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  • EUREKA! I think...

    So I've been doing a lot of thinking and research to what's going on with my knees. Lots of pain in both on the superior portion of the knee caps.

    I'm self-diagnosing myself as having quad tendonitis in both knees. Even after taking some precautions (time-off, joint supps...not really doing anti-inflammatories and I have my reasons but that's for another thread), the pain persists.

    What really got me thinking was about how I sleep. The manner and position in which one sleeps can greatly affect a person's muscular and skeletal physiology; you're pretty much in one or a few positions for 6-8 hours a day.

    When I sleep, I usually lay on my back and bend my knees so it lessens the arch in my low back and relieves discomfort. The key point is that my knees are bent at a 90 degree angle for hours a night. I'm not sure if I have a big ass or what, but this positions allows me to wake up without a nagging pain the rest of the day.

    Now, upon further research, people who sit for long periods are actually prone to quad tendonitis; not just those who perform repetitive knee-bending activities.

    The angle of the knees when a person is seated is 90 degrees, the same angle my knees are when I hike them up in bed to prevent torque on my low back!

    I just purchased one of those bed wedges/leg elevator pillows and it will arrive shortly. I really think this will kill 2 birds with 1 stone; alleviate pressure on my back as well as the pain in my knees. Kinda like these things right here...



    Let's see what happens...
    Max Muscle
    5020 Katella Ave.
    Los Alamitos, CA 90720
    www.MaxMuscleLosAlamitos.com

  • #2
    Looks like a liberator pillow....lol. Hope it works out for you
    2005 HOA Natural Classic
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    • #3
      Originally posted by breck View Post
      Looks like a liberator pillow....lol. Hope it works out for you
      I'm so glad you said it first...haha
      #docswholift
      PGY-1 FM
      "No idea is above scrutiny and no people are beneath dignity." -Maajid Nawaz

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      • #4
        Originally posted by breck View Post
        Looks like a liberator pillow....lol. Hope it works out for you
        I just looked up what that was......lol!!
        "SET NO LIMITS"

        "When the knees hurt you just wrap tighter."-Skip

        2015 NPC Supplement Express:
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        2010 NPC Virginia Grand Prix:
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        Use Discount Code MMH353..

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        • #5
          Perverts
          Max Muscle
          5020 Katella Ave.
          Los Alamitos, CA 90720
          www.MaxMuscleLosAlamitos.com

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          • #6
            This girl has bad knees as well.

            2014 USPA Nevada State / Regional Championships - 1,168 total

            2014 USPA National Championships - 1,235 total

            2014 Village Gym Meet - 1,260 total

            2015 USPA Camp Pendleton Meet - 1,235 total


            Journal: http://intensemuscle.com/showthread....80#post1112980

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            • #7
              well, as long as it gives you a reason to explain why you have one in your room i guess it actually kills three birds

              lol, j/k, working with skip i realise experimentation is the key so get one and see if it does anything for ya

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              • #8
                Originally posted by theroymccoy View Post
                So I've been doing a lot of thinking and research to what's going on with my knees. Lots of pain in both on the superior portion of the knee caps.

                I'm self-diagnosing myself as having quad tendonitis in both knees. Even after taking some precautions (time-off, joint supps...not really doing anti-inflammatories and I have my reasons but that's for another thread), the pain persists.

                What really got me thinking was about how I sleep. The manner and position in which one sleeps can greatly affect a person's muscular and skeletal physiology; you're pretty much in one or a few positions for 6-8 hours a day.

                When I sleep, I usually lay on my back and bend my knees so it lessens the arch in my low back and relieves discomfort. The key point is that my knees are bent at a 90 degree angle for hours a night. I'm not sure if I have a big ass or what, but this positions allows me to wake up without a nagging pain the rest of the day.

                Now, upon further research, people who sit for long periods are actually prone to quad tendonitis; not just those who perform repetitive knee-bending activities.

                The angle of the knees when a person is seated is 90 degrees, the same angle my knees are when I hike them up in bed to prevent torque on my low back!

                I just purchased one of those bed wedges/leg elevator pillows and it will arrive shortly. I really think this will kill 2 birds with 1 stone; alleviate pressure on my back as well as the pain in my knees. Kinda like these things right here...



                Let's see what happens...
                My brother works for UPS and as you can imagine they get crazy busy during the holidays. Well, he was complaining of knee pain so I took the liberty of doing a little research to help him figure out what's going on and what if anything he can do about it. You may find it helpful. While I haven't used in-text citations I have added a reference list so you know where the info came from.

                Patellar Tendinopathy


                What is it?
                • Overuse of the patellar tendon can lead to pain, tenderness, and functional deficit. It is considered an overuse injury and often referred to jumper’s knee, patellar tendonitis, etc.
                • It is generally NOT considered an inflammatory condition.
                • This condition is thought to be degenerative in nature.

                Epidemiology (How it happens)
                • Among those who have it, it is often related to intensity of training, jumping, and ankle and knee joint dynamics.
                • It is related to excessive, repetitive load on the quadriceps mechanism.
                • It is often linked to repeated and violent stress placed on the tendon during activities like jumping.

