Tuesday, December 18, 2012

Three weeks into my physical therapy rehabilitation, I’m still feeling the effects of a long season, felt strongest in my left knee. While I started PT three weeks ago, I laid off the running about a month prior to that. Gale Anderson at Therapeutic Associates has helped introduce me to a few modalities and techniques to address my pain, as well as spur the healing process so that I can get on with my training sooner than later.

The primary focus within the last few weeks has been to attempt to mitigate some of the pain in my anterior, medial knee. I can pinpoint two locations that give me the most trouble: just inferior and medial to the patella (the insertion site of the patellar tendon) and right over the patella itself. In 2004, I had a patellar graft taken from this very site to assist with my ACL repair. It’s very tempting to suggest my patellar tendon pain is the result of a weakened site within my tendon as a result of my graft.
Here is what Gale has helped me with so far:

  1. Astym, a form of soft tissue massage and one of the most well researched forms of soft tissue therapy used.1
  2. Friction massage
  3. Iontophoresis: A modality that uses direct current to force dexamethasone, a corticosteroid that is used widely in the treatment of different inflammatory conditions. It works best on areas more superficial to the skin surface.
  4. Eccentric loading2,3
Much research has focused on the benefits of eccentric loading to help heal tendonopathies in large tendons (i.e. the Achilles and patellar tendons). A study by Jonsson and Alfredson2 aimed to compare the results of painful eccentric quadriceps training on a decline board with painful concentric quadriceps training on a decline board (see Figure 1).

Figure 1. A demonstration of eccentric loading, which occurs
on the downward motion of the exercise.2 
Athletes were randomly assigned to one of the two treatment groups and performed 3 x 15 exercises, 2x/day, 7days/week, for 12 weeks.2 After 12 weeks, it was found that eccentric training on a decline board decreased the pain better than the concentric training.

Unlike the athletes in this study, I have continued my training, but have decreased the intensity considerably. This begs the question, “Was it relative rest that improved the patellar pain of the athletes, or was it truly eccentric loading on the patellar tendon?” I suppose I’ll be able to see if cutting out all speed and tempo work, but continuing to run short most days of the week will prevent good results. I will admit: pain still lingers, but it isn’t nearly as fierce and debilitating as it felt after a hard speed session on the track (duh).

Along with eccentric loading, I’ve also started up on balance exercises. It wasn’t until I started standing for extended periods of time on a DynaDisc that I realized just how weak the intrinsic muscles of my feet and lower legs had become. Some credit should be given to all the small muscles that do a ton of the work to keep us upright. Hence, the incredible importance of good proprioception and neuromuscular control. 

I’ve traded squats and lunges for eccentric activities; leg curls and leg presses for neuromuscular training. If nothing more, I’m learning patience. I’m also feeling thankful for exceptional physical therapy care at Therapeutic Associates via Gale Anderson.


  1. Astym. Accessed 18 December 2012. http://www.astym.com.
  2. Jonnson P, Alfredson H. Superior results with eccentric compared to concentric quadriceps training in patients with jumper’s knee: a prospective randomized study. Br J Sports Med. 2005;39:847-850.
  3. Dimitrios S, Pantelis M, Kalliopi S. Comparing the effects of eccentric training with eccentric training and static stretching exercises in the treatment of patellar tendinopathy: a controlled clinical trial. Clin Rehabil. 2012;26(5):423-430.

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