Tendovaginitis in knee

[searcher]

Hello Doc!

I have been reading this forum for a while now and I believe it is the very best possible source for all Kungfu concerns and issues far beyond. Thank you for setting this up for us.

I have been starting Kung Fu training some months ago and after a while I got that pain in the knee, not alway, but only when I really put a lot of load on it. The doctor told me it is a tendovaginitis and prescribed diclophenac but it isn't getting any better. He also told me not to exercise until I would not feel the pain any more.

It is now two weeks that I do hardly move and it isn't getting better.

The pain orininally started when I was maybe forcing a bot too much on pu bu. It hurts only ehen I do movements that stress similar to pu bu, for example when walking upstairs and shifting my weight up slowly. It is directly where the tendon is fixed on the patella.

I do have the strange feeling that if I'd just continue to train it would dissapear... (The pain was never very string, it was just there - and of course it inhibited me to go very low into pu bu...)

Do you have any advice for me?

Thanks a lot,

Michael

[doc]

I do have the strange feeling that if I'd just continue to train it would dissapear...

I have a strange feeling that if you do continue to train, it won't disappear. And I don't think you have "tendovaginitis", that sounds pretty painful, whatever it is. Tenosynovitis is the more appropriate word.

It's good that you saw a physician. That's the first thing. Now let's try to explain what's going on, so you have a better understanding of your problem, and what is best to do for it.

Is the pain directly underneath the patella? Or is it tender directly above the patella, heading up towards the quadriceps muscle? Or does it seem to be more tender deep inside the knee? Does moving it in one direction or another make it worse? Does putting weight on it make it worse?

From what you describe movement wise, it sounds like you may have strained the quadriceps tendon. Pu bu can put a lot of stress on various parts of the knee joint, well, both knee joints, all depending upon how much weight you put on it and how low you go. It's a nasty position for the leg that's bent, and can be stressful to the stretched out leg, if you lean out on it.

Regardless of what structure got stretched, torn or inflamed, if you've been cleared by a physician as to not needing surgery, what you have will get better on its own. However, rest is imperative for a while. Stressing a torn ligament or tendon is going to impair the healing process, and may actually worsen the condition. It's probably too late now, but generally ice for the first 24 hours followed by heat has been the old saw, and its effective. Anti inflammatory drugs, such as NSAIDS, if you're not allergic to them (or aspirin or red dye), will be helpful. If there's swelling, raise the leg at night with a pillow. Ice packs occasionally can be helpful, as well as heat if your past the initial injury phase.

Above all, pu bu is going to be detrimental, as well as many of the other stances. Anything whereby you have a bent knee, and your bent knees are supporting your weight, is a bozo no no. Bending the knee puts strain on the quadriceps tendon, and could further hamper recovery, and quite possibly, make matters worse.

Give it a rest. And a rest might mean, depending upon the severity of the injury, two to eight weeks. You're the best one to decide when you're feeling better. Just keep in mind, don't be too aggressive with respect to getting back into gong fu. It will be there after you heal, and if you try to return too early, you'll only make matters worse and actually lengthen your healing time.

Once you start feeling better, go slowly with it. Take your time. You'll get it back with time. Because of their poor blood supply, tendons don't heal quickly. And if you over do it, and god forbid you tear or rupture it, you'll be out of training for six month to a year. So, take it easy.

Rest it and play computer games. And make sure that you follow up with your physician so that he can watch your progress.

[searcher]

Dear Doc!

Thank you a lot for your answer, which is in fact much more competent than my physician's diagnosis. Well, my doctor has no clue aboutkung fu, after all...

After what you tell I believe that is much more lkely that I strained my quadriceps. The pain is on top and in front of the patella, no pain from deeper within the knee or from the sides. It is really directly above the patella, heading up towards the quadriceps. Moving the knee in some direction doesn't do anything, but putting weight on it when bent hurts. But it hurts only when I put quite some weight on it, not immediately. For example, depending on how I go up the stairs it might hurt or not.

Also, since I habe been taking twice 75 mg of diclophenac since one week now and don't feel any improvement. Should I, or would you, still continue using it? Would red tiger balm help? (I haven't been able to figure out what "red dye" is...)

I also have to admit that computer games are not so much my thing, I would prefer to try to stay a but in shape, even while giving my knees a rest, but what can I do? Can I do push-ups and crunches? Or other body weight exercises? I guess I can't go jogging...? Can you recommend me any king of fitness exercises I could do during my recovery?

Thanks so much again,

Michael

[searcher]

I would prefer to try to stay a but in shape, even while giving my knees a rest, but what can I do? Can I do push-ups and crunches? Or other body weight exercises? I guess I can't go jogging...? Can you recommend me any king of fitness exercises I could do during my recovery?

Or do you know of an especially suitable Qi Gong set?

Xiexie!

[doc]

Any exercise that you do that involves the legs will invoke the quadriceps to some degree, but those exercises that involve leg flexion (bending the knee) will put some serious strain on the quads and the quadriceps tendon, especially if it is weight bearing. . You want to avoid doing things that will stress that muscle and tendon. Let it heal.

