Patellar Tendinopathy: A Physiotherapist’s Perspective

Abstract

The pathology of patellar tendinopathy and the mechanisms of pain are poorly understood. The most popular treatment modality is the Eccentric overload Exercise. However, there is insufficient evidence to recommend a specific protocol and yet it is the most commonly used treatment modality. The aim of this case study is to present the possible mechanisms of pain and a treatment approach on a patient who was diagnosed as having patellar tendinopathy. It is suggested that hyper extension of the knee might be the source of patellar tendon pain in this patient. Following a course of pulsed short wave diathermy the patient was symptom free and remained so at 6 month review. Further studies to evaluate effectiveness of pulsed short wave diathermy is suggested.

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H. Ali, "Patellar Tendinopathy: A Physiotherapist’s Perspective," International Journal of Clinical Medicine, Vol. 3 No. 2, 2012, pp. 88-91. doi: 10.4236/ijcm.2012.32019.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] J. D. Rees, R. L. Wolman and A. Wilson, “Eccentric Exercises: Why Do They Work, What Are the Problems and How Can We Improve Them?” British Medical Journal, Vol. 43, No. 4, 2009, pp. 242-246.
[2] M. C. Vulpiani, M. Vetrano, E. Savioa, D. Di Pangrazio, A. Trischitta and A. Ferretti, “Jumper’s Knee Treatment with Extracorporeal Shock Wave Therapy: A Long-Term Follow-Up Observational Study,” Journal of Sports Medicine and Physical Fitness, Vol. 47, No. 3, 2007, pp.323-328.
[3] J. L. Cook, K. M. Khan, Z. S. Kiss, B. D. Coleman and S. L. Griffith, “Asymptomatic Hypoechoic Regions on Patellar Tendon Ultrasound: A 4 Year Clinical and Ultrasound Follow-Up of 46 Tendons,” Scandinavian Journal of Medicine and Science in Sports, Vol. 11, 2001, pp. 321-327. doi:10.1034/j.1600-0838.2001.110602.x
[4] J. Zwerver, S. W. Bredeweg and A. L. Hof, “Biomechanical Analysis of the Single-Leg Decline Squat,” British Journal of Sports Medicine, Vol. 41, No. 4, 2007, pp. 264-268. doi:10.1136/bjsm.2006.032482
[5] J. M. Bjordal, C. Couppe and A. E. L. Junggren, “Low Level Laser Therapy for Tendinopathy: Evidence of a Dose Response Pattern,” Physical Therapy Reviews, Vol. 6, 2001, pp. 91-99.
[6] H. Alfredson, T. Pietila, P. Jansson and R. Lorentzon, “Heavy-Loading Eccentric Calf Muscle Training for the Treatment of Chronic Achilles Tendinosis,” American Journal of Sports Medicine, Vol. 26, No. 3, 1998, pp. 360-366
[7] M. A.Young, J. L. Cook, C. K. Purdam, Z. S. Kiss and H. Alfredson, “Eccentric Decline Squat Protocol Offers Superior Results at 12 Months Compared with Traditional Eccentric Protocol for Patellar Tendinopathy in Volleyball Players,” Br J Sports Med, Vol. 39, 2005, pp. 102-105 doi:10.1136/bjsm.2003.010587 PMid:15665207 PMCid:1725109
[8] CR. Purdam, P. Jonsson, H. Alfredson, R. Lorentzon, JL. Cook and KM. Khan, “A pilot study of the eccentric decline squat in the management of painful chronic patellar tendinopthy,” British Journal of Sports Medicine, Vol. 38, No. 4, 2004, pp. 395-397. doi:10.1136/bjsm.2003.000053
[9] M. Kongsgaard, P. Aagaard, S. Roikjear, D. Olsen, M. Jensen, H. Langberg and S. P. Magnusson, “Decline Eccentric Squats Increases Patellar Tendon Loading Compared to Standard Eccentric Squats,” Clinical Bio-Mechanics, Vol. 21, No. 7, 2006, pp. 748-754. doi:10.1016/j.clinbiomech.2006.03.004
[10] A. Frohm, K. Halvorsen and A. Thorstensson, “Patellar Tendon Load in Different Types of Eccentric Squats,” Clinical Biomechanics, Vol. 22, No. 6, 2007, pp. 704-711. doi:10.1016/j.clinbiomech.2006.12.006
[11] H. Visnes and R. Bahr, “The Evolution of Eccentric Training as Treatment for Patellar Tendinopathy (Jumper’s Knee): A Critical Review of Exercise Programmes,” British Journal of Sports Medicin, Vol. 41, No. 4, 2007, pp. 217-223. doi:10.1136/bjsm.2006.032417
