Partial Patellar Tendon Tear: PRP injections PART 1.5

Well, I did NOT see this coming. So I went this past Friday for the PRP (platelet rich plasma) injections for patellar tendonosis (and a partial patellar tendon tear on the left side). I entered all excited and ready. Earlier that week I prepared to be out of commission for the weekend: The Mrs. got me food, I had online poker loaded up and my laptop was charged ready to get some sedentary work done. The doctor called me in and prepped me on what was going to happen. Considering I am a licensed physical therapist and had done my homework and research on the protocols for PRP injections, I knee what was too happen anyway. Next, his assistant laid me on the table and had my right arm slightly hanging off the table. The doctor strapped a tourniquet around my bicep and gave my arm a slight slap to encourage the veins to show. Well, no veins showed. The doctor stated “Anatomically speaking, the vein should be here. Perhaps your veins are just genetically deep”. He jabbed in with the needle, and no blood came. Then, the doctor said “Let’s try more distally (farther away from your body)”. He punctured the skin, hit the vein annnnnd nothing. I overheard him mumble “Well, this is unusual”. Now that isn’t something you want to hear! Shortly after, he said to me, “Let’s try the other arm”. So, I quickly flipped aorund and we tried the same two locations with the same amount of success = none. Shortly after this next strikeout he told me “Lets try more towards your ankle, there is a large vein that runs towards the front of your shin that we can access”. At that point, I was up for anything. So, the needle is inserted, wiggled around (which was NOT fun by the way) annnnd…nothing. Now I am starting to get a little nervous. Is it me? Is in the doctor? Am I superhuman (that would be pretty cool)? I can see the doctor’s frustration. “Alright, Joe, I have one last resort that I won’t do unless I absolutely have too. I’m going for your neck”. My response, “…What?”. He instructed me to turn my head to the left and clench my teeth. He examined my neck for a vein. Next, I heard him say “You’ve got to be kidding me! Joe, I can’t even find what I am looking for in your neck. By any chance are you allergic to sunlight?” Hahaha, I just started laughing. “No, Doc, I am not a vampire…although I hate garlic…and splinters kill me (with annoyance). All in all, he was able to perform the PRP secondary to me not being able to draw blood. I have to return (with a phlebotomist present) to go for my 2nd attempt. Wish me luck.

“Muscles in the bank”

Dr. JEST

Partial Patellar Tendon Tear: PRP injections PART 1

The dreaded news… I have been dealing with patellar tendon pain with my left knee for about 5 years now. Over the past 8 months, my right patellar tendon has been causing me pain. I can’t run, squat, jump or lift without my knees blowing up with fluid. I have played sports my entire life and started lifting heavy weights since I was 13 years old. Now being 26 years old, I am beginning to pay for my over-exertion. I have developed what I thought was bilateral patellar tendonosis.  I have done every physical therapy intervention available to me: TENS, ultrasound, transverse friction massage, ice massage, etc. Regardless of what I did I still seemed to be on a steady decline. I stopped playing sports, stopped squatting, heavy leg days, etc. I decided I would go to the doctor’s and get an MRI for my left knee first secondary to that side being more chronically involved. I was glad and not glad that I did. The reason my Left patellar tendon wasn’t healing was because it is partially torn! So now what? Surgery? I think not. I have yet to read any literature with consistent solid results of success. So, the best route that I am left with is PRP (platelet rich plasma) injections. This is a procedure where my blood will be drawn, centrifuged (meaning a big machine that spins my blood and seperates the components of blood (by their densities)), and the platelets removed. It will then be injected into the damaged site. This will cause an inflammatory response and hopefully, hopefully, new growth. Yes, it will be painful! And I may have to go back for more. But time will tell!

“Muscles in the bank”

Dr. JEST

BACK to Pain Management: How to relieve back pain!

