Daily Mobility Exercises by Dr. Kelly Starrett Forums General Patella Tendon during extension

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    • #70732

      Hi everyone,

      I wanted to know if anyone’s knee, in particular the patella tendon, also has a similar bulge on the lateral side during knee extension.
      Knee Extension

      Touching it doesn’t hurt. When I’m at full extension the bulge is fairly hard, again with no pain. Just seems weird, and I wasn’t able to find any other video’s of knee extension showing a similar bulge.

      I have knee pain, but I’ve been fighting this for quite  a while. I’ve seen doctors who have either tried to operate, or have prescribed physical therapy which I’ve been doing along with all my mobility work. So it’s hard to tell if this pain is the same old issue, or if this bulge highlights a new issue.

      Unfortunately I haven’t noticed the bulge before, so I can’t really tell when it started.

      I’ve looked at the other knee and have a similar bulge, but it’s smaller on the left. Coincidentally, I have had pain in both knee’s for quite some time and the pain is less on the left than on the right.

    • #73842

      Have you seen a doctor to address the new bulge?
      This may be a result of the other things you have going on with your knee.
      Sounds like you have a situation that needs attention on both sides.
      If you weren’t happy with the doctor you saw in the past I would find a new one.
      Ask people at your gym or at a sports facility who they recommend.
      Doing some research when looking for a doctor helps.
      Find out if they workout, what they do etc.

    • #73843

      Yup I’ve been to 3 different doctors in town and 2 physical therapists. Not a whole lot of material out there to answer the right questions for finding the right place where I live.  One of the draw backs of living in a smaller city.

      Just curious to know if anyone else with “relatively” healthy knees has a similar bulge.

    • #73868

      If anyone has a similar bulge on the lateral side of the patella, I found out that it’s not necessarily bad or abnormal.

      When in to see a physio yesterday and got good and bad news:

      Good news: All my mobility and strength work has paid off. I don’t really have muscular imbalances or range of motion issues that would contribute to my knee pain.

      Bad news: He thinks that a have a degenerative patella tendon that needs attention for proper healing.

      Essentially my bad biomechanics injured the tendon. While I’ve fixed the issues contributing to the bad biomechanics, I’ve never allowed the tissue to heal properly.

      He’s recommending Astym. I used to get Graston treatments – which after some research is just about the same thing. There are sights that say the goals of each are different, but from what I can tell – they both do the same thing to accomplish their goal and the others as well.

      I actually think that the Graston is the reason why my left knee is a lot better than my right. My left used to be the worse knee, and I had additional graston treatments to it. The left patella tendon healed better, and now the right is the worse one.

      Now my focus is to cut back on activity and focus on the damaged tissue – I’ll probably start another thread asking about how to go about finding what supplements are legit and which are a waste of time.

      So far I’ve found the following list:

      Powdered Collagen

      Otherwise, combine those with the Astym/Graston and some good exercises that stretch and strengthen the tissue (within reason) is all I should need over about 6 months.

    • #73871

      Graston is definitely effective when you have someone with experience performing it.
      Do you know that you need supplements?
      Are you missing something from your nutrition?
      I would recommend doing a Wellness Fx package so you can get information on what you are looking for.
      They have an excellent staff and you choose the doctor that you consult with. You can identify a doctor that has experience in what you are dealing with/looking to improve.

    • #73873

      Do you think Graston is better than Astym? (Assuming both are done by qualified and experienced staff)

      I just assume that with the lack of nutrition in our food, supplements couldn’t hurt. I try and eat as healthy as possible, but I find it hard to believe that I’m getting everything my body needs to not only perform, but also to recover and heal.

      I’m also up for learning about what I can eat more of to get at the right nutrients for tendon repair.

      Thanks for the Wellness FX link. I’ve never heard of this and will definitely dig into it. 🙂

    • #73877

      I’ve never had astym done to me. It sounds like it is along similar lines as graston.
      I have had graston done with good results. The person I had doing it is an athlete and works with many athletes which I think makes a difference.

