partialpatellartear

I have had chronic knee pain for years, but recently noticed that my right patellar tendon (attachment at patella) has been worse and hasn't been getting better. When squatting I could feel moderate-severe pain and I wasn't able to use my right side effectively (even with knee sleeves and 2x advil). Was getting pain when sitting and using stairs. Decided to get an MRI.

MRI showed 6mm x 6mm x 12mm partial tear in the patellar tendon (and mild patella alta and patella subluxation, edema).

After I got MRI results I tried taking two months off from squatting followed by doing my own rehab (light single leg leg presses, light leg extensions, later light squats) but neither the pain nor the strength in my right side appears to have improved when applying load. Stairs and sitting did improve substantially however.

Saw a sports medicine doctor who wants me to do physio. I also have an appointment with an ortho but it's months away and am not optimistic about that either.

I would like to eventually squat heavy again (or at all). I know you have experience with patellar tears. My question is what should I be doing? What is safe to be doing? What should I expect to be able to achieve?

John Petrizzo

I agree with this completely. Unfortunately, with your diagnosis I don't think there is any amount of PT that will get you back to heavy squatting again. The only conservative treatment that may be worth a try would be PRP injections. Ultimately I think you should push to get this thing repaired sooner rather than later if your goal is to get back to productive training.

John Petrizzo

If it is a rotator cuff tendon (such as the supraspinatus), you can train through it for a while. If it develops into a full thickness tear, then you should get it repaired. The difference between the shoulder girdle and the knee is that there are so many muscles with attachments around the glenohumeral joint that they can compensate pretty well for one partially torn muscle. For that reason, even if the tendon of one of the shoulder muscles ruptures under a load, the result is usually not catastrophic (with the exception of maybe the pec during the bench press). However, a partially torn patellar or quad tendon that ruptures under a load can turn into a very bad deal because they are the only tendons that attach all of your knee extensors to your tibia. If you lose the function of your knee extensors under a load, you lose control of your knee.

At my last meet a lifter blew out a quad tendon on their third attempt squat. The sudden loading of the opposite leg resulted in a quad tendon rupture on the contralateral side, and the resulting anterior shearing of the femurs and tibias from the loss of control of the knees secondary to the torn quad tendons lead to bilateral ACL tears. Very nasty (and unusual) injury that delayed the meet for about 45 minutes and sent this lifter to a rehab facility following his surgeries.

That is why Rip and I both recommended the OP get his patellar tendon repaired. It is not worth the risk of developing a full thickness rupture under a load. However, your situation may be different depending on the muscle involved as Rip has already indicated.

TalEphrat

One of the differences between the 2nd edition press to the 3rd, is the fact that now every rep starts at the bottom. Also, you mention that the deadlift has a great quality since it starts at the most difficult part of the movement, which is a dead stop. It's mentioned at the book also about the Pull ups / Chin ups, that the "golden rep" starts from a dead stop.

So my questions are:

1. In general, what's better for strength gains, movements that start at the top and uses the stretch reflex to bounce up from the bottom, or movements that starts from a dead stop? And does it vary between different movements?
2. If the answer to 1 is a dead stop (which maybe made you change the Press a bit), why don't we start also the Bench press and the Squat from a dead stop at the bottom?

All I could think about is the logistical problem, and the fact that there's nothing ideal to "rely on" at the bottom at the Squat and Bench press. But I'm not sure these are the reasons.