Treating "Jumper's Knee" - Patellar Tendonitis

CaliforniaBased

Woodpecker
Catholic
Hello all,

I have recently begun more seriously researching patellar tendonitis. I will be posting my findings of my research, quotes from a book I am reading and logging my progress in this thread.

A few months back, I posted a thread about knee pain I have been having. I was diagnosed by a doctor (and per my research) the diagnosis seems spot on. I went to physical therapy which restored my leg muscle function and began to help alleviate the problem. After being discharged from physical therapy, as I began to recover, I mismanaged my recovery and have relapsed (albeit not as badly as before beginning physical therapy).

I had been suffering from on off knee problems since the summer of 2018. I likely strained a tendon while squatting barbell in the gym. All along all I needed to do was take a break from heavy use of my knee (squatting in the gym, running etc.) and give myself maybe two weeks to recover. Alas, I did not do that and kept overuse of my knee while the tendon was injured until I developed a chronic problem, which came to flare up heavily last fall.

Quotes are from the book "Beating Patellar Tendonitis: The Proven Treatment Formula to Fix Hidden Causes of Jumper's Knee and Stay Pain-free for Life" by Martin Koban

What is the pattelar tendon?

The three major bones that make up your knee are the thighbone, the shinbone, and the kneecap. The kneecap attaches to the shinbone via the patellar tendon and, as you can imagine, the patellar tendon has to be extremely tough to withstand the forces exerted on it through contractions of the quadriceps muscles.
I found easy to identify the pattelar tendon, and indeed when I press on this tendon hard with my finger I feel some slight pain and tenderness.
To locate the patellar tendon, sit on a chair with your knee a little bent and relax your legs. Take the same side hand and gently press into the area below your kneecap with your fingers. Everything should be completely relaxed. Now, tense up your leg muscles. Your fingers will feel something tense up below your kneecap. This band of tissue that runs from your kneecap to your shinbone and relaxes when you relax your muscles is the patellar tendon.

Pattelar tendonitis
Patellar tendonitis is the result of your patellar tendon not being strong enough for the demands of your sport. It’s the equivalent of failing a test (i.e., playing your sport as a test on your body) because you didn’t study enough (i.e., your patellar tendon wasn’t strong enough for the test).If you retake the test without having studied more (i.e., strengthened your patellar tendon), you’re going to fail again. Fail a test enough times and you eventually fail school (i.e., the damage to the tendon becomes permanent).
Sounds like me right here...
Unfortunately, many athletes are so enthusiastic about their sport that they don’t allow their body to heal the damage properly before they jump back into the game. With repeated tissue damage, cellular degradation sets in. The body is unable to repair the injured tissue and a painful chronic condition is created that will take at least three months to heal (Wilson, Best 2005; Khan et al. 1998, p. 348)
If you continue playing, your patellar tendon will continue breaking down, making it even weaker. This increases the risk of a patellar tendon tear, and increases the time ultimately needed to heal it, once you finally decide to take action. To get healthy, you need to stop participating in your sport, go through a progressive strengthening
regimen for your patellar tendon, and fix biomechanical mistakes that contributed to the tendon becoming overloaded.

Symptoms
The symptoms for patellar tendonitis are pain on the side of, in front of, below, or even behind the kneecap. However, most commonly the pain will reside below the kneecap, where the patellar tendon attaches to the kneecap. Additionally, you may feel tenderness below the kneecap and in the area of the bony protrusion right
below. Sometimes the patellar tendon is swollen. If you have pain in the back of your knee or on the side of your knee, you are likely dealing with a different knee injury.
I have the pain below the kneecap and experienced the morning stiffness as described.
In patellar tendonitis, pain usually gets worse with activities where energy is stored in the tendon and released more explosively. Such activities include running, climbing stairs, walking downhill and – of course – jumping. Another activity that can worsen the pain is squatting. Depending on which stage of the injury you are in, the severity of the symptoms will be different. In the early stages, you only feel discomfort after activities that stress your knees. Once the injury has progressed, you may feel pain during the day, which worsens after activities that stress your knees. Additionally, there may be morning stiffness and swelling of the patellar tendon.
The particular activity that I feel triggered the relapse was pushing the quite heavy clutch on my truck for about two days straight for about 4 hours each day. I have stopped driving it since). This involves placing the knee under load while it is bent, which places load on the pattelar tendon. Squatting also places large load on the pattelar tendon.

