Knee

'HSR' Patella Tendon Program

While we recommend most people with patella tendinopathy complete an eccentric strengthening program, recent research has shown that heavy slow resistance training (HSR) can produce similar results. This program is likely to appeal to those who are used to resistance training. Technique is critially important. It is important to involve your health providers to ensure that you are completing each session safety. This program involves three sessions per week with three key exercises.

The Exercises
  • Seated leg press
  • Hack Squats

You should complete four sets of each exercise with 2-3 minutes rest between sets. The program lasts a total of 12 weeks. The number of repetitions are outlined below:

  • 15 repetitions maximum (RM) during week one
  • 12 RM weeks 2-3
  • 10 RM weeks 4-5
  • 8 RM weeks 6-8
  • 6 RM weeks 9-12

During each exercise you should not go below 90 degrees of knee flexion at any time. It is also suggested that you count 3 seconds for both the lower (eccentric) and raise (concentric) phase of each exercise. This means that each individual repetition will take a total of six seconds.

Patella
  1. Traditional eccentric squat exercise
  2. Leg Press
  3. Squat
  4. Hack Squat

You can continue to play your normal sport as long as your pain does not exceed 3/10 in severity.

Patellofemoral Pain

This is one of the most common conditions we see at UniSports. Patients generally describe a deep ache in the front of the knee. It is often felt ‘underneath’ the patella (kneecap). The pain is generally worse with activity which requires repeated knee flexion. Activities which classically make the pain worse include walking up or down stairs or hills, squatting and sitting for prolonged periods with the knee bent.

The good news for people with this type of pain is that it generally does not imply that there is a structural problem with the knee. The pain is generally precipitated by a change in activity level as well as a number of biomechanical predisposing factors. Athletes with this type of pain may have tight muscles, be relatively weak or have anatomical problems – for example flat feet. The pain generally improves or resolves when these are addressed.

The following program is a good stating point to treat this problem. It can be personalised to your exact needs if you are not seeing the improvement you would like.

Exercycle Program

We feel that this is the single most important part of the rehabilitation program for patellofemoral pain. The idea is to set the bike up so the saddle is a little higher than you would normally like. This limits the amount of knee flexion you are working with. Aim to spin on the bike at a very low resistance (easy) and high cadence (aim of 80-90 revolutions per minute) for 30 minutes. Think 'polishing the knee' rather that getting a big cardiovascular workout. Try to do this everyday if possible. You can increase the resistance as you get comfortable with this. Keep the resistance constant rather than doing repeated intervals of higher intensities.

Muncie (Quadriceps) Exercise

This exercise was developed specifically for the rehabilitation of patellofemoral symptoms. Sit on the floor and flex the unaffected knee until the heel of the foot is in line with the painful knee. Lean forward and hug your good knee. Keeping the painful knee extended pull your ankle back towards you and turn your foot out to either 2 or 10 o’clock (depending on whether you are working on your right or left knees). Lift the heel up off the ground and hold for 5 seconds. Repeat this 20 times per day. To make the exercise easier pull the heel closer to your butt. To make it harder slide the heel away from your butt. Be sure and stay leaning forward!

Gluteal (Butt) Exercise

Lie on your side fully stretched out. You should lie on the opposite side of the hip you are trying to strengthen. Flex the top hip and knee until your foot is resting on the lower knee. Lean forwards onto your top arm. You should be in the position shown below. From this point slide the top knee a few centimetres away from you. Lift this knee 5cm off the ground and hold this for 5 seconds. Repeat 20 times per day.

As with all problems it is important to have an accurate diagnosis to make sure that the rehabilitation is going to be successful. If you are unsure about your diagnosis or are not getting better as quickly as you would like ask your primary care giver to refer you to UniSports for some further advice.

Muncie Exercise

This exercise was developed specifically for the rehabilitation of patellofemoral symptoms. Sit on the floor and flex the unaffected knee until the heel of the foot is in line with the painful knee. Lean forward and hug your good knee. Keeping the painful knee extended pull your ankle back towards you and turn your foot out to either 2 or 10 o’clock (depending on whether you are working on your right or left knees). Lift the heel up off the ground and hold for 5 seconds. Repeat this 20 times per day. To make the exercise easier pull the heel closer to your butt. To make it harder slide the heel away from your butt. Be sure and stay leaning forward!

Munice

Eccentric Patella Tendon

Patella tendinopathy is a common condition in athletes involved in explosive sports like sprinting and basketball. It causes a well localised pain and tenderness over the front of the knee. The key to managing this problem is though modification of acitivity combined with a progressive eccentric strength program. This program involves a series of squats using a decline board. The lowering down phase of these squats is the important bit. You should use the 'good' leg to stand up again to get back to the start position.

The program involves three sets of 15 slow repetitions on a 25° decline board. You should do a slow controlled lower over a count of three. Between sets you should rest for about two minutes. These exercises should be done twice a day for twelve consecutive weeks.

Eccentric

If you develop pain during the exercises this is okay... in fact pain is probably required to stimulate tendon remodelling. We do not want the pain to be becoming progressively worse however. Use some simple pain relief or ice massage to treat this pain. If the exercsies are becoming 'easy' we would like you to add some weight. Either use hand weights or wear a backpack containing a few kilo's. It is better to do more repetitions overall that to use more weight.

Osgood-Schlatters

Osgood-Schlatter’s disease is repetitive micro trauma or overuse of the knee in young athletes. It generally develops during the adolescent growth spurt (8-15 years). During the adolescent growth spurt, bones and cartilage grow much faster than muscles and tendons. Increased stress of the patellar tendon and tibial tuberosity can cause the tendon to pull away from the bone a little bit. This tearing leads to increased pain and swelling below the knee cap. The condition is worsened with activities that subject the patellar tendon to high loads such as squatting or jumping.

Contributing factors to the development of Osgood Schlatter’s Disease

There are several factors which may increase the likelihood of developing this condition. These need to be assessed and corrected where possible, with direction from a physiotherapist to ensure an optimal outcome. Some of the factors may include:

  • Inappropriate training
  • recent growth spurts
  • inappropriate footwear
  • muscle tightness or weakness (particularly the quadriceps)
  • joint stiffness
  • poor lower limb biomechanics
  • poor foot posture
Physiotherapy treatment for Osgood Schlatters Disease

Consulting with a physiotherapist to diagnose the condition and rule out other conditions is important. Physiotherapy is extremely useful for patients with this condition as it can significantly reduce pain and allow for increased activity levels. Treatment may include:

  • soft tissue massage
  • stretches
  • icing
  • taping or bracing
  • biomechanical correction
  • education
  • activity modification advice
  • exercises to address any flexibility, strength or balance issues
  • a gradual return to activity program

Examples of treatment: quads stretch, alignment exercises