My knee has a problem

Peter Noyes

I am trying to figure out what is wrong with my knee.

I did the LA Marathon and was fine. I ran twice after and I was fine. After the 3rd run, (1 week ago), I developed some pain below my knee basically where the patellar tendon connects to the tibia. The pain is very localized and feels like it is the bone more than the tendon. I can push on the tendon without any pain. Walking down stairs is painful. Trying to do a squat is exceptionally painful. Getting in and out of a car hurts. Also my leg feels like it is weak/unstable from this. 

I saw an ART practitioner who gave me some stretches and worked on me. My muscles are very tight (quads, hamstrings, etc..). I have been stretching and and it felt like it was getting better but now it has gotten worse over the past 2 days. I have been cycling throughout the week. It was after cycling on Monday night that it really started to act up.

My initial thoughts are:

1. Patellar Tendonitis or Patellar enthesopathy
2. Stress fracture
3. Bursitis

I went to an orthopedist this morning and he took some x-rays. They didn't show a definitive stress fracture, but it does show something weird. The weirdness could be because I had an osteochondroma removed from that area about 10 years ago. I am going in for an MRI this afternoon.

Any ideas on what is wrong with me? Anything in this x-ray that the orthopedist could have missed?

Attached is my x-ray:

Jeremy Behler

I had the same symptoms a couple years ago and it was a soft tissue issue that was solved with ART and icing.   Did you feel any better after the ART?   Sometimes it takes a couple sessions.  I think I did 3-4 sessions with no running that week before I was better.

Peter Noyes

I don't feel any better after the ART

I got an MRI and the diagnosis is bad tendonitis / bursitis? Basically lots of fluid around the patellar tendon.

I also have bone marrow edema near right where most of my pain is. I guess the bone is under a lot of stress. Thankfully there is no stress fracture.

I am going to try physical therapy for 3 weeks with ultrasound treatment and see if that helps at all. After 3 weeks if I still have problems I go back to the Doctor. 

Attila Matyas

Peter,

Did you ever get this take care of?  If so what was the diagnosis and treatment?

Curious as I'm having very similar pain to what you described here.

Thx.

Peter Noyes

I have just started returning to training over the past month. I did physical therapy and ART for about 8 weeks. They did ultrasound treatment and gave me lots of stretches. I kept up with those for a while. I probably could have returned earlier but it is sooo hard to start up again after taking time off.

I still feel a little "something", not quite pain, but maybe that knee has a little more tightness. I am still keeping up on the stretches. It was probably brought on from muscles imbalances and lack of flexibility. I am stretching my quads like crazy and doing lunges and squats in addition to a bunch of other stuff they had me do.

In the end I think it is just bad patellar tendonitis. I have heard the eccentric squats on an incline board are good. I just bought some foam wedges and I will start that as well.

Attila Matyas

Peter thanks for the details and I'm glad yours is feeling better.

I'm going to see my buddy in a couple of days, he's a podiatrist just to see if he can give me a diagnosis.   

Peter Noyes

I also recently switched to the Altra Paradigm 3.0 which has the dynamic support. I think this is helping as well, I guess I am a bit of a pronator.