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  1. #18
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    Anti-inflammatories, ice, rest etc won't really help what is essentially a degenerative condition which has become chronic and won't reverse or heal of itself. Autogolous blood injections to kick-start the healing followed by a conservative strengthing programme based on eccentric conditioning of the thigh muscle seems to be the way that the latest research is indicating as the best approach. Dr Connell at Parkside Hospital, Wimbledon has treated hundreds of tendinosis conditions in this way and it is worth approaching their knee clinic for advice.

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    Eccentric conditioning such as drop squat do relieve much of the pain due to patellar-related knee pain. Autologous blood plasma treatment is fairly new.

    Quote Originally Posted by paul.z
    Anti-inflammatories, ice, rest etc won't really help what is essentially a degenerative condition which has become chronic and won't reverse or heal of itself. Autogolous blood injections to kick-start the healing followed by a conservative strengthing programme based on eccentric conditioning of the thigh muscle seems to be the way that the latest research is indicating as the best approach. Dr Connell at Parkside Hospital, Wimbledon has treated hundreds of tendinosis conditions in this way and it is worth approaching their knee clinic for advice.

  3. #20
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    What if strengthening exercises such as squats, etc., are a cause of pain?

  4. #21
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    Default Tendinopathy

    Eccentric exercise is really the way to go. I am biomedical engineer currently writting a paper on the conservative treatment of tendinopathy (general term for tendon pathologies) I can send you a copy once I submit it. (mid-april)

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    Default patella tendinosis

    I'm no physio, rather someone who has the condition and to a fairly serious degree - a so-called 'stage 3' tear in the tendon. After the blood injections you follow a pretty strict rehab protocol bases on eccentric conditioning of the thighs accompanied by stretching routines. The principle is you train through a certain amount of pain but the pain level should not increase. This condition is insidious and long-lasting. Patience and discipline are key to overcoming it and in my opinion you need qualified help from a doctor and physio who has practical know-how on treating the condition. It is also helpful to have an MRI or ultrasound scan to properly diagnose the extent of the condition as stages 1 or 2 may not require autologous blood treatment and the prognosis for full recovery is generally better.

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    Autologous blood treatment is also used for OA treatment in Europe.

    Quote Originally Posted by paul.z
    I'm no physio, rather someone who has the condition and to a fairly serious degree - a so-called 'stage 3' tear in the tendon. After the blood injections you follow a pretty strict rehab protocol bases on eccentric conditioning of the thighs accompanied by stretching routines. The principle is you train through a certain amount of pain but the pain level should not increase. This condition is insidious and long-lasting. Patience and discipline are key to overcoming it and in my opinion you need qualified help from a doctor and physio who has practical know-how on treating the condition. It is also helpful to have an MRI or ultrasound scan to properly diagnose the extent of the condition as stages 1 or 2 may not require autologous blood treatment and the prognosis for full recovery is generally better.

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    Default Interesting suggestions

    Its good to hear that everyone has possible solutions to your problem. You need to find out the location of pain, when it worsens, do you have associated biomechanical problems (which means you need to get them sorted out too!), do you need further investigations like X-rays, ultrasound or MRI. An experienced sports physician should be able to get that done for you. I usually do not advocate surgery unless it is really necessary. Prolotherapy is an option but exercise therapy is the way to go.

    http://sportsnmedicine.blogspot.com

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    Default tendinosis not tendinitis?

    paul.z is probably correct about the ineffectiveness of anti-inflammatory strategies if this is really a tendinosis rather than a tendinitis. Tendinitis is acute & involves an inflammation. Tendinosis is a chronic (ongoing)degeneration without inflammation and therefore anti-inflammatories may be of little or no use. It may still be worthwhile to ice after exercise.

    For possible remedies & an in-depth discussion of the diff between -itis and -osis try the following link: http://www.tendinosis.org

  9. #26
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    I still prefer to leave the diagnosis as tendinopathy as it will be difficult to determine what actually happens at the microscopic level. If you suddenly increase your wristwork and jabbing too much, you may actually get tendinitis but usually it's tendinosis.

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    Very interesting... I had no idea there was a distinction. Physicians here seem to use the blanket term 'tendonitis', but it probably doesn't really matter that much either way.

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    Good advice, sportsdoc. Not easy to determine the pathology (is it -itis or is it -osis?) without the benefit of an expert. Tendinosis (w/o inflammation) may actually much more common than tendinitis.

    Quote Originally Posted by westwood_13
    Very interesting... I had no idea there was a distinction. Physicians here seem to use the blanket term 'tendonitis', but it probably doesn't really matter that much either way.
    Yes, it seems that physicians have been leading us astray. It would appear that many diagnoses of tendinitis were really tendinosis. Actually is does matter cuz treaments for one differ form the other (altho' there is some overlap).

    As sportsdoc suggests, tendinopathy is the general term. Not sure if an individual has any hope of determining for themselves if inflammation is present or not. It seems that doctors haven't been getting it right so what chance do we have of determining the actual pathology.

    Hopefully, more physicians are becoming more aware of the difference. If you seek the advice of a doctor or other sports specialist, make sure you ask if inflammation is involved or if it is actually an -osis. This way you will be sure that they are not just throwing the common term, tendinitis, at you rather than calling it tendinosis or tendinopathy. (Remember, the latter term does not tell you if inflammation is present or not).

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    Since we seem to have quite a few knowledgable experts in this thread, I'd like to make a request?

    Can anyone throw out some recovery exercises/options?

