Knee? Pain - Tendonitis vs Osgood Schlatter

[under]

Before anyone storms on me for posting an injury thread, know this - I have scheduled an appointment with a doctor, but the only time he is available is around 2 weeks from now. Can't go to any other doctors in the area, since my international insurance only works with this guy's group.

Okay,

So I haven't squatted in 3 weeks, holiday and business travels and all, and started squatting again yesterday. I also got my first pair of WL shoes, Wei Ruis, and started using them for my squats.

Before the holidays, my squat max (high bar) was 225, not much i know. For Yesterday, I decided that i want finish that day light, with 3x5 165lbs.

On my last rep of the last set, I felt a sharp pain on, what I just learned to be, my tibial tuberosity, the bony upper part of my shin bone that attaches to the patellar tendon.

Finished that rep, but the pain lingered for a couple of seconds and then dissappeared. It still hurts everytime I push my knees beyond my toes, and if I directly put pressure (touching, kneeling) my tibial tuberosity area.

There was no swelling whatsoever, no pain/discomfort when walking normally, only when i touch it, or have weight on the leg while the knnes are forward to my toes.

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Took NSAIDs, didn't really relieve anything, since there was not that much pain to begin with.

Ordered a patellar strap online, should be arriving 2 days from now, see how that works.

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Did a little online research on this kinda pain, the two biggest probabilities are
1. Pattellar Tendonitis

or

2. Osgood Schlatter (OSD)

The symptoms seem to really be close to OSD, however, I'm currently 22 and have stopped growing a while ago, nor do I have any history of OSD from my pre-adolescent years (did mostly swimming and boxing, no high impact to the knees)

I've also read that Pattelar Tendonitis pain can be anywhere from the soft, mushy, part of the tendon (smack in the middle of the tuberosity and the patella knee cap), to the kneecap itself, or directly on the tuberosity attachment (which my pain is).

So I'm assuming this IS Tendonitis, with the strain mostly on the lower attachements, over the tibial tuberosity.

I've been RICE-ing since yesterday, mild alleviation, looking to see how it feels a week from now.

I will probably refrain from ANY leg exercise for a week (which sucks because i just got my WL shoes, and I have a bball tournament i registered for)

After this week, if the pain alleviates, what exercises am I allowed to do?

1. Bench? Pretty safe I guess.
2. OHP? Standing OHP? I'm pretty sure push presses can be detrimental
3. Chin-Ups? Don't see why not, i never kip
4. RDLs? I tried unlocking my knees enough to get enough hip ROM for RDLs, there was no pain since the knees were still behind my toes.

What y'all think?

Thanks!

 

[miaou]

Not making any sort of diagnosis, but the symptoms you describe are consistent with a strain on the attachment of the quad tendon to the tibial tuberosity. This can happen when you have an abrupt increase in the stress on the tendon, so it makes sense that if one gets into training fairly aggressively after a long lay-off, there are greater chances of something like this happening. If you have pre-existing osgood-schlatter's (it is entirely possible for someone to have it without having realized it), then that might increase the chances something like this will happen to you.

If you keep stressing a tendon strain it is entirely possible for the strain to evolve into a more chronic tendonitis. Since you have a doc appointment, my advice simple be to follow the good old rule "if it hurts/aggravates the issue, don't do it". Also, be aware that NSAIDs and ice therapy can blunt the pain without improving the injury, and can thus be counter productive (because how are you going to know what to avoid if you can't feel the pain?).

 

[Stranger Come Knocking]

yeah rice bad, herea someone smarter than me explaining why

 

[under]

Not making any sort of diagnosis, but the symptoms you describe are consistent with a strain on the attachment of the quad tendon to the tibial tuberosity. This can happen when you have an abrupt increase in the stress on the tendon, so it makes sense that if one gets into training fairly aggressively after a long lay-off, there are greater chances of something like this happening. If you have pre-existing osgood-schlatter's (it is entirely possible for someone to have it without having realized it), then that might increase the chances something like this will happen to you.

If you keep stressing a tendon strain it is entirely possible for the strain to evolve into a more chronic tendonitis. Since you have a doc appointment, my advice simple be to follow the good old rule "if it hurts/aggravates the issue, don't do it". Also, be aware that NSAIDs and ice therapy can blunt the pain without improving the injury, and can thus be counter productive (because how are you going to know what to avoid if you can't feel the pain?).

Thanks for the breakdown! So this should be fairly simple and harmless with rest right, if its just a strain. As I said before, there is no swelling or heat the morning after.

What would be the best way to alleviate this in the next two weeks? And are RDLs okay? i've tried the motion (without barbell load though), and no pain was felt.

Bad news, I might have to travel for work on the week i setup the appointment. will try to push it forward if possible. if anyone here has any experience with international health insurance (you have to pay out of your own pocket upfront, reimbursed later) please chime in on this issue.

 

[miaou]

I am not offering medical advice in any sort of official way so lets put it this way: if this happened to myself (which it has happened in the past) I would simply keep doing whatever activities I would normally do and lower the intensity in exercises that seem to aggravate the issue, or completely avoid those exercises if there is still pain despite lowering the intensity. For instance, while doing squats at high intensities may cause pain, doing light work might not aggravate the injury (and some light work that doesn't aggravate the issue might actually be beneficial as strain that isn't heavy enough to harm the injury may help in tissue remodeling).

Basically, in the case of tendon strains, your body can heal itself. All you need to do is give it enough time and don't reaggravate the injury while it's still not healed. You don't have to put your leg in a cast, use crutches, take NSAIDs and apply ice 10 times per day. Keep your activity as usual and only avoid whatever you have to.

