There are many types of knee pain. One thing that can help us in determining where your knee pain is coming from is its location. If you feel pain in your knee in the area below your knee cap when you go down stairs, squat, or initially when you walk or run, it is likely that you have pain in your patellar tendon-commonly called patellar tendonitis. In this Blog, I want to discuss the basics of treating tendon pain and specifically, how pain in the patellar tendon is managed.
Pain in the patellar tendon most often comes in with overuse i.e. doing more than what the tendon is ready to handle. This can be caused by running or jumping, starting a weightlifting program or doing more than you usually do during the weightlifting. Interestingly, it can also come on during periods of inactivity when the tendon is understressed. This can happen following surgery, hospitalization, or generally being way less active than you normally are. The photo to the right looks a bit confusing but it basically shows the two ways tendon pain can develop, the different stages of tendon pain, and the best way to get over it.
The reason this continuum is important is because it allows us to determine where you are on the continuum and identify the approach to help you recover. In some cases, this might mean decreasing the load through the tendon for a bit to let it calm down. However, the main thing that is consistent through all stages of the continuum is that tendons need to be loaded. By loaded, I mean that the tendon has to be made to take weight/resistance in order to get it back to normal. Loading it causes changes at the cellular level which makes the tendon stronger and helps with pain so that eventually you can get back to all of your normal activities without pain and the tendon will be stronger to handle whatever loads your regular activities will place through it.
So, what does appropriate loading fo the patellar tendon look like? Well, there are a lot of options, and what your symptoms are like will determine where we start. The following pictures will show some of the options available to us to load the tendon. You may not be able to all (or any of these) right away, but eventually you should be progressed through a variety of exercises that include a variety of different loads through the tendon.
The first image below shows probably the best way to isolate the patellar tendon. We sometimes start isometrically (where the weight does not move) and other times we can start with moving the weight through a full ROM. One of the more important thing with all of these exercises to begin with is “time under tension (TUT)” What this means is, the motion should be done with heavy weight and a slow movement (think 3 seconds to lift the weight, and 3 seconds to lower the weight). TUT will help the tendon heal and get back to its normal structure at the cellular level. The second image using a band to add resistance as you straighten your knee is another good option to contract your thigh muscle and plan load through the tendon
Below are step down variations. The picture on the left is a bit easier than the picture on the right. Because many people will complain of pain with going down stairs, this is a good motion/movement to train. If your tendon is a bit more irritable, the height of the step may have to be adjusted to all you to do it with an “acceptable” level of pain (determined by you and your therapist).
Most of the time throughout rehab, you can continue doing your regular sporting and home activities, although sometimes some temporary modification is needed. After all, rehab is just training while injured. But eventually, your rehab needs to progress to prepare you for your sport (if that is what you want to get back to). Continued progression could include a graded return to running program, jumping, and cutting activities. It has to be remembered that there are no bad activities for your knee-except the ones you are unprepared for. So, a good comprehensive rehab program will progress your knee and challenge it in order to prepare it for all you want to do.
If you feel you are struggling with patellar tendon pain and need some help getting over it, feel free to reach out and I would be happy to discuss options for recovery.
Thanks for reading,
Bob