Patellar tendinopathy– KNEED some help?

What is it?

The patellar tendon is a connective tissue that attaches the quadriceps (thigh muscle) to the shin bone. When you do activities involving bending the knee, the tendon is stretched like a rubber band and stores elastic energy. This elastic energy is then released and synchronises with muscle contraction to help make you explosive. 

Patellar tendinopathy is defined as pain and inflammation in the tendon that attaches your kneecap to the shin and can often be referred to as “jumper’s knee”. It causes pain below the kneecap with loaded activities such as squatting, jumping, stairs or prolonged sitting. It typically has a “warm-up” effect where it is stiff and sore first thing in the morning and eases with activity. Pain levels increase with higher loading demands such as deep squatting, walking down stairs, hopping or long running distances and is generally followed by increased pain after activity ceases. This can cause a significant loss in function and thickening of the tendon.

What caused it?

Tendinopathies are an overuse injury that develop following some form of overload. This can be from either increased training volume, intensity or nature or even something as simple as a new pair of shoes.

How do I rehab it?

Stage 1: Calm the farm

We need to settle the inflammation in the tendon. This is a great time to see your Physiotherapist for some hands on manual therapy. You can also do some muscle rolling or self-massage on your thigh muscles to decrease the pull on the tendon.

It is also important to get the muscles used to taking on load again. Isometric exercises like wall sits are a great place to start as they can assist with pain relief, but they need to be challenging! 

Stage 2: Load the quadriceps

We need to get the thigh muscles strong again so they can take some of the load off the tendon.

Some general rules to follow include 

• Starting in a shortened position – this is to avoid stretching the tendon under load whilst inflammation is settling
• Eccentric (muscle lengthening) exercises first 
• Then concentric (muscle shortening) exercises
• Seated knee extensions are a great place to start

Stage 3: Load rest of leg

It is likely that some deconditioning has occurred during the injury so we need to get all the muscles in your leg strong again.

Some examples of exercises include

• Squats 
• Deadlifts 
• Hip thrusts
• Hamstring curls
• Knee extensions
• Calf raises 
• Hip abductions

Stage 4: Retrain the spring 

This stage is all about becoming explosive again!

Some exercises can include:

• Running: jogging and sprinting
• Jumping
• Skipping 
• Plyometrics: box jumps, hurdles, step up with knee drive etc.

It is important to make sure you gradually move through each rehab phase to avoid overloading the tendon. Too much too soon can be detrimental to recovery! Patellar tendinopathy rehab takes patience, time, dedication and consistency.

If you would like some guidance through your rehabilitation, call Mundaring & Hills Physiotherapy to book in a consult with one of our highly skilled Physiotherapists.