Ask the Doc: How Do I Treat Tendinosis?

What is the best way for an athlete to approachtendinosis (a chronic condition, as opposed to tendinitis, the acute condition) — specifically, longstanding pain in the patella tendon?

-Randy Hill

Missy says…

Missy Albrecht, (DPT, CSCS, FMS| Physical Therapist/Coach)

Hey, Randy –

Thanks for your question. Treatment of this particular injury can be tricky, especially if it is in the chronic stage. The hardest part is finding out what is causing the tendon to be put under stress in the first place. Common faults that cause patellar tendinosis include weak glutes, tight IT bands and poor exercise form. A lot of times these injuries are treated initially with ice, rest, and then some hip strengthening. Treatment from a PT may include decreasing inflammation in the injured area (ultrasound, laser, ice massage, etc.); restoring proper movement of the joint; and then strengthening of the muscles supporting the joint. If it is chronic, part of the treatment may be to restart the inflammation process intentionally (through massage or some other technique) in order to get things healing properly. So here are some things you can do:

1. REST from whatever is aggravating your knee. Not forever, but if you don’t take some rest and stop irritating the tendon it won’t heal.
2. Make sure you are foam rolling your entire upper thigh, front and side. If you find a tight spot, stop and relax on it. Maybe rock side to side. Really try to breathe through it because if you don’t relax you won’t get the benefits of the foam roll.
3. Make sure your glutes are strong! Here’s a video of some good glute exercises.
4. Depending on what exercise is causing your knee to hurt, make sure you focus on perfect form. This will also help the tendon heal faster and prevent further injury.
5. Depending on the stage of your injury you can also do ice massage to the patellar tendon.

Mike says…

Mike Chin, (DPT, CSCS)

Great stuff from Missy! Definitely a great approach to managing your injury. When we get these questions, we obviously want to give you the best answer possible so you can get back to destroying WODs and PRing, but unfortunately, there is no one accepted, clear answer across all of sports medicine about how to fix these injuries. However, the interventions mentioned in this post and future ones  are proven to be effective through current research and clinical experience — though we cannot say definitively which one will be more (or most) effective for each person.

Different clinicians will recommend different care based on individual needs – there is no “one size fits all” approach to healing injuries.

For example, in regard to exercises and tendinosis, many of my clients have gotten good results from eccentric strengthening (think the phase going down into a squat). However, some of the current literature will show that eccentrics are just as effective as normal strengthening, while others will say that it is more effective. Or you may hear a clinician firmly believe in deep tissue massage or cross friction massage, while another will stay clear of that intervention. So try to embrace this gray area, because I know we all would like it to be black and white when it comes to healing injuries. Trust your plan of care, and you will be throwing weight around in no time.