                Pathophysiology (What happens)
                • It is considered a degenerative condition.
                • Tendon overload occurs when a 3-8% strain is applied to the tendon causing a microtrauma.
                • Microlesions appear through failure of cross links resulting in collagen fibers sliding past one another.
                • When this microscopic destruction from repeated strain exceeds the tendon’s reparative ability, cumulative microtrauma occurs.
                • The metabolic rate of tendons is low so the increased demand for collagen and matrix (repair processes) production is easily exceeded.
                • Inadequate repair will set off a cycle of tenocyte death with further reduction of reparative ability and further predisposition to injury.
                • The organization and architecture of the structure can change.
                • Mineralization and ossification of the fibrocartilage can occur.
                • The vascular structure can be different as well in terms of orientation.
                • The end result of this overload mechanism if the formation of a tendinosis zone in the tendon.

                Factors Affecting Injury
                • Frequency of the activity in question is correlated to incidence.
                • Athletes who practiced or competed 5 times a week had a 41% incidence, compared to 29% with those that participated 4 days per week, 15% with those who participated 3 days per week, and 3% with those who participated twice per week.
                • Biomechanical abnormality such as limb length differences, foot pronation, suppination, gait patters, etc. is not supported by evidence.
                • There is no significant relationship to heavier athletes.
                • There is no significant association between concentric strength of the quadriceps muscle group.
                • Decreased ankle dorsiflexion from joint stiffness or muscle tightness increased ground reaction forces and injuries.
                • Hypermobility of the patella and activation of the vastus medialis obliquus are risk factors.
                • Flexibility of the hamstring and quadriceps muscle groups is linked to injury.

                Pain
                • Symptoms of pain may be the result of the activation of peripheral, tendinous pain receptors.
                • Pain is typically located in the anterior of the knee and is made worse by activity or prolonged knee flexion.
                • It is most commonly manifested as chronic anterior knee pain described as sharp or aching pain localized to the patellar or tibial insertion of the tendon and is often felt during palpation.
                • Pain is often present when ascending or descending stairs or with prolonged sitting or active extension of the knee.
                • Pain often persists as frequency, intensity, and duration of activity increases.

                Management
                • Flexibility training of the quadriceps and hamstring muscle groups should be addressed.
                • Eccentric quadriceps strength and endurance should be addressed.
                • Since it results from mechanical overload, abstinence from activity is recommended, but not immobilization, just abstinence from excessive mechanical stress versus normal use.
                • Since it is not considered an inflammatory injury use of NSAIDS is not conclusive.
                • NSAIDs seem helpful for acute pain management and in early stages of the injury where inflammatory seems more likely, but long term NSAID use should be avoided after 2 weeks.
                • NSAID use should only be used after acute injury/pain, but not regularly.
                • Corticosteroids use seems less favorable and probably is not recommended as some have shown increased risk for a rupture after an injection amongst other reasons.
                • Icing may be used for pain relief and vasoconstriction however no exact protocol on duration and repetition rate can be supported. Icing should not be used pre-activity.
                • Many other modalities such as electrotherapy, electromagnetic fields, electrical stimulation, cross friction message, ultrasound and laser therapy have shown an increase in collagen synthesis and an increase in tensile strength of the tendon.
                • Extracorporeal shock wave therapy (ESWT) has been shown to have positive outcomes in chronic management.
                • MRI, tomography, ultrasound, and radiograph imaging tools are inconclusive in terms of reliability and validity to diagnose patellar tendinopahy.
                • X rays may rule out bony abnormalities, but cannot detect tendon changes.
                • Soft tissue mobilization known as ASTM AdvantEDGE is a process that employs specially designed instruments to help the clinician mobilize soft tissue fibrosis.
                • They detect changes in the soft tissue’s texture and institute a controlled microtrauma to facilitate an inflammatory response and healing cascade.
                • This treatment can be done 2 times per week allowing the body to heal between sessions as 3-4 sessions per week may not allow sufficient healing time.

                Stages
                Stage 1: Pain is usually reported only after activity.
                Stage 2: Pain is reported at the beginning of activity and resolves during activity.
                Stage 3: Pain is typically present for the duration of activity and after activity.
                Stage 4: Complete rupture of the tendon.
                • Conservative management is recommended for stages 1-3 of rest, NSAIDS, other possible modalities, and progressive therapeutic exercise.
                • Adequate warmup, cold therapy post-activity, NSAIDS post activity, knee support, and isometric quadriceps exercises are all suggestions for phase 1.
                • In addition moist heat before activity is recommended for phase 2.
                • Phase 3 simply adds more modalities that are often done by a Dr. or PT and Phase 4 is where surgical repair is recommended.
                • Orthotics is not supported by research.

