Possible Tendinos/Tendinopathy Treatment: Shockwave Therapy

This is the second treatment that my consultant mentioned. More properly called "extracorporeal shockwave therapy" it relies upon bombarding the injury with ultrasound in an attempt to increase new blood supply and healing (perhaps via the triggering of a new inflammatory process to 'remind' the brain of the injury). Again, not something I have tried. But here are some links:

Efficacy verdict on shockwave therapy (from NICE)

I decided not to go down the path of either of these since my consultant has not had good success with them on knees (some success on elbows) and also he wants to be certain that there are not other issues underlying which the arthoscope would show. From reading around I just did not feel that confident that these would not just be a waste of time and money - but they are much less invasive than surgery and might be worth a go before resorting to that - I'm interested to hear from people who have had a positive experience

Possible Tendinos/Tendinopathy Treatment: Autologous Blood Injection

Finally got my appointment with the consultant. Given the amount of time without recovery and the lack of substantial response to physio he recommended an arthoscopy and decompression of the tendon (more on this in a later post...). But we also talked about two other possible treatments (which would have to be privately funded). The first of these is blood injections into the tendon - the idea being that the platelets within the blood stimulate/help healing. Not something I have tried - but here are a couple of links:

Details of the autologous blood injection procedure
Efficacy verdict on autologous blood injection (from NICE)

Astanga Yoga

If, like me, you get laid up for ages by this condition - you are going to need some kind of exercise to keep sane. I have (despite all my preconceptions ) found yoga (in particular Astanga yoga) to be fantastic. I think Astanga suits me because of the flowing, moving cardio side to it and also a number of the poses provide lengthening (i.e eccentric) strengthening of the legs - just what you are after for tendinosis. The format of the classes (I got nowhere without an instructor) lends themselves to taking it gently and not over-reaching. I was amazed by how physically tired I got during/after these sessions and found them an amazing workout as well as leaving my muscles and tendons feeling warm, full of blood and well stretched.

I had always (as a runner, gym, bike, swim enthusiast) been a bit dismissive of yoga - but I'm a convert. You would need to find a class that suits your mindset, age, gender etc - and I would suggest that Astanga might be a good choice to suit the mindset of sports-mad people?

Go on...find a class, give it a try....at least you'll be off the sofa doing something..and you never know...you might catch the bug. I really like this poster (credit: http://dailycupofyoga.net/yoga-resources/) and love some of those bent knee standing poses - great eccentric strengtheners (but take it easy to avoid a flare up!)

Possible Tendinos/Tendinopathy Treatment: Kinesio Taping

I have found Kinesio taping to be quite helpful. Basically this kind of taping (which has a 'wrinkly' look when the tendon is compressed (full leg extension) provides a gentle 'lift', rather than constrictive support. I have been using it on my longer walks when I don't have knee supports (once a week) and when I know I'll have a heavy day. I would not say that it had a strong impact - but does seem to provide some relief and also a psychological distraction by changing the way the knee feels. My physio trained me up on how to apply it (not too hard) and you can buy the tape online. Below is a picture of what it looks like when applied (this one had been on for two days and was starting to come loose in a couple of spots). The 'wrinkles' pull up a convolution in the tendon and skin - its not just loose taping....

Eccentric Decline Squats - Third Progress Report

Over the last few months I've been gradually adding weight to my one legged squat routine. I've stuck to 3x15 squats (on each side) before bed, and added 200g every four days. Although no miracle cure I have continued to see gradual improvement and am now at 3.6Kg. I no longer get any neurological feelings and am less prone to pain on the pat and quad tendons. I would say now that I suffer mostly from very stiff and sometimes sore knees - rather than pain. If I do too much then I will still get a flare up though. Those flare ups begin with twinges in trigger points on the outside of my thigh above the knee and then spread to cause a wider flare up. Sitting and driving are still the worst for causing it to stiffen up and feel nasty

My physio has had me on a gradually increasing walking program as well - which has been a huge psychological boost. I walk three time a week, one without any support and add 10% to the time each week. I have gone up from 15 mins to 70 mins - which is a huge improvement. I have continued to benefit from accupuncture into the sore area - and get a strong, positive improvement for a few days - particularly on the quad tendon directly where it joins the patella - which is my last remaining spot which is regularly sore.

Tendons/knees are still very grindy and clicky - maybe that will never go and I just have to accept it. Now it seems like carefully managed gentle movement, walking, yoga, physio is the most effective thing at managing the stiff, sore feeling. Also interesting has been my gradual mental shift - it is true that, given long enough, you can get used to most things! I'be sort of adapted my life to not running, swimming, cycling and instead look forward to my yoga classes, walks etc. I would not have believed it - but there it is. Perhaps one advantage of this whole awful experience is that I'm learning to be more gentle with my body and exercise. When I do get back to a wider range of exercise I'm going to approach it in a much more 'for fun' and gentle kind of way

I think I have now got as far as I am going to go with the squats though. At the weight I'm at they now feel like they are starting to antagonise other parts of knee and overload it - I really don't want to cause a whole new set of problems. Through my Astanga Yoga I've learnt loads of eccentric leg exercises which are static loading and seem to have the same benefits - so I think I'll focus on those, gently building up my walking etc and see how that goes.

I'm not sure if I'll ever recover 100% - but I can already do so much more now - perhaps it's a case of finding what I can do, gradually building that and see what happens in the long term. So many of my problems seem to have come from 'heel-striking' and poor running posture - so I'm also reading a lot about barefoot running and walking - could be a way for me to go in the future. Might start up a blog on that as I get into it a bit