Elite athlete with Patellar Tendon Tear

[kresh]

I suffered a vertical patellar tendon tear in June 2014, what followed was probably the hardest 4 months of my life. My recommendations are if you can afford PRP treatments it's priceless but eccentric exercises such as 1/2 squats on a 45 degree board are just as invaluable.

I am very fortunate to have had expert physicians help me get back on track, so hopefully I can give insight to others who like me felt lost and wanted to give up.

I'm going to tell you right now this injury is 70% mental and 30% pain, once your knee has healed from surgery/injections its your onus to get back, there are no excuses and no days off. Don't get me wrong there is days I cried sitting in a car from the pain in my tendon, I barely wanted to walk outside and leave my house.

I started rehabilitation by building strength by starting off from the basic of quad strengthening by stepping on and off a box. Whilst incorporating physiotherapy with eccentric loading I was able to gradually increase loading with additional exercises such as a lot of theraband work, wall squats, leg press, and leg extension.

A standard rehabilitation day (at 11 months)
Foam Roll each muscle group 2 mins
Bicycle (5 mins) - warm up (Remember bicycle is zero times loading on your tendon, walking twice, jumping four times and running eight times)
1/2 squat on decline board @ 12kg Dumbbells
Leg Press 80kgs
Crab walks with theraband
Hamstring curls with ankle weight
VMO extension with ankle weight
Calf raise
Plank
Pelvic Floor on Swiss ball
Stretching 5-10mins

I cannot stress the importance of strengthening your sacroiliac joint, it's on the same level of importance as stretching. Don't take stretching for granted and continually utilise anti-inflammatory gel/ice. I can run at moderate pace for 20 minutes with no rest and pain, but still suffer from tenderness when pressure is placed on my knee. Eventually the pain will subside through progression of eccentric loading.

[madvillain]

Hey thanks for this. I've been following Victor Cruz's (American football player for our UK readers) recovery you're not him are you

Cruz blew out his tendon about 2.5 months before I did so I track my progress next to his and see how I'm doing.  I saw he was doing some jogging and light cutting the other week and they showed some video of his workouts and I will just say even for an elite athlete this is not an easy injury to come back from.   

I will say that if your job isn't sports however hard you try there are going to be "days off".   I encourage everyone to work extremely hard at their recovery but if you have an office job or a high stress position there will be days were recovery takes a backseat to "life in general".

Still thanks a lot for your post I"m going to incorporate (I already do many of things you listed so that's good!) a few things you mentioned into my routine.  I agree warming up with no load is key I usually go bike ---> weight work ---> jog ---> stretch. 

[Elansbkicks]

Great help and even more so encouraging. Appreciate the post. So what I'm getting from this is that you did NOT have surgery?

Can you describe more about pain levels at certain stages of the rehab. When did the pain stop borthering you daily? Thanks

[hersh12]

@Kresh if you're still around--

I also would be interested to know if indeed you did have surgery and what precisely your ailment was.  I consider myself pretty active before my rupture (high intensity workouts 4-6 days a week) and after a year of recovery am still struggling with stability/strength. 

I've also read that hamstring extensions are quiet detrimental (if I'm understanding correctly, sitting and extending with resistance) as it is an unnatural movement the body performs nowhere outside of that exercise machine and puts undue and unexpected stress on the joint and muscles, so I tend to stay away from it.

[kresh]

I never opted for surgery (Dr Leo Pinczewski advised physiotherapy under Jenny McConnell and follow ups with Dr Ken Crichton). To my recollection MRI in July 2014 indicated an intrasubstance tear roughly 5cm vertically. The latest MRI in April 2015 showed a patellar tendon tear measuring 1.6 cm x 0.5 cm. I applied McConnell taping to release pressure off the fat pad and patellar tendon for a period of 20 weeks to this present day, whilst taping my Glutes for short periods to activate the muscles.

At 12 months I really hit a brick wall in terms of struggling with a degree of pain when attempting to run (Began Physio with McConnell - still sleep with taped knees after 20+ weeks). So essentially I started the rehabilitation phase all over again by simply completing theraband work for Glutes. The aim was to begin with isometric exercises to eccentric then concentric and finally dynamic.

I'm currently at 15 months I can openly say I'm in very minimal to no pain anymore during rehabilitation. The pain from my knee is more fat pad related, most individuals will have patellar tendon tears with no symptoms such as Volleyball players up to 90% have patellar tendon tears with no symptoms (various tests indicated my situation  at 12 months was fat pad oedema). Fat pad management is easily maintainable by strengthening the muscles around the knee.

The pain stopped bothering me after I built enough VMO in my left leg. I currently run 3km intervals at a high intensity with no pain throughout. I'd hope to say by January 2016 (17 months) I should have made a full recovery from fat pad issues.

Remember this injury is not common and it is not uncommon, there is a lot of study to indicate eccentric loading is far more beneficial long-term than surgical procedure (Blazina et al.). Victor Cruz was quiet unfortunate because he would go in a separate category than to most individuals who continuously cause micro trauma to the tendon fibres, remember he tore the ligament from impact that's alot harder to fix than a degenerative issue. A degenerative issue can be mended by adjusting your biomechanics to satisfy your needs.