      Supplements can have a negative impact if it is something you are not in need of. In some cases too much of something is as bad if not worse than having not enough of it. Another impacting factor is the form of the supplement fluid, gel cap, pill etc. In some forms the body isn’t able to process it to a point where it can absorb & use it.

      Here are a couple mwods where Kelly presents aspects of Wellness Fx.
      Measuring Lifestyle and Nutrition Part 1
      Measuring Lifestyle and Nutrition Part 2
      Measuring Lifestyle and Nutrition Part 3
      I’ve had excellent experiences with Wellness Fx and you get alot of information and a plan of action on anything that needs attention. You’ll have your questions that you list above answered and answered based what your blood work results show and what you are currently doing.
      Jim is a good guy, an athlete, and involved within several communities.
      After the blood work is done you’ll schedule a consult with a doctor that you choose. There are bios on each person from your location that gives a good background on the person what they are involved with, and personally do. This makes a difference when the person understands how you train, your goals etc.
      You have the option of scheduling a consult with a nutritionist and Wellness Fx has several other resources available. You’ll receive visual representation of your test results as well.
      There are several options depending on what you want to find more about.
      One good supplement for training is 3Fuel. It is a real clean product as well. You can use the code 3FLyons for 10% discount. If you have questions on anything feel free to message me.

    • #73880
      AvatarNathan Richer

      i’m a big fan of graston. you definitely need to find a good graston person. i’ve had people who weren’t that good do graston which resulted in excessive bruising – they just didn’t have the sensitivity as to when to stop.  i’m also a big fan of ART, if you can find someone near you.

      i’ll bring up something i discovered and has been working wonders on rehabbing my right elbow which was muscular but i stupidly kept working out and now it’s gotten into the elbow itself. it’s the somapulse (http://www.somapulse.com) and uses pulsed electromagnetic fields to stimulate healing.  it’s done wonders for my elbow in only a week. i think it will take longer than the week to fully heal though – tendons/ligaments/bones just dont heal as fast as tissues do.  it is pricey at 1300$ but if you message me on this system i can give you a discount code for $400 off.
      in addition to wellnessfx, you can try insidetracker.com. they match blood test results with athlete level markers and tell you whether you’re in range compared to athletes in different sports. if you do wellnessfx, you can manually type in the blood test results into insidetracker and get a report.
    • #73894

      David and Kaitlin,

      Thanks for all the great info.

      I did some more research nutrition analysis and found that there’s different kinds.

      Blood work – which Wellness FX does; but also a kind that looks more at your muscle instead of the blood.

      The latter focuses on the fact that your blood can change throughout the day, but the muscle fibers are more consistent. A local chiro couple does their nutrition analysis with this method.

      Have either of you heard of this other method? If so, I assume you believe Wellness FX is better – since that’s what was suggested. Why do you think Wellness FX is the better choice?

      Otherwise, I’m meeting with a physicians assistant today to get the referral for a PT and hopefully some deep tissue work.  I plan on getting the Astym/Graston and isolate any remaining strength deficiencies through PT and mobility work.

      One product that has come up on my radar is Knox Gelatin. Apparently gelatin used to be common in our diets when cows and such were grass fed. Now they’re corn fed, and the meat lacks the gelatin. Any thoughts on this?

      Aside from the gelatin, the only other thing I’ve heard consistent word on is fish oil. I’m already taking some, but was curious to know if there are any brands that are legitimately more reputable?

    • #73896

      I have not heard of that method.
      Wellness Fx has several programs to choose from based on what information you are looking to get, and I haven’t seen anything like what they have available and the real information you receive and can put to use. You can track follow ups etc all on the same graphs to see ranges, changes etc. You see your results within the ranges of how they are measured as well so you where you are at within the classification as well. Wellness Fx is definitely aware that blood can change throughout the day.
      I was in a pretty big accident and consulted with Wellness Fx. It was good to have information that I wasn’t able to get through other avenues and work with qualified people who understood goals, my training, and what I wanted to get back to doing. Consistency with who you are working with is a big plus as well.
      It would be helpful to see a knowledgeable coach for an assessment of your strength.
      Moving through different movement patterns will show strength imbalances etc.
      What makes you think you have strength deficiencies?

