Patella tendon pain is the bane of existence for jumping athletes. In fact the condition is commonly referred to as Jumpers Knee.  The symptoms can be debilitation for athletes that perform a significant amount of jumping or high force end range or compressional loading (basketball, volleyball, track and field and weightlifting athletes). Its so common that up to 45% of basketball and volleyball athletes report patella tendon pain at some stage through their competitive lives. 

For the rehab specialists following along the development of eccentric loading plans have been a staple of tendon pain and rehabilitation since Hakan Alfredson detailed the effectiveness of eccentric loading exercises. However the tides are changing. And for good reason. 

For those that read last weeks blog you will be aware of the use of profiling, understanding the role of tendon stiffness function and how different exercise schemes affect the development of tissue properties within the tendon. As knowledge about tendon pathology and particularly the response of tendon to loading schemes there has been a growth in the understanding that the traditional eccentric loading schemes may not be the most effective way to return an athlete to sport following the development of tendon pain. 

This hypothesis was recently tested by a team of Dutch researchers, that looked to compare an eccentric loading scheme with a progressive tendon loading exercise regime, The progressive loading scheme used a series of progressions of isometric, followed by isotonic and then finally explosive or elastic patella tendon loading tasks. The eccentric loading tasks use progressively harder eccentric loading exercises. 

Without surprise the progressive loading scheme fared better than the eccentric loading group with improved pain and return to sport at desired level outcomes at 12 and 24 weeks. Given the need for tendon tissue to be used in a manner that is dynamic, providing the stimulus that initially acts as a driver for tissue development (isometric) and then progresses towards tasks that develop stiffness capabilities (particularly the elastic/dynamic exercises), it is no surprise that the PTLE scheme had better outcomes.

These findings are not revolutionary. They simply outline that in order for high level function of tissue in dynamic activity, it is valuable to develop capacities at high and low speeds, under high and low tension levels and through significant ranges of motion. When  rehabilitating a tendon identify these requirements and fill in the capacity gaps. 

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