I've had a major problem with my right knee tendon for just over a year. While this is certainly not the first major injury I've had, it has definitely refined my thoughts on what a rehabilitation program should look like.
Top 10 lessons of Rehabilitating a Knee:
1. Don't listen to the typical doctor who tells you to rest. It is appropriate to initially rest a tendon (which I did), but once the problem moves from acute to chronic, you have to take action appropriate to your situation. Closing your eyes for 6 weeks doesn't magically make the problem go away.
2. Find a good PT who does more than give you ultrasound and lame exercises to do. Read their biographies to determine their areas of medical interest and look for additional certifications. After I dumped my first PT, I found another one who had an interest in sports medicine and had a CSCS certification. She was very well versed in finding the imbalances in my hip that led to degeneration of my knee tendon and was able to prescribe a functional strength program to get me back on track. I also worked religiously on foam rolling, stretching and mobility.
3. I highly recommend Mike Robertson's BulletProof Knees. I now know more about knees than my Physician. The manual is pricy, but it's worth it. A free alternative to the Bulletproof Knee manual is fix-knee-pain.com. Martin Korban is well researched and knows his stuff.
4. Get an X-ray and maybe an MRI. I had an X-ray and it showed no calcification. I'll demand an MRI if I can't see my way out of this problem in the next few weeks.
5. A good sports medicine Chiropractor is invaluable. I was performing hip exercises for months but my hip wasn't getting stronger and my knee kept laying down scar tissue. I finally tapped out PT's knowledge base so I apprehensively made my first appointment with the Chiro. After a brief examination he determined that my SI joint was not functioning properly because my hip was not in the correct place. Thus I could do hip exercises until I was blue in the face, but my hip was not getting stronger. My knee was still having to work overtime to do the job that my hip could not and laying down scar tissue to protect itself along the way. It's a vicious cycle. Warning - adjustments don't hurt....but they are pretty damn
6. Read Pub Med. Learn the difference between tendonitis and tendinopathy. You CAN remodel a tendon through strength training. Google key things like tendinosis and decline squats.
7. Utilize Graston technique. It's not the most painless thing in the world but you have to break up adhesions. You can pay a Chiro to do this or can get out the cocoa butter and a butter knife and go to town.
8. Tendons heal slowly - they don't receive as much blood as other structures. Tendinopathy is damage at the cellular level. Those collagen cells can take 100 days to go through a regeneration cycle. Exercising without pain will help bring blood to a tendon. Just don't overdo it.
9. Eat whole foods and supplement smartly. The research around knees and supplementation is a little weak and fringe. But I think a short term plan of moderate antioxidants doesn't hurt. Throw in some fish oil to reduce inflammation and colostrum for hormone growth (especially IGF-1) to help with cellular repair. If I had a chance to redo this whole experience, I would have taken proteolytic enzymes when I was in my acute phase of this knee problem.
10. Sleep at least 7 hours each night and even more if you can swing it. I always struggle with this because I'm busy and work so much, but this is how you heal your body. Stay positive and try not to get a case of the fuck-its. I had a very bad case of the fuck-its once. It led to eating lots of sugar and putting 15 pounds on my frame. Never again.
Once you emerge, you will be unbreakable!