Another important note to make is that in the initial stages of tendon overuse damage there is not much pain. I frequently would revoer to the point where I felt no pain only to suddenly injury myself again to the point where I felt pain.


Stages of injury
1. Reactive Tendinopathy: The Minimally Injured Tendon

In this stage, the tendon has been exposed to excessive loads without allowing adequate time for recovery. This stage is known as reactive tendinopathy because the cells in the tendon have become reactive in an effort to repair tendon damage. In this state, the tendon thickens somewhat. This is a tempporary solution to cope with the excessive stress until a more permanent adaptation can occur. Tendon cells change their shape to increase protein production, and more water is bound in the tendon. The integrity of the collagen fibers in your tendon doesn’t change and the tendon can return to the normal stage if the load is reduced appropriately . Since the collagen alignment doesn’t change, the tensile strength of the tendon doesn’t decrease. Therefore, you can keep using your legs without a drop in performance, although your tendon might ache a bit afterward. Additionally, a blow to your tendon can also cause reactive tendinopathy as such trauma causes the same tendon response. Personally I began to feel a slight discomfort in my knee as I went about my activities (running, skateboarding, squatting barbell) and proceeded to ignore it when I was in this state. I also managed to slightly damage the tendon on my other leg while pushing wheeled trash cans while hopping on one foot as the other knee was bad. I then proceeded to ignore the slight pain i had the next day.

2. Tendon Dysrepair: You’ve Abused the Tendon More Than Once
The tendon will progress to this state of damage if the if the load is not reduced adequately or if not enough time for recovery is allowed after the initial overload occurred. The number of tendon cells in the tendon has increased, along with the protein production. The collagen has begun to become disorganized decreasing tensile strength. The tendon is now more susceptible to overload and the level of activity that will damage it is lower than in a healthy tendon. It is possible, your tendon can still be healed with an intelligent exercise regime and stopping all activities that overload your tendon. Recovery will take more time and must be approached carefully.
I progressed to this stage as I ignored the slight pain and went about my normal activities.

3. Degenerative Tendinopathy: Your Tendon Slowly Dies
If you keep overstressing your tendon, the injury will progress to the degenerative stage. Cells within the tendon have already died and continue to die. Collagen fiber alignment is chaotic. The tendon’s ability to heal is severely compromised and the tensile strength has dropped considerably. Overload can now lead to
tendon rupture. If you continue to play through pain, you will reach this stage. Soon your knee hurts all the time. Normal daily activities like sitting or walking down stairs cause pain.
I continued to ignore the slight pain to the point where I had trouble going up and down stairs and standing for prolonged periods of time. Soon I was caught in this stage of tendon damage and approached the problem by resting heavily - which turned out to be the incorrect approach.




1645315910475.png
graphic by Martin Koban


Treatment based on injury stage
Treatment for Reactive Tendinopathy and Early Tendon Dysrepair

In this stage, the tendon is still able to heal itself. There is no need for sepcial exercises like eccentric squats that specifically target the tendon. You need to reduce the load to appropriate levels and to allow adequate time for recovery. This will lead to your tendon cells becoming less reactive and pain reduction. You can determine you’re in this phase by remembering the first time you had pain or discomfort in your tendon. If it was no more than a few weeks in the past, you very likely are in this stage. Diagnostic imaging can also be used.

You could take a week off from training and only do technique drills for the two weeks that follow. Slowly return to your previous schedule once your pain is gone. You need to monitor your condition. Whenever an exercise increases your pain, meaning you have more pain a few hours after the exercise than you had before, you need to modify that exercise. To do that, train for a shorter amount of time or do less intense exercises. When you’re in this stage, allow at least two or three days for recovery between sessions that stress your knees. The duration, frequency, and intensity of exersize sessions all play a part in how much the tendon will be able to recover.