BACK to Pain Management:

Low back pain has roamed since humanity has existed. The causes of back pain can range from things such as a traumatic incident, pre-disposing issues such as scolosis or even something as simple as poor posture. Sure, NSAIDS and pain killers can give you temporary relief but it’s the mechanical issues that need to be fixed. So how do you fix it? Well, to be completely honest, set up an appointment to see your doctor because they will be the ones to point you in the right direction. Most likely, He/She will prescribe physical therapy initially. A physical therapist can cater to your specific needs and identify the underlying cause of your condition. In the mean time, a few things that you can do are as follows:

1) Posture: Remember in grade school when the teacher always instructed, “sit up straight!”? well they could not have been more right! A lumbar roll is a nice addition to a chair to provide that extra support/cuing for correct posture. Having an ergonomically sound office also contributes to less back pain.

2) Posterior Pelvic Tilt: This is a great exercise to take pressure off of your lumbar spine and to tighten up those deep core abdominal muscles. To do this exercise, lay on your back and place your feet flat on the floor (your knees will be bent). Now, as the name implies, your are posteriorly tilting your pelvis. The best way to explain this is: try to flatten your back completely on the floor and gently tighten your abdominals. Hold for 10 seconds. Repeat 10 times. You can do this any time you lay down.

3) Abdominals: It is a very simple principle. The stronger your abdominals the better support for your back. Work out your abdominal muscles like any other muscle group and hit them hard. Allow at least 48 hours of recovery and make sure you do not forget to train your internal and external obliques!

4) Hamstring stretches: Ah yes, the hamstrings. Most of us sit for long periods of time, whether it would be at work or at home watching T.V. Over time, a phenomenon called “adaptive shortening” occurs. What this means is that our hamstring muscles shorten when kept at a shortened position for long periods of time. So, stretch them out! There are multiple ways to stretch your hamstrings. One easy way is to prop your leg up on the second step of a flight of steps (or higher if able), keep your leg straight and gently lean forward until a stretch is felt. HOLD for at least 30 seconds. Repeat 5 times each leg and you can stretch throughout the day.

5) Bridges: Great exercise to strengthen the glutes, hamstrings, and quadriceps. Lay on your back with your knees bent and feet flat on the floor. Gently squeeze your glutes (butt muscles) together and lift your butt in the air. You can put your arms at your sides for extra support. One key component to this exercise is that it should be pain free! Repeat between 10-15 repetitions and 3 sets.

Dr. JEST

“Muscles in the bank”

“Ahhh I’ve fallen and I can’t get up”…well I can get up, it just hurts my knees

I picked up my first basketball at the age of 3, my first soccer ball at the age of 4, my first weight at the ripe age of 12. I began to hone my skills in the characteristics of dexterity, speed, quickness, endurance and strength. Each category steadily increased as I practiced and expanded my knowledge with reading and learning from my older teammates. Before I knew it, I was playing highschool basketball, soccer, football and track. By the time I was a senior, I have collected many awards including All-Catholic for soccer and football my senior year. The feeling of invincibility was growing from within. I attribute my success with sports to weight training (and, of course, practice). Structured weight lifting become a part of my life when I was a freshman in high school and simply became an obsession. Freshman year bench press: 135 lbs, sophomore year: 185 lbs, junior year: 225 lbs, senior year: 250lbs and it continuous progressed throughout college with the max bench press of 335 lbs. My weight from freshman year in high school to freshman year of college started with 145 lbs and ended with 195 lbs. In addition to bench pressing, my true gift was my leg strength. Maximum deadlift: 510 lbs for 1 rep, Maximum squat: 515 lbs for 1 rep.

Now, I was 19 at the time when my three max lifts were that high and I never listened to anyone who warned me about how my knees will degrade with repetitive stress of that magnitude. Ha, what did they know. I was invincible. I felt like I could take on anything. I was playing collegiate sports at this point and felt confident to run with any opponent. Through-out the next two years, I trained just as hard and kept pushing past my maximum…things got ugly. On one usual Sunday leg day, my left knee felt like something popped when I was squating 495lbs for a set. I wasn’t sure what it was, but figured I’ll just “take a few days rest”. The next leg day I tried something lighter for my squats…pain expelled through my knee like a sharp knife. My left patellar tendon was swollen and very tender to the touch. My sports were the next thing affected. I began to notice I wasn’t jumping as high or running as fast or even hitting as hard.  “Great, juusstt great” I remember murmuring to myself, as my invincibility/ego started to slip away. I guess I should go to the doctors…but did I go? Nope. I was stubborn as a mule. Instead, Dr. Google was called upon and I started researching.

