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Question:


Can you recommend me a good treatment for Patellar Tendinitis?

Anthony

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.


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