                Rehab Suggestions
                • Rehabilitation of the afflicted muscle tendon unit should make out the cornerstone of therapy.
                • Strength, flexibility, motor patterns, closed-chain rehab, priprioception, endurance, and gradual progression are all components of a rehab program.
                • No strong evidence exists on one exercise protocol over another.
                • Strength training is emphasized using eccentric exercise.
                • Improving musculotendinous function by incorporating eccentric and plyometric exercises
                • Improving the shock absorbing capacity of the limb by strengthening the complete closed kinetic chain
                • Retraining motor patterns
                • Maintaining fitness
                • Stretching of the hamstrings and calf musculature
                • Continuing exercises over 6 months
                • Use of decline squats (foot on a decline or wedge) reduces the calf complex and gluteal muscles contribution and allows more quadriceps loading.
                • Exercise daily, once or twice per day
                • Exercise for at least 12 weeks
                • Start at 3 sets of 10-15 reps
                • Build up in number of reps to 30 and in speed of movement, then in loads as pain allows
                • Single leg work is important because pain and weakness cause unloading of an effected leg, allowing the unaffected leg to dominate the exercise.
                • Improving shock absorption on landing is important below the knee (foot function, calf-muscle strengthening, and ankle dorsiflexion) will decrease the amount of forces at the knee.
                • Range of motion of the ankle is important to maximize shock absorption to reduce knee forces.
                • The gluteal muscles also need work for shock absorption.
                • Initial strength should include weight work such as leg press and leg extension and simple weight-bearing activities such as lunges, calf raises, and step ups.
                • As the program progresses speed is added, weight bearing activities at increasing speeds like skipping and running toward the end of the program.
                • Stretches for the hamstring, quads, IT band, gastrocnemius, and soleus 2 times a day for 30 seconds.
                • Strengthening with a progression of quad sets, straight leg raises, standing theraband hip flexion, extension, adduction, and abduction, heel raises, step-ups, leg press, squats, lunges, and stair climber.
                • Ice message 10-20 min 3-5 times daily.



                References

                Cook, J. L., Khan, K. M., & Purdam, C. R. (2001). Patellar Tendinopathy: Pathomechanics and a Modern Approach to Treatment. International Sportmed Journal, 2(1), 1.

                Hale, S. A. (2005). Etiology of Patellar Tendinopathy in Athletes. (Review). Journal Of Sport Rehabilitation, 14(3), 258-272.

                Peers, K. E., & Lysens, R. J. (2005). Patellar Tendinopathy in Athletes: Current Diagnostic and Therapeutic Recommendations. Sports Medicine, 35(1), 71-87.

                Wilson, J. K., Sevier, T. L., Helfst, R. R., Honing, E. W., & Thomann, A. A. (2000). Comparison of rehabilitation methods in the treatment of patellar tendinitis. Journal Of Sport Rehabilitation, 9(4), 304-314.

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                • #9
                  Knickerbocker!

                  Appreciate that man...gonna gobble this stuff up and make some adjustments.
                  Max Muscle
                  5020 Katella Ave.
                  Los Alamitos, CA 90720
                  www.MaxMuscleLosAlamitos.com

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                  • #10
                    No problem...just had it handy as I just researched this a few weeks ago...hope it's helpful.

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                    • #11
                      I think I do WAAAY too much knee-flexion intensive movements as opposed to hip-flexion intensive movements for my DC training. Tons of bottoming out on hacks and power squat/v squat machines. Guess it's time to start incorporating more squats
                      Max Muscle
                      5020 Katella Ave.
                      Los Alamitos, CA 90720
                      www.MaxMuscleLosAlamitos.com

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                      • #12
                        Originally posted by theroymccoy View Post
                        I think I do WAAAY too much knee-flexion intensive movements as opposed to hip-flexion intensive movements for my DC training. Tons of bottoming out on hacks and power squat/v squat machines. Guess it's time to start incorporating more squats
                        Could be...you want balance in your training. I think some people get in trouble by pounding out set after set on hacks, leg press, leg exts. I think hacks are particularly bad with this because they force your knee to drift out past the foot. This happens because the back rest behind you keeps you from hinging your hips back, which will place more stress on the knee. It's unlikely people will overwork knee flexion/ext with squats, deads, etc. because well...they are much more taxing. You may want to temporarily cut back on knee/quad dominant exercises and limit training them to like to once a week. Also, you may want to strive for hip hinge/glute/hamstring set for every set you perform of knee/quad work. I don't think there's a lot of research out there yet, but tissue work may help with daily foam rolling, message, etc. Also tight hip flexors can lengthen the hamstrings which is implicated in this, so work on hip mobility.

                        But, you don't have to be overloading knee in the saggital plane to work on hip extension. The glutes are an often overlooked muscle group, which doesn't make much sense because they are one of the biggest muscle groups and IMO probably the #1 thing that defines an explosive athlete. Think of things like glute bridge variations to gain neuromuscular control, then you can add some more muscle builders like hip thrusts. I have also become a fan of unilateral work the past few years. And, the hip hinge is another thing you can work without too much overload on the knee ala RDL variations
                        Last edited by ; 01-04-2013, 11:15 AM.

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