This was the start to my physical therapy interest. Long story short, as I got older, I got wiser. I have a much better understanding of body mechanics and how the body “should” function. I would like to share with you how I cope with patellar tendonosis and chondromalacia (fancy word for cartilage deteriorating from behind kneecap). I have finished school with a doctoral degree in physical therapy and it has opened a new world to how you should construct your body.

So how do I cope with knee pain and get a good workout without too many repercussions? Well, let me tell ya.

One key factor to remember is weight distribution. Your body is meant for symmetry. If any asymmetries are present, you begin to compensate. Compensate long enough (months, years, etc), stubborn problems develop. For me, my VMO (vastus medialis oblique) muscle on my left started to atrophy. Your quad muscles shut down when knee pain is present because it is your body’s attempt to avoid painful motions. As my left side got weaker, my right took much of the grunt work. Over time, both knees got worse. The goal of my leg routines is to re-establish/jump-start that quad muscle again. Modify your routines to maintain a pain-free environment. Below is what I DO for my knees. IT MAY NOT WORK FOR EVERYONE. Find what works for you. Focus on eccentric contractions, the lowering phase of a muscle contraction (aka negatives). Try to hold for a few seconds at the top of each exercise. And remember, have fun out there! The gym is a place to VENT your frustrations of the day and turn them into something positive for your body!

So for cardio: I avoid the treadmill secondary to the constant pounding. Instead I cycle through 15 minutes on the elliptical, 10 minutes on the bike and 20 minutes swimming. I go hard to get my heart-rate high but keep my knees as pain free as possible.

So for weight-lifting: NO deep squats. Focus on the eccentric (lowering) phase of all exercises

Cables: Hip abduction/Hip adduction:                                                           3 sets of 15                          weight: 50-70

Donkey calf raises:                                                                                                       3 sets of 15                          weight: 300-400

Leg extension to 45 degrees (unilateral: hold 3 secs at top):                 3 sets of 15                          weight: 80

Hamstring curl:                                                                                                             3 sets of 15                          weight: varies

Deadlift:                                                                                                                             3 sets of 8                           weight: 225

Straight leg raises:        (leg MUST be STRAIGHT)                                     3 sets of 20                        weight: 5 lb ankle weight

So for stretching:

Quads                                                                                                          HOLD ALL STRETCHES for 30 seconds

Hamstrings

IT band

Calves                                                                                                          REPEAT 3 times for everything

Adductors

Hip internal rotation

REMEMBER to ALWAYS go to your doctor to be cleared prior to attempting ANY exercises. Have fun!!

“Muscles in the bank”

JEST

Running is SOOO BORING! Here is the solution

I have been personal training in the gym for a long time and I have yet to find someone who says “I love to run on the treadmill”, perhaps some people “like” to run on the treadmill but love, that’s a different story. For all of you out there wanting to drop a few pounds but hate running on the treadmill, mix your cardio up. For example, I have my clients follow the 10 minute rule: complete 10 minutes on the upright bike, 10 minutes on the elliptical, 10 minutes on the treadmill and 10 minutes on the recumbent bike. You can alter your speeds throughout the 40 minutes. Remember, your goal is to get your heart rate up and burn those Calories!

“Muscles in the Bank”

JEST

What is the best time of the day to workout?

Ah yes, this is one question I hear all the time. Is it better to workout in the morning, afternoon, or evening? Despite what you may find on ‘Google’ there isn’t solid evidence on an ideal time to exercise. In turn, the best time is when you can dedicate a solid 30-45 minute workout routine without any interruptions. “I’m too busy” is the most overused response in regard to dedicating time to working out. Guess what, we are all busy. If you want results, you make it happen. Find a time in the day (whether it would be 12:00 am or 12:00 pm) and dedicate your 30-45 minute workout at least 4 times a week. Habits lead to results. It just depends on what actions you chose to make habits.

“Muscles in the bank”

JEST