T Nation

Patella Tendonitis Strapping


#1

Hi friends,

Ive been suffering from patella tendonitis off and on for the past 2 years. Bilateral squatting really aggravates it, so Ive been off squatting.
I have been working on hp flexor mobility etc and started to do some eccentric one leg squats to try and improve the situation. i have also been playing around with some voodoo bands.

Anyway, so often I see athletes with a strap that wraps around under the knee. I assume this is for patella tendonitis.

My questions are regarding the stepping;

  1. Is there any particular way that the strapping should be applied?
  2. Does it work?
  3. Is the method also useful for preventative purposes?

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#2

First, I would like to emphasize that this is most likely a tendonopathy and not an itis.
Some steps that may help you are:
1. Play around with your squat form, there is great individual variability in biomechanical build. From my personal experience, I found that my patellar ligament tends to respond to a more narrow stance with increased external rotation on the eccentric portion of the squat.

  1. The method you described can be accomplished with either pre-wrap or a patellar brace. The theory being it reduces the pull/strain on the insertion and changes the angle of pull of the patella. The strap should be placed on the infrapatellar area. DonJoy makes a pretty good brace.

#3

Great first post and welcome to T-Nation BHOLL.

Unfortunately I dont have much room to play in regards to my squat form. With long legs, and left inflexible ankle(due to many injuries), I squat with my legs wide.

Do you think that wearing olympic shoes for squatting could change the mechanics/force to my patella tendon??

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#4

Thank you for the encouragement. In regards to the shoes they may help indirectly by allowing u to displace or distribute more weight onto your heels thus altering patellofemoral forces.


#5

Start your squat from scratch. I had patella tendonopathy for 2 years in my right knee. Initially I worked single leg standing squat forcusing on the eccentric motion single leg and then standing up with both legs. I would stand on a small step and with a single leg squat down until my non active leg touched the floor working up to sets of 15. I performed these with my non-active leg going in front of me, to the side of the step and behind me.

I also performed squats on a 45 degree incline (initailly I rolled up a thick magazine or towel to lift my heels). Again the focus was on the eccentric loading of the patella, SO glutes contracted abs tight striaght back its all about the knee, not allowing my ass to stick out and back really hit the tendon hard. The advice I was given by my physio was if the soreness lasted more that 24 hours I had to rest a day, if 24 hours I was fine... hit them again. Therefore I trained them every day. Ice and NSAIDS were useful initially when starting out.

http://youtu.be/GiMnCi-fCvM (example video)
http://youtu.be/wY98htXP0O4 (adding weight in a rucksack to increase the stress on the tendon

I progressed this on to front squats with my heels raised and currently perform 3 x 60kg focusing on form and I still really feel this in the tendon.

http://youtu.be/4_UY8xtPpY0 (this is a little high in terms of step height but his back is vertical and all the movement is focused on hips and knee which is perfect)

My back squat is now back up to 140kg 5 x 5, I also lunge with dumbells, 3 sets of 15 each leg and finish each set with 10 jump squats to add a plyo emlement into the work (but I didnt do the plyo until a good 12 months into the training) 10kg dumbells.

I stopped any running and used rowing as my cardio (no impact on the tendon!) I also used to foam roll all IT band, hamstrings, quads adductors every other day.

Slowly but surely I recovered.

Taping and support I bought load of K Tape, my physio showed me how to tape up, it was tricky to start with if you are hairy youll be best to shave or at least trim your legs to get a better sticky. The taping lasted 48-72 hours, it lifted my petella but I wouldnt say it worked any magic.

http://youtu.be/xzDvY6Vr_uI (taping example)
http://youtu.be/aPkmo5Xqqtw (taping example)

I also bought insoles which supported my flat arches, these helped. but finding shoes that then fit is a pain in the ...er knee!!

Hope this helps. The biggest thing is to be patient with it and start from scratch to fully rehab it.


#6

lee.stanley3; Thanks for the tips buddy. Its good to hear that this injury can be overcame!!

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#7

Just a quick questions for everyone:
when doing eccentric one leg squats on an incline, what depth should I go to??

At the moment I am going down to about a 90 degree angle(I am using a box to sit down on), although watching the above videos the demonstrations show the person using a far less ROM.

Thanks

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#8

I've been dealing with this too on and off for several years and it's called "Jumper's knees" where the patella region on one leg would be sore due to leg imbalance (in my case). I found this on one of Kelly Starlett's videos. Search for this on youtube and it addresses this and ways to combat it.


#9

I have suffered with this with both knees for the last 3-4 years and squatting fixed mine, but can aggrivate it aswell. When squatting, if I break with my knees first then I'll know about it the next day. From all the research and people I've spoke to there is a definate cause for your tendonitis, you just need to find it. IMO you need to ensure everything from your quads to hip flexors to glutes to IT band are all functioning properly and have the enough flexibility. How is your pelvic alignment? If you have any lower back problems, or anything like anterior pelvic tilt, it can manifest in other ways such as patella tendonitis. Patella tendonitis seems to be one of these things that can be caused by a million other things, you just need to work through everything until you come to the cause.

Firstly, can you do a bodyweight squat without pain? If not, your doing something wrong (see Kelly Starretts pro video on this). If your accomodating your squat form to a previous injury I would also look at sorting that as it might be causing some problem else where which is causing your tendonitis. Post a video of your squat and someone might be able to see something.

I'd follow the above advice regards to the incline body weight squats as they've been shown to help as well, all the advice in that post is good advice.

TL;DR : Stop doing everything that aggreviates it, follow above post advice, look at all aspects of your body (specifically proper mobility and flexibility everywhere) as there are many causes of patella tendonitis.


#10

Thanks Shelders.

Im not sure what is the cause of the tendinopathy. I am thinking the basic action of kicking of a soccer ball(which in-season I do a lot of). Also doing the "Cruyff" move also aggravates it.

I can bodyweight squat, although with my long legs and poor ankle flexibility, my form is not pretty. I have just received some oly shoes in the mail, so Im hoping that help with my squat.

Im currently still working on the eccentric single leg squat, which seems to help. Although I have noticed I need to do them almost everyday, as if I take more than 2 days off the pain of the tendon tends to increase.

Thanks again.

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#11

Ah you play soccer , it used to interfere with my own playing as well. I doubt the kicking is causing it but as kicking a ball is generally extremely quad orientated its the reason why you can feel it when kicking.

If I were you id work on quad and hip flexor flexibility to start, going to a good physio to assess would be a good idea as they might find something less obvious.


#12

Good physios are hard to find, but I think I might know of one that may help. Im sick of paying good $$$ to be only told to rest and come back every week for 5 minutes of ultrasound therapy.

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#13

have you tried strapping as well, or pre-wrap?


#14

No. Please elaborate.

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#15

really??

"2. The method you described can be accomplished with either pre-wrap or a patellar brace. The theory being it reduces the pull/strain on the insertion and changes the angle of pull of the patella. The strap should be placed on the infrapatellar area. DonJoy makes a pretty good brace."


#16


#17

Thanks again.

So Im assuming, the brace ill help me do activities with less pain and also acts like a prophylactic by changing the angle of the pull etc, and hence decrease the irritation of the tendon?

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#18

yes, id do a trial run with pre-wrap it'll save you some money before buying a DON-JOY or you could just stick with the pre-wrap. It helps change the patella ligament pull angle which decreases irritation and stress on the ligament. I find that it helps mine out when doing a lot of squatting or plyo work. I just use pre-wrap, you wrap it around the leg and then roll it into a thin strip around the leg, im sure there is probably a youtube video on it.


#19

Thanks. I will look into that.

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