 

[under]

I am not offering medical advice in any sort of official way so lets put it this way: if this happened to myself (which it has happened in the past) I would simply keep doing whatever activities I would normally do and lower the intensity in exercises that seem to aggravate the issue, or completely avoid those exercises if there is still pain despite lowering the intensity. For instance, while doing squats at high intensities may cause pain, doing light work might not aggravate the injury (and some light work that doesn't aggravate the issue might actually be beneficial as strain that isn't heavy enough to harm the injury may help in tissue remodeling).

Basically, in the case of tendon strains, your body can heal itself. All you need to do is give it enough time and don't reaggravate the injury while it's still not healed. You don't have to put your leg in a cast, use crutches, take NSAIDs and apply ice 10 times per day. Keep your activity as usual and only avoid whatever you have to.

Sweet, what's the normal timeline on this strain usually? Sorry if I'm asking a lot of questions, in my years of training this is actually my first joint related injury, i've been lucky, and reckless unfortunate, all this time.

Any recommended stretches or rolling regiments to speed the healing? Good to know that RICE can actually be detrimental, is the patellar strap still okay tho?

Also, just tried discussing things with the doctor, a dedicated sports injury doctor (that is covered by my insurance) won't be available till February, but I can get a general practitioner to check my knee next week. Should I go with this? I'm just afraid of getting one of those, don't-squat-ever-again sissy doctors.

Thanks, miaou! Nice avatar by the way, guy from the next cubicle saw it on my screen and yelled out loud telling me to stop opening pron at work. thanks

 

[miaou]

Timeline = however long it takes. It depends on the specific condition of your tissues, which I have no way of knowing. A light strain can be good to go in as few as 5-10 days.

Light quad stretching may help (similarly to how non-damaging levels of tension may help with tissue remodeling). I don't see why rolling would help at all. Definitely don't start rolling your painful tendon!

To my knowledge, patellar strap use isn't scientifically validated. If you do have osgood-schlatter's, a patellar strap may helpful to some extent, as the rationale is it may help with proper alignment of the force through the insertion. My opinion = I don't think it will hurt you, since you bought it you can try it and see if it helps.

Since I don't know the particular gp I don't know if seeing him will help. My personal experience is that most gp's, and even most ortho's, don't know left from right when it comes to sports injuries (but that doesn't mean the particular one you are going to see will not be good).

 

[under]

how long did it take for your strain to completely phase out? just curious.

 

[miaou]

Maybe 2 weeks. Not entirely sure. It happened last august when I got a hamstring tear and started doing a lot more work for the quads (front squats and heavy TKEs) because that was all I could do while waiting for the ham to heal.

I still kept doing the front squats. I just took the TKEs out. Lowering the total stress was enough to allow the tissue to heal. It might have healed faster had I taken a more conservative approach.

 

[under]

Maybe 2 weeks. Not entirely sure. It happened last august when I got a hamstring tear and started doing a lot more work for the quads (front squats and heavy TKEs) because that was all I could do while waiting for the ham to heal.

I still kept doing the front squats. I just took the TKEs out. Lowering the total stress was enough to allow to tissue to heal. It might have healed faster had I taken a more conservative approach.

damn, double whammy. I assume to you're back to squatting heavy after slowly restarting from zero after those two injuries healed?

 

[miaou]

Did not "restart from zero" as I never quite stopped squatting. Got myself some nice gains in the front squat while waiting for the ham tear to get better. Then went on to make some good gains in the back squat in the following months.

I don't even consider the quad tendon thing an actual injury. It's just a strain.

Basically, this is bellow the threshold to be considered an injury in my book (my symptoms were worse than what you describe here, btw):

Finished that rep, but the pain lingered for a couple of seconds and then dissappeared. It still hurts everytime I push my knees beyond my toes, and if I directly put pressure (touching, kneeling) my tibial tuberosity area.

There was no swelling whatsoever, no pain/discomfort when walking normally, only when i touch it, or have weight on the leg while the knnes are forward to my toes.

 

[under]

Did not "restart from zero" as I never quite stopped squatting. Got myself some nice gains in the front squat while waiting for the ham tear to get better. Then went on to make some good gains in the back squat in the following months.

I don't even consider the quad tendon thing an actual injury. It's just a strain.

Basically, this is bellow the threshold to be considered an injury in my book (my symptoms were worse than what you describe here, btw):

Damn, if yours is worse, i don't know how you front squatted through that. Even with my symptoms, the moment i push up from the whole the pain gets kinda of scary, but it disappears at lockout. oh well, i'll stick to glute and ham movements for a week or so.

Could my starting in Oly Shoes and not lowering the weight enough have anything to do with this?

 

[miaou]

Damn, if yours is worse, i don't know how you front squatted through that. Even with my symptoms, the moment i push up from the whole the pain gets kinda of scary, but it disappears at lockout. oh well, i'll stick to glute and ham movements for a week or so.

Could my starting in Oly Shoes and not lowering the weight enough have anything to do with this?

This:

Since you have a doc appointment, my advice is simply to follow the good old rule "if it hurts/aggravates the issue, don't do it".

 

[fightingrabbit]

yeah rice bad, herea someone smarter than me explaining why

In this video, one guy is saying muscle activation is the way to go. So how is compression beneficial? Is it considered a form of muscle activation?

 

[under]

In this video, one guy is saying muscle activation is the way to go. So how is compression beneficial? Is it considered a form of muscle activation?

I'm not exactly sure, nor am I knowledgable on this, but I think muscle activation and compression can go hand in hand,

for example, lightly working the injured knee while wearing patellar straps (i consider this a form of compression) to ease the tension on the tendon.

anyhow, do you guys have ideas for exercises that would allow me to maintain quad strength while I lay off from deep squats? Is this even possible at all?

I got the hams and glutes covered by RDLs.