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Hey guys!

Here's the problem, both my left and right knee have been having patella tendonosis problems for quite a while now. This is especially noticable after doing squats even though I focus on only going as low as I can by keeping a neutral spine (bodyweight only).
I've been reading lots of articles, from Kelly Baggett to Alex V., and I've just started to focus on movement patterns (LDISO) and strengthening the core via the Chair, Non-tripod and Prone glute. Also started focusing on my slightly unstable feet by doing ankle-rocker lifting drills daily.

I'm very positive the problem is overactive quads and underactive glutes/hams. My primarly goal now is to be pain free and moving correctly primarly with the glutes. I do stretch and foam roll regularly and been doing so for like 1,5 years now. The symptoms do release for a while after foam rolling and stretching the quads.
Another thing is my right hip seems to be more in anterior pelvic tilt than my left, but my right side's glute functions a bit better. When standing with my back against a wall, the right side does have a bigger arch.

So my question to all you guys is where do I go now? What exercises strength wise would you focus on to clear up the problem and make the glutes prime movers (Glute dominant in general)?

I'm thinking for strength exercises:
-RDL's and 1-Leg RDL's
-Back extensions (only as low as I can keep spine neutral)
-Reverse Lunges (same as above)

Daily:
Foam roll quads and TFL/ITB-band
Core drills (Chair, Tripod, Planks)
Glute activation

As for the stretching, shall I only stretch right quad/hip flexor for awhile and stretch left leg's hamstrings due to the imbalance in mobility?

I have my own gym so what I have access to is a barbell, power-rack and dumbbells.

Bulgarian Split Squat targets hamstring and glutes like hell!! I love BSS! try it and you'll not regret it.

for knee problems you'll want to address ankle mobility, hip mobility and glute strength

if squats are problematic then i'd have you do plenty of deadlift and hip thrusts, improve your hip hinging technique and do single leg exercises for a little while

hard to tell what is actually your problem though...

Don't forget hip flexor stretching.

Well I do stretch the quads and hip flexors.

Bulgarian Split Squat targets hamstring and glutes like hell!! I love BSS! try it and you'll not regret it.

I have done them some in the past and I agree with you. Though I think I might have slightly rounded my left lower back due to the fact I never really hit the glutes to well on that side.

Do I understand correctly that you are doing bodyweight squats - meaning squats without a weight on your back?

Where do you think does your patellar tendinosis come from? If you think it's the squats just stop doing them and see if that helps the condition. It's not that squatting with your bodyweight will accomplish much in the first place.

Also I don't see how you doing "core" strengthening exercises is related to that patellar tendinosis. Maybe you want to help me out with that.

How does overactivity of one muscle compared to another (if such a concept is even worth thinking about) explain the development of a chronic tendon injury? Where is the link that I fail to see here? And how do you diagnose over- and underactivity anyways?

That’s correct. I’ve been working with only my bodyweight this week to get the hang on the correct technique.
Just to clarify some things, I have dropped squats before but my knee pain has still been around from time to time. Doing Squats awhile ago with weights did make the symptoms pretty intense so I dropped it. Now when trying to relearn the squat, the knee pain becomes more pronounced.
Good core strength from what I understand, translates to better working glutes and movement patterns. That’s why I’ve added it.

Of course I can’t make a perfect self diagnose, but it seems that like from what Kelly Baggett always says and others, is that quad dominant athletes tend to have problem with knee pain and such. Anyway, my glute strength sucks.

I've been working with ankle mobility for almost a year now as well, and that doesn't seem to be the problem. I think I do have some patella tracking problems as well.

A few good links to checkout with regards to glutes & comparing activation levels with numerous exercises:


Original Link: http://www.t-nation.com/free_online_article/sports_body_training_performance/dispelling_the_glute_myth

Original Link: http://www.t-nation.com/free_online_article/sports_body_training_performance/advanced_glute_training

Original Link: http://www.elevatingfitness.com/article/i-am-glute-guy-and-here-are-my-secrets-04262010

Thanks! Though I have already read those.

