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Patellar Tendonitis

by Timothy
(Tempe, Arizona)

I'm an athletic trainer who has been working with an 18 year old high school athlete who has a 2+ year history of patellar tendonitis on both knees. I started working with him approximately 4 weeks ago and we are struggling to see improvement. I've worked to improve his hip and lower extremity flexibility as well as hip strength and he has seen some improvements, but not the type of improvements that I had hoped. I have also used the standby modalities of ultrasound, e-stim, and fricton massage. Any ideas as to what I might be missing?

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Patellar Tendonitis

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Sep 19, 2011
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starstarstarstarstar 		Acetic Acid Iontophoresis efficacy
by: Anonymous

Acetic Acid Iontophoresis doesn't seem terribly well supported in the studies I'm able to google, though some may be aged. Is there a study with a control group indicating a better-than-control outcome with this approach in reducing calcification of a tendon?
Apr 29, 2010
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starstarstarstarstar 		Acetic Acid Iontophoresis
by: Mitch - MTS

Tendonitis can be a tricky thing to treat at times. First and foremost, tendonopathy occurs because of some sort of an abnormal stress. This typically occurs because of a restriction or asymmetry due to flexibility, mobility, or strength deficits. So, the key to treating tendonitis long term is to find the source of the stress and fix it. So, my answer to your question starts with making sure you check everything within the lower extremity and core to find a restriction or imbalance and correct it. Also make sure that his foot mechanics are good. If he is an over pronator, he will benefit from orthotic inserts.

Assuming that all of that has been taken care of, you need to consider what's going on within the tendon itself. With long term tendonitis, the inflammation within the tendon will eventually calcify within the tendon. So essentially, tiny bone fragments will settle into the tendon. At this point, pain is usually due to irritating the calcification within the the tendon, rather than the strain/counterstrain that once existed. You may have already addressed everything else, but they are still having pain because of the calcification.

The key to fixing it is Acetic Acid Iontophoresis. When the Acetic Acid is driven through the skin and into the tendon, it will chemically break up the calcium deposits. You want to use a 4% solution that can be made at most pharmacies and it should be driven in slowly to allow for maximum absorption. You want to drive in the maximum amount of medication (usually 80mA x min) at a slow rate (1.5mA). This will take about 55 minutes or so, but it will be worth it. Treat the patient for 6-9 sessions and it will do the job of getting rid of the calcium deposits. If it gets rid of the pain, only to have it come back in a few weeks, you know that you haven't addressed the cause of the inflammation, and it's back to the drawing boards.

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