This is an interesting case. Anterior (front) knee pain without swelling is often indicative of quadriceps tendonitis. HOWEVER this is often painful going downstairs and other eccentric activities.
You’ll see that during Ross’s case, the pain was more prominent when combining a specific degree of knee flexion with pain and had less to do with load. He said for example, that his pain doesn’t increase with heavier load when squatting
This is often a case of patellar femoral inflammation which, unlike quadriceps tendonitis, doesn’t respond well to generic overload.
Instead we opted for a combination of desensitising exercises to reintroduce pain free knee flexion to load extension.
To start with have some MET stretches to desensitise full knee flexion and then some kneeling squats which can be later loaded to discourage quadriceps atrophy and to promote pain free knee flexion.
By focusing on a clean deadlift (low hips) we can also fire off the quadriceps some more with a posterior load, which will help to reduce atrophy and create a novel (pain free) experience of lower extremity extension without eccentric load.
This will then lead us onto single leg weight bearing work where we can start to challenge the knee more so, to get Ross back to doing his normal strong man routine in no time!
Full plan below
Downloadable Rehab Packs at www.revitalizeclinic.co.uk/resources
Recommended Rehab Pack:
Lay diagnosis: knee cap inflammation
Number of expected treatments, confirmed as feasible by patient: 4
Self Management / Novel Movements
Pain Relief (desensitisation, pain education, home tools/ management)
1. self massage quadriceps with MET
2. kneeling squat 2 x 10
3. train no more than a 3/10 level of pain
4. clean position DL? and deload the squat
Phase One
Rehabilitation (Basic Load i.e. load or isometric exercises; Strategise graded improvements to function)
1. wall squat 3 x 60 seconds
2. weighted kneeling squat
3. side plank with abduction 3 x 10
Phase Two
Rehabilitation (Concentric / Eccentric load or isometric exercises; Strategise graded improvements to function)
1. reverse nordics
2. pause squat
Phase Three
Rehabilitation (Explosive / Specific load or isometric exercises; Strategise graded improvements to function)
1. weighted reverse nordics
2. goblet squats
3. scaled single leg squat
State to discharge (i.e. pain 1/10; Can squat with 20kg load; Can sit for longer than 60mins pain free)
1. pain free running and squatting based exercise