Squashing patellar tendinitis

This morning I awoke to a reminder in my calendar that made me really happy. Three months ago I set an event that said I could start playing squash again today, and I plan to do just that. Setting that calendar event was really just an emotional response to a feeling of helplessness, and I wasn't sure it would mean anything.

In March I was forced to stop playing due to chronic pain in my right knee. I would play, feel fine throughout the game, then later that night, and for days thereafter, feel like there was something not right with my leg. I say 'leg' because trying to identify and locate the pain was really hard to do: sometimes I'd feel like it was my quad, sometimes my shins, and often somewhere in arc around the inner knee. I was most aware of it when climbing stairs or doing movements that moved my knee toward 90 degrees, like lunging.

It got to the point where it was seriously affecting my life in between playing, and wasn't something I could just ignore. I'm active and work out almost every day, so living with a certain degree of muscle strain and injury is my default state. However, I've never experienced another injury quite like this one: two days after playing I wasn't feeling that much different, and any muscle or other soft tissue injury I've had responds in that time.

I didn't want to deal with a normal doctor who might tell me to just stop playing, and since my wife had had good success going to a sports medicine clinic in Waterloo, I decided to do the same. At the clinic, she had encountered a team of doctors and therapists whose primary goal was to get her running and playing her sport again, and I wanted the same.

I was able to self refer and quickly got an appointment with the doctor. He spent 30 mins assessing my leg and knee. I was really afraid that he was going to tell me that I'd injured my ACL. In December I'd played a really long match one afternoon, and at the end put my foot down and twisted my knee, at which point I felt "something go." It was bad enough that I stopped playing altogether for a month. "You did the right thing," he told me, "but you just didn't stop for long enough. This kind of injury takes a lot longer to heal...months, not weeks."

The "kind of injury" I had was patellar tendinitis. He had me do a one-legged squat, and showed me how my knee and arch were both collapsing inward, which was causing more strain on my knee vs. hips, ankles, etc. He explained to me that it's a very common injury in squash, tennis, basketball, running and other sports that have you jumping and lunging a lot. Various athletes have suffered from it, including Nedal, who has struggled through it for years.

Recovery would involve four things: 1) stopping squash, running, etc (i.e., quit making it worse); 2) strengthening and increasing flexibility in the areas around and connected to the knee (hips, glutes, quads, ankles, calves); 3) eventually strengthening the patellar tendon itself; 4) use a patellar strap when playing. He told me to stop squash for 3 months, and start to aggressively fix things through targeted exercise and physiotherapy.

I found it really hard to be told to stop playing for so long. I've been investing a lot of time in my game, and progressing really well. Our whole family plays, and it's one of my favourite things to do with the girls. Thankfully I was told that I could still do cardio on an elliptical or bike, since neither would load the tendon. People talk about developing issues in your joints with age, and here I was having exactly that kind of problem. I found it quite emotional.

I began my physio the same week, and was amazed at how quickly she was able to zero in on my pain. I had never been able to find it--it always seemed to move around and be a general pain, rather than in a specific spot. In fact it was very clearly in my patellar tendon, and she could push directly into it and get me to wince. She got me started on the following daily exercises:

Because I already had an extensive mat program that I did at home, especially for core exercises, adding these lower body exercises was easy to do. If I hadn't already been disciplined about doing daily work like this, I think my recovery would have been much harder, if not impossible. I saw a lot of people at physio who seemed to do their exercises there vs. at home, which is not good enough.

Every week I went to see her and had various treatments done (laser to stimulate blood flow and healing, electrode stimulation of my quad muscles, physical treatments on the tendon, etc.), while in between I worked on all these exercises and stretches. "So how's it feeling this week?" she'd ask, and my answer was always the same: "no difference." It was very frustrating and discouraging. "It takes time," she'd say. I was pretty sure it was never going away

A few weeks ago when she asked me the same question I had a new answer: "It's getting better." For the first time in many months I felt like I might actually be able to defeat this. I've now noticed a real difference in my whole leg, especially in the strength of my arch, the alignment of my knee and ankle, my flexibility through my quad and calves, and the amount of pain I have in my knee generally.

So is it healed three months later? No, but it's heading in that direction. Last week she told me I did't need to come for any more sessions, and that I just needed to continue on my own with the strengthening regime I already had, so things don't go backward. She also told me that I can start playing again (hurray!), once a week to start, and slowly increase the frequency and level by about ~10% a week.

There are a lot of players at our club in their 50s and 60s, and I hope to be one of them. To get there, I'm going to have to change aspects of how I play. Despite the fact that my cardio and muscle strength tell me I should play every day, move to every shot no matter how hard, and abuse my body in order to win, my tendon probably can't handle more than 3 times a week, with 48 hours between games. I'm also planning to spend a bunch of time on my footwork, and learn how to change my game so I don't overuse my right leg. I know that I tend to hit with an open stance on my forehand, and closed on my backhand, both of which involve lunging on my right leg.

I firmly believe that I'm going to have to spend the next year fully recovering from this. Despite my calendar reminder, I'm not done just yet. However, I'm really pleased to feel like I'm getting better. I wanted to write this, partly for cathartic reasons, but also in order to encourage others who are at the beginnings of an injury like this. I've discovered that you can come back from a tendon injury, if you're willing to rethink about the time scale involved in healing, and are disciplined to both rest and work hard.

See you on the court!

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