Patellar Tendon Load Progression during Rehabilitation Exercises

Patellar tendinopathy (jumper’s knee) is a common knee injury in athletes and active individuals, especially those involved in jumping and high-impact sports such as basketball, netball, running, football and so forth. The progression of knee patella tendon load during rehabilitation is crucial to reduce knee pain, optimise recovery, and prevent re-injury.

This recent study aimed to quantify patellar tendon load during 35 common knee rehabilitation exercises, categorising them into low, medium, and high load tiers for the patellar tendon.

4 Key Findings:

  1. Knee patellar tendon load varies significantly across exercises.
  2. The Single-Leg Decline Squat generated the highest tendon load, surpassing even running.
  3. Squat depth impacts loading:
    • 60° knee squats resulted in 50% less tendon load compared to full-depth (100°) knee squats.
  4. Load progression over time is more important than just exercise selection.
Stage 1: Low Load (Early-Stage Knee Rehab)

Purpose: Reduce knee pain, restore basic movement, and prepare for heavier loads.
Exercises:
– Walking
– Step-up (low box – 10cm step)
– Double-Leg Squat (60° knee flexion)
– Step-down (low box)
– Standard Step-up

Stage 2: Medium Load (Mid-Rehab Phase)

Purpose: Strengthen the knee tendon progressively while avoiding overload.
Exercises:
– Bulgarian Split Squat
– Single-Leg Squat (60° knee flexion)
– Full-Depth Double-Leg Squat (100° knee flexion)
– Standard Step-Down
– Running
– Drop Landings (20cm step)
– Lunge Variations
– Alternating Split Jumps
– Double-Leg Countermovement Jump (CMJ)

Phase 3: High Load (Return to Sport Phase)

Purpose: Prepare the knee tendon for high-performance movements and prevent re-injury.
Exercises:
– Single-Leg Maximal Forward Hop
– Single-Leg Countermovement Jump (CMJ)
– Single-Leg Drop Jump (20cm step)
– Single-Leg Decline Squat (90° knee flexion, upright trunk)
– Full-Speed Sprint with Cutting (45° direction change)

Important points:

  • The SL Decline Squat (90°) was the only squat exercise that produced more tendon load than running.
  • Depth and control matter: Shallow squats (60°) produce half the load of deeper squats (100°).

If you are suffering from knee tendon pain or anterior knee pain, book in with one of our expert physiotherapists who can guide you with an individual rehabilitation program to get you back to your best. We carefully modify intensity, reps, and tempo to prevent flare-ups and support you to get back to your activity.

Call our friendly staff on the number below to book in:
Tullamarine Clinic: 9116 8691 – 1/191 Melrose Drive, Tullamarine, 3043
Carlton Clinic: 9116 8693 – 2/221 Drummond Street, Carlton, 3053

TPC

5 Proven Treatments for Patellofemoral (Knee cap) Pain

Patellofemoral or knee cap pain (PFP) is a common issue causing persistent knee discomfort, often interfering with daily activities such as kneeling, squatting, stairs and sit to stand. A recent systematic review analysed effective non-surgical treatments to manage knee cap or Patellofemoral pain. The findings highlight short-term solutions that reduce knee pain and improve knee function, empowering patients through active rehabilitation.

Key Takeaways:

  1. Short-term Relief: 5 interventions effectively improved pain and function at 3 months:
    • Knee-targeted exercise
    • Combined interventions (knee exercises with orthotics and activity modifications)
    • Foot orthoses
    • Lower-quadrant manual therapy (soft tissue work, lower limb stretches etc)
    • Hip-and-knee-targeted exercise
  2. Prioritise Active Treatments: Active rehabilitation outperforms passive approaches like dry needling or vibration therapy, which showed no significant benefit.
  3. Combined Approach is Best: Integrating multiple interventions, such as exercises and orthoses, may enhance outcomes more than standalone treatments.

Clinical Implications for Physiotherapy:
Physiotherapists should emphasise active knee rehabilitation, combining strength-building exercises for the hips and knees with tools like orthoses to improve pain and functionality. The evidence reinforces tailored and active care can help individuals regain control over their knee symptoms and lead more comfortable lives.

If you are suffering of anterior knee pain or patellofemoral pain, call our friendly staff on 9116 8691 (Tullamarine) or 9116 8693 (Carlton) to book in with one of our expert physiotherapists for management and rehabilitation of anterior knee pain. You can also book online via www.thephysiocrew.com.au.

TPC

Creaky Knees: Should You Be Worried?

Creaky Knee, Knee crepitus, or the grating, cracking, or popping sounds around the knee, can be unsettling, but is it really cause for concern? A recent survey explored how people with knee crepitus or creaky knee perceive it, and how their beliefs may impact their activity levels and exercise habits.

Key Takeaways: Most people don’t consider knee crepitus or creaky knee a major issue, especially when there is no pain associated with the creaky knee. However, some worry that knee crepitus may signal joint damage, leading them to avoid certain movements and reduce physical activity. These concerns are often based on misconceptions that can affect how active people stay, which may lead to more knee issues then the creaky knee.

What Can Physiotherapists Do? As physiotherapists, we can play a crucial role in addressing these misconceptions and beliefs around the creaky knee. By reassuring clients about the safety of exercise, explaining what crepitus typically means, and guiding them toward beneficial, knee-friendly activities, we can help them stay active without fear.

With the right approach, clients can feel confident in maintaining movement, preserving knee function, reducing pain and improve physical performance even if their knees are a little “creaky.” At The Physio Crew we openly discuss patient belief regarding their condition and support them with a recovery plan to achieve their health goals with evidence based practice. Call you friendly staff to book an appointment on 9116 8691 (Tullamarine ) or 9116 8693 (Carlton).

TPC

Muscle strength and Osteoarthritis of the knee

knee osteoarthritis, knee pain. kneecap pain

Muscle strengthening interventions are a foundation of physiotherapy recommendations to improve knee symptoms and functional disability.

A recent systematic review by Patterson et al. in 2022 investigated muscle strength and osteoarthritis of the knee. Common findings are listed below:

  • Low knee extensor strength was associated with an increased risk of worsening tibiofemoral (Knee Joint) and patellofemoral (Knee cap) OA.
  • Low knee flexor strength was associated with an increased risk of tibiofemoral (Knee Joint) OA worsening.
  • Sub-group (by sex/gender) pooled estimates reveal significant associations for women but not men.
  • In those who already have OA, low knee extensor strength was not associated with an increased risk of tibiofemoral (Knee Joint) joint OA.

As physiotherapists working with patients with knee OA, we can take some guidance from the knowledge that lower limb strength is a key aspect of the management for the patient. Other essential factors to consider on top of strength would be other modifiable factors such as nutrition, weight management and occupational/ recreational activities.

This is one area where we can have the biggest impact on our patients (especially females) who come in with knee pain in early life. If we cement the importance of developing lower limb strength early, we can minimize the impact of OA as they age.

TPC Team