Knee Injuries: Rehabilitation Strategies for Tendon Issues

Old knee injury

Hello Doctor: About two to three years ago, I had an accident while riding my bike and fell, causing my knee to hit the ground.
At that time, I experienced slight pain while walking.
After an examination at the hospital, it was determined that there were no bone injuries, and the only issue was tendonitis.
After resting for a while, I felt that my right knee still felt strange, so I went to a well-known orthopedic clinic for further evaluation.
The doctor also confirmed that there were no bone issues, only some fluid accumulation in the knee.
After some time, I began to notice that the muscles around the knee tendon seemed to feel thinner, and I had difficulty kneeling.
Unlike my left knee, which has enough muscle to act as a cushion, my right knee felt like the bones were directly contacting the ground when I knelt, lacking the muscle cushion in between.
I returned to the same clinic for another check-up, and the doctor said that the fluid accumulation had resolved, but in addition to resting, I needed to engage in moderate exercise to prevent potential tendon atrophy.
However, two to three years have passed, and I still cannot kneel on my right knee.
Whenever my right knee touches the ground, it feels like the two bones in the knee are directly in contact with the surface, without the cushioning muscle in between.
Could this really be tendon atrophy, or could there be other reasons? What treatments or self-rehabilitation methods are available? Thank you for taking the time to read my lengthy question.
Thank you.

Hao, 20~29 year old female. Ask Date: 2021/07/13

Dr. Wang Zhaomin reply Rehabilitation

Atrophy of soft tissues such as tendons and muscles can indeed lead to abnormal sensations, and a lack of exercise may also restrict joint mobility.
It is important to maintain moderate physical activity.
A proper assessment requires an on-site examination and evaluation; online consultations cannot replace an actual medical visit.
Please consult an orthopedic or rehabilitation specialist for an accurate diagnosis and to arrange appropriate treatment.

Reply Date: 2021/07/13

More Info

Knee injuries, particularly those involving tendon issues, can be quite complex and often require a multifaceted approach to rehabilitation. Based on your description, it seems you have been dealing with persistent knee discomfort and muscle atrophy in the area surrounding your knee joint following an injury from a fall. Here’s a comprehensive overview of your situation and some rehabilitation strategies that may help.

Understanding Your Condition
From what you've described, it appears that you may be experiencing a combination of tendonitis (inflammation of the tendons) and muscle atrophy (muscle wasting) in your right knee. The sensation of your knee feeling "thin" or lacking cushioning when kneeling could be attributed to muscle weakness or atrophy in the quadriceps and surrounding musculature, which is essential for knee stability and function.

Rehabilitation Strategies
1. Physical Therapy: Engaging in a structured physical therapy program is crucial. A physical therapist can assess your knee's range of motion, strength, and stability. They can design a personalized rehabilitation program that focuses on strengthening the muscles around the knee, improving flexibility, and enhancing overall function. This may include:
- Strengthening Exercises: Focus on exercises that target the quadriceps, hamstrings, and calf muscles. Examples include straight leg raises, wall sits, and step-ups. Resistance bands can also be beneficial for progressive strength training.

- Flexibility Training: Stretching exercises for the quadriceps, hamstrings, and calves can help improve flexibility and reduce stiffness. Incorporating yoga or Pilates may also be beneficial for overall flexibility and strength.

- Balance and Proprioception: Exercises that improve balance, such as single-leg stands or using a balance board, can enhance stability and prevent future injuries.

2. Low-Impact Activities: Incorporating low-impact exercises such as swimming, cycling, or using an elliptical machine can help maintain cardiovascular fitness without putting excessive strain on your knee. These activities can also help improve muscle tone without exacerbating your knee pain.

3. Ice and Compression: If you experience swelling or discomfort, applying ice to the knee for 15-20 minutes several times a day can help reduce inflammation. Compression wraps or sleeves can also provide support and reduce swelling.

4. Gradual Return to Activity: It’s important to gradually return to activities that may have caused discomfort. Start with low-impact activities and slowly increase intensity and duration as tolerated. Avoid high-impact activities until your knee feels stable and strong.

5. Nutrition and Hydration: Proper nutrition plays a vital role in recovery. Ensure you are consuming adequate protein to support muscle repair and growth, as well as vitamins and minerals that promote healing, such as Vitamin D and calcium.

6. Self-Monitoring: Keep track of your symptoms and progress. If certain activities exacerbate your pain or discomfort, it may be wise to modify or avoid them until you have built more strength and stability in your knee.

When to Seek Further Medical Attention
If you continue to experience significant pain, swelling, or functional limitations despite following a rehabilitation program, it may be necessary to consult with an orthopedic specialist. They may recommend imaging studies, such as an MRI, to evaluate for any underlying issues that may not have been previously identified, such as cartilage damage or other tendon injuries.

Conclusion
In summary, your experience of persistent knee discomfort and the sensation of muscle atrophy can be addressed through a combination of physical therapy, low-impact exercise, and self-care strategies. It’s essential to remain patient and consistent with your rehabilitation efforts, as recovery from tendon issues and muscle atrophy can take time. If you have any concerns about your progress or if your symptoms worsen, don’t hesitate to seek further medical advice.

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