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Patellar Tendonitis

Patellar Tendonitis

Patellar Tendonitis is commonly called “jumpers knee” or “runners knee” due to the high incidence of patellar tendonitis in jumping and running sports.  The patellar tendon has been labeled as the strongest tendon in the body.  The forces imparted on the tendon are directly related to the intensity and speed of resistance placed upon it.  The patella (or kneecap) is enclosed in the patellar tendon in order to enhance the mechanical advantage and leverage of the pull of the quadriceps muscle.  Abnormal stresses on the patellar tendon can include flat feet, knocked knees, bowed legs, torsion deformities in the tibia and femur, stiffness in the hamstrings or quadriceps, and weakness in the hips, especially the gluteals.  Most people are “quadriceps dominant”.  This means that the quads are the primary activator during functional activities due to the concurrent weakness of adjacent muscles such as the hamstrings and gluteals.

At OrthoWell we specialize in the treatment of running injuries. We are all runners at OrthoWell–so we understand how pain that slows you down or prevents you from running can take its toll both physically AND mentally. It is important to understand the principles of proper running technique as well as the weight-bearing forces that can occur during running. You can read more about this in our book The Formula for Running Painfree.

We start the process with our unique bio-mechanical evaluation and video gait analysis to determine HOW things are connected and to determine WHY you are experiencing pain while running. Once we determine the cause of your pain, we will provide you with a detailed wellness plan that will spell out an effective course of action to get you back on the road as soon as possible.

Principles of Healing:

  1. Activity Modification (Refer to P.R.I.C.E.)
  2. Specialized Manual Therapy Techniques:  Often times there are soft tissue adhesions at the margins of one muscle group relative to another.  For example, the outside part of the quad (the VLO) may be adhered to the iliotibial band (the ITB) or the distal patella tendon may be adhered to adjacent connective tissues.  During activity, there is a degree of micro-trauma that occurs.  This micro-trauma can cause scar tissue.  Scar tissue is considered dysfunctional if it binds onto adjacent healthy tissue and prevents normal movement of that healthy tissue.  Techniques such as ART, Graston and Cupping Therapy are used to release these adhesions.
  3. Altered Biomechanical Forces:  We can fabricate custom foot orthotics in order to dissipate the shock caused by a supinated foot or the excessive torque created by an overpronating foot.  We may also utilize taping and strapping techniques or advise you in the purchase of a knee brace.
  4. Stretching: Stretching exercises are used to increase the length and elasticity of your tissues.  Your quads must work harder to straighten the knee against the resistance of stiff hamstrings.  Most people are “quadriceps dominant” and this means that your quads are working overtime.  This leads to significant stiffness in this overactive muscle.  We utilize passive and dynamic stretches as well as the neurological principles of reciprocal inhibition to hasten your recovery.  We utilize self-mobilization techniques on styrofoam rolls as part of a home exercise program to break adhesion in the quadriceps, ITB, and hamstrings.
  5. Strengthening:  Initially, we use Medical Exercise Therapy  (M.E.T.) to encourage circulatory exchange and promote healing.  M.E.T. is functional retraining of injured tissues and uses low weight and high reps. Repetition is the mother of skill when performing an M.E.T. program.  We then progress to functional resistance training and eccentrics using various weight bearing exercises.  Eccentrics are contractions in which the muscle elongates against resistance ie slowly lowering your heel off the edge of a step.  Scientific evidence supports the use of eccentrics.  Please refer to The Missing Link-Scar Tissue.  It is also very important to evaluate and address muscular imbalances at the hips and gluteals.  Chronic patellar tendon pain may not improve without adequate strengthening of the hips.  Weakness of the hips places greater demand upon the knee during weight bearing activities and sports.  Muscular imbalances in the hips are common in both the active and sedentary patient.
  6. Home Exercise Program: The rest is up to you!  Compliance with your home exercise program is paramount to a speedy recovery.
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