by Wayne Gilmour, DPT
Patellar tendinopathy is typically caused by overuse and rapid increase in activity without proper training. Jumping activities can cause the patellar tendon to be put under loads up to 8 times your body weight. It’s no wonder going from the couch to playing pick-up again can cause pain. A healthy tendon has all the fibers running parallel connecting muscle to bone. Fibers in a tendon with tendinopathy are disorganized and run in different directions. The structural differences between healthy and unhealthy tendons are so pronounced, they're visible to the naked eye in cadavers.
So how do we return the fibers to the happy, healthy, parallel state? Progressive loading.
Tendons heal slowly because they have less blood flow than muscles or bones. This means that we have to load the tendon enough to spur healing, but avoid overloading that can cause a setback. It also means it's better to use these exercises to prevent injury, rather than have to use them to rehab one.
Has anyone ever told you to keep your knees behind your toes while you were squatting? Has anyone told you why? Knee position impacts the amount of load going through the front of your knee. It also biases certain muscle groups to work harder. If you push your hips back and keep your knees behind your toes, your glutes do more of the work. If your knees go over your toes, there is more load through your quadriceps and more load through the quad tendon.
We can use this principle in the exercises below. If you have tendon pain, skip the last 2 exercises and keep the knees back as far as you can on the others. If you don’t have pain, perform all the exercises and try to feel the difference between each variation. Use these exercises to get your tendons strong so Jumper’s knee doesn’t bring you down!
Eccentric Single Leg Squat to Chair (3 sets x 8-10 reps)
Stand on 1 leg in front of a chair or bed. Slowly lower yourself down to the surface. Don’t allow the knee to fall inwards towards the other leg. Stand back up and repeat.
Split Squat (3 sets x 8-10 reps)
Stand with 1 foot forward with the distance between feet longer than a stride length. Keep weight on the front heel. Lower straight down until the front knee is at 90 degree angle. Push up through the heel and return to the starting position. Repeat.
Bulgarian Split Squat (3 sets x 8-10 reps)
Stand with 1 foot back on a chair or box in the split squat position. Keep weight on the front foot. Lower body straight down until the front knee is at a 90 degree angle. Push up through the heel and return to the starting position. Repeat.
Forward Step Down
Stand on step. Keep 1 leg on the step. Reach the other leg forward and slowly lower yourself to tap the floor with your heel. Press up through the stance leg and return the starting position. Keep the knee from falling in towards the other leg.
Forward Drop Jump
Stand on a step. Step forward off step landing on 1 leg on the ball of your foot. Control landing in order to land quietly.
Stay tuned for more on rehab for basketball injuries and performance improvement!