Recovery Crash Course : Patella Tendinitis

“Are you moving poorly because you are in pain? Or are you in pain because you are moving poorly?
-Gray Cook

 


 Guess how good you’re getting at box jumps by not doing them?

Are you tired of being nervous on box jumps, lunges, or step-up during the pre-wod brief? Some things don’t get better with time and,  it’s at that point that we must seek other avenues of approach. Many athletes have used the coaching staff at CFK as a resource in pain management. We’ve seen athletes make major strides in their performance by training movement patterns to fix problems.

As a student physical therapist assistant and lifelong fitness enthusiast, I’ve gained an appreciation for human movement patterns. It’s not uncommon for me to spend a Saturday night researching new ways to dial in an athlete’s squat (Nerdy, I know..), or searching for creative ways to decrease persistent elbow pain. Some of my most enjoyable times coaching have been showing athletes  how to perform special mobilizations and stretches that alleviate pain and eliminate stiffness.

CFK has a set of principles that allow the coaches and athletes to strive for fitness gains while reducing the risk of injury. Our principles, or the 3’Ps as you may have heard them called hold true in any aspect of training or rehab.  If you’ve heard the 3 P’s in class you’ll be happy to know that they are also used in our injury recovery sessions. If you have no clue what the 3 P’s are, let’s review.

Positions:  Every movement has a specific positions that must be achieved.

Parameters:  These are movement guidelines that help athletes move safely and reduce injury

Progressions:  Each movement has a specific progression or regression depending on the needs of the athlete.

What’s Patella Tendinitis and What Causes It?

 Patella Tendinitis is caused by overuse, and is typically seen in athletes that perform repetitive explosive exercise. Overuse of this tendon is caused from high compressive force causing small tears in tendon tissue leading to inflammation and swelling. It’s characterized by pain coming from the inferior aspect of the knee cap, and is often confused with quadricep tendinopathy that is located above the knee.

 

Immediate Actions to Take

This particular injury is from overuse, so athletes should take extreme caution in exercise selection. Providing an atmosphere where the tendon can actually begin healing and not become re-injured is critical. Many of the exercises I would suggest would reduce the load on the tendon, but provide a strength building stimulus to surrounding muscles.

 

Load Tolerance is the Name of the Game

 

Goal #1:  Stiff Tendons are Strong Tendons

My plan of attack at the beginning stages of this injury is to build stiffness in the patella tendon. By creating  tendon stiffness our load capacity for exercise and movement increases. Isometric loading keeps muscles in one position and does not allow them to contract or lengthen.  These types of exercises are usually performed in static positions. Exercises like wall-sits and spanish squats will be used to provide a stimulus to nearby muscles(quads, glutes, hamstrings), but not allow compressive force or friction to be placed on the injured tendon.

Ex. 5 sets of 45 second Spanish Squats

 Ex. 5 Sets of 45 second Wall Sits

*Shoutout to Phillip Burgess for the awesome technique!

Goal #2: Single-Leg Strength

It’s always important to add single leg training to any exercise  program.  Single leg training addresses any asymmetries  or weaknesses that are likely to go unnoticed in double limb stance. The term Isotonic used to describe the consistency of speed across a full rep of a movement. Isotonic movements allow the athlete to move throughout the full range of motion without tension change in the muscles.  We will be performing a variety of exercises in this portion that include Bulgarian split squats, split squats, and reverse lunges. Our focus will be increasing our load tolerance and accessing range of motion on the injured side.

Ex. 3-4 Sets of 15 quality Bulgarian split squats with a focus on stability and control

 

 

Goal #3: Take Flight Again

Now that we’ve built the pre-requisite load tolerance for more normal activities we can begin to introduce jumping exercises.

 

Goal #4: Back to Bending Bars and Causing PRs

You can return to training at this point, but it’s always a good idea to keep the rehab exercises in your back pocket to avoid future injuries. It’s a good idea to use these as accessory movements post-workout in order to keep your tendons strong and stiff.

 

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