Rehabilitation program for patellar tendinopathy

Anamnesis:

24-year-old patient, 70kg, semi-professional boxing athlete.

Diagnosis of patellar tendinopathy for about 12 months, diagnosed by the orthopedic specialist.

From the beginning of September, the subject stops all forms of training due to exacerbation of pain (7/10 of the VAS scale) after 20-30 minutes of bag training.

The subject reports localized pain on the patellar tendon, greater pain in explosive activities with flexed knee.

During the previous season he treated the tendon pathology with the application of ice, NSAIDs, stretching and passive treatments with physical therapy (laser and Tecar).

The subject reports that he has not carried out specific muscle strengthening programs for tendinopathy or for the lower limb in the last year. He does not report co-morbidities or relevant family pathologies.

Physical examination

The patient is asked to perform a “Decline Single Leg Squat” with the right leg at an angle of 20 °. During the execution of the gesture, the subject reports pain in the tendon area (4/10 of the VAS scale).

The subject is then evaluated using the baiobit motion sensor. In particular, a jump test is performed, which shows the results visible in Figure 1.

Figure 1

The picture shows that lower limbs have a right force value (0.94 KN) lower than the left value (1.06 KN).

Two strength profiling tests were then performed to assess the patient's maximum strength:

- Strength profiling test in squat.

- Strength profiling test in deadlift.

The tests were performed using the baiobit sensor and the squat report is shown in Figure 2.

Figure 2

The force-speed curve results show the squat repetition maximum (RM) of the athlete is 72.4kg. The RM therefore corresponds to 100% of its body weight (70kg).

Literature tells us that an athlete should have a maximum value of at least 150% in the squat.

Picture 3 shows the strength profiling test in the deadlift exercise. From the report we can deduce that in this exercise the subject has a deficit of strength. The maximum is 88kg which corresponds to 126% of the body weight while literature suggests that it should be about 200% of the body weight (140 Kg).

Figure 3

Rehabilitation program

By analyzing the data collected with the instrumentation and evaluating the anamnestic interview, the need to face a specific rehabilitation path for tendinopathy, with a parallel focus on general athletic skills, appears clear. The path is specifically aimed at:

- Increasing the load capacity of the patellar tendon

- Increasing strength and power of the lower limbs

- Developing a program for maintaining athletic abilities during the sporting season.

The rehabilitation program was developed using a comprehensive and sport-specific approach as follows:

First 15 days - "Work capacity" phase

- Three sessions per week of high volume global and non-specific reinforcement

- 12-15 repetitions of 4/5 single and multi-joint exercises for 4-5 series. Loads about 60% of the estimated 1 RM

- Aerobic activity of about 30 minutes at 70-80% of HR max (tested on an exercise bike).

Day 15 to 30 - Strength phase

After an initial phase of high-volume reconditioning, we brought the patient towards the pure strength recovery phase.

During this period, the patient underwent three strength sessions per week, with the following exercises:

1) Squat

2) Deadlift

3) Hip trust

4) Leg extension

5) Calf raises

According to reports from the forensics, the best parameters for strength training can be found in repetitions ranging from 1 to 5 with loads close to 90% of 1RM.

The "Velocity based training" was also included in the athlete's rehabilitation path; for instance, the use of an accelerometer (supplied with Baiobit) to quantify the quantity and quality of the patient administered force.

Finally, in the final phase of the strength macrocycle, we included the power component, a specific boxing feature.

We have therefore reduced the workloads, around 50-60% of the athlete's 1RM, making him work at an average speed of 1m / s to improve his explosive qualities.

The exercises proposed were:

1) Jump shrug

2) Olympic laps

3) CMJ At the end of the rehabilitation process, the athlete was assessed again by carrying out the jump test, which brought these results with great satisfaction.

The athlete returned to training in total safety and confidence, with tendon pain equal to 0 even after two hours of intense training.

A great job has been entrusted to his coach, as well as S&C specialist, to support our rehabilitation work with a specific sport phase, based on boxing criteria.


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