I've tried Hip Thrusts for a little while. Maybe that exercises isn't too bad. Whats your thoughts?

How is working on ankle mobility, hip mobility and glute strength going to help your knee condition? There might be a correlation between "quad dominance" and knee problems, but that does not mean that getting rid of "quad dominance" helps an already existent patellar tendinosis. It also does not mean that "quad dominance" is the cause of knee problems. If you thought that was the case you should read up on the difference between correlation and causation.

You are on a bad track to solving your knee issues. You have to figure out what actually caused those problems in the first place, like jumping on concrete everyday for hours (that's an example). Having "strong" quads in relation to your glutes is unlikely to be the cause of this "patellar tendinosis", as unlikely as ankle or hip mobility. You also need to understand what is preserving your knee problems right now and what prevents your body from healing. If squats aggrevate your knee pain you should not squat - at least not with the technique you are using at that point. If there are exercises that you can do pain free, do them. But let that knee heal up.

Obviously the ankle and hip mobility doesn't really cut it. If it would, it would probably be gone since a long time ago. For now, I would say that the squats are the main thing that made the tendonosis cause more symptoms again. It did make my knees hurt a lot before as well when doing 'em. There is probably some sort of overuse of the knees because of the tendonosis. What exactly that is, I can't tell for sure.

Well, I shall maybe add that I also wanted to strengthen and make the glutes dominant because I want to move effeciently. I do sprinting and vertical jumping. I also play soccer for fun once a week. In other words, becoming more of a pull than a push runner.
There are many exercises I can do without aggrevating the knees. Primarly those that don't bend the knees alot and those that aren't done eccentricly.

In other words, becoming more of a pull than a push runner.

That is interesting.

What is your definition of a push runner?.

What is your definition of a pull runner?.

sounds like you need stronger quads as well as stronger glute/hams etc.. stronger everything.. if you train people in person or pay attention to people's logs on various forums, alot of people with knee pain are just too weak in the lower body, they usually have underdeveloped vmo's or vmo's that don't even fire properly in relation to the VL.. you'll want to perform TKE's (terminal knee extensions) & squat, just work your way down slowly if that's your goal, but for now stay slightly above parallel and progress very slowly with some weight on your back or in your hands... go very light on tke's, it's a high rep exercises 20+ reps focusing on really contracting the vmo.

the quads are more important than the hamstrings for knee stability imo, especially for jumpers.. people with weak vmo's will have all types of patella/knee issues, people with weak hamstrings well that's a toss up - some have issues some don't, but EVERYONE who has weak vmo's has knee problems because the patella tracks improperly during knee extension.. i'm not a doctor/pt, and i havn't seen you in person so i don't know if this is your case, all i'm saying is, in your quest to become glute dominant, do not neglect the quads.

So my question to all you guys is where do I go now? What exercises strength wise would you focus on to clear up the problem and make the glutes prime movers (Glute dominant in general)?

I'm thinking for strength exercises:
-RDL's and 1-Leg RDL's
-Back extensions (only as low as I can keep spine neutral)
-Reverse Lunges (same as above)

add in 'half squat' (slightly above parallel), improve depth if you want but make sure improving depth doesn't freak out your knees, do not try to sit WAAAAY BACK, that'll probably aggravate them even more, just go right down basically, get more quad involvement.

on the back extensions make sure you're using the glutes to extend.. i'll have my back extension soon and i'll video how i do them, should help.

i like walking lunges for distance, if you can't do that then ya reverse lunges are good, but walking lunges are #1 imo.

Daily:
Foam roll quads and TFL/ITB-band
Core drills (Chair, Tripod, Planks)
Glute activation

add in tke's, there are tons of variations on youtube check them out, i actually like just a resistance-less version mimicking a leg extension and peterson stepups.

As for the stretching, shall I only stretch right quad/hip flexor for awhile and stretch left leg's hamstrings due to the imbalance in mobility?

be careful with the quad stretching, do not force rom, that could be causing some issues.. stay very light/gentle with quad stretching, allow improved ROM to come without forcing it in the least.

pC