When reviewing the literature, the most basic definition of tendinopathy is that it is a tendon degeneration that occurs from increased load and high physical demand in training and sports. It is shown that it can account for up to 30% of injuries in athletes, causing severe pain, decreased performance, and potential career enders, with the patella being the most common of them all.
As you increase volume and stress in an activity, there are many factors we can contribute to injuries, such as sleep, nutrition, biomechanics, recovery, and external stressors.
When it comes to patellar tendinopathy, we see that the biggest factor is poor load management strategies with the increases in sport demands.
As the volume and intensity increases, we tend to have more repetitive ground contacts where we minimize our time on the ground to increase our springiness. Having a better elastic recoil and increased lower body stiffness are great attributes to becoming more explosive and improving our performance. The problem that usually happens is our ability to absorb and distribute forces well under these conditions tends to diminish.
With the increase in tissue stiffness, we lose our elasticity, causing our tendons to be like stiff bands that don’t give way. If you think of a really thick elastic band, it will take a heck of a lot of tension to move it. If you do, you can snap it with a lot of recoil. That’s the tendons ability to store and release energy. If held for a long period of time, it may start to ease up and give way for a little more, giving you a chance to have a bigger recoil. On the flip side, if you tried to snap that band back very fast, there’s a greater chance it would just snap, rather than give way like a looser band that has tension placed on it.
This is exactly what happens to your tendons when they are very stiff. They can’t give way enough to store the energy and distribute the forces. As a result, repetitive stress injuries occur and slow degeneration of the tendon ensues.
So what can be done to minimize this?
I’m glad you asked.
We can reestablish our yielding capabilities, which is just a fancy way of saying force absorption. Utilizing isometrics and decelerating moves are great ways to recapture this ability and provide longevity to our tendons as we increase our load and stress to the areas.
For the sake of a patella tendon injury, an isometric lunge hold is a great start. Ideally you will want to be able to hold with the back knee just off the ground, but depending on the injury and pain threshold, you may need to start higher up until you can handle more stress in the area.
You will want to hold the position for a minimum of 30s at a time, feeling the mid quads, rather than the knee joint itself. If this is too much, decrease the time, raise the height of the foot with a block, or start higher up in the lunge. You want to be able to progress the hold for up to 45s per set, and gain a total time accumulation of 2-3 min.
For example, if you can hold for 45s, you will want to perform at least 3-4 sets of 45s to accumulate 2min 15s to 3min of total time under tension. Start slow and build your total time accumulation by 10-20s per week. It may take a few weeks to months to get to where you need to be, but you should notice increased load tolerance and decreased pain during your activities.
The idea of the prolonged holds is that it creates a stress relaxation to the area, just like holding a prolonged stretch on a thick elastic band. It will eventually give way and ease up a bit so you can gain a better recoil and access to stretch it much faster without a higher risk of snapping it.
The other way of improving the loading and yielding strategies are by using deceleration steps to create a faster stretch to the area, but having a hold for a few seconds to allow enough time for the forces to be redistributed and give you a better recoil.
After performing these activities, you should notice that with quick jumps and minimal ground contact time, you will be able to recoil much more efficiently and with less pain and soreness. This will prevent you from creating too much stiffness in the connective tissues and reduce your potential for injury.
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Dr. Peter Dionisopoulos is the owner and founder of Dynamic Performance & Rehab. He has worked with many high-level athletes and military personnel, but his true passion is to help active adults maintain their lifestyle by providing information and potential solutions to their aches and pains so they can continue with the activities they love.