Treatment for Late Tendon Dysrepair and Degenerative Tendinopathy
The tendon is no longer fully able to heal itself. You need to implement exercises that specifically target the tendon and trigger collagen formation. and refrain from all unnecessary exercises that cause increased pain in your tendon. If you kept using the tendon at a high intensity level for months after the initial onset of discomfort in your knee. The amount of time it takes depends on the weekly exposure to overload. An athlete that trains through pain four times per week will obviously progress faster than someone who “only” trains through pain twice per week. Another indicator that you’re in this stage is if you’ve had tendon pain
several times in the past. The pain resolved but then reoccurred once you resumed your training because your tendon was already weakened and its
tensile strength was decreased because the collagen alignment was disorganized. The weakened tendon cannot handle normal training loads, which is why training leads to a return of pain.

In this stage, the tendon will not heal on its own. You need to do certain exercises to restart the healing process. Don’t forget that tendon degeneration can also occur without pain. For example, one study found that two-thirds of tendons that were degenerated enough to rupture were pain-free.

Use of anti-imflamatory drugs
In the initial phase of the disease, reactive tendinopathy, taking anti-inflammatories such as NSAIDs and corticosteroids can be beneficial. However, this isn’t because of
their anti-inflammatory properties per se, but because they inhibit the cell response of the reactive cells to a certain degree. Since in the advanced stages of tendinopathy you want your tendon cells to be reactive, these treatment options are not recommended.
 

MikeV12

Sparrow
Protestant
Amazing. I went to do my leg routine which is an explosive workout for basketball after i played basketball. I felt so much pain but i thought it was just sore so pushed. Then after maybe a week it wasnt 100% healed. Waant sure if i tore something. I stopped doing legs and playing basketball for the time being and its probably 95%. Ill continue to rest it. Thanks for the post
 

droughtmeat

Kingfisher
Catholic
I actually had petallar tendonitis for about 4 years. Tried a ton of exercises, but nothing helped. I was waking up at night due to the pain, sitting was agonising, I could barely jump off that leg. Finally found out it was an alignment issue due to valgus knee. I then strengthened my glutes with lateral raises (had already been squatting for years, but that didn't address that particular issue). My problem was fixed in two weeks and I was back to dunking.

I personally think that the injury is usually due to some kind of alignment issue or imbalance. That's why it's not really a thing among NBA players, cause they have people around them who understand the injury and can help quickly.

Anyway, every injury is different so I'm not going to downplay the seriousness of someone else's jumper's knee. This is a podcast about tendon injuries and proper loading. It's from Just Fly Sports which is a really good sports performance podcast for anyone looking to improve their athleticism.

 

CaliforniaBased

Woodpecker
Catholic
Here is some nomenclature on the various pattelar tendon conditions (SOURCE). I would say that tendonitis and tendinosis describe the different stages in the chart of tendon states from Koban's book (see first post) I would say tendonitis as decribed below corresonds to Reactive Tendinopathy and tendonosis corresponds to Late Tendon Dysrepair and Degenerative Tendinopathy. This is consistent with the instructions to not use NSAIDs with tendinosis. There was a good figure online which explains how the tissue looks different on the MRI machine.

1646298871676.png
Tendonitis
Once used to describe almost any tendon pain, medical professionals now only use the term tendonitis to describe acute inflammation of the tendon
Tendonitis may develop as a result of a sudden, acute injury or repeated micro-traumas to a tendon or group of tendons. Recommended treatments to reduce inflammation may include resting the affected joint and taking over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (e.g. Motrin, Advil), or naproxen (e.g. Aleve, Naprosyn). Patients with tendonitis typically recover within several weeks.
Research suggests tendon inflammation is uncommon,1 and what is often diagnosed as tendonitis, may actually be tendinosis1-6 (defined below). Chronic tendonitis may lead to tendinosis.

Tendinosis

Tendinosis is the non-inflammatory degeneration of a tendon. This degeneration can include changes to the structure or composition of the tendon. These changes often result from repetitive strain-injuries to a tendon without adequate time to heal.1-2

Key differences between tendonitis and tendinosis:
  • Unlike tendonitis, tendinosis may take several months to treat.
  • Treatment methods for tendinosis and tendonitis may vary. For example, some experts argue that tendinosis should not be treated with NSAIDs or corticosteroids. They believe these drugs inhibit the normal reconstruction of the tendon and weaken its structure, causing long-term healing problems.7-8
Tendinosis usually affects people who engage in high intensity activities or sports requiring repeated tendon movement.

Tendinopathy

Tendinopathy is typically used to describe any problem involving a tendon. The suffix “pathy” is derived from Greek and indicates a disease or disorder. Therefore, tendinopathy literally means a disease or disorder of a tendon.

