Rehab for knee injury.

Had patella tendonitis in right knee april 2008 and got to the point where I could not walk on leg or support own weight. Six months rehab saw me return to training and then back into competition in febuary 2009.

April 2009 presentation of new pain at base of patella on right knee seemed to be patella tenonitis again but this time at pole of the patellar. Previous problem had been on tibial tuberosity. Examined found knee manip did not cause pain but pressure on that point caused acute pain. After a few weeks of treatment there was no affect. No bursitus, fat pad fine, so examined to find plica. (diagnosed as a plica)

Athlete resumed training having done no impact work for three months. Two weeks ago got similar pain to that experienced in 2008 in left knee. Tuberosity tender to touch. Discomfort when walking down hill. Knee manip was diagnosed as mild patellar tendonitis.

My physio is excellent (stuart Barton) Scottish rugby union and barbars, but I am worried (maybe paranoid) about training on the knee. I was told to carry on with training stopping when knee hurts. Plenty of ice after training and maybe patella strapping.

1. Had steroid injections into plica in right knee last thursday so done nothing since then but rest.

2. The left knee does not hurt during training but 24hrs afterward becomes tender so scared to push it unless i go to far. (would mean end of career if another six months out).

3.X ray and MRI's show very little. Cartilage fine for my age ligaments fine.

Any reccomendations or help would be really appreciated.

Why not try High Dosage Oxygen Therapy (HDOT). HDOT which delivers pressurised oxygen to the body by up to 20 times more than the normal air we breathe, is being used by many people as a therapy to help them recover from many injuries and illnesses such as:

- Multiple Sclerosis
- Stroke,
- Cerebral Palsy & Other Neurological Disorders
- Leg Ulcers, Post-operative Healing & MRSA, etc
- Chronic Fatigue Syndrome, Fibromyalgia
- Psoriasis & Eczema
- Angina and other heart problems
- Burns
- Broken Bones
- Sports Injury
Young and old can benefit from the therapy, which has also been used to speed up the healing of Sports Injuries & Work-related Injuries.

I broke my left leg in 5 places in 2005 and was told i needed a Bone graft, my consultant recommended this treatment and i have not needed a bone graft as a result, ran 1 marathon, and completed a triathlon... It works... Alot of doctors are not willing to inform you of such treatment as they dont know enough about it.. But i found it brilliant... IT WORKS!!!!

I will look into this. Interested to referred to another thread about how back manipulation may help as it could be referred pain. I will discuss these ideas with therapist.

Thanks.

Just a word of warning, your Therapist may not recommend this treatment as they may not know about it... But to use famous sports people that have availed of HDOT, David Beckham used it, and also had the BECKHAM BOOT designed for him to speed up healing.... it works.. I had back manipulation done and i can confirm... its VERY SORE! My consultant sent me running to build my leg back up... it was sore but he said that was normal..Best wishes and fast healing..

hi

were your feet, ankles, hips, pelvis, lower back L3/4 properly assessed?

force ratio i balance between quadricps and hamstrings,

muscles- gluteus med, ilitibial bend, etc?

all the best, get well

Hip and ankle were realigned and are realigned at each manipulation IT band is tight. Back has been assessed. Muscles really not in a trained state at the moment just walking for about an hour each day at the moment.

thanks for the reply

Wow things only get better.

Got the go ahead to do some light training (light training) from the physio last wednesday.

Did an extremely light sess in the gym consisting of four exercises. None of which aimed directly at training the legs.

Did a very light session on the sat. With no impact. Or what I thought was little impact. Have been walking for about an hour a day and doing 20 mins on the exercise bike three times a week.

Monday morning noticed pain around the lateral malleolus of my left leg.

Can not see physio for a week as he is a way. At first thought it was achilles tendonitis but then noticed tenderness ran under the ankle bone upto the toes.

Have I now got peroneal tendonitis?

Bon from Bradford.
Possibly look further up at the lateral and central quads as well a ITB and TFL.
I have found when it comes to patella tendon and patella problems taking the strain off them has proven to give me good results.

Hands on therapy firstly with connective tissue manipulations to the lateral and central quad, ITB, TFL, glut med. Then followed up with deep mobs to the same muscles and ITB each on a stretch. Then hold relax to the same musculature and stretch even the ITB although it is fibrous the stretch is useful.

Then i do the same to the gastrocs and hamstrings, i.e. CTM, Deep mobs on a stretch, hold relax stretch, static stretch if required.

Do not forget to work the retinaculum around the knee laterally, medially and superiorly.

Then get on to the patella tendon which is possibly more likely to be sub acute to chronic by now. I like deep tissue manips till numb then ultra sound ( ahh did i swear). I tend to use it as i was taught by an "old fashioned physio" ensuring it is not thermal but used a high level with the head moving quickly over a focal point.

Then i use ice but i use it only until the area is numb then i take the ice off and replace when the area has returned to body temp. I do this three times.

I apologise if this is prescriptive but it is what i do basically.

The purists among you may suggest i have used lots of techniques and targeted lots of areas so how can i as a physio tell what works. In the world of private practise the patient, bank manager and the kids do not care. The patient wants a result the bank manager wants the loan paid and the kids want the latests clothes. It is about results and this i think will give a positive result with appropriate continued treatment and rehab.

I hope it helps.

Originally Posted by oddscwodd Have I now got peroneal tendonitis?

try not to worry about getting exact diagnoses when you feel discomfort!

if you havent been in the gym for a while and then you go back, expect to feel it in the days afterwards.

there's the usual issues with knee pain of this ilk. have you had a biomechanical assessment? has your physio looked at your hip in detail?
also, what sports do you play? or did i miss that in my skim over your posts...

Thanks for all your input. Physio worked on peroneal tendonitus which developed in both ankles. Massage helped with the extra tight calf muscles and he manipulated talus. Hip is okay.

Constant set backs are a killer and after so long out of training suppose these things are to be expected. Three weeks of strengthening work and then maybe back into training.