What To Watch Out For In Football Camp... Volume 3

 

Well by now athletes are in the thick of it and camp is at that grueling stage.  The first game of the season is this week or just happened, but that doesn't stop the fact that a player has been through two weeks of two a days, maintenance lifts, and conditioning that has started to put some stress on the body. Volume 3 of what to watch out for focuses on patellar tendinitis.  

Picture 1
Photo Credit: Orthoinfo

So you might be asking the question what is this patellar tendinitis?  Let's first start with the anatomy.  The patella is your knee cap.  An upside down triangular shaped bone that glides across the front of the knee and is the connection point between the big quadricep muscles and the upper shin.  This is a key bone that allows the quadriceps to gain a mechanical advantage and produce force.  Whether it is running, jumping, or even cutting the patella gets some stress applied to it.  

Now that we have figured out what the patella is, let's look at the tendinitis part.  Just below the knee cap, there is a thick ligament that attaches onto the bottom portion of the patella and then the top portion of the tibia (See picture 1).  This ligament when it becomes stressed, can start to break down or become irritated causing pain and discomfort. Check out more information here. 

Typical Signs and Symptoms of Patellar Tendinitis Are:

 - pain along the bottom portion of the patella, top portion of the shin, or along the tendon itself

 - pain with specific movements like squatting, stair climbing, bending the knee, and in very severe cases, walking.

 - swelling along the tendon can be expected also

Early signs of patellar tendinitis are more vague however.  With soreness being present after practice, or after a heavy lift.  It usually dissipates quickly after resting, but could be the early warning sign that something is happening in the tendon, or the tendon sheath (covering around the tendon). 

When we think about the movements of football at any position there is a lot of bending, squatting, and creating force by running or pushing. When a football player is suffering from patellar tendinitis there is a significant decrease in force output and the condition itself can last for a few weeks.

Evaluation

Evaluating for patellar tendinitis for a physical therapist usually revolves around ruling out other potential causes of the pain like fat pad irritation, Osgood Schlatter's, patellar avulsion fracture, and any ACL/PCL irritation/tear. This along with tenderness along the patellar tendon, pain with activating the tendon, and pain with passively stretching the tendon gives us a pretty good idea of what we have going on.  

Photo Credit: Wyoming Athletics

So first part is in the books, we have a diagnosis, but without figuring out the root cause (why it developed) we have a less than likely chance we can correct the issue long term.  So the rest of the evaluation focuses on figuring out other deficits that could have caused this issue.  Could it be weak hips leading to poor force production angles, abnormal patellar movements, or in most causes a load management problem. 

Now that we have a diagnosis and have found the root cause, it's time to treat the problems and get the athlete back on the field.

Here is how that treatment plan could look:

 - Isometric loading of the patellar tendon in the form of squats, wall sits, long arch quad iso's and some additional variations and then building to concentric or eccentric loading

 - manual techniques to the patella like instrumented assisted soft tissue mobilization (IASTM), patellar mobilizations, hip mobility or even dry needling to the quad or iliotibial band (ITB). 

 - Additional exercise to address remaining deficits: weakness of the hips, control deficits with jumping, landing, single leg push off control, even deceleration drills to eccentrically load the tendon.

Prognosis:

In most cases, the prognosis is pretty good.  With early enough treatment while the injury is still in the acute phase most athletes can recover in as little as two weeks.  In more severe and chronic cases, the pain can be present for a few months.

Patellar tendinitis is common in athletes who have to bend, jump, push on a consistent bases and when athletes aren't effectively prepared for their season, you can begin to see these soft tissue injuries begin to rear their ugly head.  Don't let something like patellar tendinitis keep you or your athlete off the field. See a sports physical therapist who understands the importance of staying on the football field and knows how to do it. 

Sincerely,

Your PT Experts