While most experts define tendinopathy as an umbrella term to describe all tendon conditions, others may use it to describe a chronic tendon condition that fails to heal.9 For example, a runner who has suffered a repetitive hamstring tendon strain that does not heal properly may be diagnosed with tendinopathy.
COMPARISON FACTORTENDONITISTENDINOSIS
Recovery time in acute cases2 to 3 days2 to 3 months
Recovery time in chronic cases4 to 6 weeks3 to 6 months
Long-term outlook with non-surgical treatmentAlmost 99% of cases recover completelyUp to 80% of cases recover completely
Treatment goalsDecrease inflammation by: Rest, anti-inflammatory medication (short-term course), icing the tendon intermittently, and/or use of cast or splintEncourage formation of collagen and other proteins by: Physical therapy, exercise, and/or surgery (in some cases)
Long-term outlook after surgeryAlmost 95% of cases recover after surgery70 to 85% of cases recover after surgery
Recovery time after surgery3 to 4 weeks4 to 6 months
 

CaliforniaBased

Woodpecker
Catholic
This is the main strength building exercise for the tendons. It is recommended to provide time between each session of the strength building exercises (3 to 4 Times per Week) . I also have some stretches I will do daily that were prescribed by a physical therapist. (will post these as well). I had been recovering when following directions from physical therapy, but when my sessions terminated and I began exersizing on my own, I overused the tendon by doing too much exercise too soon and regressed; now here I am back doing more research and finally beginning to understand the problem.



Notice that the YouTuber mentions that you want to trigger some slight irritation while doing the exeresizes, as this will stimulate recovery. This is consistent with Koban's book which I discuss in the first post, which mentions you need to specifically target the tendon and trigger collagen formation by causing the to go into a reactive state.

from Koban's book
Collagen synthesis reaches a net positive value 36 hours after exercise (Magnusson et al. 2010), which may be why one researcher had great success with having his clients only do exercises three times per week (Kongsgaard et al. 2009). However, you still have to do some experimentation to find out what works best for you. Use your training journal and your pain scores to determine which exercise frequency is most effective at reducing your pain. Remember that pain will likely be present during and immediately after exercise, but it should become less in the 24 hours after training. If your pain stays higher than baseline for more than 24 hours after your training, you’ve progressed too quickly or made some other mistake.
Three to four times per week, do the eccentric squats on a slanted board. Start with the two-legged variation and do 3 sets of 10 repetitions. Work our way up to at least 5 sets of 15 repetitions. Remember to move slowly and only increase the repetitions if your pain scores keep falling from week to week!
 

CaliforniaBased

Woodpecker
Catholic
Dietary Supplements for Patellar Tendonitis
quotes are from Martin Koban's book,"Beating Patellar Tendonitis"

Starting today and for an 8 week period, daily i will take:
  • I tablespoon of fish oil
  • 2 grams of vitamin C
Dietary supplements can help speed up tendon recovery, however, there use alone will not help as cessation of overloading of the tendon and correct physical therapy is what actual drives the tendon recovery and strengthening. Author Koban also mentions that clinical trials are yet to be performed to compare recovery with or without these supplements. However, he mentions high-level athletes and coaches utilize fish oil to beat tendinopathy and research has found a beneficial effect as well. I will use supplements, because in the case they do not help recover from tendonosis, they will be beneficial in other areas.

Fish Oil

Benefits of fish oil include:
- Helps reduce stress by lowering the amount of stress hormones secreted
- Lowers VLDL cholesterol and triglycerides
- Increases HDL cholesterol
- Improves cognitive abilities (i.e., you’ll be smarter)
- Helps you lower your body fat by turning on fat-burning genes
- Will help you build muscle
The author recommends taking about two teaspoons (or a table spoon) of fish oil per day is sufficient to derive its benefits.

Vitamin C
Vitamin C has been shown to improve collagen synthesis, while lack of vitamin C, (which causes scurvy) , is associated with decreased collagen synthesis. High dose vitamin C supplementation has also been shown to enhance tendon healing in studies on rats and is being used in pharmaceutical products that promise to improve tendon healing
It is recommended to take one to two grams of vitamin C per day when dealing with tendinopathy.

