Patella Tendinopathy is a debilitating condition that can take a very long time to heal. It is often treated poorly and not well understood.
Our Quadriceps are made up of 4 different muscles - vastus medialis, vastus lateralis, vastus intermedius and rectus femoris. These muscles all join together at our knee and form our quadriceps tendon that attaches to our patella or 'knee cap.' Here they then attach to our tibia via the patella tendon. These muscles are primarily responsible for straightening or extending the knee. So whenever you are performing activities such as a squat, jumping or running you are using these muscles.
Generally, 'Patella Tendinopathy,' is diagnosed when there is persistent pain at the patella tendon and a general loss of function. Generally, this condition occurs when the tendon has been loaded and adaption is occurring. However, the load in which it is being placed under is too much and this results in pain. Pain should be located to just below the patella and when placing your knee or quadriceps under heavy load it should be quite painful. An example of this would be that a normal squat wouldn't hurt as much as a pistol squat would.
What is the Rehab for Patella Tendinopathy?
Initially, the main goal of rehab is to reduce symptoms before loading the tendon up with strengthening exercises to improve it's load tolerance.
Stage 1 - Isometrics
Example - Wall Sit
Isometrics are a great starting point for tendinopathy rehabs. They can provide an analgesic effect and usually we can do them with little to no pain. Stage 2 - Heavy Slow Resistance
Example - Squat
There really isn't any protocol to assist you on when you should move from Stage 1 to Stage 2. Throughout your rehab you should be monitoring your symptoms and as you find your pain is decreasing you can begin to increase your load. Tendons tend to adapt quicker when you increase the rate of the load that is being applied to the area. As the wall sit becomes easier you can begin to change that exercise to a squat. Squats load the tendon more through its range of motion, thus increasing the rate of the load. Generally 2-3 sets of 6-10 reps is the protocol. When performing a squat it should be a 3 second descend followed by a 1 second pause at the bottom and then 3 seconds up. Stage 3 - Plyometrics & Sport Specific Rehab
Example - Box Jumps
The last stage of rehab should be focused around sports specific exercises and fast explosive movements. These exercises tend to rapidly load the tendon up and release stored energy quickly. Generally, these exercises focus on execution and usually 2-3 sets with 4-6 repetitions with longer periods of rest between sets.
However, like with most rehabs, it doesn't necessarily run smoothly and you can often be stuck between each stage. There is no specific target to reach before progressing through to the next stage. Monitor your symptoms and progress as appropriate and don't be afraid to regress and go back if need!
If you're having troubles with your knee, don't hesistate to call and book an appointment with one of the physio's here at BodyPlus Health.