Management & Rehabilitation of Patella
By Tomás Ryan BSc.AHS,Ph.Th. MIAPT, Registered Physical Therapist based in Thurles
Patella tendinopathy is an injury caused by over training and characterised by a gradual build up of pain below the knee cap. Commonly athletes with mild symptoms continue to train. The condition is caused by Excessive overload of the patella tendon caused by a sudden and substantial increase in the amount of jumping and turning activities in training.
Patella Tendinopathy Risk Factors:
Poor quadriceps and hamstring strength and flexibility
Reduced bending movement of the ankle towards the shin bone (ankle dorsiflexion). This can become restricted following an ankle injury.
One leg is slightly longer, Flat Feet.
Athletes who are involved in Sports where there is a lot of jumping, such as basketball, GAA, Lineout Jump in Rugby.
A sudden and substantial increase in training drills and frequency.
An athlete returning to heavy training having been injured for a number of months
Patella tendonitis seen in the taller and heavier athletes.
Symptoms of Patella Tendinopathy
Soreness felt below the knee cap (patella) before & after training
Knee soreness when sitting for long durations and loss of calf & quad strength overtime
Management & Rehabilitation
The most accurate diagnosis is using a Single-Leg Squat Decline Board. Manual therapy such as myofascial release of the tight and malfunctioning quadriceps will help but correct exercise rehabilitation is vital. The high loading drills of jumping and twisting & turning need to stop immediately. Under the guidance of Registered Physical Therapist commence Isometric knee strengthening exercises of 45-60 seconds for approximately 5 repetitions in a pain free manner. The athlete can then proceed onto slow resistance exercises such as the knee extension resistance machine followed eccentric loading using graded lunges and double leg mini squats.
The Patient then progresses to plyometric training which includes jumping skipping followed by twisting & turning movements and sprinting. Once an Athlete returns to sport post a Patella tendinopathy injury, it is important that he continues his knee extension strengthening exercises at least twice per week during the playing season. This is because there will always have a segment of tendon degeneration. When players do not continue this protocol they may experience knee pain 24 hours after a game as the patella tendon commonly has a delayed response to excessive training load.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Thurles.
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