Patellar Tendinopathy in Crossfit Athletes
Knee pain is a common complaint in Crossfit. Patellar arthralgia and patellar tendinopathy are the two most common reasons for knee pain in the Crossfit athlete. The patellar tendon transfers the force from the quadriceps through the patella and down to the lower body, making it a region that is prone to overload.
Cause of Patellar Tendinopathy
Patellar tendinopathy is considered an overload condition, meaning that the load placed on the tendon is more than it can tolerate. In the short term, this overload can cause what is called a reactive tendinopathy. The sudden increase in load causes swelling in the tendon to protect the tendon against the increase in load. With relative rest, the swelling in the decreases and the tendon returns to normal.
With continued loading on the patellar tendon, a degenerative tendinopathy can develop. The prolonged loading on the patellar tendon leads to disorganization of the tendon fibers and possible degeneration in the patellar tendon. These changes to the tendon are generally not reversible, however, more healthy tendon can be built.
Treatment of Patellar Tendinopathy
The treatment approach varies depending on what stage of patellar tendinopathy.
The primary focus of a reactive patellar tendinopathy is load management, meaning reducing the load placed on the tendon. As mentioned above, continued loading on the tendon will create fluid accumulation in the patellar tendon leading to structural changes. Heavy, quick loads on the patellar tendon should be avoided in a reactive patellar tendinopathy. Box jumps, snatches, clean & jerks, and rowing should all temporarily be avoided to allow the tendon to calm down.
Building tissue capacity in a degenerative patellar tendinopathy is the initial step to recovery. Heavy loading (within tolerance of course) is used to stimulate the patellar tendon to build more healthy tendon around the degenerated tendon.
The rehabilitation program for a patellar tendinopathy progresses through isometrics, concentric/eccentric, and finally plyometrics. Isometric exercises, contracting the muscle without moving the joint, have been shown to produce a pain relieving effect for up to 45 minutes post exercise. These isometric exercises can be used for both reactive and degenerative patellar tendinopathy.
Concentric and eccentric exercises are the progression to isometric exercises. A concentric muscle contraction is where the muscle shortens as it contracts while an eccentric muscle contraction is when the muscle lengthens as it contracts. Eccentric contractions, also called negatives, have been a popular exercise for tendon pain but there is no advantage to skipping concentric contractions in the rehab program.
When returning to Crossfit, it is important for a rehab program to progress all the way to plyometric exercises. This will ensure that the loads placed on the tendon are similar to what will be experienced in a Crossfit workout.