WHAT IS PATELLAR TENDINOPATHY?
(2,4)
Injury to patellar/qaudriceps tendon
Generally not due to trauma
Overuse injury following excessive stress to the patellar tendon
Insufficient recovery time between bouts of exercise may not allow the
tendon sufficient time to remodel
Tendon becomes "pathologic" over time
ANATOMY
Patella
Tibia
Patellar tendon (ligament)
Inferior pole most common
Quadriceps tendon
Tibial tuberosity
Quadriceps
More quadriceps contraction=more stress on
patellar tendon
Fat pad?
IMAGE SOURCE, LICENSE, ATTRIBUTED TO: BLAUSEN.COM STAFF (2014). "MEDICAL
GALLERY OF BLAUSEN MEDICAL 2014". WIKIJOURNAL OF MEDICINE 1 (2).
DOI:10.15347/WJM/2014.010. ISSN 2002-4436. -EDITED BY FITNESS PAIN FREE LLC
"ITIS" VS. "OTIS" (4)
Evidence suggests patellar tendinopathy is not
purely an inflammatory condition but rather due
to degeneration (wear and tear) over time
-Opathy as opposed to -itis
Still some inflammatory markers present
PREVALENCE (4)
More common in men
Most common in age group 15-30 years
old
Common in sports which require
repetitive loading of the patellar tendon
(basketball, volleyball, tennis)
CLINICAL PRESENTATION (4)
Inferior pole (bottom) of patella
Pain with activities that require increased demand on knee extensors (quads)
Pain with jumping and plyometric activities
Only hurts when loaded
Usually pain free at rest
Pain may improve with repeated loading (warm up), however increases the next day
Aggravating factors:
More load in a squat
More depth while squatting
More intense jumping variations
Longer duration of knee intensive activities
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www.scientificanimations.com -
Edited by Fitness Pain Free LLC
RISK FACTORS FOR PATELLAR
TENDINOPATHY (3)
Increased weekly training sessions
Greater total training volume
More weight training sessions per week
Decreased hip extensor strength
Decreased hamstring and quadriceps strength
Patellar tracking issues
Non-optimal landing patterns
PATELLAR TENDINOPATHY TREATMENT
1. Knowledge about the diagnosis and pain
2. Initial period of unloading and
modification
3. Direct quadriceps strengthening and
patellar tendon loading
4. Kinetic chain and sport specific
strengthening
5. Correcting mobility limitations
6. Modifying jumping and squatting
technique
PATIENT EDUCATION (9)
Educating patients about pain:
Decreases their pain
Increases physical performance
Decreases perceived disability
Decreases catastrophization
Positively alters behavior
IMPORTANT THINGS TO KNOW
Patellar tendinopathy
Generally gets better over time
Takes a long time to improve
Patellar tendons generally do not
rupture
Pain in the patellar tendon is not a sign
of more damage
Loading the tendon directly helps
people get out of pain
Over-reliance on passive treatments
can delay rehabilitation
HOW MUCH PAIN IS "OK" DURING REHAB EXERCISES?
General recommendations
Pain should be kept at or below 3/10 during
physical therapy exercises
Pain should return to baseline level 24 hours
following a therapy session
Pain or exercise tolerance should improve
throughout rehab
DIRECT QUADRICEPS AND TENDON
STRENGTHENING
Phase 1: Isometrics
Phase 2: Isotonics
Phase 3: Energy storage loading
Phase 4: Return to sport
General Plan
Unload- > Reload -> Return to sport
Modify Jump and Squatting Technique (24)
Things that increase stress on the patellar tendon:
Modifiable variables
Dynamic valgus- knee in
Increased knee flexion (bending) under load
Increased load (barbell, additional bodyweight)
Forward weight shift (anterior knee translation
Faster, more explosive muscular contractions
Stiffer and faster jump landings
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REFERENCES
1. Superior results with eccentric compared to concentric quadriceps training in patients with jumper’s knee: a
prospective randomised study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1725058/pdf/v039p00847.pdf
2. CURRENT CONCEPTS IN THE TREATMENT OF PATELLAR TENDINOPATHY IJSPT 2016
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5095939/#B83
3. Rehabilitation of Patellar Tendinopathy Using Hip Extensor Strengthening and Landing-Strategy Modification:
Case Report With 6-Month Follow-up JOSPT 2015 https://www.jospt.org/doi/full/10.2519/jospt.2015.6242?
code=jospt-site
4. Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations
https://www.jospt.org/doi/pdf/10.2519/jospt.2015.5987?code=jospt-site
5. Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of
load-induced tendinopathy. Br J Sports Med 2009;43:409–16.
6. Neovascularisation and pain in jumper’s knee: a prospective clinical and sonographic study in elite junior
volleyball players
http://bjsm.bmj.com/content/39/7/423ijkey=a16cd5a3976373e3a7cb301804ef49f9f932f98a&keytype2=tf_ipsecsha
7. Physio Edge 075 Tendinopathy, imaging and diagnosis with Dr Sean Docking
https://www.clinicaledge.co/podcast/physio-edge-podcast/75
8. Moving Beyond Exercises for Managing PFP, Patella Tendinopathy and Iliotibial Band Syndrome Sports Kongres
https://youtu.be/VJIN-WT8N00
9. Mechanisms and Management of Pain for Physical Therapists by Kathleen Sluka IASP Wolters Kluver
10. Therapeutic Neuroscience Education - Adriaan Louw
11. The association of ankle dorsiflexion and dynamic knee valgus: A systematic review and meta-analysis. 2018
Physical Therapy and Sport https://www.ncbi.nlm.nih.gov/pubmed/28974358
12. The Relation Between Stretching Typology and Stretching Duration: The Effects on Range of Motion IJSM 2018
13. The Foam Roll as a Tool to Improve Hamstring Flexibility The Journal of Strength and Conditioning Research
(Dec. 2015)
14. Common Running Injuries Evaluation and Management 2018 by the American Academy of Family Physicians
https://www.aafp.org/afp/2018/0415/p510.html
15. O'Sullivan K, McAuliffe S, Deburca N. The effects of eccentric training on lower limb flexibility: a systematic review.
Br J Sports Med 2012; 46: 838–845
