Hi! This is Part 2 of our series on exercises for patellar tendonitis.
As I said in Part 1, I'm going to refer to this as patellar tendinopathy; it's the same thing,
it's just different words and terminology, which currently – and this thing sort of changes all the
time – is preferred to be referred to as patellar tendinopathy. If you haven't watched Part 1 yet,
please watch that first, because it's important to know when to start doing exercises and
when not to do exercises that might well aggravate the problem as opposed to get it better.
My name's Steph. I'm one of the physios at sports-injury-physio.com, where you can get
an online assessment for your injury and an individualised rehab programme for your injury
if you want one. So, if you want details on this, then please look at our website, and the details
for the website are in the description for this video. OK, in this video, I will be talking about
the progressive loading programme for patellar tendinopathy. Now, there's a
lot of different loading programmes for patellar tendinopathy, which is the first thing to mention.
You may have heard of or read about heavy, slow resistance training, which is a commonly
prescribed training programme and very successful. There's also previously an eccentric and decline
squat programme, which is probably used less now than before. I'm talking about this progressive
loading programme, because there was a nice study done in the British Journal of Sports
Medicine earlier this year, which is 2021, which compared the progressive loading
programme that I'm going to talk about with the eccentric programme that was done previously.
OK, so the main differences between these two types of exercise are: In the progressive loading,
it's really about doing exercise that is not causing pain or not causing further irritation
to the tendon. Some of the other programmes – so, heavy, slow resistance and eccentric – you
can get some discomfort in the tendon while you're rehabbing it. And while usually this can be okay,
sometimes it isn't okay and it just means it's getting overloaded again and will get sore
again. So, the good thing about the progressive loading programme is that it is in your control
as to what exercises you should be doing at that stage. And you only progress when
you can do those exercises without pain and, at the very most, a little bit of discomfort. Now,
if you haven't seen the previous video, please have a look, because you don't want to start doing
exercises until you're at the right stage to do it. So, if you're not sure, please do ask a health
professional. And then, if it is ready, then the first stage of the progressive loading programme
is the isometric exercises, which have been shown to reduce pain. And this can be done on
a leg press machine if you have access to a gym, or it can be on a knee extension machine. But
if you're unable to access either of those, you want to be doing the exercises in mid-range. You
can start off with two legs and hold for up to 45 seconds. Obviously, you're going within your pain
threshold. And then if that's too easy, then you might be doing some single leg holds, for example.
It's important that the exercises are progressed at the right time. And this is the sort of thing
that we might be able to help guide you on, because if you progress them too early,
you risk overloading things again. But likewise, if you stay at the same level for too long,
you might take longer to get better than you really needed to. The next phase of a
progressive loading programme would be isotonic exercises. So again, if you're in the gym and you
have access to kit such as the leg press or knee extension, you might want to use those. If not,
you might want to start doing things like split squats or even dynamic walking lunges. Now,
these are nice functional exercises for sports such as running. You would then add weights to
it after you've progressed a certain amount with your body weight. You want to be progressing
the weighted versions to a level that is functional and good for your body weight,
which is different for different individuals. And then once you've successfully progressed
through the strengthening phase – the isotonic strengthening phase, which means
moving up and down – then you can move on to the plyometric and jumping phase. The jumping phase
involves loading the tendon at speed. So, it might start off with just some double leg jumps.
You might progress to single leg hops. You might start to do box jumps on and off a box,
for example. You might then progress on to depth jumps – off a box, on a box. And this all depends
on what sport you're trying to get back to. If you're not trying to get back to a sport
that involves running or jumping, then there's really no need to do this side of it. If you are,
then you do need to progress through this before doing your return to sport specific training. So
finally, once you've progressed through all these phases successfully with no increase in your pain,
then you do need to do specific sports training. And that will be different for different sports.
And again, we can help guide you on this. So, for example, if you need to push off on one
leg because you play basketball and land from a height, then you probably have a much higher load
of exercises than someone who wants to return to just a 5K jog at an easy pace, recreationally,
or someone who wants to walk on hills and things. So, this is worth bearing in mind,
that the last stage is very specific to the individual. Meanwhile, it's important for you
to address any other biomechanical issues. And this is again something that we can help assess,
to see what sorts of things may have predisposed you to getting a patella tendon problem in the
first place. So, it might be that you need to work on your glutes, your core, your balance,
address some tightness in your calves, in your hamstrings, in your hips. And this sort of thing
probably needs an individual assessment, because everybody is different, so some people won't need
to work on their core, other people will. And there has been some evidence to show that a
stiff ankle or perhaps weak glutes can contribute to predisposing you to a patellar tendon problem.
So, in this study from 2021, they compared this progressive loading programme with the eccentric
loading programme. At 12 weeks they saw that both groups have improved – so they had two groups: one
group doing the progressive loading and the other doing eccentric – both have improved in symptoms
by twelve weeks. By 24 weeks, however, the people in the progressive loading programme had
a higher percentage of people returning to sport and also a greater improvement in their symptoms.
If you're shocked by the sound of 24 weeks, which is pushing half a year, that is a common timescale
for tendon recovery. So I think it's important you manage your expectations with that. Obviously,
the sooner you deal with the problem, the shorter the time it takes to get it better. But yeah, I
think this is the ... The pros of the progressive loading programme are that it takes into account
people's individual differences, you work within a comfortable zone, so you're not pushing it through
pain and therefore you're less likely to overload it. And this is just one of the approaches for
rehabbing a patellar tendon. In my further Part 3 and Part 4 videos, I'll be talking about the
heavy, slow resistance programme and the eccentric programme, so that you can get an idea of what
this means and see the differences between them. I hope you find this useful, and good luck with
your injury! Please do get in touch if you want further information or you want us to take a look.