The 200 day plan....

One good thing about tendon injuries is that they teach you to slow down and have patience:)

I really think I know the extent of my problems now and can plan a way out. The two things wrong are:
(1) general crepitus and tenoditis type feeling above, below and around both knees - caused by doing too many weights too often when trying to come back after the Marathon
(2) localised tendinosis in the right patella tendon - caused by over-training before the marathon

To date any attempts to start an eccentric protocol to work on the second cause the first to flair up. So here's the plan......

First of all I need to kick the more general problems. I've read in a number of reports and journals that it takes 100 days for Type I tendon collagen to lay down and mature. So I'll do no exercise on my legs for 100 days (bar walking around and a tiny bit of swimming as a treat). I would expect this to show a marked improvement in the more general problems. Perhaps later on I will be able to add in some gentle stretching. Other things I should do in this period would be some work on ballance/proprioception (mine is rubbish now!) and some deep tissue massage as there seem to be all sorts of rough, painfull areas on innner and outer thigh muslces and nasty trigger points. It's already 6 weeks since I laid off the gym leg weights and there is already a slight improvment in the general tendon crepitus - which is promising -but the trick is to stick to my guns. If I count from when I stopped the gym weights that puts me at 50 days right now

Then.....

I've also read that any significant improvements from an eccentric protocol aimed at tendinopathy takes a min of 12 weeks (consistent with the time above taken to lay down and collagen and re-model the tendon). So the second part of the plan is a 100 day eccentric decline squat protocol (starting incredibly gently and building up slowly). Hopefully this second phase will then start to address the specific area of tendinosis. I'm also expecting to continue the eccentric work for a long time beyond this - but I'm hoping to see improvment by the end of those 100 days

Maybe I'll be able to go for a gentle bike ride at the end of the winter (forced grin)...

Heat or Ice?

I've tried both applying heat and ice and thought I'd jot down my observations. As with all this blog - consult your GP (Doctor) or physio first.

Icing is normally recommended (as part of RICE) soon after the injury to help reduce inflammation and bring down swelling and numb pain. Most advice says not to use ice before activity. Heat is normally recommended before exercise to warm up tight muscles or in the ongoing management of conditions where increasing the blood supply to an area can reduce stiffness and help. Never apply heat to an area with inflammation as it can make it worse

There is a brief summary of the differences here:
http://orthopedics.about.com/cs/sportsmedicine/a/iceorheat.htm

So, what might we speculate would be the affect on tendinopathy? Going with the expectation that tendinopathy is not an inflammatory problem (but one of collagen degeneration) I have tried both and found the following:

Ice: Icing (freezer gel pack with cover to prevent frost-burn) worked well to numb pain (and also my weird tingling and wet/cold feelings). It left the area feeling stiff afterwards. Despite repeated and regular use over time no obvious improvement in the condition was observed

Heat: The warmth of a heat pad helped to reduce stiffnes and felt pleasant but did not provide any relieve from pain. In addition on a few occasions, where at that time I had a particular small spot of increased crepitus and wet/cold feelings it seemed to be slightly worse afterwards.

So, on balance I guess the icing was marginally more useful and probably safer in case there is some minor inflammation (perhaps caused by the rehab protocol). Heating did not some quite as useful and I had a worry that improving blood flow could be bad thing if it worked to the benefit of abnormal capillaries growing into the damaged area. Neither seem to have any curative effect at all - but ice seems the most useful palliative