Patellar Tendinopathies With Carlotta

Underrated? Overrated? You tell me. But they’re definitely a controversial topic in Physiotherapy.  Simply speaking, a tendinopathy is a general term for a damaged tendon. You might have heard about this condition and it’s usually quite common!

What is a tendon?

But let’s take a step back;  tendons transmit load from muscle to bone so that movement can occur.  As you can imagine, there are many tendons throughout the body and they are quite important.

What makes up a tendon?

Tendon structure and components

Tendons have to be very elastic in order to transmit load and its elasticity is due to the collagen fibers which are the main component. Their structure is closely related to its function: collagen molecules combine to form fibrils, which are arranged together forming fibres and fascicles. The collagen fibers consisting of mainly collagen type 1 are interspersed with proteoglycans and glycoproteins. They are also interspersed with cells called tenoblasts which further mature into tenocytes. Have a look below for a closer look!

A healthy vs damaged tendon under the microscope.

The tendon to the left has parallel collagen fibers, whereas the one to the right has a disorganised arrangement. The tendon to the right, as you can imagine, due to this arrangement, cannot function properly.

Why so common? 

The most common type of tendinopathy is patellar tendinopathy. There are many causes but usually it’s over-training – doing too much too quickly. It is usually referred to as jumper’s knee since it is also associated to repetitive jumping. In fact, many athletes in the sporting industry usually present with this injury such as basketball players. However, athletes who do sports consisting of changing direction commonly have it too.

The highest ever vertical jump goes to…Michael Jordan! An astonishing 46 inches (or 1.16 m)

Fun fact: patellar tendinopathy is actually most common in volleyball players!

My approach

How do I manage it?  Well, it’s a balancing act, it’s about timing.  It’s about choosing the right exercise at the right time.  It is easy to get too caught up and advance the exercises too soon. But it takes patience!

As you can see below, overload is what causes the tendon to become damaged and therefore cannot function properly. I will be here to guide you through the best exercises to get you back to where you want to be and as stronger as ever!

The tendon continuum.

It’s all about BALANCE!

First things first…a thorough examination!

It is crucial to have an understanding of how your body moves and how different movements can contribute to pain. You can count on a holistic approach on all fronts!

Back to basics... but in phases!

Initially  we have to control and reduce the swelling using ice.  Once the tendon is less irritable, we can start thinking about starting some exercises, but we have to start with the basics first!

A good starting point is always stretches. Those are gentle and relieve any tension you might have. Once those are easy, we can start with other exercises such as a leg extension against resistance. A very simple exercise, but is key in reducing pain.

The Spanish squat.

We will then progress to more functional movements such as a  Spanish  squat. This is my absolute favourite exercise for patellar tendinopathy as it loads the tendon.

When to progress to the next phase?

It is tricky to find a balance, but I will be here to guide you! Communication is incredibly important to make sure the progress is steady. There is always space for creativity in my sessions.You will be listened to and we will set your goals. It’s all about building up the different movements from scratch, I will be accompanying you towards your goals – no matter how big or small. Be it going back into sports, or doing sport specific exercises such as speed skaters or box jumps..  Or simply just being able to enjoy a long walk or do the stairs.