Also, your body gets used to the amount of vitamin C you ingest and will decrease the absorption. For that reason, it’s a good idea to vary the daily intake from day to day. Maintaining an overly high supplementation of vitamin C for a longer time is not advised Hence, only use vitamin C for the initial 8-week period. Taper your vitamin C dose off slowly over a few weeks to allow your body to adapt to lower dietary levels of vitamin C.
 

BobbyFischer

Chicken
Catholic
FWIW I had constant knee pain until I switched over to minimalist shoes. Brands like Xero, Vivobarefoot, Lems, Altra offer shoes that don't have any heel drop or arch support and allow your foot and leg muscles to work properly. There is a lot of good science out there about why shoes that allow your feet to be feet can help your posture and fix a whole range of issues caused by cramped and over-engineered shoes. There is a lot of misinformation that I imagine is put out by big shoe companies as well. If you are suffering from knee pain try being barefoot as often as possible and using completely flat shoes 'minimalist' shoes and see if that helps.
 

CaliforniaBased

Woodpecker
Catholic
I have begun reading this article: https://e3rehab.com/blog/patellartendinopathy/
It has a very good insight about the tendon overuse/recovery process which I had not previously considered.

The article mentions that for a proper recovery it is often important to exercise through pain, and that they key thing to monitor is an overall trajectory of improved function. Additionally, it is suggested that if there is increased pain the day after performing some exercise, that is a sign that excess load was placed on the tendon, and the exercise load must be reduced. Load is an aggregate of how long your exercise session lasts, how intense your exercise is , and how often you exercise.
1647112129791.png

Patellar tendinopathy occurs when the intensity, frequency, and volume of patellar tendon loading exceeds your capacity to recover and adapt appropriately. It often is caused by doing too much, too soon although "that’ll look slightly different for more active individuals vs less active individuals".

For me the most important part of this article was its discussion of flare-ups and the "boom-bust" cycle. A flare up is when during the recovery the pain re-occurs in the tendon. Some flare-ups of pain and other symptoms are a normal part of the rehabilitation
process. It is important to discern if the rehab exercises themselves or some other activity caused the flare up.

The Boom-Bust Cycle
I can say this describes my situation as my injury got worse all too well.
You have a spike in activity over the course of a day, week, or month that contributes to symptoms of your knee. You decide to rest completely and your symptoms go away. Excellent! You recognize that you overdid it last time, so you don’t do quite as much this time around. However, you have a flare-up despite doing less of the same activity! You rest again until your pain goes away and repeat this process until your activity level is severely diminished.
1647112946302.png
This is not an uncommon cycle. It’s often driven by the belief that pain is bad and rest is good, while also using a reduction in pain as the primary metric for success. But that’s not the way to approach patellar tendinopathy because rehab can take 3 months, 6 months, or even a year or longer. Symptoms will fluctuate on a day-to-day and week-to-week basis, which is why your focus should be on function while monitoring pain to guide the appropriate amount of physical activity.

1647113041969.png
An increase in function will not always correlate with a linear decrease in pain. If you go from running 1 mile with a 3/10 pain to running 3 miles with a 3/10 pain over the course of 3 months, that’s actually significant progress. The pain may seem like it’s staying the same, but technically it’s getting better because it requires more activity to reach the same level of pain that you initially experienced.
1647113369975.png
According to Koban, "pain will likely be present during and immediately after exercise, but it should become less in the 24 hours
after training. If your pain stays higher than baseline for more than 24 hours after your training, you’ve progressed too quickly or made some other mistake."

My progress
I started the exercise routing consisting of the eccentric squats on the slant board and various stretches. However, I suffered a flare up after driving in stop and go traffic for several hours. I began to dramatically lower my activity level, and began to rest. I have more or less recovered from the flare up after a few days. However, once again, I had a small flare up triggered by less activity. Next time I have a flare up, I will rest for a few days and then return to the baseline activity level, and then begin to gradually begin to increase activity.

Previously, in early January I had been going on some pretty long hikes and whatnot after about 2 months of physical therapy (November, December). However, I suffered some flare ups and began to ramp down my activity level. It probably was not wise to go on such long hikes every day, and I should have take a day or two to rest in between, but I should not have ramped down my activity level so dramatically.
 
