What it is

Patellar Tendinopathy, also known as patellar tendinosis, jumpers knee, or Landers knee is an overuse injury at the knee. There is no specific injury or trauma to cause it, but the repetitive motions over time result in the tendinopathy.


Suprapatellar vs Infrapatellar tendinopathy

Supra- or superior refers to   tendinopathy above the patella (knee bone). This area is also call the quadriceps tendon. This portion of the tendon connects the quadriceps muscle and the knee. Infra- or inferior refers to tendinopathy below the patella. Different authors may interchange this terminology.

Causes

There are many potential causes for patellar tendinopathy, most commonly would be chronic, repetitive tendon overload. Extrinsic factors also seem to play a significant role in developing patellar tendinopathy as well. These factors can include, how much one trains, the sport that is played, the surface that is played on, footwear and other biomechanical faults within the kinetic chain like poor flexibility at hamstrings and quadriceps or weak gluteus medius.

Treatments

Rehabilitation/ physiotherapy- Patient needs a full biomechanical assessment to understand the root cause of the issue (pronation of foot, poor glute activation etc.)

Isometric exercises have been used to reduce pain and begin strengthening the weak muscle groups. If isometric cause too much pain, begin with small ROM movement to prevent muscle stiffness before beginning a strengthening protocol.

Isotonic exercises are exercises with a concentric and eccentric phase. These exercises can cause higher fatigue of the muscle, reduce form and cause more pain and/or injury. This exercise type is a perfect progression once the joint in stable.

Non-steroidal anti-inflammatory drug (NSAIDS)- Some NSAIDs have been reported to decrease tissue repair. However, these can help in the short term to treat acute pain, but should not be a long-term intervention.

Physical activity Rehab Recommendations

Phase 1

·         Acute phase. First stage of rehabilitation. Lots of pain in area.

-          Begin with ROM movements to prevent stiffness prior to progressing to strengthening. Isometric exercises- strengthening Quadriceps, hamstrings, adductors, and abductors, gluteus medius and maximus

Phase 2&3

·         Some strength recovery. Beginning a strengthening protocol with isotonic exercises included. Watch for pain. Condition should be showing improvements as strength increases

Phase 1

 

 

Sets

Reps

Ball squeezes (adduction)

2

8-10

Resistance band abduction

2

8-10

Quadriceps sets

2

8-10

Heel press

2

8-10

 

Phase 2

 

 

Sets

Reps

Straight Leg raise

2

8-10

Side lying adduction leg lifts

2

8-10

Side lying abduction leg lifts

2

8-10

Heel slides

2

8-10

 

Phase 3

 

 

Sets

Reps

Decline Squat (heels elevated)

2

10-12

Hamstrings press w Flex band

2

10-12

Side lying adduction leg lifts with resistance

2

10-12

Side lying abduction leg lifts with resistance

2

10-12

 

References

Physiotherapy management of patellar tendinopathy (jumper's knee)

Rudavsky, Aliza et al. Journal of Physiotherapy , Volume 60 , Issue 3 , 122 - 129

Reinking, M. F. (2016). CURRENT CONCEPTS IN THE TREATMENT OF PATELLAR TENDINOPATHY. International Journal of Sports Physical Therapy, 11(6), 854–866.

Rodriguez-Merchan, E. C. (2013). The treatment of patellar tendinopathy. Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology, 14(2), 77–81. http://doi.org/10.1007/s10195-012-0220-0

Russell, Z. (n.d.). Physio Works - Physiotherapy Brisbane. Retrieved March 14, 2018, from https://physioworks.com.au/injuries-conditions-1/patella-tendonitis-tendinopathy

Schwartz, A., Watson, J. N., & Hutchinson, M. R. (2015). Patellar Tendinopathy. Sports Health, 7(5), 415–420. http://doi.org/10.1177/1941738114568775

http://www.eastsidesportsrehab.com/uploads/1/8/7/5/18757520/knee_strength.pdf