Quadrizeps tendinosis with blood accumulation

[ofenltt]

Hello Rip and other SSC’s,
Sorry for posting another tendonitis thread but I don’t find answers to my pain. I’m a 21 year old 6'0, 220 lbs lifter from germany who has a high degree of pain in my right knee. I experienced it the first time playing rugby 2 years ago after being tackled. My knee was stiff and I was not been able to bend my knee without pain for about 5 days. At the time I was a weightlifter who was part time playing rugby.. Over the next 2 years the pain was coming and going. I had setbacks all the time so i couldnt develop much. In January I started Starting Strength and improved fairly better but in the end the pain came back so I paused squats and deadlifts and after a while started again training. Recently the pain was AGAIN (apparently im just stubborn or stupid) too much during the training that I paused any squat and deadlift activities. I was for the first time seeing my doctor and he was telling me that I have a patellar tendonitis even though I believe it is a tendinosis given my injury history with it. After that I was seeing a physicial therapist and he was doing shit exercises with me and tried to ´´strengthen`` my tendon. I quit the therapy. On my own I started stretching my quads and posterior chain and applying voodoo band to my knee to increase blood flow. I also did squats with slow acceleration of about 7 sec down and 1 sec up with light weight in 3 sets of 5 and the RDL. 2 Months after this I had MRI and I have a really bad inflamation of my quadrizeps tendon with a inflamation of my kneecap, apparently it got this bad. I also have two big accumulations of blood and water in my knee. The thing is that I paused my leg training for 2 months and it didnt go away! According to my doctor the problem is that my quads are stiff and not elastic enough (so its too short apparently). I dont know if the starr rehab protocoll applies to this problem but im sick of dumb advice from physicial therapists and the reocurring pain in my right knee. I want to do and finish my Novice LP but this is deflating my motivation. I hope somebody with real knowledge can provide me with a strategy to deal with this problem. Thank you in advance and I hope my english is good enough to understand me. I might add that I can do deadlifts without pain I just have pain during and after squats! Even though I dont know why.
For form checking my Deadlift is 137.5 kg x5
Link: Deadlift 137 5x5 - YouTube
For form checking my Squat is 120 kg x 5 and 117.5 kg x 5
Links: 1NKB 117 5x5 - YouTube
Squat 120 - YouTube

[Tom Campitelli]

Guten tag, ofenltt. I can assure you that your English is better than my German, although, as you can read, my German is impressive. Very, very impressive. I have listened to my share of Rammstein. Wunderbar.

Your knee sounds fairly fucked up. What was the condition of your meniscus in the MRI? How about the collateral and cruciate ligaments? Any word on fraying of the quad tendon or patellar ligament? Is the retinaculum or the joint capsule damaged? There are a lot of things that can be pissed off in the knee. It is unusual for tendinopathy to be accompanied by blood and fluid accumulation. I can pretty much assure you it has nothing to do with your quads being stiff and inelastic. Your knee suffered a trauma and that is the likely cause for this fluid accumulation. I strongly suspect you will not be able to stretch your way out of this.

When you stop lifting, does your knee stop hurting, or at least get better? There are times when squatting and deadlifting are not advisable. This may be one of them, at least until you get a handle on what is going on. I think you need a second opinion from another doctor.

[ofenltt]

Hi! I'm grateful for the fast reply! and your german is really impressive! Gut gemacht! Rammstein is perfect for training, it puts you in the right mindset right away!

But on to your questions. I will try my hardest to convey the results of my MRI. So my inner meniscus was okay, the doctor at the MRI told me the meniscus was stressed and potentially a little bit different of a normal meniscus because of overtraining (but I wasnt training more than 3 times a week, I already started the Novice LP) and my outer meniscus was normal. The word fraying was nether used in any kind. But if I have a blood and fluid in my knee does that imply that a partial tear of my quad tendon or fraying for that matter has taken place? Furthermore, my doctor never talked about my retinaculum so I guess they are fine and did not need any discussion. The doctor also told me that my joint capsule was not injured and the only other problem was that the cartilage below my kneecap was a little bit injured and that I need to keep an eye out for that. He as I told you before suggested intense stretching of 30 minutes a day. I have to confess that I have not done the recommended 30 min a day but a fair share of foam roalling and 20 min every two days of stretching.

