In our previous knee pain series, we discussed three potential knee injuries:

1) Runner's Knee (Patellofemoral Pain Syndrome)

2) IT Band Syndrome

3) Jumper's Knee (Patellar Tendinopathy).

Today, we will focus on Patellar tendinopathy. Patellar tendinopathy, commonly referred to as Jumper's Knee, is an overuse injury that affects the tendon linking the kneecap (patella) to the shinbone (tibia). Although it may seem like a setback, there are strategies to both rehab the injury and continue running. By following a proper rehab program, incorporating specific exercises, and making necessary adjustments to your training routine, you can recover from this injury and return to your running regimen.

In this blog, we will explore some of the strategies for rehabbing patellar tendinopathy as a runner and how to keep running while dealing with this condition.

Common signs & symptoms:

• Pain localized to the anterior knee

  • Distance runners= anterolateral tibial tubercle

  • Jumping athletes= inferior pole of patella

• Pain with storage & release activities (running, jumping, etc.)

• Pain with prolonged sitting, squatting, and stairs

• “Warm-up” phenomenon—pain improves with exercise

If you've been dealing with jumpers knee and you're itching to get back into running. We get it! Here are the three phases of rehab we follow when helping a runner navigate this condition:

Relieve: The goal of this phase is to relieve the symptoms. We need to identify:

• Positions of compression

  • Positions of compression—any position that further presses “compresses” the tendon into the bone (i.e. stretching, kneeling)

• Aggravating activities—what activities worsen your symptoms?

  • Example: Prolonged sitting, walking down stairs, squatting

  • Storage & release activities—running, skipping, hopping

• Baseline pain levels

  • What's the least and worst amount of pain?

• Irritability

  • How do you respond 24 hours after energy-storage activities?

    • Stable tendon = return to baseline pain levels in 24 hours

    • Irritable tendon = takes longer than 24 hours to return to baseline pain levels

Reinforce: The goal of this phase is to start a gradual loading program.

They key to rehabbing an angry patellar tendon is to start a gradual loading program. We need to find the sweet spot of loading and activity that we can maintain without overdoing it. Before we even get started on an exercise program, we need to have a way to monitor our daily symptoms.

Cue in the daily load test in the form of a decline single leg squat. We perform this at the same time daily, and rate our pain/symptoms on a scale of 0-10 (0= no pain 10= worst pain). This allows us to monitor how you respond to the previous days activity with the goal of being back to baseline pain level 24 hours post. Example: Baseline pain levels are 2/10, you ran 45 minutes on Monday and during Tuesday’s daily load test, pain levels are 5/10. Now we know that we might have overdone it and can adjust.

General exercise guidelines:

• We encourage some “slight” discomfort at the patellar tendon during exercise (0-3/10). This ensures that we are stressing the tendon sufficiently enough to make some positive changes.

• Allow 24-48 hours in between sessions

• Start with double leg exercises progressing to single leg as tolerated

• Start within a range that's less than 90 degrees flexion and progress to deeper knee flexion (90 degrees or more) as tolerated

Progression of rehab exercises:

We adjust how we move through the stages based on each individuals presentation. They don't occur in isolation, and we try to sprinkle a bit of each stage from day one. Below are sample exercises that we use in each phase. We use the daily load test combined with what your telling us to assess readiness to progress!

Stage 1: Isometric Exercises

• Seated knee extension: Perform 5x30-45 seconds @ 70% effort 2-3x/day

PT TIP : We recommend these daily as isometrics have been shown to have a pain relief component to them.

Stage 2: Isotonic Exercises

• Front foot elevated goblet split squat: Perform 3x15 with a load that feels like effort 7/10 (0=easy, 10=hard) at the end of 15 reps. Initially, we limit depth to above 90 degrees and progress as tolerated.

Stage 3: Energy-Storage Exercises

• Double leg pogos: Perform 2x30 seconds, with the goal of progressing to 60 seconds

• Singe leg hops: Perform 2x30 seconds, with the goal of progressing to 60 seconds

Relaunch: The goal of this phase is to start a gradual return to running plan.

Our goal from day 1 is to find a way to keep you running! We take a look at your training plan and ask, what's the most amount of running (in time, not distance) that you can tolerate without aggravating your symptoms? Once we know that, we can lay out the rest of the plan! The goal is to introduce one factor (distance, speed, hills, etc.) at a time so that we can see how you respond. If we throw too many things in at once, and you have a flare up (which is likely to happen) we will have a harder time identifying what could have triggered the flare up.

Let's break this down with an example: 32 year old male with complaints of left patellar tendon pain onset 8 weeks ago. Symptoms would flare up after 45 minutes of running and take 48 hours to return to baseline pain levels of 2/10.

We know that 45 minutes of running triggered his symptoms, so instead we focused on smaller chunks of running with more rest periods in between running bouts. On non-running days, we recommend a brisk walk with the purpose of gaining some “time on your feet” and loading the body with an activity that mimics running but at a lesser intensity.

Here's a glimpse at his first week of running:

Monday: Rehab exercises + 30 minute brisk walk

Tuesday: 10 minute brisk walk + 25-30 minutes @ conversation pace + 10 minutes leisure walk Wednesday: Rehab exercises + 30 minute brisk walk

Wednesday: Rehab exercises + 30 minute brisk walk

Thursday: 10 minute brisk walk + 25-30 minutes @ conversation pace + 10 minutes leisure walk

Friday: Rehab exercises + 30 minute brisk walk

Saturday: 10 minute brisk walk + 30-35 minutes @ conversation pace + 10 minutes leisure walk

Sunday: Rest

Often times, runners will be told to completely rest from running, unfortunately, your body looses capacity and it might make it harder to find an entry point back to running. You can and should maintain some level of running when rehabbing from patellar tendinopathy!

Thank you for taking the time to read! If this sounds like something that you might be dealing with and you’d like to learn more about how to rehab a Patellar tendinopathy and come back a stronger, more resilient runner schedule a complimentary call today and let us help you RISE ABOVE INJURY!

References

Malliaras P, Cook J, Purdam C, Rio E. Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. J Orthop Sports Phys Ther. 2015 Nov;45(11):887-98. doi: 10.2519/jospt.2015.5987. Epub 2015 Sep 21. PMID: 26390269.

Cook JL, Purdam CR. The challenge of managing tendinopathy in competing athletes. Br J Sports Med. 2014 Apr;48(7):506-9. doi: 10.1136/bjsports-2012-092078. Epub 2013 May 10. Erratum in: Br J Sports Med. 2014 Sep;48(17):1333. PMID: 23666020.