In terms of strength training – there is no perfect program for everyone other than the one carefully prescribed to you by your Physiotherapist (4). For patellar tendinopathy – a single leg decline squat should be held for 30 seconds the next morning and if the pain over the tendon exceeds 3-4/10, then you did too much the day before and need to step it back. The yardstick for tendon loading progression is the loaded symptom test the following morning. Ideally, these are completed many times throughout the day. In the early stages of patellar tendinopathy, isotonic exercises should be held at 70% maximal contraction for 45-60 seconds. A classic isometric exercise prescribed for quadriceps in patellar tendinopathy is the Spanish Squat – pictured below. Isometric exercises are panadol for tendons – they are different to isotonic exercises as the muscle will activate without shortening or lengthening. To manage pain initially – Physiotherapist’s will prescribe isometric exercises for the quadriceps. But where do you start? Tendons are often irritable and careful guidance of an experienced clinician is required to carefully manage symptoms as you progress back to normal activity levels again.
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High-level athletes dealing with large amounts of loading of their patellar tendons have been shown to reverse degeneration in their tendons through a progressive loading program (ref). If overload is what makes tendons worse – careful loading is what also makes them better. Reduced hamstring and quadriceps muscle strength.Prolonged sitting – irritated tendons don’t like being stretched or compressed.Jumping/explosive leg movement – if the person is not used to it, explosive plyometric movements can aggravate tendons.
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Any large change in activity levels that involve the knee or thigh muscles can more predispose you to strain the patellar tendon.Īside from overloading, other factors that can predispose you to patellar tendinopathy or worsen symptoms include: Tendons don’t tend to like big changes in activity – they adapt slowly. This overload could be from an increase in training volume like returning to sport after a long time off, or an increase in training frequency like extra training sessions prior to a competition.
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Patellar tendinopathy is most commonly caused by an overload of the knee and quadriceps muscles on the thigh. A common and effective way to test if you potentially have patellar tendinopathy is to attempt a single leg decline squat – and check for isolated pain at the tendon and base of the knee cap (pictured below) (1,2) Therefore, Patellar tendinopathy is best diagnosed by an experienced clinician who can get a good understanding of your history, activity levels, current strength and function (1). Imaging for Patellar Tendinopathy (MRI & Ultrasound) is not as useful in confirming the condition as it has been shown that people can have tendon thickening and degenerative changes on imaging but not experience any symptoms (ref). The knee is a busy area in the body – pain in the area can arise from a variety of conditions that present similarly, such as patellofemoral pain, ITB syndrome, fat pad impingement and the less common quadriceps tendinopathy (2,3). Patellar tendinopathy occurs when there is pain and dysfunction in the patellar (knee cap) tendon #physiowithafinishline Click To Tweet Do I Have it?
Isometric exercises for knee how to#
Pain in Patellar Tendinopathy follows a classic pattern (as with most Tendinopathies – see our recent blog post by Brad Beer: How to Rehabilitate a Tendinopathy: Phase 1 – Reducing Symptoms and Pain ) where the area may be sore at the beginning of activity, but then feel better as you warm up and then feel more painful the following morning – persisting for several days to weeks (1,3). Pain in the area will often be mild at first and can progressively worsen with activity levels (1). It most commonly affects jumping athletes from adolescence through to the fourth decade of life (1). Patellar tendinopathy occurs when there is pain and dysfunction in the patellar (knee cap) tendon – the small tendon that links the thigh muscle to the knee cap and shin bone (Tibia) (1,2). Patellar Tendinopathy is different to other types of knee pain, in that it is specific localised pain over the bottom of the knee cap, rather than inside or around the whole knee (1). Despite its colloquial name – anyone can get “Jumpers knee”. You might have what is called Patellar Tendinopathy – also known as “Jumpers Knee”, named as such from its observed frequency in jumping sports.
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