Yes, my knee gets better over time and the pain goes away but it doesnt take me long to re injure my knee. During my rescent squat progression I felt good at slowly coming up from 60 kg after a 2 1/2 Month layoff. After one month I was at 3x5x120 kg and it did not hurt until I got over 100 kg. Then the pain gradually increased till last Thursday when I had bad knee pain (120 Kg squat). Of course I personally think that my layoff of 2 1/2 months should have been enough. But is my tendinosis that severe that i cant recover that fast and that I need even more time? And if i dont have tendinosis shouldn't I start the starr rehab method to repair my tear? I will try to see another doctor in about one week but 2 doctors seemed to casually mention that I have two of these blood accumulations which is kind of terrifying. Do you recommend a specific kind of doctor? one of the doctors was ought to be a good sports medicine doctor and the other is the one at the MRI who did a brief session with me about my MRI.

For now I will follow your instructions and stop any squats and deadlifts. Is it still possible for me to the RDL though? Or should i even stop that? Is it possible for me to do active recovery like bodyweight squats relative high volume like in the scarr rehab method. Or should I prefer the P.R.I.C.E. method?

Thank you again for your time! Your expertise is greatly appreciated!

[Tom Campitelli]

So my inner meniscus was okay, the doctor at the MRI told me the meniscus was stressed and potentially a little bit different of a normal meniscus because of overtraining (but I wasnt training more than 3 times a week, I already started the Novice LP) and my outer meniscus was normal.

Well, there goes that idea. They would be able to see a meniscus problem in the MRI and this would have been my first bet for the fluid and blood accumulation.

But if I have a blood and fluid in my knee does that imply that a partial tear of my quad tendon or fraying for that matter has taken place?

Unlikely. That would also have been observed in the MRI.

the only other problem was that the cartilage below my kneecap was a little bit injured and that I need to keep an eye out for that.

That is fairly common and not terribly worrying.

I have to confess that I have not done the recommended 30 min a day but a fair share of foam roalling and 20 min every two days of stretching.

What has your experience been with that? Do you feel it has been helpful?

Here is what I think: Squatting appears to be hurting you right now. I don't know what your squat looks like, so there may be form issues that exacerbate the problem. However, even fairly shitty form does not tend to cause blood and fluid build up. Fluid in the knee is a tricky problem. There is not one cause for it, nor is there an agreed-upon solution. Getting strong is good, but if that is done at the expense of your quality of life, the tradeoff is not worth it. You may find that you can squat lighter weights once or twice a week. You may find that knee sleeves or a light knee wrap helps. It may be that you don't squat at all. It may be that this eventually heals up and you can squat without a problem. I cannot say from here. I do think there is something else going on and that "stretch" is probably not a great solution.

See if you can deadlift without making your knee worse. If not, RDLs. If not those, then you can realize your dream of getting big motherfuckin' arms and can implement that biceps and triceps program you have been eyeing up. Keep the goal in mind here. You want to be strong and capable. Squatting your way into not being able to walk properly is not okay.

[ofenltt]

Thanks for the explanation of the different problems!

The foam roaller has been good to my knee and I feel a little better afterwards, but I must say that I feel very sore the day after roalling very long. My performance also seems to take a hit when I foam roal very long. The stretching has made no difference at all in my opinion but that also could be a false assumption based upon the fact that I did not do the recommendation of 30 min a day.

I have posted my squat and deadlift (links also at the bottom) from the previous two sessions in my first post and I hoped that would give you some insight in my technique! Can you open them?
I understand that this situation with my knee cannot be tolerated any more. So I will do the Novice Program as far as the deadlift takes me and then after a really big layoff see if I can squat without any pain. I will also check from time to time if my knee is ready or not. The problem is being deceived by feeling good the first training sessions.
Is a solution that a doctor extracts the blood and fluid from the knee or do a knee arthroscopie to see whats really going on?

Deadlift: Deadlift 137 5x5 - YouTube
Squat: 1NKB 117 5x5 - YouTube
Squat 120 - YouTube

[Tom Campitelli]

As per the sticky, pick one video for me.

[ofenltt]

As per the sticky, pick one video for me.

Because the squat is the lift that causes me problems I would say the squat with 117.5 kg

[Tom Campitelli]

Aside from having a slightly wide stance, those squats look pretty damn good. I would like to see you in a pair of weightlifting shoes, but that won't do anything for your quad tendinopathy. If the doctor were to aspirate your knee and remove the fluid, they probably would not analyze it, nor would they probably be able to say anything about the cause from any analysis. I think you need to press your doctor on what the possible sources of the fluid could be. Make them define for you in very specific terms how tight quads are causing fluid build up. Make them define what "tight quads" are. Make them specify how this can be tested and how they know what they know. Make them quantify how others with "tighter quads" than you do not suffer from this problem. Make them explain how your other knee, which would presumably have similarly tight quads, is not suffering from this problem. Make them pay for their facile generalities.

Pain does not always have a structural analoge. Fluid and blood accumulation probably does and it would be good to figure out what the deal is. In the meantime, train around it as best you can.