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droughtmeat

Kingfisher
Catholic
My progress
I started the exercise routing consisting of the eccentric squats on the slant board and various stretches. However, I suffered a flare up after driving in stop and go traffic for several hours. I began to dramatically lower my activity level, and began to rest. I have more or less recovered from the flare up after a few days. However, once again, I had a small flare up triggered by less activity. Next time I have a flare up, I will rest for a few days and then return to the baseline activity level, and then begin to gradually begin to increase activity.

Previously, in early January I had been going on some pretty long hikes and whatnot after about 2 months of physical therapy (November, December). However, I suffered some flare ups and began to ramp down my activity level. It probably was not wise to go on such long hikes every day, and I should have take a day or two to rest in between, but I should not have ramped down my activity level so dramatically.
How has your progress been?

Exercising through pain definitely is the right method. Here an NBA trainer also talks about how simply resting is a flawed approach.



I recently had a flare up for the first time in 7 years. Due to covid some of our basketball games were re-scheduled and we ended up playing 3 games a week. That ended up being too much and I had some patellar tendon pain. I tried the glute exercises that helped me years ago but they didn't help. I then started doing heavy single leg / rear foot elevated isometric squats, holding each rep for 5 seconds, in combination with plyometrics and the pain subsided, but I'm going to continue to do that. I found an article on that too.


Effects of isometric, eccentric, or heavy slow resistance exercises on pain and function in individuals with patellar tendinopathy: A systematic review​

Hui Yin Lim 1 2, Shi Hui Wong 1 2
Affiliations expand

Abstract​

Background and purpose: The purpose of this study is to evaluate current evidence and provide a review on the effects of isometric, eccentric, or heavy slow resistance (HSR) exercises on pain and function in individuals with patellar tendinopathy (PT).
Methods: Academic journals from CINAHL, Embase, MEDLINE, Scopus, SPORTDiscus™, and The Cochrane Library were searched from inception to August 2017. Screening of reference lists was also performed. Human interventional studies investigating outcomes of pain and function in PT using either isometric, eccentric, or HSR training exercises were included. The McMaster Critical Review Form-Quantitative Studies was used to assess for risk of bias. Levels of evidence were obtained using the National Health and Medical Research Council (NHMRC) evidence hierarchy. The NHMRC Body of Evidence Framework was utilized to formulate recommendations for clinical practice. Extraction of data was performed by two independent reviewers according to predefined data criterion, data were then tabulated, and a descriptive, qualitative data synthesis was performed.
Results: Fifteen studies (3 isometric, 2 HSR, and 10 eccentric) were included for this review. Mean quality score across all studies was 81.6% (range 70% to 93%). Nine studies were of high quality, whereas six studies were of moderate quality. Nine studies were randomized controlled trials, which provided good Level II evidence; four studies were of satisfactory Level III evidence; and two studies were case series (Level IV evidence).
Conclusions: Findings from isometric exercises can be trusted to guide clinical practice (Grade A), whereas eccentric exercises can be trusted to guide clinical practice in most clinical situations (Grade B). It is recommended that HSR exercises should be applied carefully to individual clinical circumstances (Grade C) and interpreted with care. Isometric exercises appear to be more effective during competitive seasons for short-term pain relief, whereas HSR or eccentric exercises are more suitable for long-term pain reduction and improvement in knee function.
Keywords: exercise; pain; patella; tendinopathy.
 

Celibate Warrior21

Robin
Other Christian
Were you an athlete or some sort of basketball player growing up?

I have that too...I stopped playing and gave it a one year rest. I still experience some pain from time to time, not a lot. Find other ways to be active and let your knee rest.
 

CaliforniaBased

Woodpecker
Catholic
Were you an athlete or some sort of basketball player growing up?

I have that too...I stopped playing and gave it a one year rest. I still experience some pain from time to time, not a lot. Find other ways to be active and let your knee rest.
I was into skateboarding.
How has your progress been?
That being said I am doing significantly better recently. I try and focus on other things and not let the pain get to me, but I do try and rest for 2 days after each period of heavy use.
 

CaliforniaBased

Woodpecker
Catholic
I am making good progress, but I need to remind myself to take a day off after a day of intense activity. i also need to work to cut back on heavy work/ driving and focus on the rehab exercises. My left knee is in very good condition. I drove my stick shift sports car around with no problem. I believe that driving (normally do not use left leg) is the reason my right knee is lagging in recovery.

