Patellar tendinopathy, also known as Jumper’s Knee, is an overuse condition commonly seen in jumping athletes such as basketballers and volleyballers, but also very common in runners.
What causes Patellar Tendinopathy?
Onset is not from a single, traumatic event, but often gradually over time in reaction to a sudden increase in training volume or intensity, or an extended period of excessive training relative to the body’s training capacity.
What symptoms are there?
Localised pain is often felt at the top of the patellar tendon at its attachment to the patellar (Kneecap), but can also be felt a little lower in the mid portion of the tendon. In the early stages, pain may be present with inactivity or during the warm-up, but disappears as the body warms-up throughout the day or during training (Warm-up Phenomenon). However, as the tendinopathy progresses, it will often appear at warm-up and persist or worsen throughout a run.
The importance of early rehab
The good news – Patellar tendinopathy is able to be rehabbed to the point of NO symptoms and FULL function.
The less good news – Patellar tendinopathy can progress quite quickly if not managed well, and if left to progress to severe degeneration, may require surgery and is irreversible.
This is why the warm-up phenomenon can be deceiving, and people often ignore these signs early-on. But it’s important that if you are experiencing any niggling pain, go see a Physiotherapist straight away so you can manage it before it gets worse!
Treatment – The 6 stages of Patellar Tendinopathy rehab.
Rehab should be started ASAP because the earlier rehab is commenced, the better chances of a full recovery and quicker return to pain-free running.
Stage 1- Isometric exercises
An isometric contraction is when you’re contracting a muscle against a resistance, but without producing any movement through range. Think about pushing against a wall – You’re using your muscles but not actually moving the wall. This type of muscular contraction has been shown to help with tendon strengthening in a low load setting, whilst reducing pain.
The most important muscle to strengthen for Patellar Tendinopathy is the quads- So isometrics exercises include doing a wall sit or leg extensions and simply holding the weight at the top (Can be done on a machine or at home using your other leg or someone else as the resistance). Where you can, do these exercises with one leg at a time for targeted strength development. Isometrics should be done for 3 sets of 30-60 secs daily at the start of rehab.
Stage 2- Eccentric exercises
An eccentric contraction is when you’re contracting a muscle, but it’s lengthening instead of shortening. This occurs in the quads when you’re going DOWN stairs instead of up (You’re still working them, but mostly as a stabiliser rather than primary mover)
To do this, perform the same exercises as stage 1, but only the DOWN phase of the movement. For example, this is SLOWLY sliding down the wall for a wall sit or squat, or starting at the top of a leg extension and slowly lowering the weight down. By skipping the ‘up’ phase, you are sparing the tendon of any excessive force that it is likely to NOT ready for.
Stage 3- Heavy and slow resistance training
Once stage 2 feels manageable with little or no pain, you can start performing the WHOLE movement with both the UP and DOWN phases. This includes leg extension reps through range, squats, lunges, step ups etc. Start light and with less knee bend initially, but the idea is to build up to a HEAVY weight and more depth for slow reps- Between 2-3 seconds for the up and down phases each and work up to a 6RM.
Stage 4- Plyometrics
Plyometrics is about re-introducing high energy storage and release in the tendon. As this is the main function of the tendon, this is an important phase to do, and should be introduced when stage 3 is mostly painless. Exercises here can include controlled jumping, hopping on the spot and progressing to directional jumping/hopping. Quality of movement is key here – So keep the reps under 6 for sets of 3.
Stage 5- Return to running
Return to running is listed as stage 5 here for any runners who needed to stop running completely for tendinopathy recovery. For milder cases, runners may be allowed to run through stages 1-4, but at a lower level of intensity and volume.
The main thing to remember is that the Patellar Tendinopathy occurred in the first place due to overuse. Since the tendon is still recovering, the body’s capacity is reduced, so running training and progressions week to week should be highly dependent on symptoms and Physio-dictated.
Stage 6- Strength maintenance
So you’ve returned to your full running program with NO more symptoms. Congratulations! What now? This is when a lot of runners drop off their strength training, but then they lose all the improvements they’ve developed over weeks and months of consistent building. Maintenance strength training is crucial to keep the tendon and muscular structures strong for high performance, and reduction of re-injury risk. Strength training can be anywhere between 1-4x weekly for runners, depending on training goals and running event calendar.
Note: These 6 -steps are theoretically the order of rehab, but in reality, rehab looks different for each individual case. This is where the expertise of a Physiotherapist is required to dictate timeframes, criteria to progress between the stages, running guidelines etc.
If you’re experiencing any niggling pain that you may suspect is a Patellar Tendinopathy or any other overuse injury, register your interest for a FREE Initial Assessment here.