How To Treat Patellar Tendonosis

A couple of weeks ago I wrote about my personal experience in how I recognised I was suffering from patellar tendonitis. I covered some technical points about who is at risk and what some of the contributing risk factors are for developing patellar tendonitis.

If you are considering whether your knee pain might be patellar tendonitis then be sure to read my initial blog post - What Is Patellar Tendonosis

In this part 2 follow-up I want to share some of the first stage rehabilitation activities that I have been doing to help my recovery.

After doing all the wrong things at first I sought advice from the Mount Merrion Physiotheray team who set me straight on what I should be doing. Having an inquisitive mind for the detail I asked for some evidence-based literature on the treatment of patellar tendonitis which I duly studied and supports my personal account here.

What makes patellar tendonitis unique

I am not unfamiliar with injury thanks to being an active bloke. I feel confident in my knowledge of when to use ice vs heat, when to rest, when I need to see a professional, etc.

Most injuries I have sustained in my past have all involved inflammation to a degree and follow appropriate steps are easily recovered from in a matter of weeks. However patellar tendonitis manifests itself only after 6-12 weeks of the injury occurring. The onset of a sharp pain under the front kneecap during activity is the giveaway that degenerative changes have already began. The surprise for me was the complete absence of inflammation.

Rehabilitation Stage 1 - controlled rest

It is important to note that patellar tendonitis does not heal from complete rest alone. Active rehabilitation exercises need to be performed and are more effective than any other treatment.

Treatment advice is determined relevant to which of 3 stages of patellar tendonitis you are currently experiencing:

• Stage 1 = Pain only after activity
• Stage 2 = Pain during and after activity
• Stage 3 = Pain during and after activity that affects performance

Stage 1 and 2 can continue training to a degree but with adapted activity.

Stage 3 may need to rest completely. Some aerobic activity may be possible but must strictly avoid any irritating/ pain causing exercise.

Partial weight bearing exercises

Patellar tendonitis is usually a result of overuse and therefore the rehabilitation exercises must be adopted slowly without haste. Progressing in frequency or intensity too quickly will likely result in the condition getting worse.

The primary rehabilitation exercise is eccentric quadriceps loading, a body-weight squat performed with specific control. Other activity includes stretching and friction massage of the patellar tendon.

As with any other workout routine a suitable warm-up period with stretching pre and post exercise should be performed.

Suitable stretching movements for the hip flexor, quadriceps and hamstrings will help maintain and improve flexibility and reduce risk of overloading the tendon during exercise.

Controlled eccentric squats will provide progressive stress on the tendon which is actually necessary to improve its function over time. Here are the specific controls you need to put in place to do these movements optimally.

1. Don’t perform the squat on a flat surface, a 25 degree decline angle is best. This angle more specifically targets the patellar tendon as opposed to the quadricep muscles
2. The basic protocol is three sets of fifteen one-legged squats, twice a day
3. It is preferred to partially support the eccentric movement (decline squat) with the good leg when first beginning these exercises. Try to load your injured leg with approx. 90% of your full weight, maintaining some tension in your good leg
4. Your range of motion need only be slight to begin with. Do not squat past a 60 degree angle (a 90 degree angle would be when your thigh is horizontally aligned with your knee and perpendicular to the floor )
5. The healing takes place on the downward movement (eccentric) and therefore you should use your good leg to drive yourself back up to the starting point
6. Gradually increase the number of sets you perform as your strength returns
7. Exercise into tendon pain, but stop if the pain becomes debilitating.

Here is a chap who provided a decent video recording of these exercises. He is using a purpose-made slant board but the same angle can be achieved by creatively using other material more common to the household.

There is some disagreement about whether pain should be felt during these movements or not. Some say that a bit of pain should be felt during these exercises, while others state not. Personally I allow for a slight amount of pain but allowing too much pain to manifest during a rehabilitation movement seems counterintuitive to me.

In a follow-up article I will look into Rehabilitation Stage 2 - Progression

Rest well, exercise purposefully.

Robin