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Old 04-21-2009, 08:01 PM   #1
Greg Pieris
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chronic annoying quadriceps tendon pain

I did SS for the second time from November last year to the start of April this year and made some great gains.

The first time I did SS was in 2007 and I strained both hip flexors, the left worse than the right, due to poor form - knees sliding forward. I worked through it, icing, ibuprofen, stretching, etc but never got it checked. It improved but personal circumstances meant I didn't train again until November last year. In the meantime, the hip flexor problem resolved itself and I have full strength and mobility back.

But, from about early Feb, I developed a sharp pain in around the quadriceps insertion on both legs. It's weird because sometimes the pain feel likes it's in the muscle belly of the rectus femoris - sometimes it feels like it's at the top of the patella. I can't recall any specific moment when it occurred - there was no "oh ****" moment. so I didn't ever think I strained anything. I did develop a habit of allowing the knees to cave in during the ascent once the squats hit around 250lbs in late January, but I immediately cut weight to correct this problem.

The pain presents itself when trying to stand up when the knee is flexed at 90 deg or further, ie similar to the angle of the shins in a squat. It only presents with pressure unless I sit for long periods of time without straightening my legs is the biggest killer, in which case I feel some painful tightness just sitting there. If I push through my feels with the knees between 0 and 90 degrees there is no pain.

Hard stretching of the quads provides temporary relief. As does exercise. Once I'm warm, I can squat and deadlift without pain. The pain gets progressively worse the longer I leave it after training. I tried cutting volume, and cutting training altogether and there was no difference.

I have recently joined a powerlifting club and although the pain still allows me train, I want to get this fixed before the training volume and intensity builds up in case I risk injury. My coach says there is nothing terrible about my form that would affect knees or hips - but he wants me to go deeper, use more stretch reflex, and use a higher chest than I currently am.

I have been to a physio, who confirmed there was no strain - I have lost no strength and there is no inflammation (makes sense since icing, heat, ibuprofen etc don't seem to make much difference). She said it could be a nasty case of DOMS and try incorporating a light 5-10 minute bike warmdown and see if that helps. She also said my left ITB is tight, and my VL and rectus femoris are really tight. She gave me a massage, and recommended trying some diligent stretching, massage and contrast showers as well. I've got a follow up next week, but I'm skeptical of the DOMS theory - I know what DOMS feels like and this is different. I'm also skeptical lactic acid or other metabolites have localised in my quadriceps tendon and stayed there for over 2 months, so I wanted some other opinions.

I've been foam rolling paying particular attention to the IT bands, VL and lower RM muscles daily, using extra strength dencorub, stretching, icing, and did a light cycle on a bike on monday after training. All these provide minor temporary relief but the pain comes back.

Any help much appreciated.
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Old 04-22-2009, 07:32 AM   #2
Christian Lemburg
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Re: chronic annoying quadriceps tendon pain

Dear Greg,

try trigger-point self-massage using the elbow of the same side arm to poke into the quadriceps while sitting.

See the link in my sig for why and how to massage. Most likely, you have a chronic trigger point in your quad. See the triggerpoint pics under Anterior Knee Pain at http://triggerpoints.net/ (http://triggerpoints.net/userfiles/Rect_Femoris.jpg, http://triggerpoints.net/userfiles/Vastus_Med.jpg, http://triggerpoints.net/userfiles/A...us--Brevis.jpg) - all wfs. If you can replicate your pain (red areas in the pics) while massaging those hard lumps in your muscle that feel like rubber cables (at the points marked with crosses), you know your problem, and the solution.

Good luck, and fast recovery,

Christian
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Old 04-22-2009, 03:56 PM   #3
Greg Pieris
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Re: chronic annoying quadriceps tendon pain

Christian, thank you very much for your reply. I will give it a try.
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Old 04-29-2009, 11:43 PM   #4
Greg Pieris
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Re: chronic annoying quadriceps tendon pain

A bit of a follow up on this...

I am pleased to report that the trigger points were very helpful in dealing with the pain, although they did not totally eliminate it. In fact, the pain seems to have been shifting to underneath or around the patellas on both knees. I had a follow up with my physio, who agreed that trigger points could be contributing to the pain. She did a massage and iliopsoas and rectus femoris release which immediately helped with the quad tendon pain (and some lower back soreness too). She also recommended a local massage therapist who does deep tissue and trigger point therapy.

But the pain then immediately shifted to the knees. So she taped the patella of my right leg to prevent lateral tracking changes and we did a few squats as a test.

