Patellar Tendinopathy is most commonly characterised by pain localised to the inferior pole of the knee cap and load related pain which increases the demand on the knee extensors.
Risk factors include being 15-30 years old, males are affected more than females, involvement in jump/lunging sports and training loads.
Pathology occurs because there is an ↑ tenocyte numbers, ↑ ground substance, swelling, matrix degeneration and neovascular growth.
Presentation is generally pain localised to the inferior pole of the patella, load related pain (knee extensors). Regional findings sometimes present with wasting of quads, foot issues, ↓ hamstring/ quad flexibility and ↓ dorsi flexion.
Imaging generally doesn’t confirm patellar tendon pain but can exclude other diagnosis’ such as bursitis or fat pad irritation for example.
Management of Patellar Tendinopathy
- Eccentric Exercises may be too aggressive when there is high irritability, and there is little data that leads to better outcomes.
- Heavy slow resistance exercises demonstrated similar improvements to eccentric exercises in pain and function, with the benefit of higher patient satisfaction scores.
- The focus of treatment is to develop tolerance of the tendon, muscle and kinetic chain. progressive criteria is based on pain, strength and function.
- Initial load modifications aims at reducing pain with a focus on ↓ high load energy storage tasks. Modify : Volume and frequency
- Progress loading based on pain monitoring with a 5/10 during exercise.
**********24 hour response test **********
At the same time each day the client does a single leg squat to 90 degrees and compares the pain to baseline scores. If pain is higher than the previous days it means the previous days load has not been tolerated well.
Bottom line ……..
1) Calm it down and build it back up
2) Some pain is acceptable during exercise but symptoms should resolve quickly after exercise and should not progressively worsen over the course of the rehab program.