PT on the Net Research

Patella Tendonitis Arthritis


Question:

My client has patella tendonitis arthritis in her right knee. Her doctor has advised she do only closed chained exercises. What kind of exercise would be challenging yet safe for her to do? I have read that as long as her feet have contact with something, she is ok. Is that correct?

Answer:

The key is controlling the pronation of the foot, which causes the leg and knee to rotate inward. Pronation also causes the patellar tendon to twist when it pulls on the tibia. This twisting leads to the symptoms of patellar tendonitis. The key area to focus on is your client’s form. With correct form, you can not only eliminate a lot of daily aches and pain, but you will be able to strengthen the entire body safely and effectively.

Your client needs to be performing mainly posterior exercises such as gluteus, hamstring and calves. These movements will help strengthen and give better stabilization to the knee. When you perform exercises like squats or lunges, make sure the knees track correctly, which is when the knee is in line with the second and third toe. Also the movements should be easy to start and then progress to more difficult exercises. An example is to perform a squat but only squat to a 45 degree angle then progress to 90 degrees, or perform ball squats by using a Swiss ball to assist the squat and place another ball (the size of a soccer ball) between the thighs, right about above the knee (this will help to assist the tracking of knees). On the other hand, just to stay on the safe side, your client should perform basic exercises (i.e., squats, lunges, push, pulls, bends and twists), and then after time, progress to harder more difficult movements by combining movement. A way to make basic exercises more challenging is to add an isometric phase to the exercise but hold that position longer than normal, anywhere from five seconds to muscle failure. (Cardio aspect there should be zero running or jogging, only low impact such as bike or rowing.)

On top of a strengthening program is a flexibility program. You need to focus on stretching the hamstrings, quads, calves and hip flexors. These areas are typically the tightest, which can cause minor aches and posture problems. The better your client’s flexibility becomes, the greater the chance injury and pain will lessen.

You client’s doctor is correct about open chain movements, and you should avoid these movement until your client can perform full (kinesiology) squats without any pain or discomfort.