Within a few minutes the pain in that quad and knee had been totally eliminated. I kept the tape on that evening and while my left leg started to get sore from sitting again, the right knee was absolutely perfect and felt great trying out some air squats. It still feels really good today as well - not as good as with the tape, but better than the left.

So the physio's suggested there could be some kind of patellofemoral tracking issue, that is either aggravating tissue and referring pain to the quadriceps tendon or preventing an existing aggravation from healing.

Prescription is taping my knees for workouts for the next few weeks and see whether that allows whatever's been niggling me to heal. Then I'll report back to confirm that diagnosis and deal with potential knee issues that caused the soreness in the first place, if it's not simply a matter of overuse.

Looks like I'll have to shave my legs now too
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Old 04-30-2009, 02:49 PM   #5
Steven Low
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Re: chronic annoying quadriceps tendon pain

Search the patellofemoral syndrome threads in this forum. There's quite a few of them.
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Old 04-30-2009, 04:30 PM   #6
Greg Pieris
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Re: chronic annoying quadriceps tendon pain

Thanks Steven, I'll starting reading through. I actually think it could be Retropatellar Pain Syndrome. I've got quite a few of the symptoms: pain after extended periods of sitting, occasionally clicking, and pain while applying load to the knee past 90 degrees of extension.

I'm hoping it's simply an overuse injury, which will resolve with taping/strapping, rather than some kind of structural problem.
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Old 04-30-2009, 08:59 PM   #7
Dean W. Bryan
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Re: chronic annoying quadriceps tendon pain

PFS can be tricky. I have dealt with a lot of athletes on many levels that had PFS. Over the years I have had athletes doing anything from straight leg raises to work on VMO strengthening to doing functional moment activities to address mechanical issues they have while working with a load.

I do think the MF release or trigger point massage can help you but you may need to work on a couple of other things as well.

What is your Single Leg Balance like on a scale of 1-5 (1 being unable to stand on one foot to 5 being able to stand on one foot for over 1min with out falling)?

If you answer 3 or lower then you may need to work on your stabilizers more to gain more control during the movement. Your primary movers maybe over working to not only eccentrically control the movement but also to stabilize you during the movement to compensate for your stabilizing muscle groups.

How is your hip flexibility? Do your hips feel are tight after working out? Can you lay on your back and lift one leg to 90 without your other leg coming off the ground?

If your hips are tight then they also may be causing you to have compensatory issues causing your tendinitis as well.


There is a long list of things in your kinetic chain that can cause you to have compensatory issues.

One thing I would try along with the MF release techniques before and after a work out is doing a warm up activity that I have a lot of my athletes do. Its called the Kneeling Matrix. It was designed by Gary Grey and was brought to me by a friend of mine. You can find examples of it on Youtube. Just type in Dave Gottfeld and you will find him teaching the Kneeling Matrix.
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Old 04-30-2009, 09:29 PM   #8
Greg Pieris
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Re: chronic annoying quadriceps tendon pain

Dean, that's great info. Thanks very much.

My single leg balance is probably a 4-5 on both legs, but my hip flexors get very tight - particularly the left, which is also the weaker of the two for single leg balance and single leg hip flexion movements. The physio noticed the left iliopsoas was particularly tight when she did the release. I also often get cramps in my TFL when doing adductor stretches or similar movement. But I can easily lift either leg off the ground to 90 degrees without the other leg moving.

It doesn't surprise me if there is some hip flexor issue related to the issues I'm experiencing now, based on my previous hip flexor injuries.

The Kneeling Matrix looks good - I'll incorporate it into my warmup.
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Old 05-01-2009, 05:23 AM   #9
Jake Thompson
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Re: chronic annoying quadriceps tendon pain

PM me I have a copy of a soft tissue release manual for foam roller/stick/lacrosse ball that is great.

#2 Watch Dave Tate Box squat videos, learn to squat like that and your knee pain should go away.

I just read a study, http://www.ncbi.nlm.nih.gov/pubmed/1...t=AbstractPlus, where this ortho decided to do surgery on himself, no anesthsia to determine where pain comes from. Turns out synovium and fat pad are the main culprits.

the last is more an FYI for those who care, i thought it was pretty cool
Oh, it also rules out the "tracking BS" that we have been fed over the years. The tape likely unlaods the synovium/fat pad. Whatever as long as it works use it. We're not working on quantum physics here.
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Last edited by Jake Thompson : 05-01-2009 at 05:26 AM.
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