[Ryan G]

I’m coming off a base block and heading into a strength block. In my first workout I got a twinge on my patellar tendon and now it’s remained a small niggle. As I read recovery exercises and stretches (hip flexors etc) I tried weighted leg extensions (lowering/eccentric) on my unhealthy leg. I’ve not seen much change over 2 weeks. Anyone have any experience or black magic tricks?

[LCB]

I do hero’s pose for 5 minutes in the morning when I roll out of bed, and at evening to keep my knee pain to a minimum.  You know your body best, so a couple of modifications that can help:  closed knee child’s pose, sitting with a towel between your heels and glutes, or  using your hands to bear some of your weight.  I sit in toe pose for 2 minutes after to counter the stretch on my ankles.  The other one that helps my personal knee pain is sitting in a yogi squat, again work-up to 5 minutes.  Nose breathe to help release all the muscles around your knee joint, and help you get through the discomfort of the poses.

I had my oldest daughter, a former D1 athlete (wow just realized she graduated 4 years ago) do this over the last 3 weeks and the tweak is gone from her knee.

If you think these stretching exercises may help you, give them a try twice daily for 2-3 weeks.  Scan your body if you do, you know yourself best.  Whatever you do I hope the niggle goes away.

I just started the strength training phase of the 24 week plan.  Hope your training is going well Ryan.

Note I am a yoga practitioner and instructor, not a medical professional.  Just offering up what works for my knees.

 

[Andy Reed]

Hi Ryan

Great question. Tendon adaptations, in general, are very slow, and 2 weeks will not be enough to make a lot of difference.

Things I would recommend looking at in this “acute” stage – isometric holds. There are a variety of ways to achieve this – iso-lunges, wall sits, seated leg extensions, isometric leg presses etc – you can google these. Isometric holds are quite useful early on, as they reduce pain, and trigger some of the necessary adaptations in the tendon structure; holds are usually in the 20-40s range. There is some evidence now that taking a collagen/Vit C supplement 30-6- mins before these exercises can promote more rapid healing (look up Baar et al, UC Davis’ work).

Isometrics can be done daily. After this I would usually progress to some sort of heavy eccentric or eccentric/concentric work. The weight should ultimately be challenging – 3-5 rep max. These are challenging and should NOT be done daily – 2-3 times per week is good.

I love the Spanish Squat for patellar tendons – look it up.

The final part of the equation is to introduce more explosive work – box jumps, box drops, drop squats – plyometrics basically. Again – these can be very challenging – 1-2 times weekly max.

Hope that helps – a good therapist will be able to check your form, do a biomechanical assessment, add in some additional manual therapy/modalities and confirm the diagnosis.

[Ryan G]

LCB – thank you for the response. My physical therapist had me work on mobility and it has made a difference!

Dr. Reed,

Thanks for the thorough reply. I met with Pete Dickinson from world cup physio and he watched my movement and thinks my muscles are tight and that I’m a squat dominant athlete and need to work on my locomotion; improving and utilizing deadlift motions and hip-hinging through my gait. I’ll absolutely work in your suggestions to my recovery. Going forward I’ll work in a good isometric building block to strengthen the tendons and joint. Thank you very much for your input.

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