Diclofenac is a nonsteroidal anti inflammatory agent. Keep taking it for as long as you have pain, as prescribed. However, if you start to develop stomach pain or dark sticky bowel movements, stop it and notify your doctor. You might consider weaning its use down as you start to feel better.

Push ups and crunches will use the quads to some degree as will jogging, so again, you're stressing the injured area. Walking will impact it, but recommending that you don't walk is kind of ridiculous. The injured muscle can take some degree of use; it's just a matter of how much. You will be the best judge of that, as you will feel when the discomfort gets worse. It's always best not to exercise an injured muscle to the degree that the discomfort "gets worse"; it's better to just let it rest and heal on its own, and then, slowly start your exercise regimen again.

One of the better things that you can do is get in water. Gentle swimming exercises are always good for injured tissues, especially injuries that involve the ligaments and muscles of the spinal areas. And, you can to upper body exercises, like speed bag work, some heavy bag work, etc, as long as you don't kick the bag. Kicking the bag with your lower leg or foot will put a significant amount of strain on the quadriceps tendon at impact.

Tiger Balm has various oils in it, such as camphor, cassia, menthol, and clove bud oil, all of which have some anesthetic properties. The red version has cassia oil and more clove bud oil, both of which have some anesthetic (numbing) properties. From a chemical standpoint, they don't really cut down on inflammation like the non steroidal agents do (by inhibiting cyclooxygenases, one of which is involved in propagating the inflamation pathway). Tiger Balm has a local effect to make injured areas feel better; it's effective and it won't hurt provided that you don't use tons of it, or, ingest it.

Don't be discouraged if the medicine you're taking "doesn't seem to work". These injuries, depending upon how badly you tore the tissue, can take weeks to heal, sometimes two to three months before things return to normal. Again, give it time, let it rest, and eventually, you'll get better. Impatience with these sorts of things just leads to continued pain and prolonged recovery times.

[onesp1ng]

Impatience with these sorts of things just leads to continued pain and prolonged recovery times.

__________________

ain't that the truth...

[searcher]

Dear Doc,

thanks again for you great answer and good advice. I will follow your prescriions and won't put any stress on my knees.

Sorry for not having responded to your post long time ago. I'm a musician and was on a concert tour to Egypt - no internet access whatsoever where I was and when I' d have had time...

Thanks again a lot!

Michael

[doc]

Not a problem. Let us know how you do.

[searcher]

Now the state of my knee has changed: I don't feel the pain in the upper part of the patella any more, but now the right side and lowerpüartof the patella, both towards the exterior and maybe a bit under it, hort a bit when I walk upstairs...
I'm still not doing any exercise with my legs. I think I'll have a upper body like Tarzan in e few more weeks;-)

Is this change in pain something normal?

Thanks anyway, for everything!

Michael

[doc]

You're just putting strain on tendons that either haven't been used a lot in a while, or, you had pain there before but didn't notice it because of the perceptibly worse pain just above the patella.

Give it time. It should get better. And when you start exercising it, go slowly. Don't be in a rush to get back into things.

[searcher]

That's the hardest thing: Not to rush getting back to Kungfu...

Will I be able to start over again only when I don't feel any pain any more?

Thanks a lot!

[doc]

That's best. If you re injure the area, your healing time will be prolonged, far more than if you had been patient in the first place.

[searcher]

I am starting to desperate. More than one month no sports and hardly any move with weight on my knee - and it just doesn't change.
In the contrary, now it even hurts sometimes when I don't move at all. It didn't do that before... I have the impression it's actually getting worse.
Maybe I should have listened to my inner voice that told me just to continue?!???

What's going on here, doc?

Thanks!

[doc]

Depending on the severity of the injury, it could take some time. If you had a partial tear, then we're talking months.

You are exercising it gently: you're walking.

Did your doctor recommend physical therapy to help you get rehabilitated? He's the best to know your condition because he can see you.

Otherwise, I would still recommend to people that they take it slowly getting back into things. If it hurts, slow down. Those gong fu stretches and stances are going to put a lot of strain on the ligaments and tendons; got to be careful with those. If you feel like doing them, go slowly, and see what happens.

One of the things that I've always found useful with musculoskeletal injuries, especially those that concern the spine, is getting into water. If you have a pool nearby, swimming is a great way to get things back into shape.

Don't rush. Patience. Time heals (almost) everything.

[searcher]

The doctor just said to take diclophenac until I wouldn't feel it any more. I stopped after 3 weeks of diclophenac, when I didn't see any result.
Now I still do not do any kind of exercise, so it's not that I'm exagerating any type of streches or so, you see? I'm just walking, not even for sports or rehabilitation but only for "transport".

And now it even hurts sometimes when I'm not musing (standing or sitting). I was disciplined in not exercising, but it's getting even slightly worse... After almost 6 weeks!

I'm confused... Thanks for your encouragement, doc!