I also found that taking vitamin C pills on an empty stomach is a very bad idea. And yes, simply resting is a very bad approach
 

kurtybro

Woodpecker
If it hasn't been mentioned yet, try hydrolyzed collagen 10G and 100-200 mg of vitamin c right before doing your rehab..

Joint vibrance is another supplement that's pretty damn good for joints/soft tissue issues. Pricey, but you can always just (mostly) recreate it sourcing the raw ingredients from a bulk supplier
 

CaliforniaBased

Woodpecker
Catholic
I am going to physical therapy again and my left knee has recovered very well. The right is still giving problems. I have some pain in the last few days BUT I am able to continue a good amount of activity.

Part of my problem is that I am unable to stop doing certain activities that I must do as part of my work, and when I do my excersizes I am not able to recover well, because my work keeps me using my knees. ( I am doing mechanic type work on prototype machinery as part of an engineering job).

At this time I am following this section of Koban's book. I want to build a good habit of doing the eccentric squats - something I have not been doing. I also want to work on "Low Ankle Dorsiflexion", as I do seem like I walk crooked, a bit like a duck.
To treat jumper’s knee successfully, you have to stop participating in the activities that overloaded your knees in the first place. Don’t do any jumping or running and avoid all activities that place load on your knee while it’s bent for a week or two.
The reason you’re doing this is to establish a baseline level of pain. During this initial rest period, take note of how your pain changes. Write it down on a scale of 1 to 10 (10 being the worst pain you ever felt) in a small journal, together with the activities you did on that particular day. This information will be tremendously helpful for your recovery, as it enables you to identify the activities that overstress your knees.
During this initial rest period, you can already start the treatment program suggested in this book, with the exception of the squats. Once your pain doesn’t decrease any further, you can start with the eccentric squats. At that point, the pain scores you’ve written down during the rest period can be used to modify the squat exercises.
This is the recommended initial eccentric squat routine:
Three to four times per week, do the eccentric squats on a slanted board. Start with the two-legged variation and do 3 sets of 10 repetitions. Work your way up to at least 5 sets of 15 repetitions.
To test if you are ready to increase the number of repetitions:
To do the test, perform 3 sets of 15 repetitions of the two-legged eccentric squats on the slanted board.
Take at least 3 seconds on the way down and get up the way you’ve practiced.
Are you mostly pain-free (pain score of 3 or lower)? If so, progress to the second phase of the program.

Seeking help for this issue is a big reason I am back on this forum, I appreciate the advice I have received over the past months. Please note some of these posts are meant to be my notes of sorts from my research into the problem, that I feel might be useful tos hare for those with the same issue.
 
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Johnnyvee

Ostrich
Other Christian
Dietary Supplements for Patellar Tendonitis
quotes are from Martin Koban's book,"Beating Patellar Tendonitis"

Starting today and for an 8 week period, daily i will take:
  • I tablespoon of fish oil
  • 2 grams of vitamin C
Dietary supplements can help speed up tendon recovery, however, there use alone will not help as cessation of overloading of the tendon and correct physical therapy is what actual drives the tendon recovery and strengthening. Author Koban also mentions that clinical trials are yet to be performed to compare recovery with or without these supplements. However, he mentions high-level athletes and coaches utilize fish oil to beat tendinopathy and research has found a beneficial effect as well. I will use supplements, because in the case they do not help recover from tendonosis, they will be beneficial in other areas.

Fish Oil
Benefits of fish oil include:

The author recommends taking about two teaspoons (or a table spoon) of fish oil per day is sufficient to derive its benefits.

Vitamin C

It is recommended to take one to two grams of vitamin C per day when dealing with tendinopathy.

Eating foods that contain/is collagen is a good idea, like bone marrow and chicken feat. (Maybe a collagen hydrolysate supplement) I did a lot of this when I suffered a nasty finger fracture last October and I think it had some positive effect. Bone marrow in particular has both glycine, chondroitin and glucosamine in a highly bioavailable form, which constitute some of the essential building blocks of tendons and ligaments.

 
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CaliforniaBased

Woodpecker
Catholic
^^^^
That would be chicken feet :)
I guess it is time to go learn some dishes that use chicken feet.

This link has some useful information

As does this one:
 
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