5 years, I wasn’t the worst guy on the court anymore and being good obviously made playing the game a lot more fun.

So the mood uplift from sports is not just because of the biochemical effects, but it’s also psychological. The better you are at something, the more you enjoy it. This happens to be why push-ups and chin-ups will suck when you first do them.

You need to keep this in mind when devising a strategy to feel better.

Step 3: Reframe the Sport You Love

Okay so here’s the thing.

For recreational athletes, sports are about having fun, as we just spoke about.

You will spend a lot of time enjoying the activity, the fun part, while only spending little time on prep-work such as warming up, stretching, mobility training, maintaining muscular balance, and so on.

Once you push past a certain level of competency and performance in your sport, just showing up at the court in your sneakers is no longer enough to keep you healthy.

The more serious you become about your performance, the more time you have to invest into preparing your body for your sport.

For every hour a professional athlete spends enjoying their sport, they spend several hours getting ready. That’s easy to forget when watching sports on TV or highlight reels on YouTube.

The best thing you can do now is to reframe rehab as an actual part of your sport. In your mind, doing gluteal exercises, stretching, and foam rolling will go from being something you “have to” do to something you actually want to do.

This shift in mindset has a huge effect on how quickly you recover from injuries and how happy you are with yourself.

Subtle, but Brutal

The changes we talked about in this email are very subtle at first, but combined they have a brutal effect on how you will feel during your rehab period. The better you feel, the less likely you are to do something stupid that causes a setback.

You will recover FASTER and feel BETTER during the process.

Eight months of feeling bad and being depressed could turn into five months you’ll later look back on with a smile.

Start today with 30 to 50 push-ups and see where it takes you. Take as many breaks as you need to finish, but start now.

The Most Epic Athlete I Ever Worked With

He’s charismatic, in fantastic shape, and the most epic athlete I ever worked with.

Dimitri Maramenides is like a Greek Jackie Chan.

Watching him perform made me question whether the laws of physics apply to him and I was equal parts scared and in awe.

Dimitri and I recorded the following video together and I highly recommend you check it out.

If you’re ready for more, watch his video “Fearless”.

A word warning: it’s not for the faint of heart.

To learn more about Dimitri, check out his Facebook Page or his website.

From Crippling Tendonitis to MVP Award: How Pro Athlete Boki Nachbar Beat His Tendonitis to Feel “95% Better”

bokiImagine you had the opportunity to spend every day doing what you love and earning several Million Dollars per year doing it.

Would you take that job?

There’s just one problem.

If you can’t get your knee pain under control, the fun is over.

That was Boki Nachbar’s situation. Among other teams, Boki played professional basketball for the Houston Rockets alongside Yao Ming and for the New Jersey Nets, with Vince Carter and Jason Kidd.

Boki reached out to me for help with his tendonitis last year in August, because the knee pain was ruining his love for basketball. He wanted to keep playing without using painkillers.

Here are his results after Boki and I worked together on a detailed plan for him to follow during his off-season.

  • Won league MVP award in March after a season with horrible tendonitis
  • Feels “95% better” compared to last season
  • Most importantly: Basketball is FUN again

How to Beat Your Tendonitis Using Boki’s Approach

Boki invited me for an interview on his podcast and we talked about a number of topics you’ll find interesting such as:

  • Preventing and rehabbing knee injuries in sports, particularly tendonitis
  • Why my approach helped him get better while the advice his physical therapists gave him didn’t
  • What happens if you play through patellar tendonitis

 

Click here to listen to the interview.
(Use the link at the bottom of the page to download it to your device)

 

If you found the conversation useful, please leave a short review on iTunes.

 

Picture by Boštjan Nachbar