[12] E. Anitua, I. Andia, M. Sanchez, J. Azofra, M. del Mar Zalduendo, M. de la Fuente, P. Nurden and T. Nurden, “Autologous Preparations Rich in Growth Factors Promote Proliferation and Induce VEGF and HGF Production by Human Tendon Cells in Culture,” Journal of Orthopaedic Research, Vol. 23, No. 2, 2005, pp. 281-286. doi:10.1016/j.orthres.2004.08.015
[13] S. L. J. James, K. Ali, C. Pocock, C. Robertson, J. Walter, J. Bell and D. Connell, “Ultrasound Guided Dry Needling and Autologus Blood Injection for Patellar Tendinosis,” British Journal of Sports Medicin, Vol. 41, No. 8, 2007, pp. 518-522. doi:10.1136/bjsm.2006.034686
[14] K. H. Peers, R. J. J. Lysens, P. Brys and L. Bellemans, “Cross-Sectional Outcome Analysis of Athletes with Chronic Patellar Tendinopathy Treated by Extra Corporeal Shock Wave Therapy,” Clinical Journal of Sport Medicine, Vol. 13, No. 2, 2003, pp. 79-87. doi:10.1097/00042752-200303000-00003
[15] A. Ferritti, Conteduca, E. Camerucci and P. Morelli, “Patellar Tendinosis,” Journal of Bone and Joint Surgery, Vol. 84A, No. 12, 2002, pp. 2179-2185.
[16] K. D. Shelbourne, T. D. Henne and T. Gray, “Re-Calcificant Patellar Tendinosis in Elite Athletes: Surgical Treatment in conjunction with Aggressive Postoperative Rehabilitation,” American Journal of Sports Medicine, Vol. 34, 2006, pp. 41-46. doi:10.1177/0363546505284239
[17] R. Bahr, B. Fossan, S. Loken and L. Engebretsen, “Surgical Treatment Compared with Eccentric Training for Patellar Tendinopathy (Jumper’s Knee),” Journal of Bone and Joint Surgery, Vol. 88, 2006, pp. 1689-1698. doi:10.2106/JBJS.E.01181
[18] K. M. Khan, J. L. Cook and N. Maffulli, “Where Is the Pain Coming from in Tendinopathy? It May Be Biochemical, Not Only Structural, in Origin,” British Journal of Sports Medicin, Vol. 34, 2000, pp. 81-83. doi:10.1136/bjsm.34.2.81
[19] S. Rutten, P. A. Nolte and G. L. Guit, “Use of Low-Intensity Pulsed Ultrasound for Posttraumatic Non-Unions of the Tibia: A Review of Patients Treated in the Netherlands,” The Journal of Trauma, Vol. 62, No. 4, 2007, pp. 902-908. doi:10.1097/01.ta.0000238663.33796.fb
[20] S. Jingushi, K. Mizuno and T. Matsushita, “Low-Intensity Pulsed Ultrasound for Postoperative Delayed Union or Non-Union of Long Bone Fracture,” Journal of Orthopaedic Science, Vol. 12, No. 1, 2007, pp. 35-41. doi:10.1007/s00776-006-1080-3
[21] G. Ebenbichler, “Evidence-Based Medicine and Therapeutic Ultrasound of the Musculoskeletal System,” Journal of Rheumatology, Vol. 68, No. 7, 2009, pp. 543-548.
[22] N. Maeshige, H. Fujiwara, H. Honda, Y. Yoshikawa, M. Usami and M. Sugimoto, “Evaluation of the Combined Use of Ultrasound Irradiation and Wound Dressing on Pressure Ulcers,” Journal of Wound Care, Vol. 19, No. 2, 2010, pp. 63-68.
[23] N. Shields, J. Gormley and N. O’Hare, “Short-Wave Diathermy: Current Clinical and Safety Practices,” Physiotherapy Research International, Vol. 7, No. 4, 2002, pp. 191-202. doi:10.1002/pri.259
[24] J. Hill, M. Lewis, P. Mills and C. Kielty, “Pulsed Short-Wave Diathermy Effects on Human Fibroblast Proliferation,” Archives of Physical Medicine & Rehabilitation, Vol. 83, No. 6, 2002, pp. 832-836. doi:10.1053/apmr.2002.32823
[25] J. Wang, R. Chan, H. Cheng, C. Huang, I. Lu, Y. Chen, S. Lin, S. Hsu, H. Chang, J. Huang, J. Chen, C Ho and C. Jan, “Short Wave-Induced Enhancement of Proliferation of Human Chondrocytes: Involvement of Extra-Cellular Single-Regulated Map-Kinase (ERK),” Clinical and Experimental Pharmacology and Physiology, Vol. 34, No. 7, 2007, pp. 581-585. doi:10.1111/j.1440-1681.2007.04602.x
[26] N. Cetin, C. N. Aytar, A. Atalay and M. N. Akman, “Comparing Hot Pack, Short-Wave Diathermy, Ultrasound and TENS on Isokinetic Strength, Pain and Functional Status of Women with Osteo-Arthritic Knees: A Single-Blind Randomised Controlled Trail,” American Journal of Physical Medicine & Rehabilitation, Vol. 87, No. 6, 2008, pp. 443-451. doi:10.1097/PHM.0b013e318174e467

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