Patella tendinopathy is a common condition referred to constant patella tendon pain and loss of function related to mechanical loading. This is prevalent across people of all ages, mostly in active and sporting people and typically occurs when there is excess load placed on the patella tendon that is greater than its usual capacity. The pain is normally experienced at the inferior pole of the patella and symptoms can be increased by the speed and amount of load placed on the tendon. Through structured exercise however, this can be managed by improving tolerance of the tendon to different types of loading and improving function of the knee extensor mechanism (the four muscles of the quadriceps that come together to form the quadriceps tendon and act to extend the knee). If you are experiencing patella tendinopathy- here is a brief insight on how to manage this condition, and what type of exercises to incorporate into your routine.
- Isometrics- These exercises can be performed at the initial stage or when you progress to the next group of exercises. Isometrics are exercises where the muscle group is placed under tension without any change in length of the fibres. These groups are good for building activation and strength and low loads where little movement is occurring. Furthermore, they also provide some pain relief, making them useful for any exacerbations of symptoms. Isometrics can include double leg wall sits, knee extension holds, or Spanish squat holds for 20-30s each.
- Heavy Resistance training: As pain improves along with strength and function it is important to incorporate heavy slow resistance-based exercises such as squats, splits quats and step downs. These exercises are designed to be done slowly and are to be done two to three days a week. The goal here is to slowly increase the amount of load placed on the tendon to build its tolerance and building up strength of the quadriceps complex that attaches to this tendon.
- Plyometrics, jumping and landing: Along with the previous stages, these exercises focus on faster rates of loading and should be also done two to three times a week. Exercises can include a countermove movement jump, a jump to a box, lunges etc. In this stage, you want to load the knee extensor mechanism as much as tolerable.
Lastly, there are some important things to consider with tendinopathy rehab;
- Monitoring pain – This is a fundamental component to your rehab. It is important that it is safe to push into a little of pain, but it needs to be tolerable. Pain is different for each individual so a good way to monitor this is using pain scales from 0-10. Another way of monitoring this is deciding if the pain is better, worse or the same the day after exercise. If symptoms worsen after the next day (e.g. pain levels go from 3/10 to 6/10 the next day), this is an indicator that you may have done too much during your program and need to reduce the intensity of volume of work.
- Load management and activity modifications – Tendinopathy is thought to occur when the intensity frequency and volume of load on the tendon exceeds your capacity to recover and adapt appropriately. Symptoms will normally increase if you are doing too much too soon. It is important to focus on your function while monitoring pain to guide the appropriate amount of physical activity you do every day. It’s important here to monitor your symptoms during and after exercise to ensure that you’re not exceeding your current capacity, and then modify the frequency, intensity, or volume of your daily activities accordingly.