      Before taking a supplement I would go with eating Grassfed meat. Yes, it is more expensive, but it is a better quality product. When possible it is better to get what you need through your nutrition choices. Getting the most bang for the buck when making choices. Looking at different options of veg,  fruit, meat and having a variety of types can start to address some situations. In these forms your body is best able to use it as well.

      Nordic Naturals fish oil they have alot of info on their site. Why Nordic Naturals
      Ultimate Omega is an excellent option. Consulting with someone you may increase your dose of fish oil for a time while you are healing you may not.

    • #73900

      I have good form during squats and deadlifts (at least I think I do :P), but when I hit single leg work or balancing exercises I become very unstable. I also feel that when I have the time to setup for a lift, I can perform with proper form – but if I’m doing something dynamic; like jumping for a set so I can spike it – my form suffers and this is where the damage to the tendon occurs. I can lift all week long with no pain to my knee, but if I play volleyball for 1 or 2 nights in a week, the tendon lights up.

      My plan is to cut out volleyball for a few months. I’ve contacted a personal trainer that’s FMS qualified. I spoke with him and felt very comfortable with his approach and his understanding of my situation and what my goals are. He also uses other means of measure on top of FMS to be thorough with his evaluation.  So I think this should help in that area and meets a lot of the recommendations you gave. I just wish he was also a trained PT.

      But I plan on seeing a PT as well for the Graston/Astym in addition to possibly seeing a massage therapist for deep tissue and trigger point work. I have all kinds of spots on my quads, ITB, and inner thigh that won’t go away with foam rolling and using a lax ball.

      Thanks for the tip on the fish oil, I’ll definitely be checking that out and hitting up the health foods store to find the grassfed meat.

    • #73901
      AvatarNathan Richer

      hey Thor, i am a fan of FMS. once you get tested, happy to take a look at your results also. 

    • #73902

      Oh also, the trainer I mentioned also highlighted that while I may have fixed my strength issues to a good extent since I first felt the knee pain 2 years ago – I might still have reactive/reflexive issues. So my muscles might not be firing with the proper timing which could result in excessive shearing forces on my knee. He sounded very familiar with this and seemed to be able to setup a program that would address it.

      Most PT’s don’t seem to have this education. They almost seem to focus on the controlled environment movement. Finding this personal trainer with all this extra education is a huge benefit. I have to travel 45 minutes to see him, but I think it’s worth it if I can get rid of the knee pain and learn proper movement mechanics during intense dynamic actions.

    • #73903

      Thanks David! I’ll definitely share the results. I have a meeting setup for Monday with the trainer.

      I love the concept of FMS. It’s always been what I thought would occur when seeing a doctor or PT.

      4 Doctors and 4 PT’s later – The closest I’ve gotten is one PT watching me jump on 2 legs a couple of times. All he really noted was that I didn’t really go deep when I landed and that could be creating more impact on my joints than is ideal. He was the best PT I’ve seen, so I really don’t want to bash him, I just had a lot higher expectations.

    • #73904
      AvatarNathan Richer

      PTs, trainers, coaches all have their areas of expertise and what they are exposed to. unfortunately no one person can do it all.  most PTs are trained in rehab only – getting you from pain to no pain. but they have little training in getting you from no-pain to full function, or enhanced function. that’s not a negative on PTs – it’s just that the world is wide that it’s hard to get exposed to everything….

      this is why i’m a fan of the FMS. it helps you get from no-pain to full function!
    • #73905

      Do you think that’s a problem with the “system”?

      I feel that PT’s should get you from pain to no-pain AND Full function.  Trainers should increase performance once you’re at full function. Coaches hone in on the specific skills involved in an activity.

      That’s “ideal” in my opinion. But if enough people think the same – then as a whole, maybe we can influence the system to change and be better for the general population.

      Just a thought.

