What is Patella Tendonitis?
Patella Tendonitis is a constant repetitive overuse injury of the patella tendon. Which leads to localised pain and inflammation of the tendon. This condition is commonly known as “Jumper’s Knee”. This is due to the greatest level of stress is placed through the knee with landing and jumping activities. Excessive jumping and landing overtime can strain the patella tendon and if left untreated leads to inflammation of the inferior pole of the tendon.
Activities that involve jumping, bounding, hopping and or changes in direction such as high jump, netball, ballet and stair climbing can contribute to patellar tendonitis. Other contributions can be weakness in the quadriceps muscle and poor biomechanics of the patellofemoral joint.
Signs and Symptoms
- Localised tenderness of the inferior pole of the patella (anterior knee pain)
- Tenderness on palpation through the patella tendon
- Tight quadriceps and hamstrings
- Pain with squat or a hop
Patients with this condition must be patient and this condition can require months of a multifaceted approach and rehabilitation before the symptoms subside. Conservative management of this condition entitles:
- Cryotherapy: ice treatment
- Decreases the load through the tendon
- Strengthening rehabilitation program
- Soft tissue treatment
- Correcting poor biomechanics
Cortisone injection or surgery is indicated if the treatment continues for months and the conservative management program has failed to reduce the patient’s pain and inflammation.
Patella Tendonitis Eccentric Program
The key to the rationale behind eccentric drills is that they are the best way of promoting tendon remodelling: the regrowth and reordering of collagen tissue in place of the oedematous (fluid filled) degenerative tissue typical of tendinosis.
The athlete needs to be taught eccentric exercises (See table 1). A 45-degree slope is required and (at a later stage) a weights bar. Initially the athlete stands straight on the slope, then flexes his/her knees to 90 degrees, returning to a straight position again (see illustration below left).
Table 1: Decline squat progressions
|Stage||Exercise||No of legs|
|1||Two legs, 90 degree squat, no slope||2|
|2||Two legs, 90 degree squat on 45 degree slope||2|
|3||Single leg for squat phase (eccentric); two legs|
return phase (concentric), on slope
|4||10kg bar; single leg for squat phase, two legs|
return, on slope
|5||Single leg only throughout, on slope||1|
The movement down must be done slowly (to a count of three) and the return can be done quickly (to a count of one). When away from home the slope can be replaced by the edge of a curb or step so that opportunities can be taken whenever possible to do the drills.
The number of repetitions is determined by the amount of discomfort felt in the patellar tendon. I advise athletes to stop a sequence of repetitions when they perceive an ache in the patellar tendon of 3/10, using the scale described above. The rationale for this is to stimulate the patellar tendon eccentrically to a fixed (symptomatic) level each day, but without such a high score as to produce pain and further damage. I suggest to athletes that they can do these repetitions as often as possible every day and many achieve the repetitions two to four times a day.
The exercise sequence can be progressed as shown in table 1. For some athletes stage 1 is too easy and they cannot bring on any discomfort in the patellar tendon. For others, the rate-limiting factor is quadriceps fatigue and for this reason they can use two legs in returning to the standing position (see stages 2 to 4).
As the stages progress the athlete will be able to increase the number of repetitions they can perform before the symptoms come on at a discomfort level of 3/10. There will be some days when the athlete can manage more repetitions than others, but normally they will be able to move on to the next stage after two to four weeks – so improvement in this condition is usually measured in months, not weeks.
The rate of progression will vary from athlete to athlete, dependent in large part on how often they perform the exercises. If more pain occurs in the tendon, the athlete should be advised to rest for two to three days and then drop back one stage in the rehab exercise progression.
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