For many athletes who compete at a high level, patellar tendinopathy or patella tendon soreness is a typical complaint. For other people,
these symptoms may only be bothersome. However, for some, it can cause crippling discomfort that lowers performance all around and, in
extreme situations, results in missed practice and game time.
The management of patellar tendinopathy throughout the GAA season will be covered in this article. Our goals are to lessen practice or game
time loss, enhance performance, and lessen discomfort related to his reactive degenerative presentation.
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A brief adaptation is the first sign of reactive tendinopathy, which is followed by a thickening of a section
of the tendon. This increase either reduces stress by increasing cross sectional area or permits further adaptation to compression, as
stress is equal to force divided by cross sectional area.
Tendon stiffness normally rises in response to carefully controlled stress in tendon adaptation. Conversely, reactive tendinopathy usually
arises from an acute stress overload, such as increased jogging, jumping, or high-intensity deceleration volume. The playing surface is
another component that might be involved. Compared to grass, artificial turf grounds are typically less pliable and can result in higher
tendon loading at comparable high
Intensity efforts.
Fortunately, in the absence or reduction of the overloaded stimulus, reactive tendinopathy can recover to a
normal tendon appearance.
Reactive tendinopathy and tendon disrepair both have comparable presentations. The tendon is attempting to heal itself, but the matrix is
breaking down more than before. There is more collagen separation and disarray, and more blood vessels and nerves are growing into the
tendon.
Clinically, tendon disrepair can be difficult to differentiate from reactive tendinopathy; nevertheless, in the event that imaging
modalities are unavailable, contextual considerations such as symptom duration and intensity might be helpful. When reactive tendinopathy is
poorly treated and an athlete persists in "pushing through" symptoms without changing load, tendon disrepair usually results.
Tendon disrepair and tendinopathy have distinct characteristics that set them apart. One crucial difference is that tendon disrepair requires a longer and more challenging rehabilitation process, with no guarantee of restoring the tendon to its normal structure.
The degenerative stage of tendinopathy is the most severe. It is characterized by the presence of cell death caused by apoptosis, trauma, or tenocyte exhaustion. Additionally, large portions of the tendon matrix become disorganized and contain vessels, breakdown products of the matrix, and reduced collagen levels. These areas of disorganization or degeneration no longer contribute to the distribution of tensile or compressive forces. However, it is important to note that these changes do not typically affect the entire thickness of the tendon. Instead, focal points of degenerative tissue are scattered within healthy tendinous tissue.
Athletes suffering from degenerative tendinopathy typically report a past of tendon pain that diminishes with decreased load but reappears with increased loading on the tendon.
Degenerative tendinopathy can also develop following surgery, especially after ACL reconstruction, with the patella tendon being a frequent site for graft harvesting. In severe instances, if the degeneration is severe and the tendon is subjected to excessive loads, it may result in tendon rupture.
What is meant by the term "reactive on degenerative tendinopathy" in relation to our athlete's condition?
In essence, it refers to a combination of both reactive and degenerative presentations. Reactive tendinopathy
involves the body's response to an injury or stress, while degenerative tendinopathy involves the degeneration of specific areas in the
tendon that can no longer handle the normal forces placed upon it. As a result, the remaining healthy portion of the tendon must compensate
for the weakened areas, leading to an increased risk of mechanical overload during activities that were previously well tolerated.
Athletes who exhibit reactive degenerative tendinopathy often endure discomfort and pain in the patella tendon when engaging in strenuous quadriceps loading exercises or when stretching the quadriceps. Upon conducting a thorough clinical examination, the affected area may exhibit tenderness, heightened swelling, and increased warmth.
Effectively managing these symptoms in their early stages is crucial, as it sets the groundwork for the subsequent rehabilitative process.
The optimal approach to early symptom management involves the collaboration of an interdisciplinary team comprising sports medicine, strength and conditioning, and sports science professionals. Together, they strive to enhance athlete well-being and performance.
Early intervention, whether during the active season or the off-season, should prioritize the reduction of swelling and pain, along with minimizing mechanical stress on the affected area.
It is crucial to address swelling as the build-up of fluid in the tendon can lead to heightened neurotendinous pressure, which can further hinder blood flow and increase pressure within the tendon. This combination ultimately delays the healing process.
Effective pain management is also essential during the initial stages of rehabilitation, as heightened pain - and swelling - can impede muscle function and strength. The sports medicine team can tackle pain and swelling through a range of therapeutic techniques, medications, and specific exercises such as isometrics. Early intervention, whether during the active season or the off-season, should prioritize the reduction of swelling and pain, along with minimizing mechanical stress on the affected area.
A shockwave is a purely mechanical wave, not an electric one. The treatment initiates an inflammation-like response in the tissue that is being treated. The body responds by increasing the blood circulation and metabolism in the impact area which in turn accelerates the body’s own healing processes. The shockwaves break down injured tissue and calcifications
During the competitive season, our primary goal is to ensure that athletes can participate at their highest level while prioritizing their long-term health. This process typically begins in the weight room, as in-season training is a key component of GAA programmes. While GAA remains the main focus during the season, strength and conditioning serve as a supplementary element. Therefore, any adjustments to mechanical loading must first be addressed in the weight room before considering changes to practice or game participation.
In the early stages of reactive tendinopathy, athletes may struggle with traditional lower extremity loading variations. However, isometric exercises can help maintain strength while providing immediate pain relief. For instance, a multi-angle overcoming belt squat isometric exercise may be more effective and better tolerated.
It is important to avoid deep knee flexion ranges that strain the patellar tendon and increase neurotendinous pressure, potentially hindering healing. Instead, focusing on midrange isotonic or isometric exercises can help prevent symptom exacerbation.
If modifications in the weight room fail to adequately reduce mechanical load, adjustments to the player's practice and potential game involvement may be necessary. Several variables will impact the player's participation level in both practice and games: the severity of current symptoms, the ability to execute position-specific movements, symptoms post-activity, and the player's position on the field. GPS data can help identify practice periods with fewer high-intensity efforts, leading to reduced tendon loading. Moreover, utilizing force plates for countermovement jump testing can offer valuable insights into lower extremity loading imbalances. Key metrics for patellar tendinopathy include eccentric peak force, eccentric deceleration impulse, and eccentric peak velocity. Concentric values can also provide valuable information.
Thank You Chris