    • #73906
      AvatarNathan Richer

      if you follow the FMS crowd, they have been promoting the fact that PTs etc need to do more and that getting to no-pain isn’t good enough – in fact no-pain could you leave in a increased compensatory state and severely reduced function despite lack of pain.  they’ve been trumpeting that for over a decade but still slow going….

      also many PTs don’t workout. that’s another problem. i think the most effective PTs are those who actually participate in CF, triathlon, etc. so they know first hand the problems.  standing back and looking at it academically removes one huge level of effectiveness IMHO.
      i think it’s changing with mwod etc. athletes are going to demand better results. if they can’t get it from one PT, they will find another one who is better. market forces will eventually force the PTs to do something or else they will end up only able to care for a reduced set of the population…
    • #73907

      That’s really good to hear. 🙂  At least the ball is rolling, hopefully it won’t take too much longer for it to pick up some speed.

      One thing I recently discovered, in Illinois, is that in order to even see get PT – you need to see an M.D. and get their referral. 2 of the 4 doctors didn’t even mention PT as a recommendation. I’ve said this before – one told me “These kinds of things just burn themselves out over time.” Looking back on this statement infuriates me. Really – they just burn themselves out? Are you referring to my tendon specifically so that you can get a surgery out of it???

      The only reason I got Graston was because I called his office back after doing some research and asked why he hadn’t recommended that treatment. His nurse immediately said, “oh, we can definitely get you into our clinic area for that. I’ll talk to the doctor and get it all set up.”  So I have to do the research myself and ask for non-surgical treatment? While I definitely support the idea of the general population being educated and knowing what options are available to maintain our bodies – I really think that the moral hazard here punishes those that don’t get enough information on their own.

      Apparently in this state, because the AMA has bigger pockets, they are able to influence the health care to flow from the M.D.’s down. If this is the case, and they’re not recommending non-surgical procedures while leaving you prone to further injury, then this is a huge risk for patients.

      Those 2 doctors I mentioned earlier were orthopedic surgeons – so it’s in their best interest for you to actually get worse.

      I wonder how common this approach is in other states?

    • #73909
      AvatarNathan Richer

      the whole medical system is bound by rules/regulations and making money off the insurance carriers.  the rules and regs say i cant use a doc unless i get referred AND if no referral then no insurance reimbursement. most people cannot afford or will not pay for medical treatment especially preventative stuff like this.

      i had to pay to see an ART/graston guy out of pocket every week for years. it was the best investment ever. it kept me going and training.  it was about $100/week. so $400/month. what could i have wasted $400 on every month? drinking more? buying more comic books? it was worth every penny.
      today’s world with wellnessFX and the like including mwod, we are now able to take medical issues into our hands. 
      also most docs only handle the normal sedentary population. they dont understand the athlete. i spent years in the SF bay trying many docs, getting frustrated, and finally finding the right people with the right understanding.  i would never ever go to another doc ever without a trusted referral from someone i knew who was also an athlete like me.  or from my ART/Graston guy who also knows who’s good and who’s not in the area.
    • #73911

      I get all that – but all of what you said further supports the argument that people shouldn’t have to go through a doctor to see a physical therapist.

      I agree that the money spent is a great investment – but if one’s insurance covers x number of physical therapy sessions a year, then why do I need a doctor (who’s best interest is me NOT seeing a physical therapist if they’re a surgeon) to give me a referral in order to get that preventative treatment. Especially when they don’t understand the entire population.

      Why? – Because the system is set up that way. My question is: Is the way the system is set up appropriate and in the populations best interest?

    • #73912
      AvatarNathan Richer
      first i totally agree with everything you’re saying.

      i believe the referral is only in reference to if you want insurance to reimburse you.  i have found that there are some PTs who work specifically with doctor referrals and those who will take anyone, referral or off the street. and then those are split up into those who are willing to charge you out of pocket and those who take insurance and pay out of pocket.

      as to your last question – i think the system is setup best for a cure mindset – get a big ass problem, go to the doctor, get cured.  we have little or no support for the preventative mindset which i believe is ultimately in the population’s best interest.  so for a segment of the population who dont’ give a crap about their health, then this works great. it works terribly for those who do care.  thankfully the winds are shifting. there are more resources for taking control of your own health without going to a doctor and going through the medical/insurance system.  unfortunately we’re gonna pay for it out of pocket for the time being.

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