We did some staff training the other week on patella tendinopathy because we’ve gone from not seeing anyone for months with this issue to seeing 3 people in the space of a week with it! All different backgrounds at different stages too; we had an experienced bodybuilder who had a complaint of anterior knee pain for a few weeks, a young basketball player who’d gone through a growth spurt, and a PE teacher who had a long history of anterior knee pain following a couple of surgeries to his OTHER knee.
Luckily for me when I went to research this issue there’s been an excellent review of best practice published in the Journal of Orthopaedic Sports Physical Therapy 2015 (references at the end for the academics out there). Below I try my best summarise the key points about this issue with an overview of the rehabilitation program one of our physiotherapists would take you through.
Patella Tendinopothy Symptoms
• Pain local to the tendon just underneath the patella
• Pain that increases as demand on the knee extensors (Quadriceps) increases, especially in activities related to energy storage and release through the tendon, e.g. jumping
• Pain usually occurs instantly with loading, and conversely, is rarely painful when the tendon is in a resting state
• Increased pain the day after activity
• (prolonged sitting, squatting and stairs are also likely to be painful, but these symptoms aren’t exclusive to patella tendinopathy and may indicate other anterior knee pathologies)
Who does it affect…
• Mainly the athletic population between the ages of 15-30 years old
• Male > Female
• Higher risk sports include: basketball, football, volleyball, athletic jump disciplines, tennis
What happens to the tendon?
An overuse tendon injury becomes painful, has decreased exercise tolerance and consequently a reduction in function. On a microscopic level, significant changes occur in the structure of the tendon which reduces it’s ability to sustain repeated tensile loads (think of a coiled spring losing it’s ability to absorb and produce force).
Why do people get it?
The most common cause of patella tendinopathy is as a result of increased training volume and frequency. This leads to the wear upon the tendon exceeding it’s rate of repair.
This can be applied to people taking up new sports/hobbies, as well as seasoned athletes who have significantly increased their training volume and/or frequency over a period of time.
Patella Tendinopothy Treatment
Your therapist will be able identify weaknesses in your kinetic chain and look to address any obvious deficits you may have alongside working on the patella tendon specifically.
A heavy slow resistance (HSR) exercise routine can be split into 4 stages for treatment of patella tendinopathy. The following should be performed with minimal pain (under VAS 3/10):
Stage 1 (45sec holds x 5 reps, x2-3 per day > 70% max strength)
A) Isometric knee extension (@ 30-60 degrees of knee flexion)
B) Spanish squat (@ 70-90 degrees of flexion)
Stage 2 (3-4 sets x 15 reps, progressing to x6 reps with increased load, every 2nd day)
A) Isotonic knee extension (@10-60 degrees flexion, progress to 90 as pain allows)
B) Leg Press (@10-60 degrees flexion, progressing to 90 as pain allows)
C) Split Squat (to 90 degrees on leading leg)
Stage 3 (progressively develop volume & intensity)
A) Jumping (e.g. 2 leg jumps, hops, forward hops, split jumps)
B) Acceleration (e.g. sprinting from standing start to various distances)
C) Deceleration (e.g. testing sudden stops on two legs, progress to one leg)
D) Cutting (e.g. change of direction > 70 degrees, can be 2 legs then progress to one)
Stage 4 (progressive return to training drills before competition)
A) Graded return to sports-specific training
Patella Tendinopothy Treatment
We have specifically set up our clinics within a specialist gym environment (Ultraflex Normanton, Ultraflex Gym Hull, Ultraflex York, Batley Sports & Tennis Centre) so that we can take our patient’s through these rehab plans on a one-one basis.
However, if your current therapist does not have this level of equipment available to utilise, they may be able to offer a modified home exercise program. The key thing to remember with tendons is that rest will not help it...so get comfortable with the idea of loading the painful structure and your rehab process will go much smoother.
For more information, check out instagram posts (with videos) on this topic @regenphysio, or get in touch via our website www.regenphysio.co.uk
Malliaras P, Cook J, Purdam C, Rio E.Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations.J Orthop Sports Phys Therapy. 2015; 45: 887-898.
Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009; 43: 409– 416.
As COO and Clinical Director of Regen Physio, Nick’s philosophy of Physiotherapy is to have a patient centred approach to treatment which focuses on empowering each individual to take control of their particular issue. Nick’s current passion is to promote Physiotherapy as the ‘go to’ profession for people suffering from physical pain and dysfunction.