Answer:
Dear
Anthony,
Treatment
of this condition begins with continuation of a general fitness and
flexibility program.
The best
treatment is prevention! The multi-sport athlete should utilize proper
conditioning techniques to ease the transition from one sport to another.
Proper
conditioning should include aerobic fitness, lower body strength training,
and lower body flexibility training.
Flexibility
is very important in preventing overuse injuries such as patellar
tendinitis.
The rehabilitation
should be designed to decrease the symptoms, strengthen the muscles
of the quad region and improve hamstring and quad flexibility.
Also,
factors that may pre-dispose the athlete to this injury should be
isolated and corrected.
This
could be as simple as improving the conditioning of the athlete (e.g.
non-pounding conditioning such as interval training on a bicycle rather
than running).
If the
tendinitis is due to a strength imbalance in the quadriceps and hamstrings,
the athlete should begin exercises to target the weak muscles of the
quads or hamstrings.
A General
Rehabilitation Program Should Include:
-Non-impact
aerobic conditioning.
-Flexibility training for quadriceps and hamstring muscle groups.
-Decrease in predisposing factors.
-Cryotherapy (ice massage or ice packs).
-Strengthening
exercises, such as: leg press, side step-ups, and mini squats.
It is
crucial to assess hip extension and quadriceps stretch, as these will
influence retropatellar tendon impingement.
Controlled
lunging and step-down tests may give an indication of the eccentric
control on the tendon. If this is difficult to do because of pain
on the affected side, check the unaffected knee to help you get a
better picture of the likely pre-injury proprioception of the area.
It is
also important to assess proximal stability and hip control. An isokinetic
machine cannot often replicate function but it may give the examiner
help in assessing the relative strength of the hamstring and quadriceps
muscles at different arcs of movement.
Alongside
the eccentric exercises, it is important to address other possible
contributory factors, such as:
-Quadriceps
and hip flexor tightness.
-Stiffness in the mid-lumbar spine.
-Discrepancies in leg length.
