Podcast #27: Individualizing Patellar Tendon Rehab with Dr. Ebonie Rio

Patellar Tendinopathy vs. Patellofemoral Pain

“If someone is hopping and they’re getting a lot of valgus and a lot of knee bend, they’re much more likely to be Patellofemoral presentation than Patellar Tendinopathy. People with Patellar Tendinopathy won’t want to use their patellar tendon as a spring, they’ll hop really stiff.”

“We’ve just completed some research looking at heavy isometrics in people with patellofemoral pain and it’s poorly tolerated.”

“Someone with Patellofemoral Pain might have pain cycling. Someone with Patellar Tendinopathy won’t.”

“Do you have pain running in a straight line? Because it can aggravate Patellofemoral Pain but it shouldn’t aggravate our patellar tendons.”

“Do you have pain with a squat? They both might.”

“Leg Extension. Does it get worse the longer you go? Patellofemoral Pain that could be the case whereas the patellar tendon warms up.”

“If you think you have both, the simplest strategy forward is to treat it like Patellofemoral Pain.”

Patellar Tendinopathy and Patellofemoral Pain: “We know that exercise is the most efficacious intervention, the best choice for both of those conditions.”

Patellar Tendinopathy

“There is never one exercise that will be the panacea.”

“We consider tendon pain to be linked with the rate of loading.”

“I use heavy slow resistance, but I give it single leg.”

“The decline squat. That’s not specific to Patellar Tendinopathy. That will aggravate anterior knee pain. It’s just about where their knee pain is.”

“If you have someone with a patellar tendinopathy, they likely have a calf deficit.”

“The calf is incredibly importantly to unload the anterior knee.”

  • Soleus decelerates the tibia

The Brain

“In people that have really persistent, long-term symptoms… they are more likely to have these issues associated with inhibition and motor drive.”

“Strength training, in isolation, actually doesn’t alter your motor drive. You will get stronger, you’ll get changes to your muscle physiology, you’ll improve a lot of things with strength training. But what you don’t actually alter is the brake and accelerator.”

“Metronome… combine a technique that will address the brake and accelerator while using strength training.”

Patellar Tendon Specifics

“Tendons like to hide within the kinetic chain. Athletes can have incredible squat capacity… but when you isolate out their quadricep, you can see a specific deficit.”

Spanish Squat. “It’s a great way of getting some quadriceps and some tendon load in by taking the glutes out.”

“Jumper’s Knee is a condition of our most elite, most fantastic athletes.”

“We are most interested, when it comes to tendinopathy, in our 24-hour response to pain.”

On athletes resting tendons: “Every time they have downtime, they go backwards in load, therefore they go backwards in capacity.”

“Just going from something slow and heavy into sport is too big a change.”

“We know that you can have lots of different asymptomatic pathologies in different tissues in your body and be perfectly functioning.”

“Any treatment that doesn’t cost the patient a lot of money, is not detrimental to the tendon, and the person believes helps them load, I’m actually really comfortable with that being part of their rehabilitation.”

Email: E.Rio@latrobe.edu.au