Knee Pain (Patellar Tendonitis) Exercie & Rehabilitation - Ask the Experts

Bad Knees asks:

"I work as a firefighter and have chronic Patellar Tendonitis. I'm a 34 year old weekend warrior as well (basketball mostly, biking, running, etc). My knees hurt from just daily activities. I take NSAIDs and haved applied ice 1 - 2 times each day for about 2 weeks with no relief. I have not played any ball either. Two questions: What can I do for cardio that willnot worsen my knee condition? What type of silf-therapy/rehab can I do to strengthen my knees?"

David Wales, Clinical Specialist Physiotherapist responds:

"In answer to your first question, arm ergometry and/or low to moderate resistance upper body weight circuits (between 3 and 5 sets), with a work to rest ratio of 1:1 can give you an aerobic cardiovascular workout. Non impact pool running using a buoyancy belt is also an excellent method of maintaining fitness without putting stress on the Patella Tendon.

"In answer to your second question, forget self therapy/exercises while you still have knee pain. Have the condition diagnosed by a doctor or physiotherapist. An MRI may be required to ascertain the extent of the tissue damage. If they confirm you have Patella Tendonitis (the medical term is Patella Tendinopathy) you will have to rest from the impact of running and jumping sports for between 6 and 12 weeks depending on the severity of the tissue damage, in order to allow tissue healing to take place. If your diagnosis is confirmed as Patella Tendinopathy then you should undergo rehabilitation with a physiotherapist who will be able to prescribe an ‘eccentric' strengthening programme. There is good research evidence to suggest that following this type of ‘eccentric' rehabilitation programme is extremely effective in the treatment of tendon problems.

"To explain, an eccentric contraction is defined as a contraction where the muscle is lengthening, as opposed to a concentric contraction where the muscle is shortening, or an isometric contraction where there is no change in the muscle length. The exercise for strengthening the Patella Tendon is the squat using a ‘decline' board (a wooden wedge) with the toes towards the thin end of the wedge. This position maximally works the Patella Tendon. Specifically the eccentric contraction of the Quadriceps and Patella Tendon is the lowering phase of the squat.

Double Legged squats Single Legged Squats

"There is nothing magical about eccentric muscle strengthening in the role of alleviating tendon problems. The key is the controlled progression of specific exercise, which elicits an adaptation in the tendon that produces increased tensile strength. In other words, as you slowly increase the load on the tendon it will get stronger. Research has shown that eccentric muscle contractions generate more tension than isometric or concentric contractions. By using just eccentric work this particular variable can be controlled and gradually progressed.

"It is important to note that the load and number of repetitions must be carefully recorded and progressively increased under the supervision of a physiotherapist. This ensures that the overload on the tendon is carefully controlled and gradually increased. This gradual progression allows the tendon to adapt and get stronger and healthier, but it can take 3 months in established cases of Patella Tendinopathy.

"I know this may be difficult for you to follow because of the nature of your work, but without a ‘relative' rest from sports the condition is unlikely to improve. Also, I recommend that you urgently get some advice from your doctor regarding your medication – long term use of NSAIDs (Non Steroidal Anti Inflammatory Drugs) can cause serious problems with your stomach."

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Article published: February 2007