As with the treatment of acute injury, we recommend tendon-conditioning exercises before starting eccentric training. In chronic pathology we start directly with eccentric loading (as above). The eccentric exercises are progressed depending on the patient’s progress. We use a variety of different exercises.
A single leg squat using a decline board can load the patella tendon
A more advanced isometric squat can provide good pain relief
This can be used in the chronic phase to provide analgesia and stimulate healing
A useful technique to 'warm-up' the tendon
There a variety of additional treatments that are used with these athletes. These involve the following:
- partial weight-bearing exercise including the anti-gravity treadmill adjusted to the patient’s function;
- electrotherapy following sports activity or post treatment;
- shock wave therapy can be used in this phase;
- cryotherapy three or four times a day and post sports activity.
We consider surgery when conservative treatments have not been effective for six months – or earlier if the symptoms are more severe. Currently minimally invasive, arthroscopically assisted, procedures seem to allow a faster return to sport (and are effective).21,22