3-D Knee: Patellar Tendinopathy - Understanding, Post-rehab and Prevention

Lately, a number of my athletes as well as adult clients have been afflicted with knee pain. I think I mentioned in a previous post that knee pain, in my opinion, is second to lower back pain in occurences. I have also had terrible knee pain, that at times was so bad it woke me up at night. I know from experience how debiliating it can be and I have empathy for people who have suffered or are suffering from it so I am dedicating this post to understanding, post-rehab and prevention.

UNDERSTANDING PATELLAR TENDINOPATHY:

Patellar Tendionapthy or "jumpers knee" is characterized by local tenderness in the tendon at its attachment to the bottom part of the patella (kneecap). This is usally called patella tendinitis HOWEVER, recent research has shown us that an inflammatory state of the tendon is not always present so it may not be as precise to call it as tendinitis if it is in fact a tendinosis (which is a degenerative change in the tendon without a present inflammatory condition). Many studies are conflicting regarding inflammation being the chronic condition symptom but what the researchers did find that at some point there was inflammation. This brings me to a big point which correlates the high/low strain theory of tendinoapthy, its reaction and ensuing healing.

Tendons can be broadly separted  into 2 categories of low strain and high strain. The high strain tendons are like the achilles tendon and patella tendon. These tendons have major roles in functions in activites like walking and are loaded or OVERloaded quite a bit. In a study out of the UK entitled "Management of Tendinopathy", the authors report about the tendon mechanical overload theory that can be attributed to:

1. Type of activity 
2. Duration and intensity of activity
3. Repetition of activity

This list is not all-inclusive but it does show that the tendon is a powerful collector and distributor of energy in the neuromuscular system. When soft tissue is worked to the point that it is overworked, it can begin to breakdown. Most substances, especially those in the body, have a threshold or tolerance for stress. When that threshold is crossed, damage will occur. The coolest thing is that the body has systems in place to correct this and begin the healing process. However, if the body is not able to create an optimal enviroment for proper healing, we will see a tendinitis easily transform into a tendinosis. (More about the healing proces in a future post)

POST-REHABILIATION FROM PATELLA TENDINITIS:

If you are finding that you are having knee pain, your first order of business is to consult a physician. A doctor should be able to rule out any other potential patholgies of the knee. Just because it hurts in the knee, that doesn't mean its just something easy like a tendinitis. When and if the doctor gives you a diagnosis of a patella tendon injury, then the fun can start. Depending on the severity of your injury your doc may send you to a physical therapist (PT) but if its a mild case, they may just give you the advice of RICE (Rest, Ice, Compression, Elevation) as well as perscription for anti-inflammatory medicine. After following your docs advice and/or discharged from therapy, your journey may or may not be over.

Tendinitis is usually an inital inflammatory reaction to an injury. The body is sending all kinds chemicals to the area of injury which is where the redness, swelling, pain and heat come from. The body then begins the process of rebuilding the damaged area. This a great time to use our APPLIED FUNCTIONAL SCIENCE to come up with strategies and techniques for post rehab work.

STRATEGY 1: Because we are 3-D beings that DRIVEN by physical laws like gravity, ground reaction, mass and momentum that walk around, starting at that foot to ensure proper 3-D range of motion for basic shock absorption and propulsion would be a good starting to place.

STRATEGY 2: In my "Introduction to the 3-D Knee" post, I wrote that the knee is caught between a rock and a hard place with no where to go. The rock is the foot and hard place is the hip. Allowing the hip to have the MOSTABILITY (Mobility + Stability) that it craves, will allow for more transfer of forces through the bod if it is mobilized in 3 planes of motion.

BEFORE STARTING ANY EXERCISE PROGRAM, IT IS WISE TO CONSULT A PHYSICIAN.

TECHNIQUE 1: Yogic Foot Mobilization-

1. Go into Downward Facing Dog
2. Feet are about hip distance apart
3. Fingers are spreading and hands are about shoulder distance apart
4. Start to "pedal" the feet by bending one leg as you keep the other one straight (Sagital Plane)
5. Do this for about 15 seconds and then rest in Childs Pose
6. Start to allow the arch of the feet rise and lower, alternating each foot (Frontal Plane)
7. Do this for about 15 seconds and then rest in Childs Pose
8. Finally, doing one foot of time, rise up on ONE FOOT so that your toes are barely touching the ground and roll the foot in circles.
9. Stand-up and walk around for a bit.
10. Congratulations, you have just done a ankle opener that yogis have been doing for thousands of years.

TECHNIQUE 2: Is from my post on "3-D Hips". The only modification is that you would just not go into a deep lunge AT ALL. Actually, it should be on the side of conservative and keeping the leg as straight as you need to for no pain. Everyone is different so it's hard to say. However, the rear leg is the leg that is gettig the stretch, so if you are having issues with the right leg, use your left leg to start lunging. That way you should not be absorbing forces through the knee.

• Go to my 3-D Hips post and look for the PRACTICAL section. You will find the Lunge Matrix instructions there.

Sometimes, we want to get to something so bad that we just rush right in. Well, in cases like the knee, we may we want to have a "off the beaten path" strategy. Further aggrevation of the knee is not going to expedite the healing process and will more than likely, do the opposite. As long as we can allow for an internal environment for healing, we are on a good path.

The techniques above are great for both Post-rehab as well s Prevetion. The biggest difference would be the intenstity, depths and repetitions that you go through. For Post-rehab, sit on the side of conservative and do less. However, if you are going for prevention with this strategies/techniques, going A LITTLE more, would be okay BUT you must monitor yourself and not just let your form and execution lose focus.

Also, these technuiqes are at the beginning of a program. There is an unlimited number of techniques that you can choose from. It's all very individual.

I hope this helps. If you have any questions, comments or personal stories regarding knee pain, feel free to leave them in the comments section.