    I personally have been essentially crippled by osgood-schlatters, which was then joined by tendinitis/tendonosis and led to quadricep weakening and kneecap dislocation. I have been to doctors, but I have no money with which to see a physio or athletic therapist and can barely get around. I am at the end of my rope. Typical recovery exercises (squats/lunges... that's basically all I know) I cannot do because they are too painful. How can I promote healing?

    I'm sorry to make this situational, but this is drastically impacting my quality of living.

  13. #30
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    no expert here but swimming probaly would be a rather safe bet for recovery/strengthening exercise
    of course don't do it if it actually hurts to swim even

  14. #31
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    Default Management of Tendinopathy

    The most comprehensive look at the nonsurgical management of tendinopathy I found was:

    Davenport TE, Kulig K, et al. The EdUReP model for nonsurgical management of tendinopathy. Physical Therapy 2005; 85(10):1093-1103

    You can probably find it online simply by googling: EdUReP Model

  15. #32
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    Quote Originally Posted by westwood_13
    Since we seem to have quite a few knowledgable experts in this thread, I'd like to make a request?

    Can anyone throw out some recovery exercises/options?

    I personally have been essentially crippled by osgood-schlatters, which was then joined by tendinitis/tendonosis and led to quadricep weakening and kneecap dislocation. I have been to doctors, but I have no money with which to see a physio or athletic therapist and can barely get around. I am at the end of my rope. Typical recovery exercises (squats/lunges... that's basically all I know) I cannot do because they are too painful. How can I promote healing?
    I've had a couple of young (jr high) tennis students with this problem & I believe that my brother may have also suffered from this in high school. It appears to be a growing pain, particulary for active young males (under 16). Sufferers usually outgrow it as the skeleton matures & the tendons become stronger. For my students, it only lasted a few months. For the most part, treatment consisted of ice & NSAIDs (ibuprofen, aspirin, naproxen) & reduced exercise participation.

    My advice to you is to stop growing -- jk, of course. Aren't you a college-age female? Curious that this is still a problem for you. This is an overuse injury usually developed from engaging in high impact activities, particularly those that place prolonged stress on the flexed knee. Best advice is rest, rest, rest.

    Reduce the amount of impact exercise, such as badminton. Not sure if squats & lunges are a good idea for you at this time (perhaps later when your condition improves).

    If you must play then make sure you wear shoes that reduce impact & avoid badminton gym with floors which have little or no give (such as a mat on top of concrete). Suspended wood gym floors might be best -- something with a bit of give or bounce to absorb shock. A knee brace may also help. Avoid jumping, stair climbing, bike riding & kneeling on hard surfaces.

    Ice shortly after exercise (not prior to exercise tho'). You should probably ice several times per diem (10-20 min each time). Ice cup or ice massage is a great idea. You can use a Dixie cup or sytro cup for this...

    http://SaveYourself.ca/articles/icing.php

    I'm assuming that inflammation is involved here. That being the case, then anti-inflammatories (not Tylenol) should be helpful. Ibuprofen (600-800 mg) & other NSAIDs are usually prescribed. It appears that the new generation of prescription NSAIDs, COX-2 inhibitors, are fraught with problems (really bad for the heart).

    Instead of prescription COX-2 inhibitors, you might wanna try the herbal alternatives. Cherry juice & green tea also appear to be very helpful. I've found that using herbs/spices and herbal products have signficantly reduced my own need for NSAIDs (which are not stomach-friendly).

    Two COX-2 inhibiting herbal products include D-Flame (NOWfoods) and Inflama-Rest (Source Naturals). They both contain various spices & herbs in addition to other nutrients. As an alternative or as an adjunct, you can add many of the spices/herbs to your food or encapsulate them yourself. These include: turmeric, ginger (root), holy basil (tulsi), hops, rosemary, & white willow bark (aspirin is derived from this). Note that the common sweet basil may not be as effective as holy basil. A couple other spice-herbs to consider are cayenne and cat's claw.


    Extracted from SportsInjuryClinic.net web site:

    What can the athlete do if they have osgood schlatters disease?
    • See a sports injury professional who can make a correct diagnosis to confirm the existance of Osgood Schlatters disease and make sure it is not anything else causing the pain.
    • Rest. This injury needs rest if it is to heal properly. Only do as much exercise as it will allow without causing pain. Weight bearing exercise will make it worse. Keep your sessions few and high quality rather than train every day.
    • Apply ice or cold therapy to the knee regularly throughout the day to reduce pain and inflammation and particularly following activity or sport. Ice should be applied at least three times a day for 10 to 15 minutes. Ice massage with an ice cube or a paper / polystyrene cup with water frozen in is a convenient way to apply cold therapy to a specific area such as the patella tendon.
    • Use a knee support or brace to help reduce the tension on the knee.
    Last edited by SystemicAnomaly; 03-20-2007 at 06:48 AM.

  16. #33
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    THank you very much for the lengthy advice, I really appreciate that.

    I've been following most of those standards but having no luck thus far. However, I did some research on eccentric conditioning and will try some of that... I'm also going to take you up on the cherry juice/green tea/herbal supplements idea. Since I've been injured in a significant and debilitating way continuously (different injuries) for seven years, my healing rate has come virtually to a standstill.

    Thank you so much again! And I use a knee-strap and probably couldn't get up an down stairs without it, much less on-the court, so those come highly recommended by me!

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    Default Review and try doing less

    I would suggest that you get a sports doctor to review your condition. It is not as easy to treat as what the articles may suggest. I suppose many elite athletes suffer from this too. Get the doctor to work with your physiotherapist and coach. You need to review what you do during training.

    If you have calcification in your patella tendon (demonstrated on Ultrasound) you could try Shock Wave. It will have to go with rehabilitation exercises though.

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